Agenda item

The Chairman invited the following officers and representatives to the table:

·         Mr Neil Snee, Director of Commissioning, Barnet CCG

·         Dr Jeff Lake, Public Health Consultant, Barnet and Harrow Public Health Team

·         Ms Nima Patel, Barnet Diabetes UK

·         Ms Lesley Izenberg, Chair of Barnet Diabetes UK

·         Councillor Hugh Rayner

The Chairman introduced the report.

Mr Snee addressed the Committee and gave an overview of the report. He noted that significant attention had been given to the awareness of diabetes in society. He informed the Committee that, two years ago, the update of the GP National Diabetes Audit in Barnet had been poor with only six GP Practices participating. The 2015/2016 Audit saw 90%, i.e. 56 Barnet Practices participating and he hoped this would reach 100% for the 2016/2017 Audit.

Mr Snee said a number of pieces of work were currently in progress which aim to address the challenges of improving diabetic management for patients. Mr Snee explained that investments had been made to establish multi-disciplinary teams to treat diabetes which he felt was a significant step forward.

Mr Snee informed the Committee that the National Diabetes Prevention Programme was being implemented locally in collaboration with Enfield Council, Public Health England and Diabetes UK and this is due to commence in May 2017. The programme will involve nine months of intensive dietary and physical intervention strategies for individuals who are currently pre-diabetic with a high risk of developing the disease. Mr Snee told the Committee a campaign is currently being planned to raise awareness of the disease and a report on the new prevention programme will be included in a paper submitted to the next meeting of the Health and Wellbeing Board on 9^th March 2017.

Ms Isenberg explained the role of Barnet Diabetes UK as one of 150 volunteer groups forming Diabetes UK Central. She said the group hold five talks a year at the local hub from health professionals and support groups on diabetes prevention and care. Ms Isenberg also said that when the group first started in the 1990’s, there was not much education available on diabetes and so the aim of the organisation had been to improve education and awareness of the lifelong disease.

Ms Isenberg informed the Committee that an internet programme called ‘Help Diabetes’ is available from GP practices where patients are provided with a user name to log onto the site and can access learning modules on diabetes. However Ms Isenberg said the programme is only currently available in English and tailored for Type 2 Diabetes and 10% of individuals diagnosed with diabetes in the UK have Type 1. Ms Isenberg said Type 2 diabetes patients do tend to have a more structured care plan.

Councillor Rayner told the Committee about his experience of being diagnosed with Diabetes. He said he had learnt of the dangers of the disease and the future complications on health it can have and the expensive implications for the NHS. Councillor Rayner explained he was currently able to manage his diabetes by a controlled diet and living a healthier lifestyle. He mentioned that before his diagnosis, he had limited knowledge and understanding about the seriousness of the disease and so he thought it was essential that people should be made aware of diabetes and how to take care of their diet to avoid developing the disease.

Ms Patel explained that their work aimed to emphasis to individuals the importance of physical activity and that talks on the topic were due to be held in the near future. She explained that Diabetes UK hold events such as ‘Walk in the Park’ to help promote physical activity in communities and that all the money raised from these events is sent to Diabetes UK to fund their research.

The Chairman informed the Committee that she had watched a Panorama programme on diabetes which claimed that around 10% of the health care budget is currently spent on diabetes treatment. Due to the increasing number of people being diagnosed with the disease, the Chairman emphasised the huge financial implications for the NHS. The Chairman stressed that emphasis on prevention of the disease is crucial.

Councillor Caroline Stock updated the Committee on the Mayor of Barnet’s Golden Kilometre which targets children of primary school age to take part in becoming more active. She explained that the rates of obesity in children were high and that a lack of exercise was a significant contributing factor. She asked the Committee to put forward any other suggestions they may have on ways to encourage children to exercise more.

Ms Isenberg said that Diabetes UK conduct road shows about diabetes to increase awareness of the disease to the public. She said she would be delighted to take part and help out with any initiatives or projects to further increase awareness of the disease within the Borough. Ms Isenberg stressed the need to prevent the development of diabetes in children, as research suggests complications associated with diabetes are accelerated in children compared to those diagnosed later in life.

Councillor Philip Cohen queried whether the CCG expenditure on diabetes care was too heavily weighted on prescriptions for GPs. Mr Snee explained that the CCG monitor all prescribing costs and were reducing the current spend on medication in order to spend more on prevention strategies. However, Mr Snee said that some patients choose higher costing medication. Ms Isenberg said the cost of medication for those suffering with diabetes was unavoidable as only 5% of patients can control the disease by diet alone. She said a strict diet at the beginning of diagnosis could have beneficial effects but is not effective enough in those who have been diagnosed for longer. Ms Isenberg explained that the disease is a progressive one and that cheaper medication alternatives can often have unwanted side effects, such as weight, gain which exacerbates the problem. Newer more expensive medications are more effective and have fewer side effects. Ms Isenberg said it is a case of trying to balance the short term costs with the potential longer term costs.

Dr Lake informed the Committee that prevention programmes run by Public Health have focused on obesity for a number of years. He explained that obese children have a lower life expectancy and are at a higher risk of developing diabetes. Dr Lake informed the Committee that obese children and adults are put onto a weight management pathway plan. Dr Lake also noted that targeted work is being conducted on those at risk of developing diabetes. Pre-diabetic risk individuals, with blood sugar indexes of between 42-47, are put on a 12 month review process and this will gradually become standard practice. He emphasised the importance of structured intervention.

Councillor Williams asked whether sweeteners (an alternative to sugar) were just as unhealthy for diabetics as consuming sugar. Dr Lake said that sweeteners offer a lower calorific content and that he would follow up as to whether they are as harmful as the consumption of sugar. Ms Isenberg said the danger with lower calorie options is that people often believe they can then consume more leading to bad habits.

Councillor Moore asked whether there was a socio-economic aspect to the increase of diabetes, as foods high in sugar and salt are often cheaper to purchase and may seem more affordable than healthier options. Councillor Rozenberg suggested it may be distrust in science as health professionals have moved from the message that fat is bad for the body to sugar being bad. Dr Lake said that research showed awareness of the sugar content within foods was poor and that flagging this on food packaging has led to improvements.

RESOLVED – The Committee noted the report.