The Government are absolutely committed to preventing more amputations, but we believe very strongly that money should go towards multidisciplinary teams. These have been seen to be a huge success in various initiatives taken by the likes of King’s College Hospital in Sheffield, where multidisciplinary teams were put together. It has been shown that, in Sheffield for instance, there was a 45% reduction in the number of amputees over three years, along with significant financial savings and a 90% patient satisfaction rating. This is the way to go.

My Lords, the NHS Operational Planning and Contracting Guidance 2017-2019 announced NHS England’s intention to

launch a £40 million programme of investment to support the CCGs to improve the treatment and care of people with diabetes. This includes improving access to multidisciplinary foot care teams for people with diabetic foot disease.

My Lords, it is for healthcare professionals to identify, in consultation with their patients, what support is needed to manage diabetes effectively. This includes people with diabetes accessing programmes to help manage their weight, eat healthily and be more active.

My Lords, it is still our intention to announce the obesity strategy soon. Clearly, there have been other events, which may create some delay, but we will announce the strategy as soon as possible. When we do, I am sure that there will be clear recommendations on diet that will include not just sugar but saturated fats and salt. Finally, as the noble Lord knows, I am arranging for him and the noble and learned Lord, Lord Morris, to meet people from the research community to discuss the outlook for research into diabetes, and I am sure that it will include any impact that Brexit might have.

My Lords, we want to ensure that the best possible care is provided for all those with diabetes, reducing the risks of complications and minimising the financial pressure on the NHS. Preventing type 2 diabetes—for example, through the Healthier You: NHS Diabetes Prevention Programme—and improving outcomes for all those with the condition, including through tackling variation in management and care and increasing take-up of patient education, are key priorities for this Government.

My Lords, diabetes is a key priority of the Government and part of the mandate that was given to NHS England for this year. The noble Lord is right—the direct cost to the NHS of treating diabetes is actually about £5 billion every year. Variation is the critical aspect that we should focus on. Whether it is foot care or the incidence and treatment of diabetes, across the country there is a

huge degree of variation. The work being done with Diabetes UK on a national audit for diabetes will play a big part in reducing that variation.

The Health and Social Care Information Centre provides information on the number of nursing, midwifery and health visiting staff employed in the National Health Service in England but it does not separately identify diabetes specialist nurses.

It is for local NHS organisations with their knowledge of the healthcare needs of their local population to invest in training for specialist skills and to deploy specialist nurses.

NHS England and Monitor are working closely together to ensure that the payment system supports service developments in the vanguard sites (including those where integrated diabetes care is a focus) as well as monitoring local innovative approaches to supporting integrated care taken by some clinical commissioning groups (CCGs). This is to ensure that the payment system keeps abreast with the development of future service models and is not a barrier to the development of new models of care.

During 2016/17, NHS England will look at the current incentives and funding arrangements for diabetes to see how greater alignment could be achieved between the financial incentives for primary and secondary care.

Information on how much money the National Health Service invested in structured education for diabetes patients is not collected centrally.

Under the Health and Social Care Act (2012), NHS England has a statutory duty to conduct an annual assessment of every CCG. Since April 2013, CCGs have been assessed twice, for the period 2013/14 and for 2014/15.

For 2016/17, NHS England will introduce a new CCG Improvement and Assessment Framework (CCG IAF). This new framework will align with NHS England’s mandate and planning process, with the aim of driving improvements in a number of key areas including the management and care of people with diabetes.

NHS England has been working with Diabetes UK on including diabetes indicators in the CCG IAF. The proposed diabetes indicators are:

- the percentage of diabetes patients that have achieved all three of the National Institute for Heath and Care Excellence recommended treatment targets; and

- newly diagnosed diabetes patients referred to, or attending, a structured education course.

Under the proposals, diabetes will also be one of the six clinical priority areas in the CCG IAF that will be overseen by an independent group.

The CCG IAF proposals are subject to the outcome of an engagement process which closed for comments on February 26 2016. More information can be found at:

https://www.england.nhs.uk/commissioning/ccg-improvmnt/

NHS England and Monitor are working closely together to ensure that the payment system supports service developments in the vanguard sites (including those where integrated diabetes care is a focus) as well as monitoring local innovative approaches to supporting integrated care taken by some clinical commissioning groups (CCGs). This is to ensure that the payment system keeps abreast with the development of future service models and is not a barrier to the development of new models of care.

During 2016/17, NHS England will look at the current incentives and funding arrangements for diabetes to see how greater alignment could be achieved between the financial incentives for primary and secondary care.

Information on how much money the National Health Service invested in structured education for diabetes patients is not collected centrally.

Under the Health and Social Care Act (2012), NHS England has a statutory duty to conduct an annual assessment of every CCG. Since April 2013, CCGs have been assessed twice, for the period 2013/14 and for 2014/15.

For 2016/17, NHS England will introduce a new CCG Improvement and Assessment Framework (CCG IAF). This new framework will align with NHS England’s mandate and planning process, with the aim of driving improvements in a number of key areas including the management and care of people with diabetes.

NHS England has been working with Diabetes UK on including diabetes indicators in the CCG IAF. The proposed diabetes indicators are:

- the percentage of diabetes patients that have achieved all three of the National Institute for Heath and Care Excellence recommended treatment targets; and

- newly diagnosed diabetes patients referred to, or attending, a structured education course.

Under the proposals, diabetes will also be one of the six clinical priority areas in the CCG IAF that will be overseen by an independent group.

The CCG IAF proposals are subject to the outcome of an engagement process which closed for comments on February 26 2016. More information can be found at:

https://www.england.nhs.uk/commissioning/ccg-improvmnt/

NHS England and Monitor are working closely together to ensure that the payment system supports service developments in the vanguard sites (including those where integrated diabetes care is a focus) as well as monitoring local innovative approaches to supporting integrated care taken by some clinical commissioning groups (CCGs). This is to ensure that the payment system keeps abreast with the development of future service models and is not a barrier to the development of new models of care.

During 2016/17, NHS England will look at the current incentives and funding arrangements for diabetes to see how greater alignment could be achieved between the financial incentives for primary and secondary care.

Information on how much money the National Health Service invested in structured education for diabetes patients is not collected centrally.

Under the Health and Social Care Act (2012), NHS England has a statutory duty to conduct an annual assessment of every CCG. Since April 2013, CCGs have been assessed twice, for the period 2013/14 and for 2014/15.

For 2016/17, NHS England will introduce a new CCG Improvement and Assessment Framework (CCG IAF). This new framework will align with NHS England’s mandate and planning process, with the aim of driving improvements in a number of key areas including the management and care of people with diabetes.

NHS England has been working with Diabetes UK on including diabetes indicators in the CCG IAF. The proposed diabetes indicators are:

- the percentage of diabetes patients that have achieved all three of the National Institute for Heath and Care Excellence recommended treatment targets; and

- newly diagnosed diabetes patients referred to, or attending, a structured education course.

Under the proposals, diabetes will also be one of the six clinical priority areas in the CCG IAF that will be overseen by an independent group.

The CCG IAF proposals are subject to the outcome of an engagement process which closed for comments on February 26 2016. More information can be found at:

https://www.england.nhs.uk/commissioning/ccg-improvmnt/

Podiatry services are commissioned locally by clinical commissioning groups working with local partners and based on the need of the local population, resources available and evidence based practice. Treatment decisions should always be made by doctors based on a patient’s individual clinical needs.

Preventing diabetes and promoting the best possible care for people with diabetes is a key priority for this Government and is part of the 2016/17 Mandate to NHS England. Building on the NHS Diabetes Prevention Programme, the Department of Health and NHS England are exploring options for ensuring a sustained focus on improving the management and care of people with diabetes.

The new National Diabetes Foot Care Audit, a module of the National Diabetes Audit, aims to establish the extent to which national guidelines on the management of diabetic foot disease are being met. The audit will provide local teams with the evidence needed to tackle any identified differences in practice which will lead to an overall improvement in management and outcomes for patients. Local and national level results will be available in March 2016. However, we do know that there has been an increase in the proportion of Trusts with multidisciplinary diabetic foot care teams, from around 60% in 2011 to over 70% in 2013.

Podiatry services are commissioned locally by clinical commissioning groups working with local partners and based on the need of the local population, resources available and evidence based practice. These commissioning decisions are informed by the Joint Strategic Needs Assessment and the local Health and Wellbeing Strategy. Clinical networks provide opportunity to adopt and disseminate best practice.

The National Institute for Health and Care Excellence Quality Standard for diabetes, attached, sets out that people with diabetes should receive a structured educational programme. NHS England is statutorily required to have regard to this.

There are a number of national and locally developed patient education programmes available including Dose Adjustment For Normal Eating (DAFNE) for Type 1 diabetes, and Diabetes Education and Self-management for Ongoing and Newly Diagnosed (DESMOND) for Type 2 diabetes.

While there is still much room for improvement, the proportion of people with diabetes being offered structured education is improving. 16% of people newly diagnosed with diabetes were offered structured education in 2012/13 compared to 8.4% of those diagnosed in 2009. In the same period the number of people newly diagnosed with diabetes offered or attending structured education rose from 11% to 18.4%.

No estimate has been made of the cost over a five-year period of providing group based education courses for all people living with diabetes.

The Department is developing plans to improve outcomes for those with diabetes. This will be announced in due course.

The National Institute for Health and Care Excellence Quality Standard for diabetes, attached, sets out that people with diabetes should receive a structured educational programme. NHS England is statutorily required to have regard to this.

There are a number of national and locally developed patient education programmes available including Dose Adjustment For Normal Eating (DAFNE) for Type 1 diabetes, and Diabetes Education and Self-management for Ongoing and Newly Diagnosed (DESMOND) for Type 2 diabetes.

While there is still much room for improvement, the proportion of people with diabetes being offered structured education is improving. 16% of people newly diagnosed with diabetes were offered structured education in 2012/13 compared to 8.4% of those diagnosed in 2009. In the same period the number of people newly diagnosed with diabetes offered or attending structured education rose from 11% to 18.4%.

No estimate has been made of the cost over a five-year period of providing group based education courses for all people living with diabetes.

The Department is developing plans to improve outcomes for those with diabetes. This will be announced in due course.

NHS England and clinical commissioning groups have responsibility for determining the overall approach to improving clinical outcomes from healthcare services for people with diabetes. Nevertheless, there are various actions at a national level which will help to ensure that all patients with diabetes receive good quality care, including foot care, to help improve outcomes and minimise amputation rates.

The new National Diabetes Foot Care Audit, a module of the National Diabetes Audit, aims to establish the extent to which national guidelines on the management of diabetic foot disease are being met. The audit will provide local teams with the evidence needed to tackle any identified differences in practice which will lead to an overall improvement in management and outcomes for patients. Local and national level results will be available in March 2016. However, we do know that there has been an increase in the proportion of trusts with multidisciplinary diabetic footcare teams, from around 60% in 2011 to over 70% in 2013.

As part of its focus on the Cardiovascular Disease Outcomes Strategy, NHS Improving Quality is working with the National Clinical Director for Diabetes to identify potential areas of service improvement such as diabetic foot disease. A number of Cardiovascular Strategic Clinical Networks are focussing on this to ensure that appropriate clinical pathways are in place which will deliver improved clinical outcomes for people with diabetes, including minimising amputation rates.

Within NHS England, the National Clinical Director for Rehabilitation and Recovering in the Community and the Chief Allied Health Professions Officer are leading work to improve rehabilitation services, including collection and dissemination of good practice. This will help to improve outcomes, such as improving/maintaining foot health, by putting the patient at the centre of their care, and a focus on their goals.

In January 2014, NHS England published the Action for Diabetes plan, which sets out how it intends to improve outcomes for people with, and at risk of, diabetes in England. The report acknowledges that type 2 diabetes is estimated to have cost the United Kingdom £8.8 billion in direct costs in 2010-2011 and that these costs are set to rise.

The action that NHS England is taking and will take to drive the prevention of Type 2 diabetes and earlier diagnosis of all diabetes and support better management of diabetes in primary care includes:

- Developing general practitioner contracts and incentives;

- working with primary care services to trial and roll out case-finding and decision-support tools in primary care to support earlier diagnosis; and

working with Public Health England to roll out the NHS Health Check programme.

My Lords, we have set clear objectives for the NHS and Public Health England to improve the care and quality of life for people with diabetes. The public health outcomes framework includes an indicator on preventable sight loss, which will track three of the commonest causes of preventable sight loss, including diabetic retinopathy, to drive improvements in quality.

I would be happy to meet the noble Lord. I am aware that the whole area of the cataract threshold and, perhaps more importantly, the interpretation of that threshold, is one that NHS England is now actively looking at to ensure greater consistency around the country.

I do not agree with the noble Lord’s interpretation of the screening figures. The UK countries, I believe, lead the world in the area of diabetes eye screening. This is the first time that a population-based screening programme has been introduced on such a large scale. The latest figures show that up to March 2013, 99% of people with diabetes who were eligible for screening were offered it in the previous 12 months.