195. Diabetes Review by Public Accounts Committee. Call for Action

The UK House of Commons Public Accounts Committee (PAC) is currently reviewing the effectiveness of the treatment of diabetes by the Department of Health (DoH) and the NHS. My previous blog has explained the background (1). I have now had a chance to look at the transcript of the session when officials from the DoH/NHS presented evidence to the Committee. It is very obvious that there is general acceptance of the current strategy. It is clearly recognised that the number of people affected is increasing but the emphasis of the proceedings was on how to improve the effectiveness of the existing programmes. This is probably because as shown below the PAC’s remit is to consider how public money is spent, while government policy would be examined by the Health Committee.

Nevertheless there are several members who clearly wish to know why things are getting worse and why there is so little progress. However it was also evident that they were completely unaware of why the current strategy is going nowhere and is really part of the problem not part of the solution. They seemed to have no idea that there are numerous initiatives all over the world which demonstrate conclusively that Type 2 Diabetes (T2D) can be overcome by a diet which is low in carbohydrates and high in fat (LCHF).

Furthermore it could well be argued that this approach is not inconsistent with current policy as there are some individuals who are using the LCHF strategy within the NHS. One of the most notable is Dr David Unwin in Southport (2).

The purpose of this blog is to encourage anyone who wishes to see genuine progress with T2D and other diseases by  adopting an LCHF diet to make contact with the committee secretariat, chair and individuals. I believe it is important they are properly informed of the enormous benefits of an LCHF diet and of the growing pressure for a fundamental change in mainstream attitudes towards the dietary guidelines (which would require a change in policy) and in the treatment of T2D.

My previous blog summarises the main points but as far as the PAC is concerned it should be worth highlighting the financial aspects. Interestingly there are some relevant points made in the submission from Novo Nordisk (3). These include:

• Since the previous PAC report on the management of diabetes in 2012 an additional 900,000 people in England have been diagnosed with diabetes which makes a total of 3.2 million people with diabetes in England. It is estimated that an additional 9.6 million people in England are at high risk of getting T2D.
• The NHS faces a predicted funding shortfall of £30 billion by 2020/21. Presently diabetes costs the NHS nearly £10 billion a year in direct costs. Which is about 10% of the NHS budget. In addition, the annual social care costs associated with supporting people with diabetes are estimated to be a further £1.4 billion. This figure is expected to rise to £2.5 billion by 2030.^.
• The costs to the economy, due to people with diabetes not working because of poor health, having a lower level of productivity or as a result of death, are estimated at nearly £9 billion per annum. It follows that these costs will continue to increase in line with the number diagnosed which is estimated at 5% every year.
• The National Diabetes Inpatient Audit states that about 1 in 6 hospital beds in England are occupied by a person with diabetes. The estimated cost of avoidable admissions in diabetes is £686 million per year.
• Patients admitted to hospital with diabetes also stay on average 1.1 days longer than a person admitted for a similar compliant without the condition, leading to bed blocking and capacity issues for the NHS.

These are all points well worth re-iterating.

Finally, the PAC should consider inviting Dr David Unwin to present a paper which describes his success in treating T2D with the LCHF. Many of his patients have improved their health very significantly as a result. Because this has enabled them to reduce their dependency on drugs, the practice has saved at least 20,000 for each of the past 3 years. Presumably he is operating within the framework of current policy especially as Dr David Haslam, Chair of NICE has said that NICE guidance is not meant to be prescriptive and should not replace a doctor’s clinical judgment (5).

Call for action

If you wish to see progress, please feel free to use any of the information here or in any other blogs, especially the previous one (1). No doubt many of you have lots of your own ideas and stories that will be appropriate.

All the relevant contacts are shown below. Click on the names to obtain emails and other details. Although I do not know of any plans by the Health Committee to tackle T2D, I suggest a direct approach to PAC members but copy to Health Committee members.

Public Accounts Committee

The PAC is appointed by the House of Commons to examine:

“the accounts showing the appropriation of the sums granted to Parliament to meet the public expenditure, and of such other accounts laid before Parliament as the Committee may think fit”

The Committee looks at how rather than why public money has been spent and does not examine the merits of Government policy. That role is performed by the relevant Departmental Select Committee.

Committee contact details:

Committee of Public Accounts House of Commons London SW1P 3JA

Telephone: 020 7219 4099 Fax: 020 7219 2782

Email: pubaccom@parliament.uk

Health Committee

The Health Committee is appointed by the House of Commons to examine the policy, administration and expenditure of the Department of Health and its associated bodies

Committee contact details:

Health Committee House of Commons London SW1A 0AA

Telephone: 020 7219 6182

Email:healthcom@parliament.uk

REFERENCES

1. https://vernerwheelock.com/?p=897
2. https://vernerwheelock.com/?p=842
3. http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/public-accounts-committee/diabetes-followup/written/24521.html
4. http://www.diabesityinpractice.co.uk/media/content/_master/4311/files/pdf/dip4-3-102-8.pdf
5. http://www.gponline.com/gps-patients-choose-when-ignore-nice-advice-says-haslam/article/1368070