Chamber and committees

I have a question about eligibility for people with long-term conditions such as Parkinson’s. I remind everybody that I am a registered nurse.

Under “Eligibility”, in section 3, the bill says:

“A person has capacity to request lawfully provided assistance if they … are not suffering from any mental disorder which might affect the making of the request”.

There are issues around depression. It is considered to be a mental disorder, but is it? How severe is it? A person who has an MND diagnosis might also have a pre-existing depression diagnosis. Parkinson’s is a long-term condition, but is it a mental disorder?

Do we need to assess the level of understanding and knowledge of the people who will make the decisions to determine capacity? Does that need to be fleshed out a bit further?

On the rural issue, a lot of members have talked about Glasgow and Edinburgh, which are in the central belt. As a keen Burnsian, does Clare Adamson welcome the fact that the Big Burns Supper is going ahead this year? Next week, we have entertainment such as Eddi Reader, Wet Wet Wet and an underwater Burns supper.

Will the member take an intervention?

I congratulate Foysol Choudhury on securing this debate on diabetes tech. I thank Diabetes Scotland and the Insulin Pump Awareness Group—IPAG Scotland—for their briefings ahead of the debate and for all the work that they do to support people and families living with diabetes.

I remind members that I am a type 1 diabetic and use a hybrid closed-loop system myself. I was diagnosed on my 12th birthday, which was not yesterday. Two of my sisters and my mum have type 1 diabetes, too. I got my first pump 25 years ago, when I lived and worked in Los Angeles, which is where Medtronic pumps are manufactured. Given my professional background as a nurse, I joined the cross-party group on diabetes in 2015, before I was even elected to this place, and I am now co-convener of the group along with Paul O’Kane.

Members might think that I would be a total expert in managing my own blood glucose, counting carbohydrates, managing exercise and doing all the balancing that is needed, but I am not. The work environment that we have in the Parliament doesnae make it easy. Diabetes is relentless; it is part of life 24/7, and there is no opportunity to take the day off without facing some consequences. At this point, I want to thank my diabetes team in NHS Dumfries and Galloway for their support—and especially for their non-judgmental support. That lack of judgment is vital.

However, this isnae a “woe is me” debate. There are already 33,452 people in Scotland who are living with type 1 diabetes, along with the physical and mental health problems that are caused by the demands of managing diabetes daily, coping with diabetes-related complications and worrying about future complications.

Diabetes-related complications place a substantial burden on the NHS in the UK. As Mr Choudhury has mentioned, the UK spends about £10 million annually on diabetes, 80 per cent of which is spent on treating complications. I have raised that point many times at the Health, Social Care and Sport Committee in the current session of Parliament, and I did so at the Health and Sport Committee in the previous session.

Ensuring that people with type 1 diabetes have access to the right technologies to manage their condition is a priority in the Scottish Government’s “Diabetes Improvement Plan: Diabetes Care in Scotland—Commitments for 2021-2026”, and I welcome that. We know that demand for closed-loop systems and for the artificial pancreas is increasing, and many people with type 1 diabetes are expected to benefit from those systems in the future.

The motion mentions that people who live with type 1 diabetes make an extra 180 decisions every day, and I read the same information in a Stanford Medicine blog post, which focused on avoiding hypoglycaemic seizures during sleep. That is a particular issue in paediatrics, which is why the technology to help parents monitor their weans’ blood glucose overnight is fantastic.

It is valid to reflect on the burden of having to make any number of extra decisions. Managing diabetes for optimal blood glucose control requires decisions to be made on managing blood glucose levels and on dietary intake; working out how many carbs and how much protein and fat are on your plate; deciding whether the carbs are low or high glycaemic index carbs and how exercise will interfere with glucose levels; and ensuring that you have back-up or replacement supplies in the car, at home or in the office in case the pump cannula becomes dislodged or is even pulled out.

Just as we were sitting down for the debate, my continuous glucose monitor alerted me that the cannula needed changed. That means my blood glucose will not be monitored for the next hour, until I get up to the office. Using the tech minimises manual interventions, simplifies decision making and eases the burden of the mental workload; in fact, it has been described as absolutely transformative in the self-management of diabetes.

However, as we have just heard, the tech is not equally available across Scotland, and I note what Mr Choudhury said about the specific challenges faced in Lothian. Indeed, we have heard about that at the CPG and at the recent diabetes event that I hosted in Parliament. We know that there are many complex reasons for the disparities in availability, but there is no doubt that funding plays a part.

I am aware of the work of Healthcare Improvement Scotland’s Scottish Health Technologies Group and its recommendations for the closed-loop system, and I highlight again the SIGN guidelines. I ask the Minister for Public Health and Women’s Health to continue to work on implementing the diabetes improvement plan and to work with health boards to ensure that all those who can benefit from diabetes tech have the opportunity to do so.

We know that one of the best ways to reduce the risk of flu and other viruses is for people to take steps to protect themselves. The cabinet secretary has already mentioned uptake of vaccines. I remind members that my previous role was as a clinical educator in NHS Dumfries and Galloway. What further public health messaging will the Scottish Government utilise to re-emphasise how people can keep themselves safe from flu and other viruses? I am thinking about infection control and prevention measures, as well.

To build on that response, does the minister agree that the uncertainties that the proposed inheritance tax change have brought about come in addition to the damage that has been caused by other policy decisions that have been taken by the current and previous UK Governments, including reckless trade deals that undercut our Scottish farmers?

My understanding is that the NRAC formula, which you mentioned, is under review and could be altered. Where are we with that? When will the findings be ready to be published, for instance?

I have a supplementary question. I want to give an example of sustainability or supporting people to avoid hospital admission. Folk with chronic obstructive pulmonary disease or asthma can be helped to improve their lung health by going to a local choir, for instance. We know that that helps with pulmonary rehabilitation. How do we recognise the importance of, for instance, the third sector, in helping COPD patients or people who need lung rehabilitation to avoid admission to hospital?

Good morning, minister. I am interested in the vaping issue, as I am co-convener of the cross-party group on lung health, and ASH Scotland has come and presented to us. I am thinking about how retailers seem to be everywhere now—taxi drivers are selling vapes and online food companies will sell vapes as part of your food delivery. How will retailers be educated on or supported in the change in the law?

Parents need to realise the damage that nicotine does to their children. We hear about kids who are so anxious that they cannot sleep, and when they try to withdraw from vaping, they have withdrawal issues. There are total health impacts for young people who vape, so I welcome this legislation, but how do we make sure that retailers are aware of it, and how do we curtail the number of businesses that are selling vapes?

Good morning. The overall budgets of some territorial boards are increasing in cash terms by 14.2 per cent, but some—including NHS Borders, NHS Dumfries and Galloway, NHS Highland, NHS Orkney and NHS Shetland—are receiving increases in their budgets above 14.9 per cent. I am interested in the decisions that were taken to increase the budgets for those territorial boards. Were they taken to support reductions in waiting lists, to address delayed discharge and to address other aspects?