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Mr. Andrew Mackinlay (Thurrock): The right hon. Gentleman keeps a very good wine cellar, too.

Mr. Hutton: I have no knowledge of that. Perhaps in the light of my comments, I might get to sample some in the near future.

Sir Peter Emery: I extend an invitation to the Minister now.

Mr. Hutton: Great--your place or mine?

I also pay tribute to the right hon. Gentleman's wife, Lady Emery, with whom I have had dealings in my role as Minister with responsibility for social services, and who has done outstanding work with the International Social Service, which is a fantastic organisation. She has been a marvellous advocate and champion for what it does.

Having gone through the parliamentary pleasantries, which I am delighted to have had the opportunity to do, as the last Minister to speak in this Parliament, I turn to what the hon. Member for Buckingham said about the important subject of the treatment of diabetes. He referred to the diabetes pledge that was issued recently by Diabetes UK. It urged decision makers in this place and health care professionals to recognise the seriousness of diabetes as a

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growing health challenge, and we certainly do. Therefore, I assure the hon. Gentleman of the seriousness with which the Government take diabetes.

As the hon. Gentleman said, diabetes has a major impact on the lives of nearly 1.4 million of our fellow citizens, who have been diagnosed either with type 1, which is insulin dependent, or type 2, which is non-insulin dependent, diabetes. As he rightly said, the number of people with type 2 diabetes is forecast to increase significantly over the next decade, yet at the same time healthy eating, physical activity and weight management can prevent or delay the onset of type 2 diabetes.

If not properly managed, diabetes can result in a range of long-term complications--cardiovascular disease, blindness, renal failure, lower limb problems leading to amputation and, in some cases, earlier death. As a consequence, it has a significant impact on the national health service: diabetes and its complications cost the NHS nearly £5 billion a year, or 10 per cent. of its overall expenditure.

As the hon. Gentleman observed, there is evidence of unacceptable variations in the standard of the diabetes service provided throughout the country. The Audit Commission study of diabetes recently demonstrated that. That report showed some areas of very good practice, with staff working across sectors to improve patient care, but those examples are not always widely shared throughout the NHS. I strongly believe that there is nothing wrong with the NHS that cannot be put right by what is best about the NHS. That particularly applies to some of the issues to which the hon. Gentleman has referred.

It was the variations in the organisation and quality of service that prompted the Government to announce in 1999 the development of a new national service framework for diabetes in England. It is also worth highlighting that the Government have taken action in different spheres to help to improve the lives of people with diabetes. For example, we responded positively to a campaign by Diabetes UK by adding insulin pen needles and certain reusable insulin pens to the drug tariff last year, making them available for the first time on general practitioner prescription. On a different matter, following a review prompted by the House of Commons Select Committee on Science and Technology inquiry into driving and diabetes, new arrangements came into effect last month for individual medical assessment of people with insulin-treated diabetes who apply for licences to drive small goods vehicles. The Government are willing to listen to the concerns of people with diabetes and, where we can, to act on them.

The hon. Gentleman asked a number of questions about the national service framework for diabetes. I shall try to deal with the points that he made. The aims of the national service framework are to improve health outcomes for people with diabetes by raising the quality of services and reducing variations between them. In doing so, I expect it to deal with the issues highlighted in Diabetes UK's diabetes pledge.

The scope of the national service framework is broad and covers prevention, identification and management of diabetes and its complications, including rehabilitation and continuing care. The framework will set clear national standards that we shall expect to see implemented. It will

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also define new service models, put in place effective strategies to support implementation and delivery of the new standards, and establish performance measures against which progress within an agreed time scale will be measured and monitored.

As with previous national service frameworks, that for diabetes has been developed in close consultation with an expert advisory group that has brought together service users, patients, health care professionals and health service managers. As the hon. Gentleman must know, that group was chaired in an effective and distinguished way by Professor Mike Pringle, chair of the council at the Royal College of General Practitioners, and Peter Houghton, regional director of the eastern regional office of the NHS executive.

We have published information about and arising from the development of the national service framework for diabetes on the worldwide web. We expect to publish the framework itself later this year, for implementation throughout the NHS in 2002. In general terms, we are seeking to put the person with diabetes at the centre of the health care system. His or her needs must be paramount. It will be a model for how the NHS supports and cares for people who are disadvantaged in some way--in this case, as a consequence of chronic disease.

The national service framework for diabetes is an important plank of the Government's quality and modernisation agenda for the NHS. In 1997, shortly after taking office, we set out how we intended to set a clear structure that held those who deliver services to account. In the White Paper "The new NHS" and the policy document "A First Class Service", the Government introduced a range of measures that we hope will raise quality and standards and decrease unacceptable variations in service. Standards will be in the first instance set by the National Institute for Clinical Excellence and by national service frameworks; delivered locally by means of clinical governance; underpinned by professional self-regulation and lifelong learning; and monitored by the new Commission for Health Improvement, the NHS performance assessment framework and the NHS patients survey.

For the first time in the history of the NHS, we are trying to set clear national standards to guarantee fair treatment wherever patients live--whether in the hon. Gentleman's constituency or in mine. For the first time, we are inspecting all parts of the health service to ensure that patients get the top-class service that they deserve.

The quality agenda, which I am sure the hon. Gentleman also places heavy emphasis on, is at the heart of the Government's strategy for modernising the NHS. The NHS plan takes the agenda further still, introducing further steps to improve both customer service and the safety of patient care. The plan sets out how we will develop the role of primary care through better facilities--the hon. Gentleman was concerned about the balance between secondary and primary care--more staff and more integrated and multi-disciplinary working. That will raise the standard of care for people with diabetes in the primary sector, easing the pressure on hospitals, so that they can concentrate on providing the necessary specialist care.

Diabetes UK's diabetes pledge refers to the importance of patient-centred care. Care dictated by the needs of the patient, not the system, will be at the core of the NHS

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plan. The Government therefore attach great importance to involving patients, carers and the wider public in decisions about health service policy and delivery. That is why we have made great efforts to ensure that we hear the voices of people with diabetes and of parents of children with diabetes--I know that that is a concern of the hon. Gentleman--in the development of the national service framework. There were, for example, two people with diabetes on the expert reference group, plus Paul Streets of Diabetes UK. Other people with diabetes were on the various topic area groups set up by the expert reference group. There were more than 40 people with diabetes among the 120 or so who attended a 24-hour workshop in October 2000 to focus on patient and care pathways. The National Centre for Social Research was commissioned to run user focus groups and to conduct in-depth interviews with people with diabetes.

We want individual patients to play a greater role in determining the care that the NHS provides. We believe that an NHS that works effectively with patients will deliver better results for individual patients and better health for the whole population.

The hon. Member for Buckingham may be interested to know that an example of that objective in action is provided by the Bradford health action zone programme, which is developing models for delivering diabetes care within primary care. The local community and health care professionals are working together to improve the diabetes care within the sector through the development of new care models. Bradford demonstrates how our determination to modernise the NHS and tackle inequalities can improve services.

Encouraging people with diabetes to play a full role in the management of their own condition will be a cornerstone of effective care. To do that, we have to help them develop the knowledge and skills to become partners in their own care. Diabetes is an excellent exemplar of the need for a partnership between patient and clinician. As I have suggested, that will be a key focus of the diabetes national service framework. It is also central to the work of the expert patients task force, which I expect to inspire a major expansion of patient-led self-management programmes across the NHS. Indeed, the NHS plan committed us to establishing a comprehensive expert patients programme. We shall deliver that commitment.

The hon. Gentleman is right to draw attention to the particular prevalence of diabetes in south Asian, black African and black Caribbean people. The diabetes national service framework will therefore pay particular heed to the needs of those who are disproportionately affected by diabetes, including people from minority ethnic groups.

The hon. Gentleman also rightly stressed the importance of detecting diabetes as early as possible--an issue highlighted by Diabetes UK in its diabetes pledge and, indeed, in its missing million campaign. Whether or not there are as many as 1 million people in the UK with undiagnosed diabetes, as Diabetes UK estimates, early detection to enable early treatment is clearly important. That is why we asked the UK national screening committee to consider how that objective could most effectively be achieved and whether there was a case for introducing a targeted screening programme or more active case finding for type 2 diabetes. The evidence on screening for type 2 diabetes is not clear cut.

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The national screening committee came back with proposals for a type 2 diabetes development project, which were approved by Ministers last month. The project will aim to assess the implications of targeted screening for those working in primary care and the practical issues in its delivery. It is being designed to dovetail with existing research projects on screening for type 2 diabetes and should ensure that we have a clear picture of whether screening is the most appropriate way of improving identification of the condition.

Once they are received, the national screening committee's conclusions will inform implementation of the diabetes national service framework, as, too, will its recommendations for a national screening programme for diabetic retinopathy, which the hon. Gentleman mentioned and which we published last November.

We know that, once diabetes has been diagnosed, tight control of blood pressure and blood glucose levels are of key importance in its management. The UK prospective diabetes study--UKPDS--found that the lives of people with type 2 diabetes can be saved by more frequent checks and better treatment to keep blood glucose and blood pressure levels as normal as possible.

The Department of Health and the NHS, with the Medical Research Council, Diabetes UK and other sponsors, have made a major investment over many years in the UKPDS. It is an example of the real, life-saving benefits that can come from investment in high-quality long-term research. The Government themselves make a significant contribution to diabetes research through both the Medical Research Council and NHS support for research and development.

The hon. Gentleman also mentioned the work of the National Institute for Clinical Excellence. A whole raft of other work on diabetes feeds into the new quality agenda to which I referred earlier, including that of NICE. NICE will help to ensure that the NHS provides the best possible treatment with the available resources, to bring an end to the lottery of care in which some treatments are available in some areas but not in others. The hon. Gentleman and all other hon. Members are concerned about that issue.

NICE will be issuing clinical guidance on aspects of the management of type 2 diabetes this autumn, and developing clinical guidelines for type 1 diabetes for publication next year. In recent months, NICE has also appraised the effectiveness of two new diabetes drugs to which the hon. Gentleman referred, and published guidance on their use.

NICE has recently reviewed the evidence on the clinical and cost-effectiveness of the two drugs. Its guidance on both drugs was similar--that either can be considered as a possible alternative to insulin for patients with type 2 diabetes whose condition is not being satisfactorily controlled by diet and other tablets. Of course, they will also give doctors another tool in the armoury of treatments available to them. However, prescription for individual patients will still be a matter of individual clinical judgment. Nevertheless, given NICE's guidance, use of both drugs, which are new on the market, can be expected to increase in the future.

Earlier this week, the Minister of State, Department of Health, my right hon. Friend the Member for Southampton, Itchen (Mr. Denham), announced consultation on the proposed next wave of appraisal topics to be referred to NICE. It includes three diabetes topics:

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insulin pump therapy, to which the hon. Member for Buckingham quite properly referred; insulin glargine; other long-acting insulin analogues; and patient education models for diabetes. We shall consider further diabetes issues for possible addition to NICE's future work programme.

The importance of giving the person with diabetes appropriate information, to which the hon. Gentleman quite properly referred, was one of the issues highlighted by the tragic death of a young woman with diabetes, on which the health service ombudsman issued a special report only last December. The ombudsman made specific recommendations to the general practitioner and the hospital involved. However, as the ombudsman suggested, there are wider lessons to be learned from that sad case about the diagnosis and treatment of diabetes which we are determined to learn. We shall seek to ensure that those lessons are taken on board in the diabetes national service framework.

Finally, I should like to highlight some of the dramatic improvements in health outcomes that research suggests we can expect once best practice becomes the norm. We aim to reduce deaths related to diabetes by one third, and to reduce the risks of coronary heart disease, strokes, kidney damage and serious deterioration of vision by at least one third. Diabetes is the biggest cause of blindness in people of working age. We should also be able to reduce amputations and ulcers significantly. We could also provide better co-ordinated patient and family focused services for children and young people making the transition to adult services.

Those are all major goals for the treatment of diabetes in the future. The diabetes national framework will, for the first time, give us the practical means of ensuring that those aspirations become a reality.

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