Diabetes

I beg to move

I will accept the amendment in the names of Dr Hendron and Mrs Courtney.

"Diabetes - possible to deal with, deadly to ignore" is the sound bite used by Diabetes UK, the primary group that represents diabetes sufferers. I thank that group for its work on researching and promoting awareness of the illness. However, the issue is not given the coverage that it deserves in the political arena, and I am grateful, therefore, that time has been set aside for this debate.

I must declare a personal interest, because I suffer from type 2 diabetes. Recently, I was interested to note that the Deputy Prime Minister, John Prescott, is also a sufferer, and I am glad to hear that he is prepared to work with Diabetes UK.

A joint task force on diabetes was established in March 2001 to consider Northern Ireland's response to the diabetes national service framework in England. Some might argue that the motion should have been debated after the report is published; however, the motion will help to highlight this much-neglected issue and move things forward. As the motion suggests, the debate has two simple objectives. First, the problem must be highlighted, and secondly, we must support the call for a screening process.

The facts about the seriousness of diabetes are startling - even frightening. The disease's seriousness was highlighted in Diabetes UK's presentation in the Long Gallery. I congratulate them on the success of that event.

Forty thousand people in Northern Ireland suffer from diabetes. It is estimated that nearly 4,000 people are suffering from it in my constituency, Lagan Valley; in the Health Minister's constituency, West Belfast, the number of sufferers is approximately 3,500. This includes those who are aware that they have diabetes and those who are not, which is why screening is needed. That is another reason for screening: 25,000 people have the condition but do not actually know, which is worrying. That supports my argument for the introduction of a carefully planned screening programme, but I shall deal with that in more detail later.

As well as affecting many people in Northern Ireland, the condition also has a major impact on NHS resources. This debate comes at a time when the Minister of Health, Social Services and Public Safety is continually saying that the NHS is severely underfunded. If diabetes were dealt with more effectively, then the NHS would be able to save substantial resources. Some may question that, but according to Diabetes UK, diabetes accounts for approximately 9% of hospital costs in Northern Ireland, which is the equivalent of over £100 million a year. If diabetes were taken seriously, which is the objective of this motion, the NHS would not only be able to save money, it would also deal more effectively with the condition. Recent research has revealed that in Britain there is a shortage of specialists to deal with diabetes, and I will be pursuing this matter with the Minister to see if the same situation exists in Northern Ireland.

Turning to a screening programme, you may ask what I mean by "serious", and what do I actually want to see happening. As the motion says, it is important that a programme of screening be introduced. This programme would not cover every adult in Northern Ireland - that is not really feasible. I am suggesting that adults in high-risk groups should be screened. For instance, it is recognised that the older you are, the greater the risk of diabetes. Also, diabetes runs in families, and the closer the relative, the greater the risk. It also appears that the vast majority of those with type 2 diabetes are overweight at diagnosis, so certain groups of people are immediately at high risk. Evidence suggests that people with type 2 diabetes have the condition for between nine and 12 years before they are diagnosed. Consequently, over one third of people with type 2 diabetes have at least one complication at the time that happens.

Of course, there are issues and details that need to be carefully considered. For example, how often should screening take place; where would someone go to be screened; and would it be appropriate for pharmacies with adequately trained staff to offer such a facility? Then there are the consequences of screening. If someone is diagnosed with diabetes, support has to be available to him and his family. Diabetes is a chronic condition, and there are many other effects beside the medical ones. Being diagnosed means a change of lifestyle, including employment and insurance matters.

Diabetes UK has been calling for such a screening programme for many years now to reduce the impact of the disease on people and NHS resources. That is why I tabled a question to the Minister on 15 June 2000 on examining the need for a screening programme. However, to the best of my knowledge, nothing has resulted from that.

I urge the Assembly to support this important motion.

I beg to move the following amendment: In line 1 after "Assembly" insert:

I thank Mr Davis for tabling the motion and for accepting our amendment, which adds to the motion rather than detracts from it. We want the report of the task force, but we agree with the spirit of the motion and with everything in it.

The initiative on diabetes in Northern Ireland incorporates a multidisciplinary approach and was launched in March 2001. The initiative involved establishing a joint task force between the Clinical Resource Efficiency Support Team (CREST) and Diabetes UK Northern Ireland. The task force is chaired by Dr McClements, who is the first convenor of CREST. It has a broad representation that includes healthcare professionals, the Department of Health, Social Services and Public Safety, representatives from public health, education and training, psychology and pharmacy, people with diabetes, and carers and representatives from the Republic of Ireland. It was a response to the national service framework for diabetes in England, Scotland and Wales. A vital factor in the task force's work is the focus on patient involvement. Crucially, the real experts in living with diabetes - the patients - have been central to shaping its work.

We musk ask what diabetes is and how much we know about it. It is defined as a chronic condition in which the amount of glucose or sugar in the blood is too high because the body cannot use it properly. Normally, the body produces a hormone called insulin that helps the glucose to move from the blood into the cells where it is used as fuel by the body. Forty thousand people in Northern Ireland have diabetes, and it is estimated that a further 25,000 remain undiagnosed. One pound in every seven spent in the Health Service here goes toward diabetic care. Better education may lead to prevention in future and therefore reduce spending.

As the condition is largely treatable, it tends not to be taken as seriously as it would be were the full implications known. These include blindness - diabetes is the main cause of blindness in people of working age in the United Kingdom. Diabetes is also the main cause of end-stage kidney failure and a main cause of lower limb amputation. I know that because three young cousins of mine died, and they all had to have toes amputated before their deaths. Diabetes increases a person's chance of a stroke by three, and it increases a person's risk of heart disease by five. It can also seriously damage other parts of the body.

Ignorance is a major problem with diabetes. People read up on its dangers only after they have been diagnosed - when it is already too late. We must find out why the condition is chronic.

There are two types of diabetes. In type 1, the immune system turns against the body, destroys the insulin and produces cells in the pancreas. This results in a complete deficiency of insulin. It is most often diagnosed in children and young people, although it can occur at any age. Symptoms are often marked, and diagnosis usually follows quickly. It is treated with insulin injections and by change of diet.

Type two is caused by a shortage of insulin or by a fault in the body's response to insulin. Most people will have type 2, which mainly affects people over 40. The symptoms are less marked, with the result that it often goes undiagnosed. Type 2 can be treated by diet alone, by diet and tablets or by diet and insulin injections.

What are the dangers if it is not diagnosed? Too many people are diagnosed so late that they are already developing complications by the time of diagnosis. On average, people will have type 2 diabetes for nine to 12 years before diagnosis, and up to 50% of them develop complications by the time they are diagnosed. Only 46% of people know that death is a possible result of diabetes. There is diabetes in my family; two of my cousins died of diabetes in their 40s. It is a killer. Of those at highest risk, 76% do not know that they are in danger. Too many people are suffering and dying unnecessarily as a result of the complications they develop - complications that can be avoided, and one of the most proficient ways of doing that is to raise awareness dramatically of the condition, highlight the symptoms and promote a positive, preventative approach. Increased thirst, going to the toilet excessively, especially at night, extreme tiredness, weight loss and blurred vision are some of the symptoms to look out for.

The best way of avoiding diabetes, as well as many other illnesses, is to follow a healthy diet. Keeping blood sugar levels within healthy limits is a keystone of diabetes management. Preventing diabetes therefore means avoiding sugary foods, and targeting foods with a low glycaemic index such as unrefined brown rice and bread, oats and grains, following the recommended nutritional guidelines of eating five portions of fruit and vegetables a day, drinking lots of water and getting plenty of exercise.

Diabetes can adversely affect everyday living in other ways. Unless their diabetes is very well controlled, those taking insulin may be precluded from taking some jobs in, for example, the Police Service, the Fire and Ambulance Services, the armed forces and the merchant navy and the Prison Service. They cannot be train drivers, airline pilots, air traffic controllers, cabin crew (on some airlines only) or have any job which requires a HGV or passenger-carrying licence. Some local authorities have a blanket ban on all types of drivers, including cab drivers, who have been diagnosed as having diabetes. As has already been stated, having diabetes can affect a person's ability to drive, and if one has been diagnosed, one must tell the vehicle licensing authority and one's insurance company. If the diabetes is well-controlled and a person takes care, he should be able to do most jobs.

People should remember that they are in control, and there are diabetic specialist nurses in most hospitals who will give advice if anyone is in doubt. People who are on insulin should carry it with them and avoid a hypoglycaemic attack - where blood sugar falls to a dangerous level. They should also keep a sweet drink, for example, Lucozade with them. I agree with screening and family members should be screened.

The task force will distribute the draft recommendations for consultation over the summer, and the completed guidelines will be published in the autumn of 2002. This Assembly must recognise that these recommendations represent the best opportunity to establish an effective framework to ensure quality healthcare for those with diabetes living in Northern Ireland. The Executive must prioritise diabetes in a meaningful way and resource the task force's recommendations fully or the problem will spiral into the next century.

I welcome the opportunity to support the motion and the amendment, which Mr Davis has already accepted. I congratulate him for bringing this very important debate to the House today.

Diabetes is undoubtedly a condition with which all Members will be familiar. Three in every 100 persons are now likely to be affected by it, so I would be most surprised to learn that there was anyone in the Chamber who did not have some knowledge of the disease in either of its two forms.

I would like to draw particular attention to the earnest, hard work done by voluntary groups throughout the Province. Mr Davis has already mentioned that, and I concur with his remarks, because as well as providing a forum for those people who have the condition, they have offered support for their families, friends and carers.

Significant advances have been made in our understanding of diabetes and in our capacity to treat those who have been diagnosed with the illness to enable them to live longer and healthier lives. However, as well as those whom we know have been diagnosed as having diabetes, there are those who have not yet been diagnosed, and I will come to the reasons for that.

It is the strategy of many of those groups to bring so much attention to the subject that diabetes can no longer be ignored as a healthcare priority in Northern Ireland. It is no longer an option to deny the seriousness of the disease. It is a lifelong chronic condition, and it is rapidly increasing.

As the Diabetes UK Northern Ireland association said when it lobbied us in the Assembly last month, diabetes has become an issue that is "too deadly to ignore". Recent figures bear testimony to that, and I congratulate it on its straightforward presentation. This is a very clear and stark reality: diabetes is too deadly to ignore.

There are 65,000 diabetes sufferers in Northern Ireland. While the known figure is 40,000, the worrying facts show that 25,000 people do not know that they have it. From speaking with diabetes sufferers in my constituency I have learnt that it is not uncommon for a person to live with type 2 diabetes for nine to 12 years before it is diagnosed. That is totally unacceptable, and one of the reasons we are having this debate.

Consequently, over one third of those with type 2 diabetes have established complications on diagnosis that might not have developed had they been detected earlier. There is a need for prevention and early screening, particularly for high-risk groups such as those with a family history of diabetes, those aged between 40 and 75 - and that will include quite a number in the Chamber - and those who are overweight, which will include some more in the Chamber.

I was concerned when I read in a recent communication from a diabetes support group in Mid Ulster that many have died prematurely or have developed diabetes complications such as heart disease, stroke and blindness simply because they went undiagnosed for years and were completely unaware that they had this life-threatening condition.

It is not widely known that diabetes can kill. Each year, thousands of lives are blighted by a condition that can be treated successfully. That is the other side. It can kill - "too deadly to ignore" - but it can be treated successfully if detected early. It is important to remember that life expectancy is reduced, on average, by more than 20 years for people with type 1 diabetes and by up to 10 years for people with type 2.

Mortality rates from coronary heart disease are up to five times higher in people with diabetes, while the risk of a stroke is up to three times higher. Those are startling figures and merit serious consideration. Diabetes is the leading cause of renal failure, accounting for more than one in six people starting renal replacement therapy, the second most common cause of lower limb amputation and the leading cause of blindness in people of working age. With that being a factor, and medical science knowing it, why is the Health Service not taking it more seriously and dealing with it?

Diabetes leads to additional risks in pregnancy. Women with diabetes have an increased chance of losing the baby during pregnancy or at birth, of having a baby with a congenital malformation and of the baby dying in infancy. That shows the seriousness of the situation.

The ability to recognise the symptoms and the increasing of public awareness through the introduction of screening programmes are the key recommendations for dealing with diabetes in England. I have no doubt that such principles will also find a place in the Northern Ireland task force's report on diabetes.

The number of people affected by diabetes in Northern Ireland is expected to double by 2010. That will undoubtedly put a severe toll on an already overstretched health budget. What is being done to address the situation? The presence of diabetic complications increases National Health Service costs more than fivefold, as it does the chance of a person needing hospital admission.

Diabetes also has a profound impact on social services costs, with one in 20 people incurring annual costs whether in residential care or at home. That puts another strain on the Health Service. However, we always return to the fact that diabetes can be treated and can be cured. Research has shown that early screening, especially of high-risk groups, has the potential to save lives and improve the quality of life. It is essential that the public are made aware of what screening programmes are available, and the importance of having a particular test or examination must be emphasised.

A modern, patient-focused approach is required that will not only deliver a strategy aimed at care and prevention through an appropriate screening programme, but will provide a service of first choice, not one of last resort.

I support the motion and the amendment.

Go raibh maith agat, a LeasCheann Comhairle. I thank Ivan Davis, Joe Hendron and Annie Courtney for tabling the motion and the amendment to it. Like other Members, I commend the community and voluntary organisations for their valuable work in this field, not only for sufferers of diabetes, but for their families too - because the disease has a knock-on effect.

I do not intend to repeat all the figures that have been highlighted. Ivan Davis pointed out that 40,000 people here suffer from diabetes and that a further 25,000 are unaware that they have the disease. That is a matter for concern, because people will have lifestyle problems and remain unaware of their cause. It has been pointed out that the effects of diabetes include heart disease, kidney disease, blindness and, most surprisingly, premature death. Some sufferers of the disease also have to have limbs amputated, so it is crucial that those facts are publicised.

I thank Ivan Davis for accepting the amendment tabled by Dr Hendron and Mrs Courtney. I welcome the thinking behind the motion. On reading it, I can see that a common sense approach is the most sensible way ahead. We are targeting those adults who are in the high-risk group. There is no evidence to suggest that universal screening would be effective. The motion does not call for universal screening; it is about targeting and identifying adults in the high-risk group.

There is emerging evidence that it may be good clinical practice and cost-effective to offer screening to sub-groups of the population who present multiple risk factors for diabetes. As many of the risk factors are similar, that could be combined with screening for cardiovascular disease. The evidence, however, is not definitive, so the screening committee has recommended further analysis of the existing research as well as further research into which sub-groups should be included in the screening programme, how to identify the people in those groups, whether it is better to rely on opportunistic screening by healthcare professionals, the sort of tests that should be used, how often people should be tested and the balance between the benefits and the drawbacks of early diagnosis.

The task force that was set up in 2001 is due to report in the autumn. One issue arising from the screening committee's work is the importance of early detection of diabetes, but there is a possibility that - and I could be wrong - the task force will wait for evidence from the screening committee, and that could take up until 2005.

Members have highlighted the different causes of type 2 diabetes, and I do not think that I should waste anyone's time by going over them. The causes can be genetic or related to lifestyle or social class. With regard to prevention, Members have a duty to highlight the 'Investing for Health' strategy, which was announced by the Health Minister some weeks ago. All Ministers and Departments are responsible for delivering on it. It involves the promotion of physical activity and improvements in diet and nutrition, the prevention of obesity and a reduction in the number of people who are overweight - I am a classic example of that.

As Members have said, it is better to prevent diabetes than to treat it, and we can take that from the 'Investing for Health' strategy. The Minister for Social Development is committed to removing 8,000 households a year from fuel poverty. That is a core aspect of deprivation. The Department of Culture, Arts and Leisure is committed to pursuing an increase in participation in sporting activities. The Department of Health, Social Services and Public Safety has a 'Be Active, Be Healthy' strategy. The Department of Education is implementing its 'Catering for Healthier Lifestyles' strategy in September 2002. Although we are talking about diabetes and the responsibility of the Department of Health, Social Services and Public Safety and, ultimately, the Minister, the 'Investing for Health' strategy has to come into play because we are talking about prevention as well as cure.

I have one concern about the amendment. Although we agree to support it, the members in whose name it is are looking forward to the report of the joint task force, but they then go on to say that we should introduce screening now. We are probably pre-empting the outcome of the task force. However, the motion, as amended, is very good, and Sinn Féin will be supporting it.

I will support any proposal or amendment that seeks to help the plight of people suffering from diabetes. I also welcome the presence of the Minister here today. I see that she is taking notes, and I am sure that she will act when the opportunity arises. I also attended the presentation in the Long Gallery a few days ago, and I pay tribute to those people who so ably explained the suffering and needs of diabetics and all the risks associated with the disease.

As health spokesperson for the Alliance Party, I am extremely concerned at the apparent lack of knowledge. Mr Davis commented on the lack of public knowledge of this terrible disease. The leaflet that was produced by Diabetes UK gives some startling statistics, and it must make public representatives and health providers sit up, take notice and do something. The figures are astronomical. Diabetes accounts for 9% of NHS spending - some £14 million a day throughout the United Kingdom.

This figure could be reduced drastically if the disease were treated in its early stages or prevented in the first place.

Diabetes UK has described the disease as the epidemic of the twenty-first century. Unless urgent action is taken by the Department of Health, things can only get worse. Currently 40,000 people in Northern Ireland have been diagnosed with diabetes, which leads to heart disease, blindness, kidney disease, lower limb amputation and finally death. These figures are expected to increase twofold unless drastic action is taken to call a halt to the epidemic.

The Northern Ireland Task Force on Diabetes is currently conducting an inquiry, and we look forward to its recommendations, which will be reported in September or October. We will then look to the Executive to prioritise diabetes and to provide funding so that it can be eradicated as far as possible. We need early detection and early remedies to surmount the disease. I support the motion and the amendment.

Rev McCrea mentioned that many Members know someone who suffers from diabetes; my mother has the condition. I am glad that the debate is taking place, and I look forward to positive action in this area.

Diabetes UK's Northern Ireland representative, Stephen McGowan, is in the Public Gallery to listen to the debate. I have had a long series of discussions with him. It is estimated that 3,746 people in my constituency of Strangford suffer from diabetes. However, the figure includes 1,000 people who are not yet aware that they have the disease. If anyone asks why we need a screening programme, they should be shown those figures as well as others quoted by Members. I agree with my Colleague, Mr Davis, that any such screening programme should not be aimed indiscriminately at adults in the Province; it should target high-risk groups such as the elderly and those with a family connection to the condition.

It is worrying that many people do not consider diabetes to be a serious condition. This point was recently reinforced by Diabetes UK, which commented that 46% of people in Northern Ireland do not realise that diabetes can be fatal. It is also interesting - but disturbing - that 76% of people who are at high risk from diabetes do not know that they are. The issue must be dealt with in a sensible and correct manner, starting with a screening programme.

I look forward to the report of the Northern Ireland Task Force on Diabetes, and I congratulate Diabetes UK and the Clinical Resource Efficiency Support Team (CREST) on the task force's wide-ranging membership. Hopefully this will result in a report full of helpful suggestions that will not be set aside by the Minister of Health, Social Services and Public Safety. Indeed, it should be analysed carefully and any useful policies or measures should be implemented as soon as is practicable.

It is worth noting the link between diabetes and mental health. Four in every 10 people who suffer from diabetes will also suffer from depression or anxiety. Research conducted by Dr David Knopman in the United States argues that there is a link between diabetes and mental illness. He comments that

The National Health Service should work closely on matters of mental health to get to the root of the problem. In Northern Ireland, there is a lack of psychological support for diabetics. As far as I am aware, there is no such support outside Belfast. Mental illness, such as depression, can lead to severe worsening of diabetes.

Diabetes is not being taken seriously enough, as is demonstrated by its rapid rise throughout the UK. With that in mind, I strongly support the motion, and I hope that the Minister will not easily dismiss the House's views.

Ilka sennicht it seems that we'r protestin that ae group or anither in the Halth Service hae its parteiclar wants an misters wrut lairge. A - an, A'm shuir, a whein ither fowk in this Chaumer - can haurdlie credit it that, insteid o the Meinister warin siller whaur it's nott, the'r siller gaein on haivers the lyke o signs. Gif siller wes wared on immident problems an investit in hinnerin disaise, we'd mebbe see the Halth Service back on its pins insteid o gettin slawlie smusht unner the wecht o fowk waitin on tent, traetment an help.

Diabetes haes neir cum an epidemic in this kintra, wi mair nor 40,000 tholin a disaise that taks fowk doun awthegither whyles, causin hert an neir problems alang wi blinndness an bluidflaw problems as can cum aff in the amputation o airms an legs. The exeistence o this wapon-gret percentage o fowk in Norlin Airland is made mair complicate wi fower in 10 o thir fowk tholin gloums an stress. As Paul Street fae Diabetes UK haes alloued, "Diabetes is ower deidlie ti sling a deifie."

It seems that every week the Assembly calls for one group or another in the Health Service to have its wants and needs highlighted. It is incredible that money is spent on signage and trivial things instead of being spent where it is needed. If money were spent on immediate problems and invested in preventing disease, perhaps the National Health Service would recover instead of being slowly squashed under the weight of people who are waiting for care, treatment and help.

Diabetes has become almost epidemic in Northern Ireland. Over 40,000 people suffer from a disease that can be debilitating, can cause heart and kidney problems, blindness and circulation problems that can lead to the amputation of limbs. Four in 10 of these huge numbers also suffer from depression and stress. Paul Street of Diabetes UK has told us that diabetes is too deadly to ignore.

One of the main reasons for the increase in diabetes is obesity. More and more children, as well as adults, are obese because of their sedentary lifestyles. Children and adults alike are more likely to be found in front of the television than walking or playing sport on sunny evenings - when we ever have them. While people sit in front of the television, they seem to be eating more processed fatty foods, which contribute to the growing numbers of overweight people. That means that 20,000 diabetics could be dying from coronary heart disease. Diabetics aged under 20 die mainly from diabetic ketosis. All those deaths are preventable.

It is a startling fact that most people with type 2 diabetes have had the condition for between nine and 12 years before they are diagnosed and have usually acquired some of the most severe symptoms. Therefore, their treatment is more involved and puts an increasing strain not only on them but also on the Health Service that we all subscribe to.

It is estimated that at least 50% of GP surgeries have no policy for screening patients for diabetes. That is incredible, given that at least 4% of the population of Northern Ireland suffer from diabetes. Therefore, many people have lost the opportunity to be diagnosed early and to receive preventative procedures before the disease gets out of control and kills them. Perhaps we can have some response about preventative medicine and actions.

A test for diabetes can be as simple as an eye test. Inevitably, there will be initial costs, but fewer patients would occupy hospital beds because they could control their diabetes through diet, exercise and insulin. That is a clear example of spending money to save money in the long run. Is the Department of Health, Social Services and Public Safety too short-sighted to see what the rest of us see - that an impending diabetes epidemic is about to take hold of the country? Many Members were impressed by the facts that were outlined and the concerns that were expressed in a presentation about diabetes in the Long Gallery.

If something as simple as an eye test could save someone's life, it is surely the duty of the Department of Health, Social Services and Public Safety and, indeed, of Government to initiate such a programme. It is estimated that at least one million people have diabetes but do not know it and may have to wait nine to 12 years before it is detected. Those one million people - roughly the population of Northern Ireland - could be helped if the Government, and especially the Department, took it upon themselves to be forward-thinking, and progressive and if, instead of dealing with the consequences, they deal with the threat before it grips the nation completely.

It was revealed in the press yesterday that the number of diabetes specialists is not adequate to deal with the growing numbers of people being diagnosed. That is another issue that the Department can address. It is also thought that the current failure to obtain enough specialists means that the Health Service will be short of specialists for years to come, which will compound the situation. That is another reason for a preventative rather than a curative programme.

At least three quarters of the people at the greatest risk of developing diabetes have no idea that they fall into that category. All those statistics are frightening to people on the street - however, they are real. Something must be done about the situation now.

The diabetic epidemic costs the National Health Service £165 a second, or £9,900 a minute. Imagine how much has been spent while we have been debating the issue and how much will be spent by the time we are finished. The mind boggles, especially when most of the money need not have been spent had there been adequate screening and education, and enough staff in the Health Service, to deal with the disease. I support the amendment and the motion.

Go raibh maith agat, a LeasCheann Comhairle. I congratulate Mr Shannon on his frequent use of Ulster Scots. It takes me back to my school days when I was taught Robbie Burns. It is good to hear it spoken in the Chamber.

I welcome the opportunity to contribute to this important debate because like asbestosis, which was the subject of an earlier debate, diabetes is a silent disease that creeps up on people and, suddenly they are diagnosed as being diabetic. Increasingly, diabetes is affecting young children. A screening programme may have merits. However, there is much debate about the task force, and, in the context of the amendment, I wonder whether we should wait for its report in the autumn. The task force in England does not intend to report until 2005. It is unlikely that the autumn report will contain evidence better than that of the National Screening Committee (NSC). Perhaps we should wait for clear evidence. We should hear the task force's recommendations before we jump immediately into a screening programme, important as such a programme would undoubtedly be.

Diabetes is present in my family. I know its effects, the tests that children and adults must undergo, and what one must do to ensure that one does not develop it. The effects of diabetes include heart disease, kidney disease, amputation, blindness and premature death. Some 30 years ago, diabetes caused the blindness and death of a first cousin of mine, when treatment was not as good as it is today. Diabetes accounts for 9% of NHS resources, which is £100 million a year.

I agree with the motion and its contention that there is merit in introducing a screening programme. There is, however, also merit in waiting for the task force to tell us how to develop such a programme. How should people in high-risk groups be identified? Is it better to rely on opportunistic screening by healthcare professionals? What type of test should be used and how often should people be tested? What are the benefits and drawbacks of early diagnosis? As yet, there is no definitive evidence that early detection prevents complications.

We should promote prevention. Drinking, smoking and obesity are separate from heredity. Promoting physical activity, good diet and nutrition and reducing obesity are all important.

I support the motion and the amendment. However, there is a contradiction in the amendment. It is saying that we support the immediate introduction of a screening process while we look forward to the publication of the task force's report, which could be significant. We should perhaps give that time to develop. This is a very serious issue and I congratulate Ivan Davis for raising it.

Go raibh maith agat, a LeasCheann Comhairle. Gabhaim buíochas leis an Uasal Davis as an cheist thábhachtach seo a tharraingt anuas. Gabhaim buíochas fosta le bean Courtney agus leis an Dr Hendron as a leasú ar rún an Uasail Davis. Is fíor dóibh agus do chainteoirí eile gur galar an-chontúirteach é diaibéiteas agus gur cúis imní ar leith dúinne anseo é. Caithfidh mé a rá nach bhfuil leisce ar bith orm teacht leo ina mbarúil. Cé nach bhfuil aon fhigiúirí beachta ar fáil, meastar go bhfuil diaibéiteas ar idir a dó agus a trí faoin chéad den daonra: sin idir tríocha cúig mhíle agus caoga míle duine.

Buaileann sé óg agus aosta araon - agus is léanmhar a iarmhairtí ar gach a mbuaileann sé. Tá laghdú suntasach ar ionchas saoil na ndaoine sin a bhfuil diaibéiteas orthu. An té a bhfuil diaibéiteas air, tá sé cúig huaire chomh dóiche bás a fháil le taom croí ná duine gan diaibéiteas agus trí huaire chomh dóiche bás a fháil de bharr stróic. Mar a chuala muid cheana i rith na díospóireachta, is é diaibéiteas an chúis is mó le cliseadh duánach - ós cionn duine as gach seisear a thosaíonn ar chóireáil scagdhealaithe is mar thoradh ar chliseadh duánach é. Is é an dara cúis is mó é le teascadh géige íochtaraí, agus is é is mó is cúis le daille i measc daoine in aois oibre.

Tá an diaibéiteas a fhorbraíonn níos deireannaí i saol an duine fhásta ag éirí níos coitianta anseo agus ar fud an domhain ós rud é go bhfuil daoine ag titim chun feola agus ag tabhairt saol níos lú gníomhach. Is coscrach an scéala é fosta go bhfuil an cineál seo diaibéitis ag goilleadh ar dhéagóirí fiú féin, rud a bhí beagnach gan iomrá roinnt blianta ó shin.

I thank Mr Davis for tabling what is an important motion, and I thank Mrs Courtney and Dr Hendron for tabling the amendment. I agree with the Members who spoke that diabetes is a serious disease. I thank and praise the representatives of the community and voluntary groups that are here today.

Although no exact figures are available, it is estimated that between 2% and 3% of the population has diabetes, which represents between 35,000 and 50,000 people. As several Members said, diabetes can strike old and young alike, with equally devastating affects. Life expectancy for diabetics is considerably reduced, and a person with diabetes is five times more likely to die of a heart attack and three times more likely to die of a stroke. Diabetes is the leading cause of renal failure, and it accounts for more than one in six people starting dialysis treatment. It is the second most common cause of lower limb amputation and is the leading cause of blindness among people of working age.

As a result of increases in levels of obesity and the tendency for people to lead less active lives, diabetes that develops later in adult life is becoming more common both here and throughout the world. It is distressing to learn that that type of diabetes is affecting teenagers - a situation that was almost unheard of a few years ago.

Influencing the eating patterns of children and young people offers us the potential to improve their health immediately and to help prevent the onset of diabetes in later life. Eating habits that are established early in life are often maintained in adulthood, when they can be much more difficult to change. Research indicates that children's food preferences strongly influence meals served in the home, which is why it is important that parents ensure that children eat a healthy diet. As Members have stated, prevention is vital.

Diabetes places a significant financial burden on health and social services. Estimates suggest that approximately £1 from every £7 of the total health budget is spent on caring for people with diabetes. The draft position report that I forwarded to the Committee for Health, Social Services and Public Safety on 17 April states that the costs associated with the treatment of diabetes in the NHS are thought to amount to 9% of total hospital costs. That funding would provide support to diabetes services at the interface between primary and secondary care, and could ensure that the condition be more aggressively treated in the community. As Members stated, the cost of the disease, in financial and personal terms, is considerable. The position report also states that failure to improve the health of our people not only adds to patients' distress but adds to pressure on expensive hospital services. Therefore, the Department has bid for considerable funding to provide services that improve the health of our population.

I should also like to highlight some of the positive aspects of diabetes care. Medical research has transformed our understanding of the disease's development in the first instance and its progression once it has developed. That knowledge is a powerful ally for diabetics and for the professionals charged with their care. As has been said, that research now shows that the most common form of diabetes that occurs in adulthood can be prevented. Lack of physical activity and obesity are the main risk factors. Therefore, integrated action is required to reduce the numbers of people who are physically inactive, overweight and obese. Promotion of a balanced diet and increased physical activity can do that. Members mentioned some of the ongoing and planned activities that several Departments are undertaking.

The principles laid out in 'Investing for Health' are the way forward to tackle many of those problems. As we know, 'Investing for Health' is the strategy that was drawn up by the ministerial group on public health, which I launched on behalf of the Executive. I chair that group, and senior officials from all Departments are members. The strategy's title was chosen because we recognise that by investing even modest amounts of money, time and resources we can make great savings and bring great benefits for the future.

Health professionals and patients are now armed with the knowledge that rigorous control of diabetes can also substantially reduce the onset of complications that it causes. It is heartening to hear of the dedicated work of teams of professionals involved in primary care, community health services or hospitals. They conscientiously monitor their patients for diabetic complications and liaise effectively with each other to ensure that access to appropriate treatment is available as and when required.

A vital example of that work includes initiatives to detect harmful changes in the eyes of those already diagnosed with diabetes. If treated early, blindness can be prevented. Support for the patient, especially empowerment through education, is increasingly seen as an important part of the health professional's role. With heightened public awareness about diabetes, the rates of diagnosis of the disease are rising. I am glad that public awareness has increased; that is important.

Responsibility for managing the care of patients with diabetes falls largely to GPs and other primary care professionals. Against that background, the management of diabetes care is an area on which many of the new local health and social care groups may choose to focus. One of the primary care commissioning pilots - the forerunners of the local health and social care groups that are being set up - identified the provision of an enhanced local service to people with diabetes as one of its targets. That recognised that many of the more serious problems caused by diabetes, such as heart disease, strokes, kidney failure and blindness could be prevented or delayed by good diabetes care, especially in the early stages of the disease. A task group made up of representatives of GPs, community dieticians, podiatrists, specialist nurses and others involved in the care of patients with diabetes was, as has been heard, formed to design a service for patients based on best practice. As a result, guidelines were drawn up on the care of patients with diabetes. Patients, GPs and other local professionals are following those guidelines. The primary care commissioning pilot was able to do some of that work. The establishment of local health and social care groups will offer similar opportunities for primary care professionals to work together in seeking to improve diabetes care for their patients.

There has been much debate among professionals and the public who are interested in diabetes as to whether there should be a screening programme for the disease. Most people's instincts lead them to think that that could only be a good idea. After all, it is a common condition with serious complications, especially if left unchecked. However, screening is a complex issue and demands close scrutiny of all the available scientific evidence. There is no recommendation in the English national service framework for diabetes to screen the general population for diabetes.

The framework recommends that awareness of symptoms be increased among professionals and the public. It also suggests that, following further research, a screening programme for high-risk groups may be introduced.

The UK National Screening Committee, chaired by the Chief Medical Officer, Dr Henrietta Campbell, is responsible for providing advice on all aspects of screening policy, including the matter of whether programmes should be started, stopped or amended. The committee provides advice to the Department of Health, Social Services and Public Safety, the Department of Health in England and analogous Departments in Scotland and Wales. The committee assesses proposed screening programmes against internationally recognised criteria, studying details relating to the condition in question, the test, treatment options, their effectiveness and the acceptability of the screening programme to its intended recipients. Assessing programmes in this way is intended to ensure that they do more good than harm at a reasonable cost.

The committee considered a universal screening programme for diabetes against the criteria, and concluded that screening the whole population for diabetes would be an impractical and inefficient use of resources.

That brings me to this motion, which calls for a screening programme targeted at adults and high-risk groups. For several reasons, diabetes may be present for several years before it is recognised. Some people may have no symptoms, while others may ascribe symptoms such as tiredness and lethargy to the rigours of everyday life. Health professionals can also misinterpret the symptoms of diabetes when people initially present to them, so half of those diagnosed with diabetes may have developed a complication by the time it is detected. In some cases, that can have very serious consequences, such as permanent damage to eyes or kidneys. Therefore, it is vital that people with diabetes are diagnosed as early as possible. Greater awareness of the symptoms of the onset of diabetes among health professionals and the public is also essential so that it can be diagnosed as early as possible.

Some people are known to be at an increased risk of developing diabetes. This is particularly the case with people who are overweight, have a family history of diabetes, or come from certain ethnic minority groups where diabetes is more common. Other people in this category include people who have had abnormal blood sugar tests in the past and women who have temporarily developed diabetes during pregnancy. These people must receive regular check ups so that, should diabetes develop, it can be detected quickly.

TOP

<< Prev / Next >>