The next item of business is a members’ business debate on motion S4M-08516, in the name of David Stewart, on the Melbourne declaration. The debate will be concluded without any question being put.
Motion debated,
That the Parliament notes that the first meeting of the global Parliamentary Champions for Diabetes Forum was held in Melbourne from 30 November to 2 December 2013; understands that there are an estimated 382 million people with diabetes, including in the Highlands and Islands, and that this number is expected to rise to 592 million by 2035, that 80% of people with diabetes live in low and middle-income countries, that diabetes will cause 5.1 million deaths in 2013, one every six seconds, that the 66th World Health Assembly held in May 2013 has adopted nine global targets and 25 indicators to help address the non-communicable diseases (NCD) pandemic and that diabetes is the only one of the four major NCDs with its own global target, to halt the rise in diabetes and obesity by 2025; congratulates the 90 nations that have signed the Melbourne Declaration on Diabetes, and acknowledges what it considers the pivotal role of the International Diabetes Federation as the unique global voice for people with diabetes.
12:32
A few short months ago, I strolled in the Melbourne summer sun from my hotel to Victoria state Parliament House. I was due to speak to an unusual audience—nearly 100 national champions for diabetes from as far afield as Russia, Ukraine, Nigeria and Canada. We even had South Africa’s own first lady. [Interruption.]
I am sorry to interrupt you, Mr Stewart, but I ask those in the public gallery who are leaving to do so quietly please. Thank you. Please resume, Mr Stewart.
Thank you, Presiding Officer.
It was a privilege to be asked by the International Diabetes Federation to represent Scotland at the first-ever global forum of parliamentary champions for diabetes. The next forum will be in Canada in 2015 and I hope that Scotland will be represented again by other members, such as Nanette Milne, who, along with me, co-convenes the cross-party group in the Scottish Parliament on diabetes.
The conference concluded with the signing of the Melbourne declaration, which committed Parliaments around the globe to ensuring that diabetes is high on their political agenda. The declaration called on nations to have a stronger emphasis on preventative work, early diagnosis, management and access to adequate care, and to ensure that treatment and medicines are available for all those living with diabetes. The declaration was the brainchild of the International Diabetes Federation, the president of which is Sir Michael Hirst, former MP and ex-chair of Diabetes UK.
I was proud to talk to the conference delegates about Scotland but also about issues of international significance for diabetes. I am proud to come from a nation of Scots with a strong track record in innovation and discovery, such as Alexander Fleming, who discovered penicillin; James Watt, who invented the steam engine; and Alexander Graham Bell, who invented the telephone.
However, international collaboration is where real strides can be made. In 1922, Professor John Macleod from Aberdeen worked with two other outstanding scientists, Dr Banting and Charles Best, and discovered insulin. Macleod and Banting won the Nobel prize for medicine in 1923, which was shared with Charles Best.
Fast forward to today and, as co-chair of the cross party group on diabetes, and convener of the Public Petitions Committee, I have worked with politicians, the public, medical experts and campaign groups to be an evangelist for the treatment of diabetes.
As a non-diabetic, why am I so passionate about the subject? In 1997, as a freshly elected, fresh-faced member of Parliament—hard to believe as that might be today—I was given a tour of the diabetic unit in my local hospital. I met a diabetes nurse who encouraged me to take an interest in the subject. She told me that diabetes is the main cause of blindness among people of working age. It is responsible for half of all non-traumatic lower limb amputations and, then, was costing the national health service £0.5 billion.
I joined the all-party parliamentary group on diabetes at Westminster and was its secretary for eight years. As part of my duties as secretary, I hosted a reception in the House of Commons for MPs, peers, patients, doctors, nurses and NHS bosses. There were 200 guests and I met the star attraction, Gary Mabbutt, who football fans in the chamber will know is the ex-captain of Spurs and an English international. Gary has diabetes and he told me that when he was preparing to leave home to travel to Mexico for the world cup, he received a phone call from the England team doctor who told him he could not go to Mexico because it was too hot and, as a diabetic, he would be unable to cope. It was a ludicrous decision because he was probably the fittest person on the team. In my view, that was a clear example of discrimination against diabetics. We also heard about newly diagnosed diabetics being sacked or downgraded in the police, the fire service and the armed forces.
The other event that focused my attention was personal. My late father-in-law had type 1 diabetes for more than 70 years and lost sight in one eye. He taught me that it is possible to lead a normal life with well-controlled and well-maintained pen-needle injections.
Last time I asked a parliamentary question of the health minister, I was told that approximately 250,000 people in Scotland were diabetic and that a further 620,000 were at high risk of developing type 2 diabetes. In addition, 49,000 people in Scotland have the condition but are undiagnosed. That means that approximately 1 million people in Scotland are directly affected by diabetes, either by having it or by being at high risk of developing it. It means that, if my maths is right—of which there is no guarantee—there are about 800 undiagnosed diabetes sufferers in each Scottish parliamentary constituency and that scores of staff in the Scottish Parliament, and perhaps one or two members, have diabetes without knowing it.
Screening for type 2 diabetes is vital but it requires planning that tackles local needs within a national framework. The key is targeting, so that interventions can do the most good. We should view screening as a form of prevention rather than as a cure. It would allow general practitioners, or indeed diabetes and practice nurses, to offer screening earlier to patients who are most at risk, which is normally people over 45 who have a family history of diabetes and are overweight. Early detection is vital. Diabetes UK Scotland reports that most people with type 2 diabetes suffer the condition for between three and seven years before diagnosis. Early detection will reduce the number of patients suffering from complications and will reduce costs. That detection can be done by a simple and inexpensive urine or blood test that takes about 30 seconds.
There have been some strong, positive steps in the care of people with diabetes, such as the provision of insulin pumps to under-18s, but the number of people with the condition is rising, which will have a serious effect in Scotland’s immediate future. Beyond the grave social cost of the condition on individuals and families, there is the huge economic cost to the NHS in Scotland, estimated at £1 billion annually, 80 per cent of which goes on managing avoidable complications.
With the Melbourne declaration focusing on the prevention of diabetes, the Scottish Government must have a focus on the condition that properly reflects the size of the problem. There are now more people in Scotland living with diabetes than with coronary heart disease. Two and a half times more people have diabetes than have all cancers combined. Each year in Scotland, 1,900 people have an emergency admission for diabetic ketoacidosis—a critical, life-threatening condition that requires immediate medical attention. More than 40 per cent of those admissions are of people under the age of 25.
At any one time, people with diabetes account for a fifth of hospital in-patients. In Scotland, a person with diabetes can face a reduced life expectancy by up to 14 years. Diabetes is the leading cause of blindness among people of working age and a main contributor to kidney failure, amputations and cardiovascular disease, including heart attacks and strokes.
People with diabetes should be getting their 15 healthcare essential checks from the NHS and previous action plans have been instrumental in taking that forward.
We have a great opportunity in Scotland to raise the bar in healthcare. Scotland has one of the highest incidences of type 2 diabetes in the world—it is time that we tackled that ticking time bomb. Not only would it be cost effective, it would, on an individual basis, tackle a condition that blinds, maims and kills.
12:40
I congratulate David Stewart on securing this important debate. I join others in congratulating the International Diabetes Federation on organising the global parliamentary champions for diabetes forum, which was held in Melbourne last year. I understand that parliamentarians from 90 countries have signed a commitment to establish a parliamentarians for diabetes global network.
Diabetes is, of course, a global crisis as well as a crisis here in Scotland. There are 382 million people around the world with diabetes. That number is expected to rise to perhaps 600 million by 2035. Diabetes will have caused 5.1 million deaths in 2013—that is one every six seconds.
It is an economic issue as well as a social issue and a health issue, with 80 per cent of people who have diabetes living in low and middle-income countries. The annual world cost is about £330 billion. It is a very significant issue on a whole series of different levels.
More fundamentally, the number of diabetics who have been diagnosed continues to rise in Scotland. Of course, that is partly due to better diagnosis and screening procedures but the number of cases is rising by between 4 and 5 per cent per annum.
The Melbourne declaration identifies three specific areas where action could be taken: in prevention, in increasing early diagnosis, and in increasing access to diabetes care and to therapies.
In Scotland, we have the diabetes action plan, which is an excellent way of focusing on some of the issues. In particular, the plan seeks to reduce obesity, which is a primary cause of type 2 diabetes, because as we have heard—and I have some limited personal experience in this regard—diabetes carries with it a whole series of secondary consequences such as amputations and blindness.
The Scottish Government has provided substantial support to diabetes research organisations—it has provided £10,000 to Diabetes UK Scotland in the current year.
I myself am lucky because I have an annual medical so at least in the last 12 months I know that I am not subject to diabetes. The simple urine test that comes as part of that medical is a kind of reassurance that I hope more and more people across Scotland can have.
I have some direct interest in this issue through a member of my own family, who is in Australia. My nephew, Alan Baxter, is a professor at James Cook University—in Townsville, Queensland—who specialises in diabetes. He established a facility there and he is one of a range of scientists around the world who have come up with some remedies. He has come up with one variant of an inoculation for one of the variants of type 1 diabetes. Many of the variants are genetically driven by a series of different triggers. The inoculation is designed to switch off one trigger. I hope that he and the many other doctors and researchers who are working to address the causes and effects of the disease continue to undertake that good work, while our policy makers must continue to support them.
The Melbourne declaration on diabetes has put diabetes on the world stage. I hope that we in this Parliament will add our parliamentary weight to this worldwide parliamentary initiative.
12:44
I congratulate Dave Stewart on lodging his important motion, and I pay tribute to his passionate championing of the issue during the past 17 years. As his motion commends the International Diabetes Federation, it is appropriate that I pay tribute to the work of Sir Michael Hirst as the president of that organisation. His position is a great honour for Scotland and, as some members will know, he was formerly a Conservative member of Parliament.
The motion refers to the Melbourne declaration and the World Health Organization, and highlights the great increase in the number of diabetes cases worldwide. In Scotland, the number of those with diabetes has increased from 150,000 in 2002, when the first framework was launched, to 258,000 now. Of course, those figures do not take account of the many people whose diabetes is undiagnosed; the figure of 46 per cent is generally accepted as a good guide to the proportion of type 2 diabetes cases that have not been diagnosed.
In addition to the importance of general prevention programmes on exercise, diet and so on, support should be given to activities that aim to raise awareness of the risks of diabetes, which are perhaps not so well known. I support the work of Diabetes UK Scotland, for example, which takes roadshows to local communities.
More focus is needed on early diagnosis, as Dave Stewart emphasised with regard to effective targeted screening programmes. Perhaps the minister will say something about that—I am not sure where we are at with screening, but it is clearly necessary given that so many cases remain undiagnosed. There has been progress as a result of the focus on diabetes in the quality and outcomes framework, and I know that GPs do a lot of good work on diabetes that they did not necessarily do before, but I do not know whether any of that work encompasses screening.
There has been other progress—a lot of progress, really—in the past decade. There is now a high uptake of screening for retinopathy, which is important as blindness is one of the serious potential complications of diabetes. There have also been many other great advances. When the first action plan was launched in 2002, during my time as Minister for Health and Community Care, I was a great admirer in particular of the work of the Tayside diabetes managed clinical network.
The current minister is very lucky to have Professor Andrew Morris, who was the main driving force behind that network, as his chief scientist at present. We should pay tribute to Professor Morris for all his great work on diabetes, which has been internationally recognised. His work has included the diabetes register, and more generally work on the therapeutics and genetics of diabetes.
We in Scotland have a lot to be proud of in dealing with diabetes, but the focus of this debate—as in other health debates—must be on what more needs to be done. Dave Stewart mentioned insulin pumps, on which he has done a great deal of work. I had a constituent at my surgery two weeks ago who told me that her daughter was not able to achieve blood sugar control through the normal means, and she asked me to write to NHS Lothian about the provision of an insulin pump. I hope that she will get that if it is appropriate for her, and I hope that insulin pumps will become more generally available.
It is perhaps time to update the action plan, which must recommit to bringing down the numbers of diabetes cases and continuing to improve the care of those who have the condition.
12:49
I am very pleased that David Stewart has brought the debate to the chamber, following his attendance at the recent meeting in Melbourne that culminated in the signing of the declaration that we are discussing today, and I thank him for doing so. I am sorry that I was unable to get to the meeting in Australia, but I am delighted that the declaration secured support from parliamentarians from a wide and diverse range of nations.
I also congratulate my good friend Sir Michael Hirst—Micky, to those who know him well—on his efforts to tackle the growing scourge of diabetes through his work with Diabetes UK over many years, and with the International Diabetes Federation, of which he is current president. Micky has taken a very active part in efforts to secure early diagnosis of diabetes and to ensure that those who have it receive effective glycaemic control in order to avoid the awful complications that can result from the condition, if blood sugar is not kept within the normal stable range. He has also been actively involved in studies of the emotional and psychological problems that are associated with type 1 diabetes—in particular, during the transitional adolescent years between childhood and adulthood, which is a time when it is all too easy to let the condition get out of control.
I will digress a little. I am very pleased that the Health and Sport Committee has taken on board my concerns about transitional care for not just diabetes, but several other long-term conditions, and that it is, in a few weeks, having a round-table discussion with experts to find out how the transitional years are being dealt with and to discuss how the situation could be improved for the young patients involved.
As we know, diabetes of both types, but especially type 2, is on the increase around the globe. In Scotland, the number of people with diabetes is growing at an annual rate of 4 per cent to 5 per cent, which means that if trends continue there will by 2030 be 350,000 people in Scotland with the condition. Just think of the effect that that—never mind the other pressures that will result from the increasing ageing population—will have on the NHS. We know that more than 600,000 people in Scotland are at risk of developing diabetes, so it is crucial that we have an action plan that aims to reduce its prevalence—in particular of type 2, for which the increase is explosive.
Closely aligned with the increasing incidence of type 2 diabetes is the increasing obesity of our population, with 64.3 per cent of adults in 2012 being classed as overweight and getting on for half of them being classed as obese. In 2012, 16.8 per cent of children were overweight and 13.8 per cent were at risk of being obese. All credit is due to those who are behind the Melbourne declaration, and who want to see more preventative work, with early diagnosis and access to adequate care, treatment and medicines for all those who are living with the condition.
We are a bit ahead of the game in Scotland compared with some other countries, thanks to the strategic approach that has been taken by successive Governments—from the publication of the first “Scottish Diabetes Framework” in 2002 to the “Diabetes Action Plan 2010”—although there are disparities across the country. Clearly, more needs to be done to bring down the rate of increase of diabetes by an effectively targeted screening programme for diabetes and support activities that raise awareness of the condition. Malcolm Chisholm mentioned the Diabetes UK road shows as a case in point.
Our successes so far lie in the greater availability of insulin pumps, particularly for the under-18s—that was fought for very hard by the cross-party group in the Scottish Parliament on diabetes—which can achieve better glycaemic control in the people for whom they are suitable; in better staffing levels of specialists in diabetes, both nursing and consultant; and in the national retinopathy screening campaign, which is highly rated. However, the diabetes action plan needs to be updated and to build on the improvements of the past 12 years. I understand that we may—the minister will tell me whether I am right—hear more of that fairly soon, which will be welcome.
The Melbourne declaration gives us the ideal opportunity to reinforce our commitment to improving diabetes diagnosis and care, and to support the global parliamentary alliance that is now in place and focused on dealing with what has been described as a modern pandemic. I commend David Stewart for bringing it to our attention.
12:53
I thank David Stewart for securing this debate on an issue that is of great concern to people in this chamber and in Scotland, and around the world. Further, I congratulate David on having had the honour to represent the Scottish Parliament at the first-ever meeting of the global parliamentary champions for diabetes in Melbourne. He has done a fantastic job in raising the profile of diabetes in the Scottish Parliament. I am sure that we all pay tribute to that work.
As colleagues have stated, diabetes is a major public health challenge. The motion highlights that last year it was responsible for 5.1 million deaths around the world, which is one every six seconds. In my constituency of Dunfermline in Fife, in Scotland and around the world the number of people who suffer from diabetes is rising at an alarming rate. Colleagues have already talked about the figures in Scotland, and it looks like we are on the brink of a diabetes epidemic.
The figures are extremely worrying for us all. In 2002, it was estimated that 150,000 people in Scotland were living with diabetes, but by 2006 the estimate was 170,000 and it rose to 228,000 in 2010. Today, the figure is almost 260,000. That means that, in just over a decade, we have seen a 42 per cent increase in the number of people who have been diagnosed with diabetes in Scotland. When we factor in the substantial number of people who are living with diabetes but are undiagnosed, we are looking at a major public health time bomb. With 50 people being diagnosed with diabetes every day in Scotland, those are shocking statistics that are of deep concern to all of us here today.
The cost of diabetes is not measured only in the suffering of those who are afflicted with the condition, or by the impact on their families and friends. As colleagues have said, it is also counted in the resources that it uses in our national health service and in our social services, and in the productive lives of which it robs our society.
It is absolutely vital that we take action to tackle this costly disease, but we also need to do more to ensure access to adequate care, treatment and medicines—including insulin pumps—for those who are living with the condition, in order to ensure that they have a better quality of life.
Although not all diabetes cases are preventable, the vast majority of type 2 diabetes cases are weight-related, and the numbers will inevitably keep going up as the Scottish population grows older and fatter. A recent report by NHS Fife revealed that one in five primary 1 children in my constituency, Dunfermline, is overweight or obese. The same report found that one in three adults in west Fife is obese, and that only a third of adults there do 30 minutes of physical activity a day.
We are all, rightly, proud of Scottish food and drink, but the reality is that most people’s diets in Scotland feature too much sugar and fat, and that most people do too little exercise. Those are the key factors in the diabetes challenge that we face.
If we are to tackle diabetes successfully, we need a complete change in our attitudes, but small simple steps will also make a big difference. Taking the stairs instead of the lift, having an apple instead of a digestive biscuit and walking to the shops instead of jumping in the car are just three small steps that will make a huge difference in the long term.
We need to reach people early. The worrying obesity figures for children in Dunfermline show the importance of early intervention. I would like to highlight Fife Council’s take time for a cuddle campaign, which was launched recently at the excellent Beanstalk nursery in my constituency. The campaign is aimed at showing parents how making small behavioural changes can make big differences to a child’s development and have a significant impact on their future life chances by reducing the likelihood of their suffering from conditions such as type 2 diabetes later in life. Although, inevitably, early intervention work will take a long time to reap results, if we are to successfully tackle the growing diabetes epidemic in Scotland, it is vital that we invest in it.
The motion highlights the global nature of the problem, and although there is much that we can do to tackle diabetes in Scotland, we must keep sight of the fact that it is a global issue. We must continue to work with our colleagues in the UK, Europe and across the world to develop solutions and ensure that people are aware of how to reduce the risk of type 2 diabetes and to address the common challenges that we face.
I look forward to hearing from the minister about how we can ensure that diabetes stays high on the political agenda in Scotland.
12:57
As other members have, I offer congratulations to David Stewart on securing time for this debate. I also want to acknowledge the expertise that he brings to Parliament, not only as the co-convener, with Nanette Milne, of the cross-party group on diabetes, but also as a result of the eight years that he spent as the secretary of the Westminster all-party group on diabetes, which he mentioned. It should be recognised that he has been committed to the issue for a considerable time, to his credit.
This afternoon's debate has given us an opportunity to underline the serious challenge that diabetes presents to countries all round the world. Scotland is not immune to the challenge. I want to spend some time outlining some of the work that we have done to improve the lives of people with diabetes.
The International Diabetes Federation estimates that one in 10 of the world’s population will have diabetes by 2035. Scottish figures for 2012 saw the number of people with diabetes increase to more than 258,000—that is 4.9 per cent of our population, or one in 20 people. Those sobering figures demonstrate the significant challenge that we face.
I also very much welcome the renewed focus that the Melbourne declaration on diabetes has brought to the subject, and the work of the global parliamentary champions for diabetes forum. I hope that, at some point, they will be able to come to Scotland as part of their programme in the years to come. I recognise the important work that has been undertaken by the IDF in promoting the ethos of the declaration, to promote solutions for managing and preventing diabetes globally, as David Stewart outlined.
As several members, including Nanette Milne, have recognised, we are thankfully well placed to answer some of the challenges in Scotland. We are very fortunate to have outstanding clinical leadership as well as a strong patient voice. I record my thanks to Professor John McKnight, Professor Donald Pearson and Professor Andrew Morris, who have all chaired our Scottish diabetes group over the past decade and have provided excellent clinical leadership to ensure that diabetes services in Scotland are second to none. I also recognise the work that Sir Michael Hirst has undertaken, as president of the IDF, and the work of Professor Steve Green, who chairs the International Society for Paediatric and Adolescent Diabetes. Both are fellow Scots and both are highly regarded, with reputations both at home and internationally.
Our national diabetes programme has, for over a decade, helped to co-ordinate the safe, effective and person-centred diabetes care that we want to be delivered throughout Scotland. Members are familiar with the diabetes action plan and have referred to it. That plan has been key in driving forward improvements in a number of important areas of diabetes care, including delivery of state-of-the-art e-health solutions for monitoring progress; the improvement of foot care services; an increase in access to insulin pump therapy; and the enhancement of the knowledge and skills of staff in our NHS in both acute and primary care.
I do not have sufficient time to go into all the successes of our diabetes programme in great depth, but I will update members on a couple of key areas. A key measure of diabetes care in Scotland is our Scottish diabetes survey, which is perhaps the most comprehensive national record of its kind in the world. One of the major issues to be highlighted in the most recent survey is the fact that the percentage of people with diabetes who have had their foot risk recorded more than doubled between 2008 and 2012, rising from just 31 per cent to 70 per cent. That has had a major impact by reducing the incidence of foot ulcers and lower-limb loss, and we want to make further improvements through developing that service. There is evidence that our world-leading triage system for assessing foot risk, which was developed by our diabetes foot action group, is working, and that people with diabetes are having their foot risk properly assessed to avoid complications in future life.
A second area in which we have made substantial improvements is access to insulin pumps. Several members have referred to that, and Malcolm Chisholm mentioned it in relation to his constituent. Insulin pump provision for under-18s has increased from 8.4 per cent to 22.6 per cent across Scotland since December 2011. We have also seen a more modest increase in provision for those aged over 18. As Malcolm Chisholm said, his constituent feels that her daughter would benefit from an insulin pump, and we have provided additional resource to our boards to allow them to make the pumps available when that is clinically appropriate.
The whole insulin pump issue has been driven forward by the interest of David Stewart and the cross-party group on diabetes and the work of the Public Petitions Committee. I am sure that he knows that health boards that have not come up to the mark have been left in absolutely no doubt that the Government wants them to make progress and to ensure that they achieve the target that we have set for them.
Members have also mentioned a national screening programme. The Government is advised on such programmes by the National Screening Committee. The most recent review of evidence on a national screening programme on diabetes and the modelling work that was undertaken concluded that there was no conclusive evidence on whether screening should be undertaken, or which population sub-group would potentially benefit. In light of the review’s findings, the NSC recommended that screening the general population for diabetes should not be offered. However, that recommendation is under review and we expect to receive further advice on screening programmes in May.
As members have rightly highlighted, we do not just need excellence in and equality of access to clinical services that we offer to people who have diabetes; we need also to ensure that we take action to prevent diabetes from occurring in the first place. The world health assembly’s global target to halt the rise in diabetes and obesity by 2025 is very much welcomed and will give added focus to our work.
We are progressing a range of programmes to address the need for healthy eating habits and we have taken forward work with a range of stakeholders to achieve that. Last year, we funded Diabetes UK’s live for it school programme, which teaches children how to eat healthy meals and to be active, and about how that can have a positive impact on long-term health. The programme has been very successful and we are giving further consideration to how we can work with Diabetes UK to develop the work in the months and years to come.
I hope that I have reassured members that we take the issue seriously. We are committed to building on the progress that has been achieved under the “Diabetes Action Plan”, to looking at what further measures are required to ensure that we provide patients with the best clinical care, and to taking the right measures to prevent diabetes from occurring in the first place.
13:07 Meeting suspended.Previous
First Minister’s Question Time