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10.45 am
Using the prospective date--that suggestion has certainly been made in our debates on this matter--would unfortunately give rise to national insurance avoidance opportunities. It would also leave companies little time to consider the effect of this measure on their national insurance liability.
Another possibility that has been considered is giving companies a choice of two dates. That would present serious problems, especially given the roll-over provisions in the Bill. The hon. Member for Arundel and South Downs has played a helpful role in this process and I am happy to put on the record my appreciation of the good deal of helpful comment that he has made on a number of the provisions. A moment ago, he drew attention to the complex character of the roll-over provisions. If we were to proceed with a choice of two dates, he could imagine, probably better than anyone else in the House, how complicated that would become. It is not an attractive proposal.
Mr. John Bercow (Buckingham): I do not want this to become an exchange purely between what might be described as roll-over anoraks. I am in the somewhat unfortunate position of not having the extensive knowledge of these matters with which the Minister and my hon. Friend the Member for Arundel and South Downs (Mr. Flight) are blessed. I therefore wonder whether it would be in order, as well as being helpful to
the House, if the Minister were either to dilate upon, or at any rate animadvert to, those roll-over provisions in some modest detail.
Mr. Timms: I am grateful to the hon. Gentleman for that generous invitation. What I can best do is refer him to clause 3, the character of which has already been referred to by the hon. Member for Arundel and South Downs. The hon. Member for Buckingham (Mr. Bercow) will see that the clause is called "Special provision for roll-overs" and there are three pages on the subject. If his perusal of the clause gives rise to any questions in his mind, I should be happy to address those. We looked at the clause in some detail in Committee and I am confident that it is now in good order and has benefited from the critical examination that it received.
Let me explain briefly to the hon. Gentleman what happens when an option that has been settled is subsequently rolled over. Where options were granted during the relevant period and rolled over after that, the settlement will relate only to the part of the gain on the new option that relates to the original. Provided that the options are rolled over at parity, the national insurance contribution will remain settled. Where a roll-over is not at parity, the amount of the gain on the new option relating to the amount in excess of parity at the time of the roll-over will be subject to class 1 national insurance contributions under the existing rules.
If the new option comprises additional shares that are in excess of the market value of the shares subject to the original option at the time of the roll-over, they will be liable to class 1 national insurance contributions on any gain arising on exercise of the additional shares.
Mr. Bercow: The Minister is doing his best to respond to the request that I put to him. As he knows, I do not lightly pay tribute to him, but I am bound to say that his explanation thus far has been comprehensive, racy and--dare I say it?--even intoxicating. I am concerned, as I know he is, about fiscal and fiduciary responsibility. I know that we are coming to an election, but he should bear it in mind that, when I am in Buckingham town centre on Saturday, my constituents will not be able to cope with a detailed explanation. However, they will ask about what he said on the exercise of fiduciary responsibility in relation to the amendment.
Mr. Timms: It is a shame that I shall be unable to listen in on those conversations on Saturday morning, but the hon. Gentleman should tell his constituents that all the actions of the Government have been marked by prudence. That is certainly the case in this connection. It will not assist the House if I proceed much further with our discussion, but I am pleased and grateful to the hon. Gentleman that we have been able to cover the matter in the way that we have.
The hon. Member for Arundel and South Downs referred to the proposals in the Conservative manifesto. I say to him that the problem is that the sums simply do not add up, and that will become apparent in the days ahead.
Lords amendment No. 2 agreed to.
Clause 5
Lords amendment: No. 3, in page 8, line 34, leave out "this section" and insert
"the provisions of this Act".
Mr. Timms: I beg to move, That this House agrees with the Lords in the said amendment.
This second change, which is probably less racy than the first, will bring the Bill within the ambit of part I of the Social Security Contributions and Benefits Act 1992, which is the main social security legislation. Without the amendment, we would be unable to use the existing administrative procedures in the main Act to introduce the regulations to be made under the Bill. That problem was spotted by the Delegated Powers and Deregulation Committee of the other place, and I am grateful to it for that. I am glad to have the opportunity to put my thanks on record, and I am confident that the House will support the amendment.
Mr. Flight: I also support the amendment. Furthermore, I make it clear to the Minister that we
support it and the Bill because they solve a problem, but, as I tried to make clear earlier, imposing additional stealth taxes on unapproved share options is a mistake.I say to my hon. Friend the Member for Buckingham (Mr. Bercow) that, when he talks to his small business people in the high street, he should point out that the issue is that unapproved options are no longer of any great use in giving people incentives and procuring good management from large companies that can afford to pay them more. People will not take lower pay and the chance of making unknown gains that depend on how the business performs if they have to pay 47.3 per cent. tax on those unknown gains. They will almost certainly stay in a safe job with the Government or a large company.
It is a great pity that a Government who put so much spin on wanting to support entrepreneurship and making this country achieve as well as the United States does should go down such a path. I am churlish not about the Bill, but about the cause of needing it in the first place.
Diabetes
Motion made, and Question proposed, That this House do now adjourn.--[Mr. Clelland.]
10.55 am
Mr. John Bercow (Buckingham): It is a pleasure and a privilege to introduce the last Adjournment debate of this Parliament, and it is a particular and unexpected pleasure to do so in the knowledge that the Minister for Public Health will reply to it. If memory serves me correctly, and I am woefully faulty in those matters, as you, Mr. Deputy Speaker, are well aware, I first locked horns with the Minister on the BBC's "Any Questions?" on 21 November 1997. We have periodically jousted since, and it is a delight, albeit a surprise to her as well as to me, to see her in the House today.
The treatment of diabetes is a subject of the greatest importance, and interest in it in the House has been reflected since 1 May 1997 in six oral questions, 110 written questions, 14 early-day motions, three of which were tabled this Session, and no fewer than three Adjournment debates, each of was initiated by the hon. Member for Torbay (Mr. Sanders). They took place on 20 November 1997, 4 March 1998 and 30 November 1999.
In preparation for today's debate, I have received useful briefings from a number of individuals: the public affairs officer of Diabetes UK, Mr. Peter Bainbridge; the honorary secretary of the Aylesbury and district branch of Diabetes UK, Mr. Tony Ibotson; the marketing director of leading diabetes pharmaceutical operation Novo Nordisk, Mr. Adrian Haigh; and the House of Commons Library science and environment specialist on these matters, Dr. Alex Sleator.
What is diabetes? It occurs when there is an excess of glucose or sugar in the body, such that it cannot be used properly. People will probably be aware, and by the end of the debate they ought to know, that there are two main types of diabetes. The more severe version of the disease causes its victims to be dependent on regular supplies of insulin. That is called type 1 diabetes, from which approximately 20 per cent. of sufferers suffer. The other 80 per cent.--between 1 million and 1.2 million people--have been diagnosed as suffering from type 2, which is less serious, though still a worrying and painful affliction. Those individuals are not dependent on insulin and they can be treated by a combination of good diet, tablets and occasional provision of insulin.
We are discussing not only the 1.4 million people who have, as I advisedly said, been diagnosed as suffering from diabetes, but the large number of people--about 1 million--who suffer from the condition in ignorance of the fact. The Minister will know that, on average, people suffer from the disease for seven years before it is diagnosed, though it can be as many as 10 before diagnosis takes place. I shall come to the serious consequences of late diagnosis and, therefore, the corollary of it--the absence for several years of any treatment for the condition.
What causes diabetes? In truth, despite the many studies that have been conducted over a long period in this country and elsewhere, we do not know for certain what causes the condition. However, we do know that certain identifiable factors seem to provoke it. One is
heredity. There is often a family history that can be regarded if not as a certain, but as a reliable predictor of someone getting this ghastly disease. A second factor is age. People over 40 are more likely to get it. Overweight--obesity, to give it its modern term--is also a significant cause of diabetes. In addition, we know from empirical evidence that there is, regrettably, a propensity to develop diabetes in the black and Asian communities. It is a truly horrifying fact that one in four Asians over the age of 60 suffer from the disease.The symptoms of untreated diabetes are unpleasant. They range from extreme thirst to excessive tiredness to frequent urination to severe weight loss to genital itching and to blurred vision. The effects, as distinct from the symptoms, of untreated diabetes are even worse. To avoid doubt, and so that people realise the significance of the problem that we are confronting, let me spell those out. They are heart disease, kidney failure, amputation and, ultimately, blindness.
It is a not a common or garden disease to which we should not give much attention. People often imagine that it is not too serious. They think that it is regrettable and involves some inconvenience, but that it is not a big deal in overall medical terms. I want to emphasise that diabetes is a big deal. It is a big deal in terms of the number of people who suffer from one or other variant of it; it is a very big deal in terms of the costs to the national health service in its diagnosis and treatment; and it is a very big challenge for Governments and, indeed, all parliamentarians to do what they can to address the problem.
It is the significance of the disease that has propelled Diabetes UK to issue a challenge to Members of Parliament in all political parties to sign up to its pledge to recognise that diabetes is a serious disease, to appreciate the importance of early diagnosis--which is accomplished, not least, through early and comprehensive screening programmes--and to accept that each and every diabetes sufferer has a right to receive the best possible treatment available, irrespective of who he or she is, where that person comes from or what particular complications of the disease he or she experiences.
We are in possession of recent and valuable research, which is a result of work carried out in November 1999 by the Audit Commission. The findings were published in April 2000. The study makes salutary and alarming reading. It found that there were huge disparities--as much as fourfold--between the number of clinicians available in some parts of the country relative to others for the treatment of diabetes. The Audit Commission also found that there were substantial variations in the referral patterns in relation to the disease. There does not seem to be a consistency of practice between one area and another.
The quality of hospital care is variable. That is not because of a lack of will, but because of a significant disparity in the number of expert clinicians available to treat those suffering from the disease. There is also a problem at primary care level, where there is a major gulf between the expertise and understanding of some general practitioners and others.
So far as the sufferers are concerned, there are great differences in the level of education and understanding of the disease. Some people have a great understanding of it and know how best to minimise the symptoms and to improve their quality of life. Others, sadly, have not been
well informed and are ill aware of what they can do to help themselves and how to seek expert and professional help from others.We face a serious and growing problem. About 2.5 per cent. of the population suffer from diabetes. The threat--I do not want to be alarmist, but merely to interpret the facts available--is that that will increase in the coming years and 3 per cent. or more might suffer from one or other of the variants of the disease. That leads me, in the short time that I intend to detain the House, to highlight several challenges that I should like to put to the Government.
The Government are formulating a national service framework for the treatment of diabetes. I welcome that and am anxious, as I think everyone of good will in the House will be, to ensure that it best caters to those who suffer now, and offers the maximum hope of prevention and deterrence of the disease. I have three specific inquiries on the national service framework. The first relates to diabetic retinopathy. That phrase does not readily trip off my tongue because I am not expert in such matters. However, it is important that we do not allow complex medical terms to obscure the significance of the subject.
The strong body of opinion says that there should be regular screening for diabetic retinopathy on, for example, an annual basis, which is a modest suggestion. I am not entirely clear whether the Government have decided that that should be a headline objective and written commitment of the national service framework. The framework has yet to be published and I am not expecting the Minister to share all its details on the Floor of the House in advance of its publication, although debates are, regrettably, sometimes the best way to maintain a state secret. However, it would be helpful to hear about the kernel of the Government's thinking.
My second inquiry relates to the need to have a regular and comprehensive screening programme, which Diabetes UK also wants. That does not have to be of the whole population, because that would be superfluous and extortionately expensive, but of the groups that are most at risk. They are, indeed, known as the at-risk groups. Specialist opinion suggests that a regular screening programme could be invaluable in reducing the incidence of the disease. Do the Government intend to go ahead with such a programme? If they do, how is it to be implemented, what resources are to be made available and within what time scale will the objective be accomplished?
Thirdly, I should like to get a feel about how the Government envisage the balance will lie between the primary, secondary and tertiary sectors in the treatment of the disease. I mentioned the variable pattern of hospital provision--some good, some bad, some indifferent. Do they think that the volume of resources consumed in hospital care of sufferers should continue and be extended, or--as I suspect might be the case--are they thinking in terms of greater provision through general practitioner services? I shall be gentle, because I am always understated in such matters, but if the Government have the latter in mind, do they intend to put their money where their mouth is to extend training for general practitioners and provide specialist back-up services to complement the work of GPs in the localities?
Clearly, there will be cost and training implications. If we accept that the treatment of this disease will be multi-faceted, co-operation and co-ordination between the various sectors will be required. The treatment of diabetes is a complicated equation. No one suggests that it can all be dealt with in hospital or at general practitioner level. What is to be done about the shortage of specialist nurses, when is it to be done and how can we be reassured?
I want to refer to the guidelines produced by the National Institute for Clinical Excellence on two drugs that have been recognised as having a potential benefit and palliative impact--pioglitazone and rosiglitazone. Those drugs are of some significance, because they have been given a nudge and a recommendation by NICE and because, to be effective, they require sufferers to have a considerable knowledge and understanding of the disease.
I am well aware that those drugs are not suitable for all sufferers. They will probably be of little use to the many sufferers who, through no fault of their own, are ignorant of how best to minimise their burden. However, the medical experts suggest that if people know quite a lot about their condition--they may have suffered from it for a long time and have taken advice--those drugs can be of value to them.
It is only fair to note the great difference between the usage of those two drugs in this country and elsewhere. I am not making a partisan point, because that has been the position under successive Governments of both political persuasions. A tiny fraction of sufferers of type 2 diabetes use one or other of them. Perhaps we should be ashamed of our performance, or perhaps there are good reasons to explain the differential about which I shall shortly be enlightened by the Minister.
The lower usage of those drugs in this country than elsewhere provides food for thought. Do the Government intend to develop their take-up and use? If so, can we be sure that it is more than just an early pledge, as there will be a resource implication? Do the Government intend, in the very short time available to them before they make way for my hon. Friends and me to take over from them, to provide the resources consistent with adequate provision? I am sure that we are about to be enlightened by the hon. Lady, and that is an enticing prospect for me.
Funding is available through the Medical Research Council for important studies on the causes of diabetes, its incidence and the means by which it can be effectively controlled. In 1998-99, about £3.5 million was made available for that purpose, and in 1999-2000 the figure was about £6.5 million, which was a substantial increase. I do not cavil at that. Those resources would probably have been used to good effect, but I should like to be clear that a continuing value-for-money study is taking place. Are there benchmarks or yardsticks for future research? Is the availability of resources tied to an improvement in the findings of the MRC studies?
What can we expect in practical terms? We are all prone to talk about inputs. We are entirely justified in doing so, but what interests sufferers of this disease, as of others, and their families is not input, but output. What are the results? How are we improving? Are we detecting the disease earlier? Are we preventing it thereby? Are we treating it more effectively? Are we reducing its incidence? Can we hold out the prospect of a diabetes-free age, or at least of an age in which its incidence is dramatically reduced?
Finally, I should like to refer to insulin pumps. The usage of insulin pumps is also relatively low in this country--the figure is about 0.5 per cent.--by comparison with practice elsewhere. In Germany, the Netherlands, Norway, Sweden and the United States, usage by sufferers in the relevant category is 5 per cent. I am uncertain about what the Government have in mind.
In a consultation paper issued in July last year, Ministers said that it would be good if the expert reference group conducted research to see whether wider use of insulin pumps would be effective. Curiously, on 26 February this year, in a written answer to the hon. Member for Romsey (Sandra Gidley), the Under-Secretary of State for Health, the hon. Member for Birmingham, Edgbaston (Ms Stuart) said that no comprehensive evaluation of insulin pumps had taken place, and that no specific guidance had been issued. Is that the Government's final position, or do they intend to do something about it?
There is a need for a vision, for a series of practical steps and, by way of reassurance and encouragement to sufferers, for an indication of a time scale within which these important objectives will be accomplished. I look forward immensely to what the Minister has to say.
I thank you, Mr. Speaker, for your indulgence. I want to pay tribute to the parliamentary and political giant of our times, the right hon. Member for Chesterfield (Mr. Benn), who is present for the final time in this Chamber. It is 51 years and three months since he was first elected to the House. I know that he does not want to be embarrassed by excessive effusions from his lifelong political enemies, but a modest dose of embarrassment does no harm to anyone's health, and what I say to him is sincerely meant. The term is much abused and much over-used in our political life, but he is genuinely a great man.
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