Skip to main content

Language: English / Gàidhlig

Loading…

Chamber and committees

Meeting date: Thursday, September 21, 2017

Meeting of the Parliament 21 September 2017

Agenda: General Question Time, First Minister’s Question Time, National Eye Health Week 2017 (Diabetic Retinopathy), Urgent Question, Nuisance Calls, Edinburgh Bakers’ Widows’ Fund Bill: Preliminary Stage, Contract (Third Party Rights) (Scotland) Bill: Stage 3, Decision Time


Contents


National Eye Health Week 2017 (Diabetic Retinopathy)

The Deputy Presiding Officer (Linda Fabiani)

The next item of business is a members’ business debate on motion S5M-07369, in the name of Stuart McMillan, on national eye health week 2017 and the threat to vision posed by diabetic retinopathy. The debate will be concluded without any question being put.

Motion debated,

That the Parliament congratulates Diabetes Scotland and RNIB Scotland on their campaign to mark National Eye Health Week 2017 by highlighting the threat to vision posed by diabetic retinopathy for people with all types of diabetes; considers that increasing rates of diabetes in the Greenock and Inverclyde constituency and across Scotland pose long-term risks to eye health among the population and recognises the costs that this will have for wider society; welcomes the emphasis given to eye screening in NHS Scotland care plans for people with diabetes, and believes that everyone with diabetes should recognise the importance of attending regular eye screening to detect any early symptoms of retinopathy, given that treatment can save vision.

12:50  

Stuart McMillan (Greenock and Inverclyde) (SNP)

I thank members for signing the motion, and I thank those who will take part in this afternoon’s debate. I am aware that some members of RNIB Scotland will be in the public gallery. I thank you, Presiding Officer, for presiding over the debate.

As the convener of the cross-party group on visual impairment, I welcome the opportunity that national eye health week provides to remind members and people across Scotland of the importance of looking after our eye health. Since 2006, everyone in Scotland has been entitled to a free eye health check every two years. As well as picking up on treatable eye conditions such as diabetic retinopathy and cataracts, the checks can spot the early signs of heart disease and brain tumours. Free eye checks are therefore an opportunity that is too good to miss. They can prevent sight loss in Scots, and they have done so. Quick treatment of eye conditions that are picked up by the tests can slow sight deterioration and sometimes prevent it altogether.

The checks are particularly important for diabetics, who are entitled to a free yearly eye check, which can pick up the early signs of diabetic retinopathy—the leading cause of sight loss in working-age adults in Scotland. It is caused by consistently high blood sugar levels damaging blood vessels in the back of the eyes. By the time that the damage has affected a diabetic’s vision, the retinopathy is already at an advanced stage. Eye health checks are vital to picking up the early signs of retinopathy so that it can be treated before it becomes so advanced that it affects vision. The free yearly eye checks can be sight saving and sight preserving for the 291,000 people in Scotland who are living with diabetes.

That is one reason why I am glad that the motion was chosen for debate. It is important to raise awareness of the free eye health checks among the general population and the diabetic community, and I hope that the debate will go some way towards doing that.

I commend the work of Diabetes Scotland and RNIB Scotland, whose joint campaign video this week highlights the effects that diabetic retinopathy can have on a person’s vision and, more important, promotes the free eye health checks. In the past 15 months, 42,000 diabetics missed their eye screening and so missed out on a vital opportunity to check that their eyes are healthy and that they do not need vision-saving treatment. I hope that the video will encourage more people to attend their annual eye screening and have their eye health checked. I recommend that members check out the video for themselves to get an idea of what it would be like if their vision was impaired.

The Government is committed to raising awareness of the importance of eye health checks and has set a self-imposed target of running localised campaigns, particularly among communities where take-up is lowest, to ensure that everyone, from my constituency of Greenock and Inverclyde to the Grampians, knows about their entitlement and can take advantage of it.

The community eye care review that Shona Robison commissioned last year has done great work in evaluating community eye care services across Scotland and providing a list of recommendations for the Government to raise the quality of eye care to an even higher standard and take it to everyone in Scotland. The cross-party group on visual impairment was pleased to hear from representatives of the review, who explained their findings and recommendations, and we would be keen to hear further updates on the issue from the Government.

I would appreciate it if the cabinet secretary updated the Parliament on progress so far on the objective of promoting the importance of eye health checks, as cited in the community eye care review recommendations, and if she updated us on what plans the Government has to continue pursuing the objective during year 2 of the current parliamentary session.

Since eye health checks were made free in 2006, uptake has risen by 29 per cent. That is a great achievement, but there is still scope to do more. Uptake is still low in the worst-off communities and in ethnic minority communities where sight loss is genetically more prevalent.

One in 10 people over the age of 65 from black and minority ethnic communities will experience serious sight loss. People from black and Asian ethnic groups have a higher risk of developing eye conditions such as diabetic retinopathy and glaucoma—the causes of such conditions are genetically more prevalent in those groups—and are more likely to go blind after diagnosis.

It is particularly important for higher-risk groups to take advantage of free eye health checks, but recent studies, such as “Improving access to optometry services for people at risk of preventable sight loss” which was conducted in 2014, have shown that those groups are less likely to get their eyes checked. We need to find out why that is the case and address the causes. The Government has a responsibility to focus on raising awareness of free eye health checks among such groups and there is precedent for that.

In 2015, the Welsh Government made eye health checks free for people from BME communities, in recognition of the need to raise awareness among those groups in particular. In Scotland, we have the universal free eye health check, but it remains the case that such groups are less likely to take up their entitlement and that they need special Government attention. As a country, we must do more to support hard-to-reach communities and those from diverse backgrounds. We cannot rest on our laurels; we must focus on preventing avoidable sight loss.

There are good examples of work with diverse communities. RNIB Scotland’s diversity in sight team does important work in that area and it is attending the Muslim Council of Scotland meeting this Saturday to talk to people from BME communities about the higher risk that they have of developing eye conditions and the importance of taking up eye health checks.

I urge the Government to target campaigns at such hard-to-reach groups, as recommended by the community eye care review, and to monitor the results of the campaigns to ensure continuous improvement.

Sight is the sense that people most fear losing. As a Government, we can and must aid the prevention of sight loss. Raising awareness of free eye health checks generally goes some way to helping to prevent sight loss, but we must also ensure that the Government has a special focus on groups such as diabetics and people from BME communities who are at a particularly high risk of developing eye conditions.

I look forward to the cabinet secretary’s update on the progress that has been made on the recommendations of the community eye care review in relation to localised campaigns and on the plans that are in place to build on that progress.

I hope that today’s debate will help to raise awareness in the general population and specifically in the diabetic community of the importance of getting eye health checks. I look forward to hearing fellow members’ contributions.

12:57  

Miles Briggs (Lothian) (Con)

I congratulate Stuart McMillan on securing today’s important debate during this year’s national eye health week. I acknowledge the good work that he has done over many years in raising eye health issues in the Parliament. I also thank the organisations that have provided briefings for the debate. I commend Diabetes Scotland and RNIB Scotland for the joint action that they are taking to raise awareness of diabetic retinopathy.

Last night, I caught one of the campaign adverts on Channel 4. It was incredibly hard hitting to see the impact of different versions of sight loss. For those of us who have not experienced sight loss, such campaigns present an opportunity to see the impact that it has on people’s lives.

It is right to focus on the most common cause of vision loss among people with diabetes and on the leading cause of vision impairment and blindness among all working-age adults. Given that more than 290,000 Scots are living with diabetes and given that that number is predicted to continue to grow in the years ahead, we must all agree that tackling diabetic retinopathy and reducing its impact must be a key health priority, as well as addressing factors such as diet, obesity and physical activity levels, which are linked to the increasing prevalence of type 2 diabetes in Scotland.

Early diagnosis of diabetic retinopathy can lead to treatment that can prevent or reduce sight loss, so encouraging every person over 12 who has diabetes of either kind to take up their annual screening appointment is vital in addressing the issue. The condition often has no symptoms until it is well advanced, so the importance of annual screening cannot be overstated. As has been said, it is hugely concerning that 42,000 people with diabetes in Scotland have no record of having attended a retinopathy screening appointment over the past 15 months. It is clear that more action is needed to increase screening uptake rates. I urge friends and family members of people with diabetes to encourage them to attend the screening and remind them of the importance of the annual check.

We should also continue to get the message across that the screening for diabetic retinopathy is different from the eye test that we get from an optician. I welcome the work that has been done to look at innovative ways in which the Scottish Government can improve the uptake of screening and the work that has been done in relation to certain communities and on enhancing the information that is provided.

In addition, we must emphasise that anyone with diabetes who believes that they have not been invited to attend screening or who believes that they have missed an invitation in a particular year should not hesitate to speak to their general practitioner or local diabetes healthcare team about that.

I welcome the powerful online and cinema commercial that is based on the message “How do you see Scotland?”, which is being shown at the moment. I commend Brian Cox for his support of the ad and for talking publicly about his experiences with diabetes, which is incredibly important. I know that members of the Parliament have done so, too, which can only help to address some of the issues. The campaign has generated significant media coverage in recent days and I hope that it will have helped to raise awareness of this important health issue.

I very much welcome this debate in national eye health week 2017 and I am pleased to join Stuart McMillan and other members in welcoming the combined work of Diabetes Scotland and RNIB Scotland. I wish the campaign every success and I hope that we will see an increase in the number of people with diabetes who take part in the screening programme each year, with a corresponding reduction in preventable sight loss or visual impairment caused by diabetic retinopathy, which can have such a devastating impact on someone’s life and wellbeing.

13:01  

David Stewart (Highlands and Islands) (Lab)

I, too, congratulate Stuart McMillan on securing the debate.

As co-convener of the cross-party group in the Scottish Parliament on diabetes, I will tell members about the hidden epidemic in Scotland. Some 291,000 people in Scotland have been diagnosed with diabetes; 49,000 people have the condition but are undiagnosed; and 620,000 people are at high risk of developing type 2 diabetes. That means that nearly 1 million people in Scotland are directly affected by diabetes either because they have it or because they are at risk of developing it. It means that scores of parliamentary staff have diabetes without knowing it, along with perhaps an MSP or two, a dozen MSP assistants and a clutch of the people in the gallery.

It is a true Scottish epidemic. Diabetes is the main cause of blindness for those of working age. That is why I congratulate Diabetes Scotland and RNIB Scotland on their campaign marking national eye health week 2017, which, as we have heard, highlights the threat to vision that is posed by diabetic retinopathy. While I am on my feet, I congratulate Jane-Claire Judson, the chief executive of Diabetes Scotland, on the work that she has done, because she is leaving the organisation in the next few weeks for a new post.

Two and a half times more people have diabetes than have all cancers combined. It is a true Scottish epidemic of health inequality; children in areas of deprivation are more at risk of obesity, which is a severe risk factor for type 2 diabetes.

What is diabetic retinopathy screening and why is it so important? As we heard, 42,000 people with diabetes in Scotland have no record of having attended diabetic retinopathy screening in the past 15 months. As part of essential diabetes care, everyone aged over 12 who is living with diabetes should attend annual retinopathy screening. That is not the same as the normal eye examination that we get at the optician. Regular screening is vital to pick up early signs. I repeat the point that diabetic retinopathy often has no symptoms until it is well advanced, so the 42,000 Scots with diabetes with no record of having attended recent screening are putting their sight at risk.

The how do you see Scotland? campaign will help raise awareness of the issue and, I hope, encourage more people to attend their screening appointments. However, as with many aspects of health delivery in Scotland, there is a postcode lottery. Non-attendance at retinopathy screening is only 8 per cent in Dumfries and Galloway but nearly 20 per cent in the NHS Highland area and nearly 21 per cent in Lanarkshire and greater Glasgow and Clyde.

Diabetes is a ticking time bomb and the fastest growing health crisis of our time. More people have that serious health condition than dementia and cancer combined. As the Cabinet Secretary for Health and Sport will know, NHS Scotland spends more than £1 billion annually on diabetes. However, by providing the knowledge, skills and tools to support people to live well with their diabetes, we can reduce diabetic complications. That will improve quality of life for people who live with the disease. It will lead to long-term cost savings as fewer people will require treatment, admissions to hospital and surgery. Everyone, irrespective where they live in Scotland, has the right to the treatment, support and technology that will help them to live well.

A few years ago, I was proud to address the first-ever global forum of parliamentary champions for diabetes in Melbourne. It was an unusual audience with nearly 100 national champions from as far afield as Russia, Nigeria and Canada. We signed the Melbourne declaration, which committed Parliaments across the globe to ensure that their political agenda had a higher emphasis on preventative work, early diagnoses and access to adequate care.

I said in my speech in Melbourne that I was proud to come from a nation with a strong track record in innovation and discovery. Scots such as Fleming, Watt and Bell led the way in discovery. International collaboration is the way forward. In 1922, Professor John Macleod from Aberdeen, working with two outstanding scientists—Banting and Best—discovered insulin. Before that date, type 1 diabetes was a death sentence in Scotland.

We have a great opportunity to raise the bar in healthcare. I again congratulate Stuart McMillan on his timely motion, which allows us to focus on the threats that diabetic retinopathy poses and to raise awareness of the importance of regular eye screening across every health board area in Scotland.

13:07  

Emma Harper (South Scotland) (SNP)

I remind members that I am a registered nurse and co-convener of the cross-party group in the Scottish Parliament on diabetes.

I congratulate my colleague Stuart McMillan MSP on securing the debate as part of national eye health week. Diabetes UK funded a programme in 1986 to take retinal photography screening out to people with diabetes. The Scottish diabetic retinopathy screening programme was started in 2003 and collected together what had been carried out before. According to the latest statistics from the Scottish diabetes survey, there are almost 260,000 people with type 2 diabetes living in Scotland. Everyone over the age of 12 with type 1 or type 2 diabetes should be screened but 42,076 people were not screened last year.

Screening, which is required annually, takes less than 10 minutes. That is great news. My sister Marina Forbes is a clinical ophthalmic nurse specialist and she informs me that people with diabetes who take up the offer of screening now have the same potential of maintaining the same eye health as those without diabetes. She also informs me that 30 per cent of visits to her clinics are made by people with diabetes. Many may have had type 2 diabetes for 10 years prior to diagnosis. The goal of the screening programme is to recognise problems and use the data from subsequent retinal photographs to track whether there is deterioration in the vascular structures and the macula. Early detection leads to early treatment, promotes visual health and keeps folk independent and able to remain in their own homes longer.

Diabetic retinopathy, of which there are various types, is the leading cause of preventable sight loss in working-age adults in Scotland. Background retinopathy is the earliest visible change to the retina, when the tiny wee blood vessels become blocked and are at risk of microaneurysm or haemorrhage. Maculopathy occurs in the most important area of the retina—the macula, which provides our central detailed vision. Proliferative—members should try to get these words out—retinopathy occurs when retinal hypoxia, which is low oxygen supply, allows new immature blood vessels to develop. Those immature blood vessels leak fluid, which damages vision.

Various treatments are available depending on the severity of the condition. Laser treatment, or photocoagulation, was commonly used prior to the advent of antivascular endothelial growth factor injections into the vitreous of the eye. Antivascular endothelial growth factor, or anti-VEGF, halts the production of extra protein and, in turn, the growth of new blood vessels.

Laser treatment revolutionised retinopathy treatment in the past; it was the only effective treatment. However, anti-VEGF treatment has superseded that—it is a great method of treatment. Together with effective screening and good blood glucose and blood pressure control, it can successfully maintain vision.

It is good news for NHS Dumfries and Galloway that the number of people who attend screening there is really high. I thank my colleague Dave Stewart for mentioning that.

The overtly symptomatic damage that is happening in people’s eyes could also be happening to the tiny wee vessels of their feet, heart and kidneys. The microvascular damage in the eyes can alert health professionals and direct further action so that the other vessels and organs can be monitored and protected, too.

Again, I congratulate Stuart McMillan on securing the debate, and Diabetes Scotland and RNIB Scotland on their campaign to mark national eye health week. It is important that everyone recognises the benefits of attending the regular eye screening services that are available to them, because it can save their vision.

I am one of those type 1 diabetics who are at risk, but I had my retinae photographed a couple of weeks ago as part of my eye screening programme and my eyes—my retinae—are doing fine.

The Deputy Presiding Officer

I think the official report will appreciate a copy of your speech with those spellings, Miss Harper.

13:11  

Alexander Burnett (Aberdeenshire West) (Con)

I join members in congratulating Stuart McMillan on securing this important debate on national eye health week. I also join members in commending Diabetes UK and RNIB Scotland for joining forces in the how do you see Scotland? campaign to raise awareness of diabetic retinopathy and the importance of screening. It is great to see those two charities working together to tackle the condition, which is caused by complications of diabetes, typically through high blood sugar levels damaging the back of the eye.

Constituents around Scotland who are watching our debate today might have some questions and, having read the briefings, I trust that I am now better equipped to answer them. I will rhetorically answer three questions so that our constituents can be better informed, too.

To those who ask whether they are at risk, I say that NHS Scotland advises that everyone with diabetes who is 12 years old or over goes for eye screening once a year. The how do you see Scotland? campaign has found that 15 per cent of those who are eligible for that screening have not attended in the previous 15 months. I urge those people to get an appointment, so that they have the opportunity to tackle the condition early.

To those who ask how they can reduce their risk of diabetic retinopathy, I say that they should attend their screening appointments, which are different from eye tests at the opticians as pictures are taken of the back of the eye to assess whether there is any damage to the blood vessels. Further, NHS Scotland advises those people to control their blood sugar, blood pressure and cholesterol levels and to take their diabetes medication as prescribed. I am sure that the majority of those with diabetes are all too aware of the importance of that, but we must raise awareness to remind those who are at risk.

On the final question of whether diabetic retinopathy can be treated, the sad answer is that there is no cure. However, there are treatment options. There are three different stages to diabetic retinopathy—background, maculopathy and proliferative retinopathy—and there are different treatment options for each, ranging from regular monitoring of blood vessels to laser treatment. We are told that, at all stages, it is crucial that people manage their diabetes. Controlling their diabetes can prevent such conditions developing at all, but, in the more advanced stages of affected vision, taking control can prevent the condition from getting worse.

I am aware of the great work that RNIB does for people across Scotland. One of my former members of staff has benefited from its work. Earlier this year, they ran the London marathon to raise funds for it. I give my personal thanks to both RNIB Scotland and Diabetes UK for the constant support that they provide to patients, families, communities and elected officials in informing us of important health issues that can affect us in so many ways.

13:15  

Colin Smyth (South Scotland) (Lab)

I echo others’ comments by thanking Stuart McMillan, who is a fellow member of the cross-party group on visual impairment, for lodging his motion and providing members with the opportunity to congratulate and thank Diabetes Scotland and the RNIB for their campaign to mark national eye health week by highlighting the threat to vision that is posed by diabetic retinopathy.

Some members will have seen the excellent campaign film by Diabetes Scotland and the RNIB, which has been shown in cinemas and online. It is a powerful film, and it hits home about the importance of getting one’s eyes checked in order to avoid sight loss, where possible.

As World Health Assembly figures show, sight loss is avoidable in 50 per cent of cases, especially when sight problems are detected early. We cannot underestimate the massive impact that loss of vision has on a person’s life. It can drastically affect their confidence, self-esteem and mental health. We all have roles to play in doing what we can to promote early detection of sight problems.

It is more than a decade since the introduction of free eye health checks by my Labour colleague Lewis Macdonald, who was the responsible minister at the time. The move brought about a step change in the eye health care pathway in Scotland and, since then, the number of eye examinations has increased significantly.

We cannot be complacent, however; we know that the number of people with sight loss is set to double by 2030. That is why, like Stuart McMillan, I welcome the findings of the community eye care review. The review sets out important recommendations on how best to achieve higher uptake of eye health checks, and it highlights how to do more with less to provide a good-quality service to all areas of Scotland by creating a national list of optometrists and dispensing opticians in order to improve service planning and reduce duplication, and by making some eye services that are usually provided in hospitals—for example, follow-up cataract surgery appointments—available more locally.

As we have heard in the debate, and as has been highlighted by Diabetes Scotland and the RNIB’s campaign, one of the factors that are contributing to the rise in sight loss is the increase in the number of people who are being diagnosed with diabetes. As members know, a key part of controlling diabetes is monitoring of blood sugar levels, which guides what a person eats and, often, how much insulin they take. At the moment, people with type 1 diabetes typically self-monitor their blood glucose level by using a finger prick, often about a dozen times a day and often during the night.

As I found out when I went on the recent visit to Kirkcudbright by members of the Public Petitions Committee, including Angus MacDonald—who was in the chamber earlier—stabbing your finger with a needle is not exactly a pleasant experience. I had to do it only once on that visit, but some children as young as three have to do it a dozen or more times a day, every day.

During that visit I had the pleasure of meeting local mums Seonaid Anderson and Emily Ross, whose daughters Maisie and Robyn have type 1 diabetes. They highlighted the alternative to the painful and distressing process of finger pricking—namely, continuous glucose monitoring, for which a small sensor is placed under the skin to check glucose levels. That allows for more frequent readings of glucose levels and for fine tuning treatment, and it reduces the need for painful finger pricking. However, it is not currently available on prescription. I urge the Government to consider seriously the case that is being made by mums like Seonaid and Emily and, more important, by their daughters Maisie and Robyn and many others across Scotland, and to make continuous glucose monitoring available on prescription.

The Government has a duty to support the best possible care for people with diabetes, and to raise awareness of the risk that consistently high blood sugar poses to their vision. That includes the importance of attending annual eye checks. That fits perfectly with the Scottish Government’s 2020 vision strategy, which emphasises prevention and anticipation in health and social care.

In order to anticipate which parts of the population are likely to have a bigger increase in sight loss, we need to know how many people currently have sight loss and the rate at which sight loss is rising. I therefore ask the cabinet secretary to tell us when figures on the number of blind and partially sighted people who are registered per local authority will be published. In the past, those figures were reported annually. A return to that frequency of reporting would be invaluable.

Once again, I congratulate Stuart McMillan on his motion. I hope that today’s debate will result in increased focus on how we can best promote prevention of sight loss, including by improved management of diabetes and by carrying out the recommendations that are set out in the community eye care review.

13:20  

The Cabinet Secretary for Health and Sport (Shona Robison)

I also congratulate Stuart McMillan on securing this important debate, and I join Miles Briggs in paying tribute to Brian Cox and his support for the how do you see Scotland? campaign, which is a powerful campaign, indeed.

I welcome Diabetes Scotland and the RNIB’s campaign to raise awareness of diabetic retinopathy and encourage attendance at screening appointments. This is an important initiative during eye health week; such campaigns are crucial for highlighting the on-going importance of attending regular eye screening appointments, as well as all other diabetes health checks.

It is regrettable that diabetic retinopathy remains the leading cause of preventable sight loss among people of working age in Scotland. The posters and film in the campaign clearly show how damaging and devastating retinopathy is. Far too many people have an eye test only when they experience a problem with their eyes or their vision, which might be too late. That is tragic and avoidable when one considers that current screening techniques are capable of detecting referable retinopathy at a stage at which, with proper treatment, the probability of preserving vision is high.

At the end of 2016, there were 291,981 people in Scotland diagnosed with diabetes of all types, which represents 5.4 per cent of the population. We know that on top of the life-changing effect of diabetes, the indirect costs that are associated with poor management are very high. Diabetes is an important issue to tackle at any time but, when we have financial pressures such as we have now on the national health service, it becomes even more pressing to ensure that we are doing everything that we can to address the avoidable complications of diabetes. That is why the Scottish Government considers driving continuous improvement in retinopathy screening practice to be an important priority.

Scotland has a world-renowned diabetic retinopathy screening programme, and I thank the diabetic retinopathy screening collaborative, which oversees the performance of the programme. In the past 15 months, 84.1 per cent of eligible people had their eyes screened by the DRS service. In 2016, 222,893 people had their eyes screened, which was more than ever. We must not be complacent, however, and we should seek to have even more eligible patients being screened for early signs of diabetic retinopathy.

David Stewart

Will the cabinet secretary have a look at the issues around the postcode lottery in screening? I made the point earlier about 8 per cent of patients in Dumfries and Galloway, but in the Highland Council area, 22 per cent of people do not turn up for retinopathy screening. It is a real issue across health boards.

Shona Robison

I was going to come on to talk about that, and I will do so. David Stewart also mentioned the health inequalities dimension. The Scottish diabetes group, which oversees, co-ordinates and reviews implementation of the improvement plan, is working to establish an inequality group to deliver the priority of equality of access. I will be happy to keep the member informed about that. It is about driving improvement and dealing with issues around differences in attendance levels, especially where there is a health inequalities dimension.

NHS Scotland has recently invested in a replacement information technology system for the screening programme, which was successfully implemented across Scotland early in 2017. The new system is now being used across all health boards to screen an average of 1,000 people with diabetes per working day. That system maintains and supports our commitment to people who have diabetes by providing the best possible care now and for the years ahead.

Members might be aware that Health Improvement Scotland revised DRS standards in 2016 to support staff and ensure that the highest standards of screening are achieved. The standards also detail what people, patients and their representatives, and the public can expect of the services. Two of the new standards relate to protocols for referral and treatment.

Ophthalmologists play a crucial part in delivering high-quality eye care for people who have diabetes. In the spring, I welcomed the publication of the national ophthalmology workstream, which demonstrates the benefits of close working between local clinicians, managers and the Scottish Government.

The report identifies solutions to improve the flow of patients through hospital ophthalmology services. That will be done by adopting new methods of working, using modern technology and making use of the entire workforce, such as by up-skilling the non-medical workforce, including nurses, to deliver anti-VEGF—vascular endothelial growth factor—injections and by optometrists reviewing lower-risk patients, to ensure that all patients get the timely hospital eye care that they need.

Retinopathy screening is one of the nine healthcare checks that people with diabetes should have. Only a few months ago, we ran a poster campaign in community pharmacies to encourage people to make sure that they get all their healthcare checks in order to better manage their condition and to help them to live a longer and healthier life.

We also need to ensure that people who are living with diabetes have the tools and skills to manage their diabetes well in order to prevent and reduce risk of developing complications that can have a significant impact on the quality of their life. That includes access to appropriate technology and support, treatment, and lifestyle management. “My diabetes my way”, for example, is an award-winning resource that enables people to see and check their clinical results and health information. It provides a wide range of advice and is demonstrating its value in helping people who use it to improve their blood glucose control.

We recently allocated additional funding to support not only the increase in the provision of insulin pumps for adults but—importantly, as Colin Smyth mentioned—to support continuous glucose monitoring for those who have the greatest clinical need and who will benefit most from that important technology.

A newly formed expert group is leading work on the prevention framework, which focuses on supporting NHS boards to help people to reduce the risk of complications, and on identifying people who are at high risk of type 2 diabetes and taking action to reduce their risk of developing the condition, including through lifestyle changes.

It is recognised that many long-term conditions, including type 2 diabetes, are related to lifestyle factors such as obesity, lack of exercise, smoking, excessive alcohol intake and poor diet, and to the health inequalities dimension that I mentioned earlier. In our programme for government, we have already set out that we will consult this year on a range of actions to deliver a new approach to diet and healthy weight management.

There are no simple solutions for addressing diabetes, but Governments, patients and wider society all have roles to play, as do members of Parliament. Together we can build on the real and tangible progress that has already been made towards preventing the complications of all types of diabetes and towards improving the quality of life of the tens of thousands of people in Scotland who live with the condition.

13:27 Meeting suspended.  14:30 On resuming—