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Diabetes in Parliament: 16th – 22nd January

Our weekly parliamentary diabetes round-up is now out. See below for all the latest on what MPs and Peers have been saying, asking, and debating in Parliament this week.

MPs debate the childhood obesity strategy

Thu, 21 January 2016 | Debate – Adjournment and General

SUMMARY – read the full transcript here.

The Government’s Childhood Obesity Strategy would be “wide-ranging and involve Government action across a range of areas”, MPs heard today.

Opening a debate on childhood obesity, Health Committee Chair Dr Sarah Wollaston moved a motion calling on the Government to bring forward a “bold and effective strategy” to tackle the problem, which was now reflected in the fact that a third of primary school leavers were overweight or obese, while obesity was especially high among the most disadvantaged children.

Dr Wollaston demanded to know whether the Government’s strategy would seek to narrow the social gap.

She argued that there would be no single measure that could solve childhood obesity, but that many smaller issues must be addressed, covering “every single aspect”. However, given that obesity was costing society an estimated £27bn, she declared that “we simply cannot afford to take no action”.

In particular, Dr Wollaston noted that children were consuming more than three times the recommended quantity of sugar. She called on the Government to address the fact that supermarkets were offering promotions on sugary and other unhealthy products, as a “level playing-field” was needed to “rebalance” price promotions while avoiding the risk of promoting other products like alcohol. “We need to take a careful, evidence-based look at all this”, she commented.

Presenting the argument for a sugary drinks tax, the Committee Chair pointed to experience from Mexico, and argued that it was the current situation that was regressive. She suggested that ensuring the funds raised went to good causes could help increase public support, as it had with the plastic bag tax. It could help support exercise in schools, as well as cookery and health education, she noted.

Furthermore, the Committee wanted to see a “centrally led programme of reformulation across food and drinks” like that imposed with regard to salt content. This could reduce children’s sugar consumption by six per cent, she pointed out.

She also called for an examination of “the pervasive effect of marketing and promotion”, and a 9pm advertising watershed.

Responding for the Government, Public Health Minister Jane Ellison welcomed the Health Committee’s report on these issues and noted that the Government would make a formal response soon.

She noted that childhood obesity statistics had stabilised, “although it is at far too high a level”, and there was a “pronounced gap between different income groups”.

The forthcoming Child Obesity Strategy would make clear the need for a range of measures to address the problem, she said. She also responded to concerns about funding for public health by declaring that “we are still going to be spending £16bn” over the Spending Review period.

Ms Ellison also highlighted the role of the Change4Life programme and the evidence it had produced, and hailed the launch of the new Sugar Smart app.

Discussing the political rationale for what she termed “intervening to protect” young children, she observed that “children deserve protecting from the effects of obesity, for their current and future health and wellbeing and to ensure they have the same life chances as other children, especially those in better-off parts of our society”. Comparing intervention to the requirement to wear seatbelts, she further justified her position by noting the interest in such issues bred by the presence of a state-funded health service.

Ms Ellison declared that the food industry still needed to make “further substantial progress” beyond the voluntary measures it had already implemented.

“As a Conservative and a former retailer I believe in customer choice, but if consumers are to make an informed choice they need information. Informed consumers can of course shape markets and drive change”, the minister reflected.

Concluding, she also highlighted measures designed to increase participation in physical activity.

For the Opposition, Shadow Health Minister Andrew Gwynne called on the Government to name a date for the publication of the Childhood Obesity Strategy.

Calling for supply-side action “on the part of food and drink companies” in combination with better education and “the means to eat healthier food”, he also noted the importance of addressing poverty more generally to ensure diets were healthy.

He warned about the impact of cutting public health spending, suggesting that this could jeopardise awareness campaigns and local authority support for healthier lifestyles.

While Mr Gwynne did not positively back a sugar tax, he said that any funds raised from such a measure must be reinvested in public health. He called for attention to evidence from other nations, and noted that some were concerned about a potential regressive effect. He called on the Government to clarify its position in this regard, arguing that it should “take a much stronger line”.

Westminster Committees

Public Accounts Committee – ‘Significant action’ needed now to combat diabetes

Fri, 22 January 2016 | Commons Select Committee Press Release

CONTENTS

22 January 2016

The Public Accounts Committee today sets out new measures intended to improve treatment for diabetes patients and bolster prevention of the condition.

In its Seventeenth Report of this Session, the Committee concludes weaknesses in the approach of the Department for Health and NHS England mean “the costs of diabetes to the NHS will continue to rise”.

It finds that while progress has been made since the Committee last examined diabetes services, there remain “unacceptable variations in the take up of education programmes, delivery of recommended care processes, achievement of treatment standards and in outcomes for diabetes patients”.

These include geographic variations across clinical commissioning groups, as well as variations between different groups of diabetes patients.

Complications continue to rise

While the number of diabetes patients experiencing complications continues to increase, diabetes specialist staffing levels in hospitals are not keeping pace with the increasing percentage of beds occupied by diabetes patients.

The Committee calls on the Department and NHS England to take rapid action to improve the spread of best practice in preventing and treating the condition.

It recommends that by April 2016, diabetes data should be used to identify clinical commissioning groups performing poorly compared to the national average, and “establish interventions to help them improve”.

Prevention programme

Also by April this year, NHS England and Public Health England should set out a timetable “to ramp up participation in the national diabetes prevention programme” to 100,000 people a year.

By July, the Committee urges the Department and NHS England to put in place a separate timetable “to reduce geographical variations and variations between different patient groups”.

Other recommendations in the Report include making it mandatory for GP practices to submit data for the National Diabetes Audit, and for NHS England to develop a “better and more flexible range of education support” for diabetes patients.

In 2013-14, there were an estimated 3.2 million people aged 16 years or older with diabetes in England. The condition is estimated to cost the NHS £5.6 billion a year.

Chair’s comments

Meg Hillier MP, Chair of the PAC, said today:

“The NHS and Department for Health have been too slow in tackling diabetes, both in prevention and treatment.

The number of people with diabetes is increasing, as is the number of patients who develop complications. It is a very serious condition that can have a huge impact on people’s lives. Yet support available to patients and those at risk varies hugely across the country.

There’s clear evidence of what works and as a priority action must be taken to ensure best practice in treatment and education is adopted across the board.

Taxpayers must have confidence that support is available when and where they need it, rather than by virtue of where they live.”

Report summary

Since the previous Committee of Public Accounts reported in 2012, the Department of Health and NHS England have made progress in improving outcomes for diabetes patients. International evidence now available also suggests that the UK performs well compared to other countries in terms of outcomes for diabetes patients.

However, there are significant variations in the routine care and support that diabetes patients receive, and in outcomes for diabetes patients.

“Unduly healthy picture” painted

We are concerned that the witnesses from the Department and NHS England painted an unduly healthy picture of the state of diabetes services in England. Although an individual diabetes patient’s prospects are getting better, the number of people with diabetes is rising by 4.8% a year, and performance in delivering the nine care processes and achieving the three treatment standards, which help to minimise the risk of diabetes patients developing complications in the future, has stalled.

In addition, very few new diabetes patients are taking up education that could help them manage their condition, and the number of diabetes patients experiencing complications (which account for over two-thirds of the cost of diabetes to the NHS) continues to rise.

This all means that the costs of diabetes to the NHS will continue to rise. In order to control these costs, the Department and NHS must take significant action to improve prevention and treatment for diabetes patients in the next couple of years.

Background

There are two main types of diabetes, a chronic condition where the body does not produce enough insulin to regulate blood glucose levels. Around 10% of people diagnosed have type 1 diabetes, which occurs when the body produces no insulin. The remaining 90% have type 2 diabetes, which occurs when the body cannot produce enough insulin to function properly, or when the body’s cells do not react to insulin.

Being overweight is the main modifiable risk factor for type 2 diabetes and 90% of adults with type 2 diabetes are overweight or obese.

With education and appropriate support most people with diabetes can manage their condition themselves. They also need regular checks to monitor treatable risks for diabetic tissue damage and to detect the early damage itself, so that treatment can be given to prevent deterioration.

The risk of developing diabetic complications can be minimised by early detection and management of high levels of blood glucose, blood pressure and cholesterol. The cost of complications accounts for over two-thirds of the £5.6 billion a year that diabetes is estimated to cost the NHS.

The Committee last took evidence on diabetes services in 2012. Its Report concluded that too many people with diabetes were developing complications because they were not receiving the care and support they needed.

House of Commons Questions

Diabetes – DH – Jim Shannon

Wed, 20 January 2016 | House of Commons – Written Answer

CONTENTS

Asked by Jim Shannon (Strangford) To ask the Secretary of State for Health, what discussions he has had with the Royal College of Nursing on steps to reduce the fat intake of people with diabetes.

Answered by:
Jane Ellison
Answered on: 20 January 2016

There have been no such recent discussions.

Palliative Care – DH – Emma Reynolds

Mon, 18 January 2016 | House of Commons – Written Answer

CONTENTS

Asked by Emma Reynolds (Wolverhampton North East) To ask the Secretary of State for Health, if his Department will mandate that nutrition is written into all national care pathways for long-term conditions.

Answered by:
Jane Ellison
Answered on: 18 January 2016

The National Institute for Health and Care Excellence (NICE) has developed a range of care pathways covering the management of long term conditions, such as diabetes and chronic obstructive pulmonary disease, which are based on its best practice guidance for management of these diseases. Where appropriate to the management of a condition, nutritional assessment and advice are included. In addition to this, there are specific care pathways covering nutrition support in adults and maternal and child nutrition which can be found at the following links:

http://pathways.nice.org.uk/pathways/nutrition-support-in-adults

http://pathways.nice.org.uk/pathways/maternal-and-child-nutrition

NICE is the independent body responsible for developing best practice guidance for the National Health Service and its guidance is based on a thorough assessment of the available evidence and is developed through wide consultation with stakeholders. NICE has issued guidance on a broad range of medical conditions, treatments and interventions and periodically reviews and updates its guidance to ensure that it reflects new evidence and other developments.

Individual Politician Press Releases and Blogs

Dr Sarah Wollaston MP – It’s time for a bold and brave strategy on childhood obesity

Thu, 21 January 2016 | MPs Blog

CONTENTS

21 JAN 2016

It’s time for a bold and brave strategy on childhood obesity

I wrote the following article for PoliticsHome

On the morning of the 2012 track cycling Olympics, the architect of Team GB’s victory, Sir David Brailsford, attributed their success to the relentless pursuit of ‘marginal gains’. He looked at absolutely everything that goes into riding a bike, from the rider and their bike to the environment around them. It was by improving every aspect, even if that was by a small margin, that the sum total struck gold.

There is no single easy solution to the crisis of obesity which is blighting the lives of our nation’s children and I hope that David Cameron will look at the success of team GB and apply the same principle of marginal gains.

Some firmly believe that tackling obesity is all about education and information, others that exercise is the answer. Some will focus on the role of marketing and promotions, tackling super-sizing and reducing the levels of sugar in food or the role of taxation.

The fact is that we need all of the above, and far more. We need a bold and brave obesity strategy because of the sheer scale of the problem and the implications both for individual children, their families and wider society.

A third of children are now moving on to secondary education obese or overweight. Independent data also highlights the stark and widening health inequality associated with obesity. A quarter of children from the most disadvantaged families are leaving primary school obese, more than twice the rate for children from the most advantaged families.

The consequences for the physical and mental health of the individual children who are falling down that gap are serious: they face a significantly increased risk of type two diabetes, heart disease and cancer and they are more prone to bullying and marginalisation.

There are costs too to wider society and the NHS because of our failure to take effective action – diabetes care already consumes around 9% of the NHS budget and the total cost of obesity is estimated to exceed £5bn per year.

It makes sense to prioritise the measures that will produce the greatest gains and especially where they can produce those changes quickly.

The greatest gains lie in tackling our food environment because, whilst exercise is important whatever a child’s weight, no strategy can succeed without tackling the prime culprit; too many calories. That is why we must tackle promotions, advertising and marketing, portion sizes and reformulation. The government must also take into account the potential of a sugary drinks tax.

Price helps to determine choices and relatively small changes can have an enormous impact.

The 5p plastic bag levy has driven a 78% reduction in the use of plastic bags at Tesco. It changed behaviour in part because most of us just needed that final nudge to change the way we shop and its acceptability was increased because all the money raised goes to good causes. One paper suggested that apparently outraged customers could defy the imposition of the tax… by taking their own bag… which was of course the whole point of it in the first place.

The same applies to a sugary drinks tax. No one would need to pay it at all because its primary purpose is to nudge consumers to low calorie alternatives. It should be included because we know that it works and that it works quickly. It particularly helps the heaviest consumers as demonstrated by the 17% fall within this group in Mexico one year after the introduction of a 10% levy on sugary drinks. If every penny raised went to funding programmes to benefit children and young people, it could provide financial backing for additional school sports, education and to teach cooking and nutrition skills.

The Prime Minister is right to focus on a childhood obesity strategy and his action list will need to be far longer than space in this article allows, including clearer information for consumers and giving local authorities and schools greater powers to tackle obesity. My plea would be to follow the lead of British Cycling on marginal gains and make a lasting and positive difference to our children’s future.

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