Asked by
To ask Her Majesty’s Government what was the business case for
not recording the percentage of patients who joined the Diabetic
Prevention Programme between 2018 and 2019 but failed to complete
the course; and whether this information is now recorded.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
Data on completion rates is collected for specific reference
periods. Rather than looking just at a yearly comparison,
completion is analysed to understand the impact of changes to the
programme, such as providing a digital option for consumers. Data
collected at specific reference points, such as from January 2017
to March 2019, shows a completion rate of 53%.
(Lab)
My Lords, I am grateful to the Minister for that. He may not know
it, but I have been on the diabetes prevention courses, as I am
on the cusp of diabetes. I was amazed by the rate of drop-out on
the course that I was on. It ran for nine months. I wondered
about the cost and so asked a Written Question on the details,
which the Minister has now given me. With a nearly 50% drop-out
rate, surely there is something wrong with the course. I want to
see more courses but they should be run properly. Can we get the
NAO to look at this to see if we can have some improvements and
get better returns?
(Con)
I thank the noble Lord for the question and pay tribute to him
for his work in this area over many years. He is absolutely
right. One of the challenges of this programme is that it is a
nine-month course. Clearly, like many things, it was impacted by
Covid, with a lack of in-person consultations and appointments.
However, the silver lining to the cloud was the digital service.
The course was able to move some patients on to digital services
and to self-referring. One impact of that has been more people
signing up to this programme.
(Con)
My Lords, is it possible that it is not the course that is at
fault but the people who go on it? Has the department not
considered charging people a refundable attendance fee to ensure
that they roll up?
(Con)
I thank the noble Lord for his question but what is more
important is that we get people who have diabetes on to the
programme in the first place. As we adjust the programme to take
account of the pandemic, for example, and digital offers, we are
also looking at different ways to work with different
communities. For example, I was talking to a young girl of
Bengali origin in my department the other day. I said, “What do
we do about getting to the heart of the communities, given that
we are in Westminster and Whitehall?” She said that one of the
problems in her community is that, “We love ghee—we love
clarified butter, in our curries and our rotis.” We are looking
at alternative recipes and menus so that people can still have
the same food but it can be healthier.
The Lord Speaker ()
The noble Baroness, Lady Brinton, is contributing remotely.
(LD) [V]
My Lords, the observational study by academics of the 2018-19
wave of the NHS diabetes prevention programme, published by BMC
Health Services Research, observed disengagement within sessions
when patients reported that information was difficult to
understand, and when there were very large group sizes and
problems with session scheduling. This is all before Covid.
Problems with the course will inevitably make patients more
likely to drop out but 50% is shocking. Now that this diabetes
prevention programme has been rolled out across England, have
these specific problems been addressed?
(Con)
The noble Baroness makes an important point about what we have to
learn from these programmes. In many of these programmes we are
in a process of discovery. You try things—some will work and some
will not. Those which do not work, we want to learn the lessons
from. Clearly, the length of the programme, nine months, has put
some people off and led to the dropout rate. We are looking at
shorter programmes, digital access and self-assessment, and at
community-led initiatives rather than top-down government
initiatives. To give another example, I met someone at a meeting
yesterday who told me that his mosque in Accrington was running
healthier-diet programmes for worshippers. We need to see a lot
more of those programmes as well.
(Lab)
My Lords, the national paediatric diabetes audit shows that the
impact of type 2 diabetes and the cost-of-living crisis is
disproportionately felt by children living in the most deprived
areas. What preventive measures specifically geared towards
children are in place so that they may avoid type 2 diabetes?
What are the Government doing for the almost 4 million children,
and their households, who are struggling to access and afford
enough fruit, vegetables and other healthy foods to meet official
and basic nutrition guidelines?
(Con)
One of the NHS programmes that will be repeated by integrated
care boards when we have them is the eight annual diabetes checks
for people of all ages. Certain factors—HbA1c, which is your
average blood glucose level, or your glycated haemoglobin; blood
pressure; cholesterol; serum creatinine; urine albumin; foot
surveillance; BMI; and smoking—are checked for patients of all
ages to identify early onset of diabetes.
(Lab)
My Lords, further to my noble friend Lord Brooke’s Question about
the drop-out rate and his suggestion of an independent review,
what mechanism is there for assessing courses that clearly are
not as successful as they might be if there is such a high
drop-out rate?
(Con)
The point is about what we learn. For example, some noble Lords
will have seen stories about the impact of minimum alcohol
pricing in Scotland. Clearly, it did not turn out as intended
because the review found that people from poor communities were
spending more on alcohol, rather than the alcoholism rate being
affected. In this case, we have learned that the nine-month
programme and some of the other processes behind it clearly lead
to a drop-out rate. We are looking at other programmes. One of
the great stories we have seen is the use of digital and other
forms of access. If we can roll that out as well with community
programmes, it might be a better way of doing things.
(Lab)
My Lords, following my noble friend Lady Merron’s question
regarding children, could the Minister say a little more about
schools and what work the Government are doing to raise these
issues there? We all know that the earlier we can prevent onset
the better. Schools are a great place for this to be done.
(Con)
The noble Lord makes an important point. When I speak to experts,
policy officials and people working on diabetes, one of the
things they say is that the Government cannot reduce obesity
alone; efforts also have to include businesses, health
professionals, schools, local authorities, families, individuals,
community groups and civil society. We all have to come together
collectively. There clearly are programmes in schools to
encourage people to eat more healthily, but I am sure the noble
Lord would recognise that, when we were children, we had
programmes about not smoking, sex education and people not
drinking alcohol. We would come out of them and say, “I’m never
going to drink alcohol or smoke cigarettes again.” Two years
later, we were all at parties and what were we doing? We have to
make sure that it is impactful all the way through life, not just
at that time.
(Con)
My Lords, does the Minister agree with the recently published
scientific evidence that fasting is actually good for you and
that missing an occasional meal would be a good thing, especially
for preventing diabetes?
(Con)
As my noble friend will be aware, there are always debates in
scientific circles on this. There are different types of fasting
regime as well. For example, during Ramadan lots of mosques
expounded it as a great example of something that is not only
spiritual but good for your physical health. It does depend.
Other studies show that it depends on who is doing it and their
other circumstances.
(LD)
My Lords, could the Minister say what is being done regarding the
latest statistics, which showed that just 34% of people in the
north of England who have diabetes have access to the eight
health checks that they should have?
(Con)
The noble Lord makes an important point. The Office for Health
Improvement and Disparities is looking at a number of these areas
and where the health service or the ICS locally has to target
more resources. Clearly, one of the big concerns is disparities.
The noble Lord has given the example of the north-east; as he
rightly said, there will be parts of the country where those
checks are not happening. It is vital that we tackle those
disparities.
(Lab)
I am sorry to be so persistent, but we are spending millions on
these programmes. Since some work is being done to try to improve
them, could the Minister give the House a report in six months’
time to tell us what progress is being made and give us some
targets that are being delivered?
(Con)
I am not entirely sure that I can give the noble Lord what he
asks for, but I suggest that he asks me a Question about progress
in six months’ time. Given that the noble Lord asked this
Question, I will go back to the department and see what answers
we can give.
(Lab)
My Lords, is there any link between patients with diabetes and
other ailments and the drop-out rate? Can the Minister give any
evidence for that?
(Con)
I apologise, I did not hear what the link was: between diabetes
and what, sorry?
(Lab)
Patients with other ailments or conditions and the drop-out rate.
(Con)
I am not entirely sure of the answer to that. I will check and
write to the noble Lord.
