World Diabetes Day
The final item of business today is a members' business debate on motion S2M-5099, in the name of David Davidson, on world diabetes day 2006. The debate will be concluded without any question being put.
Motion debated,
That the Parliament expresses its support for World Diabetes Day 2006 on 14 November and the launch of the year-long campaign to raise awareness of the impact of diabetes among disadvantaged and vulnerable groups; notes the campaign's message that every person with diabetes, or at risk of diabetes, deserves the best quality of education, prevention and care that is possible; is concerned that people on the lowest incomes are around twice as likely as those on the highest incomes to develop type 2 diabetes and that the prevalence of diabetes in the most deprived areas is over two-thirds higher than in the most affluent; further notes that black and minority ethnic groups are at least five times more likely to develop diabetes than their Caucasian counterparts and are more likely to live in more deprived areas; recognises the developing epidemic of diabetes in young people in Scotland, and believes that the Scottish Executive should ensure that the needs of disadvantaged and vulnerable groups are fully addressed in the roll-out of the Scottish Diabetes Framework: Action Plan and that resources for diabetes awareness, screening and early intervention treatment to reduce long-term costs to the NHS are made available to all of Scotland's NHS boards.
I will start with a declaration of interest: I have been a diabetic for 32 and a half years.
I welcome the people from the diabetes community who are in the gallery and point out that, because of the long parliamentary day, not so many of them are able to be here, but they have sent their apologies and support.
I am delighted to be having this debate on behalf of the cross-party group on diabetes and to celebrate world diabetes day 2006, which was yesterday. Celebrated on 14 November every year, world diabetes day was established by the International Diabetes Federation and the World Health Organization in 1991 with the aim of co-ordinating diabetes advocacy worldwide. It has become the primary global awareness campaign of the diabetes community throughout the world, and through the activities of the IDF and its member associations and partners the world diabetes day campaigns reach millions of people around the world. Diabetes communities in more than 150 countries are united in what is both a targeted campaign to raise awareness of diabetes and its complications and a celebration of the lives of people everywhere who have diabetes.
For the historians, 14 November is the birth date of Frederick Banting who, along with Charles Best, discovered insulin back in 1922.
Diabetes is one of the greatest challenges facing Scotland today. We have 180,000 diagnosed diabetics, and that figure is expected to reach more than 400,000 within the next 10 years. Approximately half of those cases will come from disadvantaged communities, and they are the people who are least likely to access appropriate care. Unless the disease is diagnosed and effectively treated, it puts people at risk of serious complications, such as heart and kidney disease, blindness, stroke and amputation. Deaths from diabetes are expected to rise by 25 per cent during the next 10 years.
The most deprived groups are two and a half times more likely to have diabetes, and 80 per cent of people who present with type 2 diabetes are overweight or obese at diagnosis. The prevalence of diabetes increases with age, such that almost one in 10 of the population over the age of 64 has diabetes. People from black and minority and ethnic groups are up to six times more likely to develop diabetes.
One in five people who has a severe mental illness has diabetes. The prevalence of diabetes in nursing homes is up to 25 per cent, compared with 3 per cent in the general population. Complications such as heart disease, stroke and kidney damage are three and a half times more likely in the lowest socioeconomic groups, and people from deprived or ethnic communities are less likely to have their body mass index or smoking status recorded. They are also less likely to have records for their HbA1c blood screens. They do not have retinal screens, blood pressure checks or checks for neuropathy. They also do not get access to flu vaccinations.
Mortality and morbidity are increased by deprivation, and there is a proven link between deprivation and the prevalence of type 2 diabetes. There are more obese patients in deprived areas than anywhere else in the world, and they require more targeted resources and more primary care to prevent the complications that are expensive for the health service to treat, such as heart disease and the other conditions that I have mentioned.
Inequality in health outcomes in people with diabetes has many causes. Fifty per cent of the increased morbidity is due to smoking and uncontrolled hypertension. Other factors are poor glucose control, raised cholesterol, obesity, lack of education, lack of access to services, unemployment, housing status and so on. It is frightening that young people are very vulnerable, with high rates of psychological morbidity, particularly anxiety, low self-esteem and even eating disorders. They have acute problems and they also suffer from stigma in our communities.
Scotland has the highest prevalence of type 1 diabetes in children in the world, and health outcomes for such children have not improved in the past 10 years. The majority of sufferers are at risk of future microvascular complications. A flood of children are presenting with type 2 diabetes, a condition that used to be associated with adults over the age of 40.
Our ethnic communities are at high risk. People of south Asian origin are six times more likely and people of black Afro-Caribbean origin are five times more likely to develop diabetes than the general white population, which results in two or three times higher rates of heart disease, renal failure and stroke for those groups. Part of that is because of socioeconomic deprivation, genetic risk factors, displacement, mobility, discrimination and racism, difficulties with communication and literacy, and cultural and religious influences and behaviour, including issues such as physical activity and food choices. I highlight the work that is being done on those issues in the Lothian NHS Board area. A poll this year showed that those groups have low awareness of diabetes and its complications.
In older people, diabetes rates increase steeply with age. Some 10 per cent of people over 64 and up to 20 per cent of the over-85s suffer from diabetes and all the problems that go with it. As I mentioned, the prevalence of diabetes among care home residents is as much as 25 per cent, but many sufferers do not receive adequate support, especially with their diet.
The Scottish diabetes framework action plan of 2006 sets out the diabetes challenges that Scotland will face over the next three years. The priorities include improved care for people with type 1 diabetes and the need to improve health outcomes, especially for children with diabetes. We need to ensure that our health boards, community health partnerships and managed clinical networks make more of an effort to tackle the outstanding awareness and prevention issues.
Having taken part in a charity walk for the Juvenile Diabetes Research Foundation, I received a letter today from a parent in Aberdeen who raises money for JDRF. My constituent's nine-year-old child suffers from depression because he needs to perform all sorts of injections and tests every day and he cannot really cope with it. He has no access to pump therapy because of a lack of resources in the Grampian NHS Board area. I hope that the minister will address that point.
Diabetes is a global pandemic that results in one death every 10 seconds from diabetes-related complications. An amputation takes place every 30 seconds because of neuropathy. One new case is diagnosed every five seconds. If no action is taken, the number of diabetes sufferers in the world will rise from the current total of 240 million to more than 400 million by 2025. That will put intolerable strain on the health budgets of all nations, especially those in the developing world.
To do nothing is no longer an option. Through tonight's debate, I call upon Scotland to wake up and join the battle to improve treatment and care for diabetics in Scotland and assist those struggling economies abroad that share in what is a global diabetes pandemic.
I congratulate David Davidson on securing this important debate on diabetes. I will home in on how type 2 diabetes in adults is treated in our system.
Diabetic retinopathy screening is an important part of the checks to ensure that the eyesight of people with diabetes is secure. However, quality assurance issues have resulted in the national health service in Scotland moving to a more complicated system of checking how such screening is carried out. In the past, optometrists carried out screening as part of their regular check-ups for patients, but audit requirements to ensure that screening is carried out in a suitable fashion mean that each screening must be checked by at least four people. That has resulted in more screenings being done in hospitals rather than by optometrists in patients' own towns.
In the case of Raigmore hospital, that means extended journey times for patients, because they must wait some time before the eye-drops that they are given so that photographs can be taken wear off. I know of one case in which the photographs that were taken by the hospital technician were not good enough and had to be taken again. In the meantime—this story covers the months of October and November—the patient had an annual check-up with their local optometrist, who was able to do the job, which he does very well, with equipment that was up to scratch. The local optometrist was able to assure the patient that there was no problem.
It is important that in our system we recognise that around Scotland there are very different ways of handling the matter. In Orkney, an optometrist already has the kind of digital camera that can do the job, but the health board has also bought one. In Ayrshire, the health board has ensured that digital cameras are available to all optometrists. That best practice has allowed practices to deal with the issue close to where patients are. In Highland, a software problem has resulted in a five-month backlog. In an attempt to catch up, patients who live relatively close to Inverness have been taken to hospital.
The minister needs to respond on the treatment of diabetics. According to the Kerr report, chronic conditions such as diabetes should be dealt with in the community, as close as possible to where patients are. I contend that, although optometrists have the necessary skills, the system should be organised to allow screening material to be transmitted by electronic means, so that the four experts who are required to consider cases under the new form of quality assurance are able to do so. The procedure should be carried out near to patients' homes, but checks should be made where the experts are.
The patient to whom I referred has fallen between two stools. Twice they were forced to travel much further than was necessary in order to have taken the right kind of photograph, although their optometrist was perfectly capable of carrying out the procedure locally. I ask the minister to ensure that when clinical services are audited the root reason why quality assurance is carried out in that way is identified. We want to avoid clinicians finding themselves in the same situation as those who were associated with the cervical smear problem in Inverclyde. Patient journeys must not be increased to the extent that patients are put at greater disadvantage, and we should make best use of the resources that are available. I would like the minister to respond to that point, because we want the NHS and optometrists to deliver screening procedures throughout Scotland in a suitable fashion.
I am pleased to speak in the debate. I congratulate David Davidson on securing it and on his continuing work with the cross-party group on diabetes. I also thank Diabetes UK and the International Diabetes Federation for their on-going work.
The Highlands and Islands, which I represent, has a high incidence of diabetes, including type 1 diabetes. The briefing from Diabetes UK Scotland states that Scotland has a high incidence of diabetes, but in the Highlands it has historically been high—I saw it as a junior doctor when I worked on the paediatric wards at Raigmore and, many years later, as a school doctor. Recently, many of our debates have focused on type 2 diabetes. I will say a little about that, because incidence of that form is increasing and we can do a lot more to prevent it. However, type 1 diabetes is still important and I welcome the Scottish diabetes action plan priority of providing improved care to children with it.
I have encountered many cases of type 1 diabetes. I am aware of the upset, shock and lifestyle readjustment to a whole family—and beyond—that occurs when a child is diagnosed with the condition, and of the concerns of teachers and other school staff when a child with type 1 diabetes is admitted to school or a child who is already at school is diagnosed with it. The role of the diabetes nurse is important. We could clone them several times over and still not have enough. When we were able to get diabetes nurses to go into schools to show what needed to be done and to talk about the management of hypos, testing and so on, it was incredibly well appreciated, but because their time was so valuable it could never happen enough.
Because of the high incidence of diabetes in the Highlands and Islands, I welcome a major development that is about to take place in the region. An article that was published in the Inverness Courier last week states:
"Plans are well under way to establish a dedicated diabetes clinical research facility within a new £5 million Diabetes Institute to be based at Raigmore Hospital in Inverness."
The facility will be part of the UHI Millennium Institute department of diabetes. There will be a diabetes institute and a research professorship sponsored by LifeScan, a health care firm that is big in the Inverness area. The institute will collaborate in research with other centres. The facility is supposed to open in the spring of 2008.
It is all very exciting because the institute will also consider the use of telemedicine. As Rob Gibson said, telemedicine is very welcome, because diabetes—particularly type 2, which tends to affect older patients, although it increasingly affects younger people—is a chronic condition that should be managed by patients as much as possible, with support in their own communities. Travelling long distances to hospital appointments is perhaps not the best way to manage the condition. If we can use telemedicine so that people can be monitored in their own homes from a distance, that will be welcome. If telemedicine is sophisticated enough to allow retinal images to be sent down the line, that is excellent. The institute may become a centre of excellence in diabetes care in remote and rural settings.
I would like to mention the local group, Diabetes UK, Inverness and district branch, which has set itself the target of raising £15,000 in the coming year to help equip and furnish the new centre. I wish the group's members every success. They are a determined bunch, so I am sure that they will do it. I also wish the new unit every success. I know that this is not a subject for this debate, but I hope that we can not only stop and reverse the incidence of type 2 diabetes, which is increasing at a worrying rate and is a ticking time bomb, but that we can improve our management of type 1 diabetes and the outcomes for people who have that condition. I welcome the opportunity to make those points in the chamber today.
I add my congratulations to those that other members have given David Davidson on obtaining this evening's debate. This is an important subject and it is essential that the Parliament and the Scottish Executive recognise that diabetes is a growing problem.
I entirely agree with David Davidson that diabetes is one of the great challenges that face Scotland today. It is a particularly great challenge because not only do we know that the number of people involved is rising but, as the 2004 review report said, many thousands of cases go undiagnosed. That must be a cause for considerable concern—early diagnosis enables appropriate interventions to be made to prevent the onset of some of the other symptoms that manifest themselves, beyond the disease itself.
The Scottish Executive's introduction of free eye tests was an important new policy. I talked to an optician who recently established a practice in Duns in my constituency—the first optician in Berwickshire for some 20 to 30 years—who emphasised the fact that he can spot where there might be as-yet-undiagnosed diabetes. There might be more cases in future, but perhaps that is to be welcomed if we can diagnose them more quickly and ensure that the appropriate interventions are available.
As Eleanor Scott said, some parts of Scotland have had a higher incidence of diabetes than other parts. The Highlands is one such area. The Borders is another. I welcome the fact that the Scottish Executive has provided some pilots for anticipatory care in disadvantaged areas. That is clearly correct, but disadvantage is not located in only one part of Scotland; it can be found throughout Scotland. It is essential to look to areas that might not appear to have major disadvantage, but which have considerable disadvantage hidden away, perhaps in an affluent community or in a sparsely populated area. It is important that anticipatory care, including early diagnosis of diabetes, is sought and obtained throughout Scotland.
I am particularly concerned—I had not previously appreciated this—that the black and ethnic communities experience much higher rates of diabetes. I cannot intuitively think of a reason for that. I ask the question—although perhaps I should already know the answer—whether research has been done on the matter. Is there some way in which we can find out the reasons why those communities experience much higher rates of diabetes? I hesitate to suggest any reasons, but there clearly must be some. I cannot believe that there should be such marked differences, particularly between people who live in similar areas.
It is important that the excellent work in producing the "Scottish Diabetes Framework", in reviewing the framework and in the "Scottish Diabetes Survey 2003" is continued. I note that the foreword to the review of the diabetes framework in 2004 mentions that progress will be made in reviewing the framework by early summer 2005 and that further work will take place. It would be helpful if the minister could clarify exactly what is going on, what work the Executive is undertaking and what the timeframe is, because there is no doubt that diabetes is one of the more serious matters that we need to address in Scotland today.
I congratulate David Davidson on securing a debate on this important subject. I frequently disagree with him on political matters, but on this occasion I pay tribute to him as a practical example of longevity in a diabetic, which serves as a model of what can be achieved. He also illustrates perfectly some of the points that he made. Although I disagree with him, he is articulate and able to engage with his condition, understand it and ensure that he is managing it. The best way to manage a lifelong condition is for the person who is subject to it to be a key part of the management. That illustrates why there are difficulties in more disadvantaged communities in which people have less capability.
Like Eleanor Scott, I have examined the figures. Having had a brief exchange with her, I think we agree that the prevalence of type 1 diabetes is higher in the Highlands than it is anywhere else in Scotland but, paradoxically, the prevalence of diabetes overall is lower in the Highlands than it is in many other parts of Scotland. That means that the prevalence of type 2 diabetes in the Highlands is low compared with the rest of Scotland. The reason for that is that people who live in a rural area such as the Highlands are much healthier and fitter psychologically, physically and dietetically, even though there is deprivation in rural areas. City deprivation, in particular, is a problem.
About one in 25 of our population has diabetes. The interesting question to pose is what proportion of people with diabetes have intrinsically avoidable diabetes. The answer is that a very high proportion of people with diabetes have essentially avoidable diabetes, because type 2 diabetes is environmental and diet based.
I have been doing my bit to constrain the further development of diabetes. I will name names. When I found Jamie Stone and Frank McAveety eating chips in the members' lounge during the stage 3 process that we started today, I pointed out the health risks that they were running and told them that they were in conflict with the Executive's policies and practices, which I support. Perhaps the minister will have a reinforcing word with them.
As David Davidson said, diabetes is a worldwide problem—but we should consider some uniquely Scottish aspects of the issue. Scotland was one of the first countries in the world to have a world-class medical school, which was located in Edinburgh. The huge morbidity on the doorstep of the medical school in the old town of Edinburgh provided a climate in which people could study the conditions that were engaging practitioners in medicine in the middle ages.
As various genetic links are associated with type 1 diabetes and as, with record-keeping that is superior to that of many other developed countries, we have a very good understanding of the genetic mix of the people in this country, we have a key opportunity to take a lead in research into how we can prevent the development of type 1 diabetes and continue, support and reinforce a primarily diet-focused approach to dealing with type 2 diabetes.
Of course, we also have to engage with the psychology of people whose behaviour, as far as diabetes is concerned, is not good for their health. As other members have pointed out, diabetes is accompanied by a wide range of other conditions that not only damage people's quality of life but incur substantial public costs. That should give us a clue about where we should look for the money to invest in world-class research that would benefit the people of Scotland and make a contribution to the rest of the world.
By the way, coming to the Parliament might be one solution. My blood pressure is 30 points lower, which helps a wee bit. That said, my diet might not be any better for being here.
We certainly have to engage with the problem. I congratulate David Davidson on securing this debate and am interested in hearing what the minister has to say.
I, too, congratulate David Davidson on his securing this timeous debate and I welcome many of the comments that have been made. I also welcome the opportunity to confirm our recognition of the challenge that is presented by diabetes and to highlight our actions to address it.
We acknowledge David Davidson's points about the impact of type 2 diabetes on disadvantaged and vulnerable groups. Of course, tackling health inequality is one of the key themes of our vision of future health care—"Delivering for Health", which we set out in Parliament just over a year ago.
Since devolution, we have been endeavouring to develop more effective ways of improving care of people who have diabetes. Euan Robson asked about the basis of that work. The "Scottish Diabetes Framework", which was published in 2002, set out a clear vision for improving diabetes services and the diabetes action plan, which came out earlier this year, refocuses that approach on consultation of diabetes sufferers, carers and service providers and sets out a clear three-year programme of action. We welcome health care professionals' commitment to delivering the action plan's recommendations.
Diabetes services have improved considerably in recent years. Most important, the creation of managed clinical networks for diabetes care in every NHS board area has provided leadership and focus on delivery of local diabetes services. Investment in information technology has resulted in the creation of a fully electronic diabetes patient record that will be available at all stages of the patient's pathway. It will provide timely clinical data to support the care of the patient and increasingly robust data that will be used to examine the overall quality of care. The number of diabetes sufferers who receive the required regular tests has increased, which has led to an overall improvement in the number of patients who reach their treatment targets.
In my speech, I mentioned a letter that I received today that highlights the lack of access to insulin pumps, which the cross-party group on diabetes discussed earlier this year. Does the minister have any comments about the roll-out of pump therapy in Scotland? I know that some trials are being carried out, but despite the fact that the treatment frees up services and allows people to lead normal lives, Lothian NHS Board has struggled to get the system up and running and it is simply not available elsewhere.
In answering that question I will also address the issues that Rob Gibson raised to do with diabetic retinopathy screening. We look to managed clinical networks to address such issues within regions such as Grampian, as mentioned by David Davidson, or Highland, as mentioned by Rob Gibson, or Lothian. In all places, we look to MCNs to define the services that are needed in their areas and to ensure that those services are delivered in an integrated way.
The action plan also emphasises the importance of supporting people who have diabetes in caring for themselves. We have to ensure that people have access to good-quality education and information so that they can improve their knowledge and skills and gain the confidence to deal with the condition and to integrate self-management into their life and care. Such education on self-care will be a key part of our work. It will be taken on board by the NHS as mainstream NHS business.
Disadvantaged groups have been mentioned, including people from minority ethnic groups. For example, a genetic predisposition among south Asian people can be the fundamental cause of their particular disadvantage. We look to MCNs to undertake a needs analysis of their local populations to identify disadvantaged groups and appropriate treatments. People may be disadvantaged because of their ethnic origin, because they have learning disabilities, because of their social or economic position, or because of geography or transport issues. The MCNs will be key agencies in developing understanding of what is required and in ensuring that services are made available. I have already mentioned "Delivering for Health", in which a key point is that we should address inequalities in access to health services. Diabetes services are one such area in which we would be keen to address inequalities.
We also have to consider the many people who are living with diabetes but who have not been diagnosed. In that regard, we take advice from the National Screening Committee, which advises all four United Kingdom health departments. It feels that general population screening for diabetes is not necessarily the best way forward, but that it will be critical in reducing risk among the groups that are at highest risk. We will continue to listen to such advice and to act on it.
Work on diabetes screening should be taken forward in the context of addressing general cardiovascular risk factors. That is the advice of the National Screening Committee on the basis of its projects and pilots. It is also the focus of the keep well programme on anticipatory care, which is being piloted in five areas. Euan Robson asked whether the pilots and the focus on cardiovascular risk factors such as diabetes will be confined to those five areas. The intention is to use the results from the pilots to inform policy more generally. We have to acknowledge that there are disadvantaged groups as well as disadvantaged areas. Those groups exist all over Scotland. We hope to extend the pilots beyond the current five in the reasonably near future.
We are committed nationally, regionally and locally to the goals in "Delivering for Health". Those goals include reducing inequality and improving treatment. "Delivering for Health" puts a clear emphasis on increasing support and increasing the focus of health services on people who are living with long-term conditions. That offers a basis for sustainable improvements in how we will support people with diabetes in the future.
We support the call of world diabetes day for care for everyone with diabetes and we are working hard to deliver that care in Scotland. "Delivering for Health" sets the context and the diabetes action plan sets out the programme of steps that we need and intend to take. The direction that we are taking will, I hope, bring the kind of improvement that all the members who have spoken this evening have called for.
Meeting closed at 18:30.