Plenary, 28 Jun 2007

Meeting date: Thursday, June 28, 2007

Official Report 682KB pdf

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Diabetes

Despite the holiday atmosphere, members should clear the chamber unless they are participating in the next item of business.

The final item is a members' business debate on motion S3M-147, in the name of David Stewart, on national diabetes week. The debate will be concluded without any question being put.

Motion debated,

That the Parliament welcomes the Small Change, Big Difference campaign being run by Diabetes UK Scotland for National Diabetes Week 2007; commends the tremendous support that Diabetes UK Scotland gives to the estimated 173,000 people in Scotland who are living with diabetes; notes that, in the Highlands alone, the number of people living with diabetes stands at 11,111 and this figure is predicted to rise to at least 13,000 by 2017, and therefore considers that the Scottish Diabetes Framework Action Plan should be delivered by 2009, as set out in the Diabetes UK Scotland Manifesto 2007.

I welcome the opportunity to debate diabetes, which is appropriate given that it was recently national diabetes week, to which the motion refers. I thank the 37 members who have given their support to the motion.

Some may argue that the last members' business debate before the summer recess is the graveyard shift. I welcome the hardy members who have delayed their escape to the sun to contribute to this evening's debate, although there is perhaps a question about how much the sun is shining this evening.

I warmly welcome the visitors in the public gallery this evening, particularly the representatives of Diabetes UK Scotland.

My proposition tonight is straightforward. At a naive level, it is about prevention being better than cure. The question this evening for me is: how do we detect and treat the 60,000 undiagnosed diabetics in Scotland? I will argue that high-risk screening, particularly for type 2 diabetes, through a threefold focus on those who are overweight, on those who have a family history of diabetes and on those who are over 45, would be the most successful tactic.

My interest in the subject is twofold. First, about 10 years ago, when I was first elected to another place, I had a tour round Raigmore hospital in Inverness and met a diabetic nurse in the clinic in the unit there. She convinced me to take an interest in diabetes, which has continued to this day.

The second reason for my interest is that one of my close family relatives, who tragically is no longer with us, had diabetes for more than 70 years. He taught me that it is possible to lead a normal life with well-controlled and well-maintained pen-needle injections.

I was for eight years the secretary of the all-party group on diabetes at Westminster. At a reception that I chaired a few years ago, I met Gary Mabbutt, who football fans in the chamber might know was once the captain of Tottenham Hotspur. I mention his name in the debate because he was diabetic and was an international player for England. He told me before the reception that he had been all ready to go to Mexico with England for the World Cup, when he suddenly had a phone call from the England team doctor, who told him that he was not going to Mexico because he was diabetic. Of course, that was a ludicrous decision because he was probably the fittest person in the team—it was a discriminatory view of diabetics. I do not have time to talk about that in detail, but I flag it up as an issue. I am sure that many diabetics who are in, for example, the police, the fire services or the armed forces can relate to the point about discrimination.

So what is diabetes? The British Diabetic Association was the predecessor body of Diabetes UK—incidentally, its original members included H G Wells and D H Lawrence—and it defined diabetes as

"the result of impairments in the body's normal abilities to produce or use insulin. This natural substance is vital for control of blood glucose levels. People with diabetes are vulnerable to various forms of long-term damage to their blood vessels and vital organs."

So what are the effects of diabetes? I am sure that members will be well aware that diabetes is the main cause of blindness for people of working age. Half of all non-traumatic lower-limb amputations are due to diabetes and the incidence of heart disease and stroke is two to three times higher than the average among diabetics. There is also higher perinatal mortality among babies born to women who have diabetes. Highland NHS Board tells me that—at its local level—people with diabetes have higher admission rates to hospital, longer stays and more outpatient attendances.

I recently asked the Minister for Public Health, Shona Robison, who is present for the debate, for a breakdown of the number of people in Scotland who are diagnosed as having diabetes. Her answer of 14 June told me that there are 193,000 diabetics in Scotland. In addition, of course, around 60,000 people have the condition but are undiagnosed.

Those figures break down to suggest that about 5,000 people in the Highlands and 4,745 in Tayside, which covers the minister's constituency, have diabetes. That means, if my maths is right—which is not guaranteed, I hasten to add—that there are about 800 undiagnosed diabetes sufferers in each Scottish parliamentary constituency. That would mean that scores of staff in Parliament and perhaps one or two MSPs have diabetes without knowing it.

We must also consider the issue in an international context. The St Vincent declaration was adopted by 32 countries in an attempt to tackle diabetes internationally—the United Kingdom adopted the declaration in 1992. Members know that there are two types of diabetes: type 1 normally develops early in life and sufferers tend to be dependent on insulin, while type 2 is known as maturity onset diabetes or non-insulin diabetes mellitus, and about 80 per cent of diabetics suffer from it.

Screening for type 2 is vital, but it requires planning that tackles local needs within a national framework, so the key is targeting. I do not suggest for a second that we should have random or mass-population targeting. That would not work and Diabetes UK Scotland does not support it. It is not viable because of the costs and workload that would be involved and because of the number of false positive results that would be produced. We should view screening as a form of prevention rather than as a cure. That would allow general practitioners or, indeed, diabetic and practice nurses to offer it earlier to patients who are most at risk—normally, people who are over 45, or people who have a family history of diabetes or people who are overweight. Early detection is vital.

Diabetes UK Scotland reports that most diabetics suffer the condition for between three and seven years before diagnosis. Early detection will reduce the number of patients suffering from complications and it will reduce costs. That detection can be done by a simple and inexpensive urine or blood test that takes about 30 seconds. I accept that no perfect screening solution exists, but a GP who detects diabetes through a urine test can follow up the findings with a blood test.

Members will be aware that the United Kingdom National Screening Committee, which advises the Westminster and Holyrood Governments on screening protocols, has recommended that screening for sub-groups of the population that are at high risk of type 2 diabetes is feasible but should be part of an integrated programme to detect and manage cardiovascular risk factors. Although the Scottish diabetic framework of 2002 and the diabetes action plan of 2006 made no clear commitment to screening, I congratulate Andy Kerr on the work that he carried out, as a minister, in developing diabetic retinopathy screening for all people over 12 with diabetes. However, a recent health technology assessment of screening for type 2 diabetes shows clear evidence that it would be extremely helpful, particularly in conjunction with awareness raising campaigns.

In passing, I will highlight some examples of very good practice—

You should draw your remarks to a close, as you are well over time.

In conclusion, we have a great opportunity to raise the bar in health care and to lead the way in western Europe by introducing a high-risk targeted screening policy for type 2 diabetes. Not only would that be cost effective, it would, on an individual level, tackle a condition that blinds, maims and kills. Together, we can create fresh vigour to slay Scotland's silent killer.

I congratulate Dave Stewart on raising the issue, which has been raised in the Parliament on many occasions. I acknowledge the contribution of Karen Whitefield, who in the previous session of Parliament worked with me and others on the cross-party group in the Scottish Parliament on diabetes. I also acknowledge the perpetual and worthwhile work of Diabetes UK in keeping the issue to the fore.

I came to be interested in the issue because four members of my family by blood have type 2 diabetes and two members of my family by marriage have type 1 diabetes. That is a huge proportion in a small catchment and that is just the tip of the iceberg. Dave Stewart mentioned that 193,000 people are diagnosed with diabetes and that many other people—60,000-odd—are undiagnosed. That gives us an idea of the size of the problem. One fact that arrested my attention is that 25 per cent of people in Scotland aged 16 and over are obese. There is a link between obesity and type 2 diabetes. The figure on obesity comes from 2003, so one suspects that even it is now significantly increased. As Dave Stewart rightly said, for the undiagnosed, damage is being done during all the years that they are in that situation. A written answer to Dave Stewart of 14 June stated that in my area, the Borders, an estimated 1,618 people are undiagnosed, but I suspect that the actual figure might be even greater.

I commend Lloyds Pharmacy, which carried out diabetes testing of members of the Scottish Parliament to show us how simple the test is, and tested at various conferences. The test is worth while and takes very little time. One of our members was diagnosed with type 2 diabetes after having the test. When people are diagnosed, they can go into panic mode and think that it is the end of their life. Dave Stewart mentioned a football player who had diabetes and who was very fit, as he managed the condition. However, a cautionary point is that that approach can sometimes be double-edged, because when people get over the initial problems and can manage the condition through diet or tablets rather than injecting, they sometimes become complacent and slip back into old ways—they think that they have got over it. However, people do not get over it, as it is a permanent state that remains to be managed.

People who are diagnosed can also have psychological issues. A young man from Selkirk who came to the cross-party group on diabetes said that he went crazy when he was first diagnosed and attempted to challenge the disease by drinking and eating what he liked. Of course, he came to a crisis point and realised that it was not a war between him and diabetes—he realised that he was not going to win in that fashion.

I acknowledge that early intervention is invaluable and that prevention is even better—it is better than cure. That is why I am pleased that the cabinet secretary's title contains the term "Wellbeing" and that the relevant parliamentary committee is called the Health and Sport Committee. I know that when people look at me they do not always think about health and sport, but we must connect the idea of exercise and being fit with that of avoiding a high risk of developing type 2 diabetes.

I am pleased that Dave Stewart has raised the issue and I commend the other members who have campaigned long and hard on the issue. I look forward to hearing the minister's response.

I thank David Stewart for securing the debate and, like Christine Grahame, I acknowledge the excellent work that Karen Whitefield did in the cross-party group in the previous session.

I am not a clinician, so I might have no right to say this, but many of my friends who have diabetes are not overweight. I sometimes think that people are in denial and think that they could not possibly have diabetes because they are not overweight. When we talk about obesity and diabetes, people assume that they have to be obese to have diabetes.

I, too, thank Diabetes UK Scotland for providing the information stand in the Parliament this week. I certainly found it to be helpful and it gave some background for this debate. As David Stewart said, diabetes is a long-term, progressive condition that affects thousands of people in Scotland. There has been a rise of 53,000 new cases in just four years, so this will not be the last debate on the subject.

I am not quite sure how an economist can come up with a figure for those who have not been diagnosed. I accept the figure, but David Stewart will understand that it is rather difficult to measure.

As a Highlands and Islands MSP, I commend the work of Fergus Ewing's friends Munro and Mhairi Ross, who run an excellent self-help group in Inverness. I know that there are many similar groups throughout Scotland.

The Scottish diabetes framework was an excellent piece of work by the previous Government and all parties were signed up to it. Like many others, I fully endorse the priority that is given to people with diabetes for podiatry care. However, it was not the intention that, in order to prioritise one group of patients, many elderly patients would not be able to access foot care. Therefore, although I fully support the measure, I ask that, when one patient group is prioritised, the capacity of podiatrists is increased so that others do not lose out.

Early diagnosis has been mentioned, and I will give a brief example. One of my hill-walking friends attended the doctor for two years with tiredness and various other problems, and was issued with antidepressants. It was only when he applied for a pension scheme and was asked to take a medical that his diabetes was discovered. Four years later, he is still on antidepressants, although he has never been depressed in his life, and an enormous amount of damage has been done. David Stewart was talking about screening, but I would like to focus on better diagnosis and early intervention rather than a screening programme for everyone.

The condition can be self-managed, but people need support to do that. I understand that in some health authorities the test strips for self-testing are being rationed and some people who need to do regular tests are having to buy their own. I hope that the minister will look at that.

"Delivering for Health" signalled an intention to shift the balance of care towards preventive medicine and, by increasing anticipatory care, to reach out to those who are at greatest risk. The success of the health improvement agenda is crucial if we are to slow the increase in the number of people who are developing diabetes and reduce the rate of life-limiting complications.

I hope that more emphasis will be put on prevention as well as care and treatment.

I am pleased to speak in the debate. I congratulate David Stewart on securing a debate on such an important issue.

On 14 November, it will be world diabetes day. Two years ago, I secured the first-ever debate in the Parliament on diabetes. It was a notable occasion, not least because the then Lord Advocate, Colin Boyd, spoke in the debate and went public for the first time about his diagnosis of type 2 diabetes. It was unusual for the Lord Advocate to speak in the chamber, but he felt that he had to say something about the issue, especially about the need to increase awareness of diabetes risk. Some members may recall that I spoke in the debate about the devastating impact that diabetes has had on my family. Unfortunately, as others have said, that is not unusual. As David Stewart's motion points out, it is estimated that 173,000 people in Scotland have diabetes. The illness touches most Scottish families.

David Stewart spoke about the need for early intervention, and he was right to highlight that important point. To improve the health of people in Scotland, we must become better at identifying the tens of thousands of people who have the condition but do not yet know it. Across the parties, we should commit ourselves to moving forward with urgency to address that vital issue.

This year, world diabetes day will focus on children and young people living with diabetes; that is the issue about which I, too, wish to speak. According to the International Diabetes Federation, there is an annual increase of 3 per cent worldwide in the number of children with diabetes. We know that Scotland has one of the highest prevalence rates in the world for diabetes in children. In the Highlands, the rate of increase for the number of children with type 1 diabetes is the highest in the UK. No one is sure why that is the case. The reason for the increase may be environmental or genetic; it is probably a combination of the two. However, when it comes to children and young people in Scotland who are living with diabetes, we need to do more and better.

A recent report on diabetes in the young in Scotland showed that in the past 10 years there has been no improvement in their diabetes control. We all know that the consequences of poorly controlled diabetes can be devastating. Yesterday, Diabetes UK Scotland and the Royal National Institute for the Blind Scotland brought their retinopathy campaign exhibition to the Parliament. The campaign built on the fact that diabetes can lead to sight loss. One of the people who were involved at its launch earlier this month was a young woman who lost her sight due to diabetes at the age of 19. She is not an isolated case. Unless we can find better ways of supporting children and families to take full control of their diabetes, we will consign too many of our young people to an adulthood that is fraught with avoidable problems such as sight loss, cardiovascular disease, neuropathy and kidney problems.

The Scottish diabetes framework and last year's diabetes action plan offer the best way of tackling the issue. The action plan gives priority to developments for young people and children living with diabetes. That must mean better health outcomes for individual children. We cannot afford to see no improvement over the next 10 years.

I congratulate David Stewart on securing the debate and look forward to working with members of the cross-party group on diabetes to continue to raise awareness of the illness and to ensure that health policies and spending improve the lives of those who suffer from diabetes.

Like those who have spoken before me, I congratulate David Stewart on securing this debate on a particularly important issue. Even though I am new to the Parliament—certainly in my current capacity—I am familiar with the work that Karen Whitefield and other members in the chamber have done on the issue. Like many others, I used to have scant knowledge and understanding of diabetes. Since my late father was diagnosed with type 2 diabetes—or late onset diabetes, as it was more familiarly called—I have known a little bit more about the condition, but I cannot claim to be as expert or knowledgeable as others in the chamber.

Increasingly, late onset diabetes is a misnomer. As Karen Whitefield said, the number of teenagers and young people who are being diagnosed with type 2 diabetes is a serious issue. The statistics that have been collated are certainly a cause of concern. As far as young people with type 2 diabetes are concerned, we are on the edge of a crisis, and we must examine a number of areas, not least of which is diet and obesity.

It is well known that type 1 and type 2 diabetes are not standalone ailments. We have done a lot of work on treatment and preventive measures, and in that respect I commend, for example, the guidelines from the Scottish intercollegiate guidelines network; the managed clinical networks that are beginning to emerge; and, in particular, Diabetes UK's very valuable work. Preventive measures can be taken and are bound up with the clear problem of the way Scotland eats. In fairness, the previous Administration tried to tackle the issue in its hungry for success initiative. I seek assurance from the minister that she will continue to support such initiatives.

Education is critical in addressing this matter. We must find a way of tackling certain entrenched cultural positions, particularly those of males in the west of Scotland. As I come from a working-class background, I am familiar with the pride associated with telling people that we have not been to the doctor for 20 or 30 years, but such people have not had the opportunity to take advantage of the preventive measures set out in the SIGN guidelines. We need to widen the information base in that respect. The fact is that, although we have made some progress, we need to tackle all the issues that I have highlighted.

As other members have covered many of the other points I wished to make, I will not take my full four minutes.

I, too, will be brief. I congratulate David Stewart on securing this debate and echo what he and other members have said about the importance of raising awareness of diabetes; of tackling ignorance and discrimination; and of detecting and treating diabetes as early as possible. Like other members, I have experience of diabetes in my extended family, and I am very aware of the difference that is made by early detection and the increasing availability of user-friendly treatments. Indeed, the latter aspect is particularly important for young people who have to face the shock of such a diagnosis.

I also pay tribute to David Stewart for leading an all-party approach to this issue during his eight years in another place—and to the all-party approach that has been taken and referred to by the members who have spoken in the debate.

It is worth noting the point about wider UK engagement. With diabetes, as with other long-term conditions, we must join up the work being carried out in Scotland with UK research and diagnosis initiatives.

David Stewart highlighted the importance of screening. As he said, the previous Administration introduced a number of helpful initiatives such as retinopathy screening for those who have already been diagnosed as having diabetes, but the issue must be addressed in the wider context of the NHS's general management of long-term conditions. I hope that, in her response, the minister will relate her comments on diabetes to the bigger picture of how the NHS can shift its focus from the traditional emphasis on acute hospital care as the health service's main activity to a greater emphasis on detection, early intervention and support for those who have to live with long-term conditions. Indeed, as Mary Scanlon said, that is what delivering for health is all about. Further development of that approach will command very broad support.

As has been said, the issues that are raised by the growing incidence of diabetes relate to some of the wider issues of health and well-being in our population. Those issues are not always related to deprivation—sometimes they are to do with lifestyle. It is clear that there are important matters for the health service in Scotland and elsewhere to address and that that must be done in the context of the way in which we approach long-term conditions.

I thank Dave Stewart for lodging his motion on diabetes and welcome the expertise that he brings to Parliament as the former secretary of the all-party parliamentary group for diabetes at Westminster.

I welcome this evening's debate as an opportunity to underline the serious challenge that diabetes presents in Scotland, and to welcome the work that Diabetes UK does during diabetes week and the rest of the year to improve the lives of diabetics. As many members do, I have family members with diabetes and I know the impact that it can have.

The Cabinet Secretary for Health and Wellbeing was delighted to support diabetes week through the launch of the campaign by Diabetes UK and the Royal National Institute for the Blind to promote awareness of the importance of retinopathy screening for people who have diabetes.

When it was published, we welcomed the national framework for service change as a sound analysis of the health challenges that face us. Its conclusions remain valid and we continue to support them. As Karen Whitefield did, we welcome, too, the positive contribution that the diabetes action plan is making to diabetes care. The action plan was developed with support and contributions from a wide range of stakeholders, including voluntary groups and diabetics. It has been well received and there is, among health care professionals, a strong commitment to delivering it. It includes commitments on a number of important areas, including patient education, improving access by disadvantaged groups to services for people with diabetes, improving foot care services, implementing state-of-the-art e-health solutions, enhancing the knowledge and skills of staff, and improving access to diabetic retinopathy screening. Continuity of policies and targets is crucial where they bring benefits to patients, so we support delivery of the diabetes action plan.

I turn to the six key themes in the "Diabetes UK Scotland Manifesto 2007", the first of which is to

"Support people with diabetes to look after themselves".

That is an important objective, as Mary Scanlon said. It is imperative that we equip diabetics with the knowledge, skills and confidence to deal with their condition and to effectively integrate self-management into their lives so that they can improve their quality of life.

Mary Scanlon mentioned blood-testing strips. As I understand it, the issue that Diabetes UK raised related more to the problem that health authorities in England were encountering with blood-testing strips, but if members have any evidence of that being an issue for health boards in Scotland, I would like to hear from them.

As a Government, we believe that patients and carers should be genuine partners in the design and delivery of care—I expect that principle to be applied in the context of diabetes. Systematic structured education is a central part of diabetes care, and I welcome the emphasis that the diabetes action plan places on education and the efforts of diabetes services to extend such provision to everyone who requires it.

The second key theme in Diabetes UK's manifesto is to

"Retain entitlement to free prescription charges for people with diabetes".

I can offer members comfort on that because we agree that diabetics should be entitled to free prescriptions and will ensure that that remains the case. We made a manifesto pledge to phase out prescription charges and we are taking steps to deliver that goal.

The third theme is about diabetes education for non-specialist health care professionals. All health care professionals who care for diabetics should have the knowledge and skills to provide safe and appropriate care. We look to health boards to provide suitable training courses and support to non-specialists so that we can help shift the balance of diabetes care towards local communities. Lewis Macdonald mentioned that—it is particularly important in remote and rural areas, such as the Highlands and Islands.

The fourth theme is to

"Identify people with Type 2 diabetes early",

which a number of speakers mentioned. Early identification of people with type 2 diabetes offers significant benefits. Providing people with appropriate diabetes care and treatment reduces the risk of complications and produces benefits for the person with diabetes and for the resources of the NHS. The keep well projects, which target at-risk groups in deprived areas, provide one mechanism through which to reach at an early stage people who may have undiagnosed diabetes. The figures that were referred to by David Stewart show the extent of that group of people.

We also have a manifesto commitment to introduce "life begins" health checks for all men and women when they reach the age of 40. Such checks could provide a systematic mechanism through which to identify people with undiagnosed diabetes and those who are at risk of developing diabetes. We will introduce plans for those checks at a later stage.

The fifth theme is to ensure access to treatments and therapies. Increasing numbers of people with diabetes are receiving the regular tests that they require, and we have seen an overall improvement in the numbers of patients reaching treatment targets. We need to build on those successes and ensure that remaining service gaps are filled. I welcome the fact that the diabetes action plan highlights the need to improve access to diabetes services for disadvantaged groups and communities.

I am aware that the number of people in Scotland who use insulin pumps is low in comparison with other countries. We are working with health care professionals to develop national guidance for those professionals on the use of insulin pumps, and we will monitor that through an audit. We are also exploring whether insulin pumps can be added to our drug-prescription lists to allow people who have an insulin pump to obtain their pump supplies on prescription. We expect such measures to make it easier for the people who meet the criteria for a pump to obtain one.

The sixth theme is to implement the diabetes action plan by 2009 and update it to 2012. I have already emphasised that we intend to see though the objectives of the action plan, and we will look closely at the outcomes of the current action plan and consider, in consultation with others, what further steps need to be taken to secure improvements in diabetes care beyond 2009.

Overall, diabetes services in Scotland provide a high standard of care. There is, of course, more to do, and there are gaps in provision that need to be filled, but I congratulate health care professionals who work in diabetes on what they have achieved in recent years to improve services. We want to develop that work throughout Scotland.

I wish members a productive recess.

Meeting closed at 17:37.