That this House has considered tailored prevention messaging for diabetes.
It is a pleasure to serve under your chairmanship, Ms Buck. It is good to see a group of MPs here who have made the effort and taken the time to come to a Thursday afternoon debate. I am pleased to see the Minister in her place. As she knows, I am particularly fond of her as a Minister and look forward to her response. I have given her a copy of my speech, so we can perhaps get some helpful answers. I thank her in advance for that. I am also pleased to see the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), who is always here, and other right hon. and hon. Members who regularly come to diabetes debates.
I am particularly glad to see the right hon. Member for Leicester East (Keith Vaz), who chairs the all-party parliamentary group for diabetes, of which I am the vice-chair. We have many things in common. Not only are we both type 2 diabetic—I make that clear at the beginning—but we are faithful fans of Leicester City football club. We have followed it for years, and it is third in the premier league. Tomorrow night, as I understand, it plays Southampton away, where I hope Brendan Rodgers will do the best for us again.
We are here to discuss diabetes. I have been a type 2 diabetic for 12 to 14 years or thereabouts. I was a big fat pudding, to tell the truth—I was 17 stone and getting bigger. I enjoyed my Chinese and my two bottles of Coke five nights a week. I was probably diabetic for at least 12 months before I knew I was. When I look back, I can see the symptoms, but I never knew then what the symptoms were—I was not even sure what a diabetic was. When the doctor told me that I was a diabetic, he said that there were two things to know. They always tell people the good news and the bad news, so I said, “Give us the good news first.” He said, “The good news is that you can sort this out. The bad news is that you’re a diabetic.”
I went on diet control and stayed on it for four years. When I talked to my doctor again, he told me that the disease would get progressively worse. Even after four years of diet control and dropping down to 13 stone—about the weight I am now, although I am a wee bit lighter at the moment, because of not being that well for the last couple of months—I went on to metformin tablets. A few years later, they were no longer working, so he increased the dosage. He also said, as doctors often do, “You might have a wee bit of bother with your blood pressure. You don’t really need a blood pressure tablet, but take one just in case.” I said, “Well, if that’s the way it is, that’s the way it is”, but he said, “By the way, when you take it, you can’t stop it”, so it was not just about blood pressure.
I say all that because diabetes is about more than just sugar level control. It affects the arteries, blood, kidneys, circulation, eyesight and many other parts of the body. If people do not control it and do not look after it, it is a disease that will take them out of this world. That is the fact of diabetes.
I congratulate my hon. Friend on securing the debate. He is an assiduous attender; he attends so much that I think the Speaker of the House said on one occasion that he thought my hon. Friend actually slept in the Chamber. He is alluding to his personal circumstances, but I and other hon. Members have raised the issue of juveniles and underage individuals who have an obesity problem that, over time, begins the process of type 2 diabetes. Although we need to tackle the problems in adulthood that he is raising, we also need to tackle them among children.
My hon. Friend is absolutely right. The figures that he and I have indicate that almost 100,000 people over the age of 17 live with diabetes in Northern Ireland, out of a population of over-17s of 1.6 million. We know it is more than that and that there are a lot of diabetics under 17, so he is right to bring that up. Northern Ireland has more children who are type 1 diabetic in comparison with the population than anywhere else in the United Kingdom.
David Simpson (Upper Bann) (DUP)
I congratulate my hon. Friend on securing the debate. He referred to having been a big fat pudding; well, I probably am, but we will not go there. Importantly, we have young children in schools who need insulin, but there is a difficulty with teachers and classroom assistants giving it to them. What more can we do about that? How can we encourage the education people to do it?
I know the Minister will reply to that, because that is one of the questions that I had hoped to get an answer on.
On the Monday before last, we had a diabetes event in the House. Before I came over, some of my constituents said, “Will you go along to this event about diabetes? It is really important, because some great things are being done in some parts of England and we would like to know about them.” When I got there, the people were most helpful and informed me that Northern Ireland has one of the better type 1 diabetes schemes, which is reaching out to 70% of people. As we often do in Northern Ireland, in this case we have a scheme in place that is almost voluntary. We have an un-functioning Assembly, which is disappointing, but we have a system whereby that scheme is working. Some of the things that we are doing, we are doing quite well.
There are 4.7 million people living with diabetes across the UK, each of whom should be treated as an individual. In Northern Ireland, we have 100,000 people with diabetes in that 17-plus bracket, but obviously it is more than that when it is all added up. Every day across the United Kingdom of Great Britain and Northern Ireland, 700 people are diagnosed with diabetes; that is one person every two minutes.
I had a good friend—he is not in this world any more, but that is not because of diabetes—who was a type 1 diabetic. He ate whatever he wanted and I always said to him, “You cannot eat all those things.” He said, “Oh, I can. All I do is take an extra shot of insulin.” I said, “That’s not how it works!” I do not know how many times I told him that. My three hon. Friends—my hon. Friends the Members for East Londonderry (Mr Campbell), for South Antrim (Paul Girvan) and for Upper Bann (David Simpson)—will know who it is, so I will not mention his name. He was very flippant about the control of his diabetes, but it seemed to work for him. I could never get my head around the idea that an extra shot of insulin seemed to cure the problem.
Paul Girvan (South Antrim) (DUP)
I thank my hon. Friend for bringing this important debate to the Chamber. My wife is a type 1 diabetic who is insulin-dependent. She has already—she is a bit younger than me—lost a kidney, because of lack of control, which can cause problems. That needs to be identified: control is vital, and it is important for people to monitor regularly. New technology is available that can actually give readings constantly, as people go. It is important that people start to use the available technology, so they do not have to take more insulin than they need, but can take it only when it is needed.
Like my hon. Friend, my wife is younger than me. It must be a Northern Ireland DUP MP thing—we look for younger wives to keep us young. I am not sure if that is right or wrong, or if it is politically correct to say that, but my wife is nine years younger than me. She understands the issue of me and diabetes.
Some 10% of people with diabetes have type 1 and 90% have type 2. I will refer to both throughout my speech, and I encourage hon. Members to do the same and to acknowledge the different factors at play with each. We can manage type 2 with medication, provided we control what we eat and what we put in our bodies. Of those living with diabetes, we have the broadest cross-section of society. The condition affects all genders, ages, ethnicities and financial situations. However, too often I see that policy makers and clinicians fall into the trap of treating people with type 1 or type 2 diabetes as homogenous groups that will respond to the same approach and message, but they respond in different ways.
During this debate I want to focus on four things: the primary prevention of type 2 diabetes; the need to offer different messaging to ensure that the support is appropriate for each individual living with diabetes; the necessity of preventing the complications of all forms of diabetes; and innovations in technology—there is marvellous technology —and patient pathways that can improve outcomes for people living both type 1 and type 2 diabetes. I wish that I had known 12 months before I was diagnosed that the way I was living—the lifestyle, the stress—was putting me at risk. We all need a bit of stress; it is good and keeps us sharp, but high stress levels with the wrong eating and living habits is harmful. I do not drink fizzy lemonade any more because it was one of the things pushing me over the edge. That was probably why I lost most of the weight fairly quickly.
Let us talk about prevention. Today more than 12 million people are at increased risk of type 2 diabetes across the UK. More than half of all cases of type 2 diabetes could be prevented or delayed. If I had known a year before my diagnosis, I could have stopped the downward trend in my health, but I did not know, and I wish that I had done. Many in this House offer leadership on type 2 diabetes prevention; the right hon. Member for Leicester East is certainly one of them. England is a world leader on this front, having recently committed to doubling its national diabetes prevention programme.
The hon. Gentleman has highlighted two important themes: self-management and knowing how to go about it properly; and the more recent theme of the potential of technology to achieve good control. He knows I am keen on both. However, does he accept that artificial intelligence can never replace the human element of having someone to talk to, who can give good, accurate information about how to deal with the condition?
The right hon. Gentleman is absolutely right. Artificial intelligence is beneficial: it can help where it can help. However, it is better for people to have the chance to talk to someone who can instruct them. I think probably we all want to talk to someone face to face, so we can understand the issues better.
An event that I attended here—with the hon. Member for Heywood and Middleton (Liz McInnes), I think—was about diabetes and also bariatric surgery. It may have been in the Thames Pavilion. I mention it because sometimes bariatric surgery may be the only way to reduce weight and enable someone to get to the other side, to address the issue of diabetes. That, as the right hon. Member for Knowsley said in his intervention, is something that people need to talk about. It needs to be discussed so they know what the options are. It is not for everyone, but it is for some people. A number of my constituents over the years have had that surgery and it has always been successful. It has reduced their weight in such a way as to control their diabetes. They are fortunate. Not everyone would have been able to have that surgical operation, but bariatric surgery is important.
To conclude, there is no one solution to diabetes prevention or management. Sometimes, no matter how well informed we are, diabetes can present new and potentially insurmountable challenges. I have some recommendations for the Minister. Primary prevention of type 2 diabetes should take a broad population approach, while ensuring that there is a range of programmes, including digital ones, so that no groups are excluded. There should be someone to speak to—access to someone to converse with who can advise and take things forward. Messaging should be varied and regularly re-evaluated, to ensure that there is engagement from those subsets of the population at the highest risk of type 2 diabetes. We cannot ignore the issue of obesity and diabetes. That was referred to at business questions and will probably be referred to during Health questions on Tuesday.
3:26 pm
Liz McInnes (Heywood and Middleton) (Lab)
It is a pleasure to serve under your chairwomanship, Ms Buck. I am grateful to the hon. Member for Strangford (Jim Shannon) for bringing this important debate to the Chamber today and for his comprehensive introduction to the subject, which included his own personal experience. I speak in my capacity as co-secretary of the all-party parliamentary group for diabetes, and I recognise the hon. Gentleman’s active role as vice-chair of the group.
My interest in diabetes comes from my background as an NHS clinical scientist, as well as the major health issues presented to our communities by the prevalence of diabetes. My constituency has a higher than average incidence of diabetes—8.5% of the population compared with 6.7% overall in England—so I am always interested in what steps can be taken to improve control of the condition and what preventive measures can be taken to lessen the risk of type 2 diabetes developing.
I want to draw attention to the difference between type 1 and type 2 diabetes, and I sometimes think it would be helpful if we considered them to be two completely separate and distinct diseases. I stress that while being overweight or obese is a major risk factor in type 2 diabetes, type 1 is caused by the body not being able to produce enough insulin and is an autoimmune disease. Although diet and exercise have a role to play in type 1 diabetes management, they cannot reverse the disease or eliminate the need for insulin. It is important to stress that, because of the number of times I have stood in this Chamber and listened to MPs saying, “If only people would lose weight their diabetes would be cured.” It is misleading, and it is unfair to people who are unfortunate enough to suffer from type 1 diabetes.
I am grateful that my hon. Friend made that point. She knows that I, too, insist that we deal with them as two separate diseases. There are consequences to the myth that everyone’s diabetes is lifestyle-related. In some cases children are bullied at school for having an autoimmune condition that they have no control over. Yet people believe they have caused it themselves.
Liz McInnes
My right hon. Friend is absolutely right. There is an unfortunate blame culture and children can be quite cruel to each other at times; we, as adults, must be careful about the language that we use about diabetes. If I achieve one thing in this place, I would like to get people to understand the difference between type 1 and type 2 diabetes—then I would feel as though I had achieved something.
Despite the growing public pressures associated with both type 1 and type 2 diabetes, a person living with diabetes only spends, on average, three hours a year with a clinician. People with diabetes are often put under a great deal of stress, because of the challenges and complexity in managing the condition and the multiple day-to-day decisions they have to make. In order to allow them to develop the necessary skills to manage their own condition, further support is required—including, but by no means limited to, weight management support.
This debate is very timely and follows a meeting we held in parliament in June of this year, which was attended by the hon. Member for Strangford and my right hon. Friend the Member for Knowsley (Sir George Howarth), among other MPs. The meeting was about realising the potential of health coaches in diabetes care, which the hon. Member for Strangford has already mentioned, and it was supported by Roche Diabetes Care—although of course I have to say that other diagnostic companies are available.
The meeting heard from health coaches about how they support participants in a lifestyle management programme, using their professional expertise as qualified nutritionists to support people to better manage their weight.
Paul Girvan
Does the hon. Lady agree that sometimes GPs do not give the right advice to patients? Perhaps a patient who presents with a bad infection is put on antibiotics, which can have an impact on their absorption of insulin, and as a result they can go into a hypo or take a low. That can cause major problems unless they have someone who knows them well, who can watch the signs and knows how to deal with them. Some GPs do not relay that information to patients when prescribing.
Liz McInnes
The hon. Gentleman makes a very important point, which I will come to later in my speech, about the need for all health professionals to be aware of diabetes and the complications that can arise, particularly in the situation he describes, where a GP may prescribe something without asking how it will impact on other conditions. The hon. Gentleman highlights the need for more and better training for health professionals around the whole condition of diabetes.
The meeting held in Parliament in June had three main themes. The first theme was relieving workforce pressures in diabetes care by providing non-clinical advice where there are gaps in clinical capacity, which refers back to the point that the average diabetic does not spend a lot of time every year with a clinician. The second theme—it is very pertinent to this debate—was about helping people to find their own tailored solutions to immediate health challenges such as weight management, as well as changing the way they think about their situation. The third theme, which the hon. Member for Strangford mentioned, was digital solutions to deliver 24/7 services to users. The health coaches explained to us how, through apps and other devices, users can message them at any time of day or night. The health coaches will get back to the individual, talk to them and help to address the issue.
Health coaching should be seen as a complement to clinical work and not as a tangent to it. It does not necessarily have to be done by discrete health coaches and could be incorporated into the day-to-day work of NHS staff; that relates to the point made by the hon. Member for South Antrim (Paul Girvan) on GP coaching. It should be incorporated into the day-to-day practice of all staff who work with people with diabetes. That is a point that NHS England and Health Education England should be considering.
Some would say that coaching on lifestyle and weight management is a role that should be fulfilled by the diabetes specialist nurse. I am interested to hear the Minister’s comments on the decline in the numbers of those who perform that very important specialist role. The National Diabetes Inpatient Audit reported that more than a quarter of hospital sites do not have a dedicated in-patient specialist nurse—there is a real gap that we need to examine. The specialist nurse is recognised by most diabetics as their go-to person, so it is quite shocking to hear that they are no longer available in a quarter of our hospitals.
I agree with the basic premise of the hon. Member for Strangford on tailored solutions and prevention messaging for diabetes. I hope the Government will follow the issue up, as well as ensuring that provision is equitable and that variations in uptake are addressed.
It is a pleasure and honour to serve under your chairmanship, Ms Buck—for the first time, I think. I thank the hon. Member for Strangford (Jim Shannon) for securing this debate, not only as vice-chair of the all-party parliamentary group on diabetes, but as a fellow Fox—a supporter of Leicester City Football Club. As we heard from the hon. Member for South Antrim (Paul Girvan), he is also probably one of the most assiduous Members of this House.
I am pleased to see the Minister in her place and congratulate her on her appointment. I hope she will last longer than the last three diabetes Ministers—I am not one of those who wants a general election tomorrow, and we would like to see her build herself into her portfolio. I hope she will last as long as the shadow Minister, who has been there a while and so has been through many Ministers. We hope they will be able to share information. Let us keep the Minister in her place for some time—until the election, of course.
I declare my interest as a type 2 diabetic and chair of the all-party parliamentary group on diabetes. I have a family history: my mother, Merlyn, and my maternal grandmother both had diabetes, which gave me a 4% higher than average chance of getting diabetes. Added to my south Asian heritage, that makes me six times more likely than my European counterparts to be someone who would get type 2.
We have heard some amazing statistics. We should all just sit down, as if we were sitting in the Supreme Court, and say, “We agree with the hon. Member for Strangford,” because we agree with practically everything that he and my hon. Friend the Member for Heywood and Middleton (Liz McInnes) have said. However, it would not, of course, be the nature of Parliament if we all just agreed with the speech of the person before us, so I will plough on; I apologise if I repeat some of the things already mentioned.
As we know, every two minutes someone is diagnosed with diabetes. In my own city of Leicester, a higher than average number of people have diabetes—8.9% compared with 6.4% nationally—and that is expected to rise to 12% of the city’s population by 2025. That is due to the higher proportion of black and minority ethnic residents compared with the UK national average—BAME communities are genetically more likely to get diabetes.
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I was pleased to attend a roundtable discussion last summer, chaired by the hon. Member for Enfield, Southgate (Bambos Charalambous), at which we considered the link between obesity and diabetes and the importance of tailored messaging for the different subsets of the population. During the discussion I met the inimitable Professor Valabhji, the national clinical director for obesity and diabetes at NHS England, whose leadership in this space should be celebrated. I put that on the record because his knowledge and help for those around him, and his research into and development of how we deal with diabetes, are incredible.
For people with type 2 diabetes, there is the additional aspiration of achieving remission. I echo colleagues’ congratulations to the deputy leader of the Labour party, the hon. Member for West Bromwich East (Tom Watson). We watched him almost shrink. One day I stopped him and said, “Tom, is everything all right?” He was losing so much weight, but it was his choice to diet as he did. He is an inspiration for many people because of what he has done, and I commend him for it. The concept of remission can be alienating, however, because it is not possible for every person with type 2 diabetes.
Central to the effectiveness of all types of support for the individual and the wider population is the messaging used, which is what this debate is about. Tailored messaging should be developed for the sub-groups most at risk of type 2 diabetes. For example, those in the most deprived areas of the country are nearly 50% more likely to be obese and have type 2 diabetes than those in the most affluent areas: there is type 2 diabetes in areas where people do not have the same standard of living.
Obesity is responsible for around 85% of someone’s risk of developing type 2 diabetes. Additionally, south Asians are six times more likely to develop type 2 diabetes than Europeans are. It is a well-known cliché that men are not so open or proactive—I can say this is true—about their health needs, and men are 26% more likely than women to develop type 2 diabetes. I am willing to speculate, as one who fell into that category, that that is in part due to messaging not being in a format that reaches men. I did not know what it was, did not know what it meant, did not know what the symptoms were, but it was happening.
We need to focus some of the messaging on the importance of prevention and the risk of type 2 diabetes for men. Will the Minister commit to ensuring that all messaging to support those with type 1 and type 2 diabetes, as well as for type 2 diabetes prevention, is tailored to the relevant sections of our society?
I have to manage my diabetes every day. I take my tablets in the morning and at night. I am careful about what I eat. By and large, I manage it. I check my sugar levels every morning. The doctor tells me to check and I do it every day so that I know where I am. I am a creature of habit; I do it all the time so that I know exactly where I am. Some days it is out of kilter, probably because I transgressed and had a cream bun when I knew it was the wrong thing to have. None the less, we do such things.
On self-management, the average person with diabetes will spend just three hours a year with a healthcare professional. That means that they will spend most of their time managing the condition themselves and will need appropriate education. The right hon. Member for Leicester East chairs the all-party parliamentary group on diabetes. He organised a seminar where we looked at healthcare professionals and how people manage their own condition and therefore need appropriate education. The current delivery of structured education does not reflect the varying needs of each individual living with diabetes. We are all different.
The best efforts of healthcare professionals and those who provide education often focus on perfect self-management or no self-management at all. In reality, the daily struggle of living with a long-term condition means that every marginal improvement should be seen as a true achievement. We have to manage it and encourage ourselves as we move forward. We have to make sure that by moving a step forward we can then move forward again. There has been an admirable drive to increase the uptake of education, but education alone will not help an individual manage the ups and downs of living with the condition. They need the tools and confidence, as well as the education, necessary to manage their condition.
When I speak to people in my constituency who live with diabetes, they often highlight the feeling of isolation. I am sure we can all agree today that there is a need to provide each of those individuals with the support they need to take away the isolation. Being a diabetic can be lonely if someone does not know how to manage it. They might think they are doing the right thing when they are not. Issues have been highlighted to me about the delivery and format of education programmes. Digital solutions and coaching services should be explored. The Minister referred to that in a conversation that we had prior to this debate. I look forward to her response. We always get something positive from her, and we will certainly get something positive today.
Will the Minister commit to ensuring that the delivery, format and content of structured education programmes is improved through the use of digital solutions, and that national guidelines are adapted to accommodate that? Health apps could also be used to refine and augment diabetes training programmes by enabling clinicians to learn from patients about what motivates them and therefore what support to provide.
I want to congratulate the hon. Member for Wolverhampton South West (Eleanor Smith) on her leadership on how health apps can be used to improve care and patient self-management. Many MPs in this House are diabetic or have an interest in diabetes. That is why we are here today. We are either diabetic or interested in the matter and here to make a contribution. I commend and thank right hon. and hon. Members for their commitment.
Will the Minister commit to undertaking an extensive public engagement and education programme, using digital platforms where appropriate, to showcase effective and evidence-based health apps and encourage their wider usage? Support needs to be tailored to individuals’ particular needs, in recognition that no single solution works in self-management for everyone. Everybody’s needs are different. I was the first diabetic in my family. When the doctor diagnosed me as a diabetic he asked me about my mum and dad and my wife’s mum and dad, and whether there was anybody in my family tree with the condition, but there was no one there. Unfortunately, my condition was caused by my diet and my lifestyle, so I created the problem. It was not hereditary, but it is how we deal with such things and tailor our responses that matters.
I have recently been convinced that health coaches—the Minister will comment on this—can play a key role in this space. Coaches can bring a distinct non-clinical skillset that poses questions for patients to help them devise the solutions that work for them, to help build their self-confidence and self-motivation—in stark contrast to the more prescriptive approach taken in clinical settings. Coaching needs to be clearly defined, and the full range of support that coaches can provide to support tailored prevention messaging needs to be identified. I look to the Minister’s response, because I believe it will have some positivity in relation to what we seek and what will happen.
It has been brought to my attention that the health service may ultimately need to decide whether to adopt a population-based approach to support improved outcomes across the entire population, or a more targeted approach aimed at those facing the greatest barriers to effective self-management. Will the Minister ensure that the health system explores the full range of ways in which health coaches can support people living with long-term health conditions, as well as carers and family members, through the development of an NHS definition of health coaching? Does she agree with me—and I hope with others in the House—that the UK has an opportunity to be an exemplar in the use of health coaches? It is an excellent opportunity and I hope that through the Minister we can make those changes.
I want finally to discuss the potential of innovations and technology in addressing issues related to self-management. That is what I do—I self-manage my diabetes. A flexible approach to the provision of structured education is vital to support self-management. Once equipped with the information and skills necessary to self-manage, people must have access to, and choice from, a range of proven technologies to help them manage their condition in everyday life. There has been a big investment in technology recently in the NHS.
We welcome the Government’s commitment to the extra spend on health, which we talk about regularly. All us in the House are particularly appreciative of the Government commitment. People with type 2 diabetes are now provided with glucose monitors; my hon. Friend the Member for South Antrim (Paul Girvan) referred to those in an intervention. However, people are offered little education on how to use them appropriately. There may be something more that we can do about that. It is good to have the technology, and to be taking steps forward, but it is also good for people to understand how to use it appropriately for management.
The level of investment in innovative hardware for people with type 1 diabetes is substantial and should be commended. However, individuals can be left lost if timely support is not available to help them to interpret and utilise those tools as a means of preventing complications. Many people with type 1 diabetes choose not to access the technologies now available to them. Why is that? I do not know the reason, but it is a question we must ask. I believe that it is partly because of a lack of individual awareness. In the case of my diabetes, that would be right. It could, potentially, be linked to a lack of information. If information is not being provided, I should hope that something could be done about that.
Later in the month an event is being held in Parliament, chaired by the right hon. Member for Knowsley (Sir George Howarth). The event, held in partnership with the type 1 diabetes charity JDRF, is to do with the development of a new report on access to technology for people with type 1 diabetes, “Pathway to Choice”. I look forward to reading the report when it is published, and I know the Minister will be keen to read it.
All of us with an interest in diabetes—and that is why Members are here for the debate—will be interested to read it. Can the Minister inform colleagues here today what measure will be introduced to ensure that all people living with either type 1 or type 2 diabetes can access the latest proven technologies that are right for their situation?
Finally, a holistic approach should be taken to diabetes care both to ensure value for the individual and to maximise the benefits to the NHS. When we are dealing with the NHS we must look at the money we have to spend, and how to spend it better. Prevention and early diagnosis are among the ways to do that, and the area of type 1 diabetes technology is important. Over the years I have had a number of constituents under the age of 10 who had early-onset type 1 diabetes. I can picture some of their faces, as I speak. They will always have to manage their diabetes. Mine came about through bad diet and bad management, but for some people it is hereditary. I ask the Minister to ensure that the Department for Health and Social Care will continue to focus on the important issue of messaging, in relation to diabetes.
Of course, underpinning the whole issue is the need for better public health funding. It is no coincidence that just yesterday in this very Chamber in a debate on the declining numbers of health visitors, I quoted the figures for the national reduction in public health funding and the local reduction in my own borough of Rochdale. Nationally, there has been a reduction of £531 million on public health spending. In my local borough, there has been a cumulative reduction of £8 million over the last four years.
We cannot provide important services on an ever-decreasing budget. It was short-sighted of the Government to try to cut costs by reducing public health funding, and the chickens are now coming home to roost on this ill-thought-out decision. Given the emphasis on prevention in the NHS long-term plan, I will be interested to hear what the Minister has to say about how the cuts to public health funding will be reversed, and how quickly.
Finally, I understand that a National Audit Office report on health inequalities will come out at midnight tonight. I suspect that that report will lay bare the health impacts of cuts to public health services. I will certainly read it with great interest, and I hope the Minister will too.
In the time that I have spent as a type 2 diabetic, which is about 10 years, and as the chair of the APPG, I have come to the conclusion that there are five pillars of diabetes care, and I want to talk briefly about each one. The first is putting consumers first: we must put diabetics at the heart of diabetes care. There are meetings, seminars and events—a whole industry around diabetes care. We need new technology, experts and so forth, but we must never forget that it is the consumers—the diabetics—who should be put at the forefront of the debate on diabetes. Sometimes we forget the user: the people at the end of the process.
As we have heard, we need better technology. Members of the APPG and I visited the Abbott site in Witney in July 2019. I was first invited to go there by the former Prime Minister, in whose former constituency Abbott is based, because we wanted to look at the company that produced flash glucose monitoring devices, which have transformed the lives of so many people with type 1 diabetes. We went there because there are shortages of the equipment. In the past, one could go on the website and take one’s own device. There has been a shortage since the Government very kindly decided that everyone with type 1 diabetes would be able to get a machine on World Diabetes Day last year, so we went to talk to the chief executive about it. I know the company is working hard to ensure that the situation is reversed—I suppose we win the lottery by being able to provide the machines, but then we find that we do not have enough machines. I hope that this is going to improve.
I would like to show you my fingers, Ms Buck, so you can see the holes from my twice-daily finger pricking—I am surprised that I have any blood left. I use my GlucoRX device in the morning and am shocked at the reading in the evening, but I just carry on. I would love to have a flash glucose monitoring device—I cannot get it on prescription, because it would probably bankrupt the NHS if all type 2 diabetics received it, but it is a very important device.
My hon. Friend the Member for Heywood and Middleton, who is an assiduous member of the APPG, reminds us of the importance of diabetes specialist nurses such as Debbie Hicks in Enfield and Jill Hill, who have both given evidence to the APPG at one of our meetings. They have an incredible amount of knowledge. To go back to what the hon. Member for South Antrim said, we know that doctors are gods—they have a better reputation than MPs, anyway. Who wants to listen to an MP when they can listen to their local GP? However, they do not have the time. From our constituents, we all know that doctors are unable to see all their patients and spend sufficient time with them talking about diabetes. The point that has been made about diabetes specialist nurses is very important: we need to ensure that we have more of them.
The second pillar of diabetes care, after the need to put consumers first, is awareness. We all know that diabetes is a ticking timebomb. There are 4.6 million people with diabetes in the country, but an additional 1.1 million people, which is equivalent to the entire population of Birmingham—imagine the whole of Birmingham suddenly getting diabetes overnight—are undiagnosed. We therefore need to support awareness campaigns, which have been led very much by the private sector but supported by the Government, because that is the best way to tell whether people have type 2 diabetes and whether they can change their lifestyle.
We have heard from the former Chinese-meal eating, lemonade and fizzy drink-drinking hon. Member for Strangford how he changed his lifestyle. If only he had been told before, he might have changed it earlier. I remember that when my mother had type 2 diabetes, I had just been appointed Minister for Europe by Tony Blair and had no time to look after my mother. I was flying around Europe trying to enlarge the European Union by bringing in Poland and Hungary—as we are about to leave the European Union, I will not start another debate about that. The fact is that I did not spend enough time with my mum, which is a source of great guilt for me personally—finding out about diabetes, how she got it, what she was doing about it, and why she was still eating chocolate when she was a type 1 diabetic. Looking back at it, it seems amazing. It is important that we diagnose earlier, because then we can take our medication.