The final item of business this evening is a members’ business debate on motion S6M-13791, in the name of Foysol Choudhury, on the importance of medical technology for patients with diabetes.
Motion debated,
That the Parliament recognises what it sees as the vital importance of medical technology, especially real-time continuous glucose monitoring (rt-CGM), for patients with diabetes; notes the Stanford University study that highlighted that type 1 diabetics, and those who use insulin to manage their condition, make about 180 more decisions each day about their health than those without diabetes, and that access to diabetes technology helps to reduce this burden; welcomes the recent SIGN guidance to improve the accessibility of such technology to patients via NHS Scotland; understands that many patients are not able to access rt-CGM or are being forced to switch to a product less suitable for their needs; is concerned about the impact that changes to product use and a lack of access to medical technology is having on patients and the potential impact on diabetes complications; recognises what it sees as the value of sustainable multi-year funding and lifecycle cost benefit analysis in diabetes care, and notes the calls on the Scottish Government to consider what action can be taken to protect patients, including those in the Lothian region, and maximise the availability of cost-saving medical technology.
17:20
It is an honour to open my members’ business debate. I thank all members who have signed the motion and everyone who has chosen to attend today to discuss this important issue. I offer special recognition to the campaigners and type 1 diabetics who are watching in the public gallery and online, and I thank them for their hard work.
Some 36,000 Scots live with type 1 diabetes, a chronic condition that cannot be prevented and that must be managed 24 hours a day. People with type 1 must constantly adjust their insulin levels on the basis of what they have eaten or how much physical activity they have done. At least 42 different factors affect blood glucose levels, and too much or too little insulin brings about a number of health issues, including hypoglycaemia, heart disease and blindness.
Diabetes technology, which refers to technology for administering insulin, checking blood sugar and general management, can be transformational in improving the quality of life of people who live with type 1. The most effective form of diabetes technology is the hybrid closed-loop system, which involves an insulin pump combined with a continuous glucose monitor that automatically doses insulin. It means less finger pricking, no more injections and no more planning one’s life around one’s condition. It is the closest thing that we have to a cure, but, sadly, that life-changing technology is unavailable to many.
In October, I hosted a round table on diabetes technology at which I heard from health practitioners and people living with type 1. The stories that I heard included that of a woman whom we will call Jane, who described a constant battle to keep her blood sugar at the right level. She said that she would wake up every night, sweating and drowsy with low blood glucose. Her diabetes affected her hobbies and her ability to drive her car. Indeed, one day she was forced to do eight injections and 16 finger pricks, and she described her situation as a “never-ending cycle of despair”.
Given that people with type 1 diabetes make, on average, 180 more decisions each day than those without, the impact of technology in lessening that mental burden and improving wellbeing is massive. Jane, however, does not have access to a closed-loop system. Like so many others, she has faced the twin battles of long waiting times and a shocking lack of choice in how their care is delivered. The waiting time for an insulin pump is over a year in every national health service board, with the longest wait coming in at over five years. The number of people referred to NHS Lothian for diabetes technology is projected to grow to 1,200 by March this year. That alone should be alarming. Even after being seen, diabetes patients are being failed.
There is no single treatment for diabetes. Diabetes devices have different algorithms and features for managing blood glucose. For example, some devices have a “follow me” function that allows parents and carers to track their child’s glucose levels using their mobile phone. That is essential if a child is to go out to play or to compete safely in sports.
Choice in technology is explicitly recognised by the Scottish Intercollegiate Guidelines Network guideline “SIGN 170: Optimising glycaemic control in people with type 1 diabetes”, which states that adults should be offered
“a choice ... based on their individual preferences, needs”
and
“characteristics”.
In Scotland, however, that guidance is not followed, and many national health service boards offer only one device.
Jane was told that the pumps that she needed to manage her condition were “too expensive”. Users are being moved to less suitable options, which is putting them at risk. The safety and the needs of users must come first. In England, people are given a choice. Type 1 diabetes does not change once someone crosses the border, so why should type 1s in Scotland miss out and receive worse care on the basis of where they live? We must see action to ensure that SIGN guidelines are followed by all clinical teams.
Last year, the Scottish Government pledged up to £8.8 million to increase the provision of diabetes technology. Improved funding is welcome, of course, but despite that new funding, NHS Lothian states that diabetes technology remains a “significant financial pressure”. It has been found that treating complications from diabetes costs the NHS approximately 10 per cent of its whole budget, while the University of York has found that diabetes results in a productivity loss to the UK economy of £3.3 billion. Diabetes technology is genuinely preventative care that will save the NHS money in the long term, and we should be doing far more to ensure that it is widespread.
England has a five-year plan to ensure that 90 per cent of children and 50 per cent of adults with diabetes get such technology. The Scottish Government should be as, or more, ambitious, with a long-term plan to get every adult and child the technology that they need, adequate multiyear funding and full implementation of SIGN guideline 170 to guarantee choice in devices.
I finish by asking members to place themselves in the shoes of someone with type 1 diabetes, who knew that, although the technology that would change their life was available, there was no political will to ensure that they got it soon. I ask members to imagine the frustration that they would feel day by day. We cannot tell people just to wait. People with type 1 diabetes should not have to fight for their care.
We move to the open debate. I ask for back-bench speeches of up to four minutes.
17:28
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.
17:33
I thank my colleague Foysol Choudhury for bringing the debate to the chamber on behalf of those across Scotland who are living with type 1 diabetes. I also thank Emma Harper for sharing the story of her own journey with type 1 diabetes.
The debate focuses on the importance of medical technology and, more specifically, on how important diabetes tech is—as we have heard—for individuals in managing their diabetes. According to Diabetes Scotland, diabetes tech aids people in monitoring their blood sugar levels or taking insulin, and includes insulin pumps, continuous glucose monitors and hybrid closed-loop systems, which connect a continuous glucose monitor with an insulin pump that adjusts insulin levels automatically in many instances. That tech spares people who are living with diabetes from having to do painful finger-prick tests regularly. Given that the technology is a vital part of the lives of people who live with type 1 diabetes, proper funding is essential in ensuring that their needs are met.
Last summer, the Scottish Government recognised that with its £8.8 million commitment to improving access to diabetes technology, which is very welcome. The same commitment was meant to align with the Scottish Health Technologies Group’s recommendations and with the SIGN guidelines, which are designed to give young people and children access to technology in such a way that they can exercise choice.
Despite that positive commitment, however, concerns remain regarding accessibility and choice. For example, numerous families feel that their needs are not being met, because, although central funding covers insulin pumps and glucose monitors for those under 18, their options are still quite limited. That can contribute negatively to people’s quality of life, which is already impacted by managing their diabetes. According to IPAG Scotland, managing type 1 diabetes means—as we have heard—that an individual has to make an extra 180 decisions every day. Accessible technology that provides real-time information can significantly improve that daily challenge.
However, the challenges remain on-going, so we need to consider what can be done to address them. Fortunately, organisations such as Diabetes Scotland and IPAG Scotland have spelled out some recommendations with that goal in mind. They have advocated for regular reviews on how funding is used, promoting greater access to hybrid closed-loop systems and tailoring approaches for paediatric-specific needs such as remote monitoring. Moreover, they have pressed for ensuring that guidelines are followed by all health boards and clinical staff to ensure safety, and that patients and their families are informed of all available choices in diabetes tech so that they are empowered through making their choice.
There are currently 36,000 people across the country who are living with type 1 diabetes, and it is clear that there is a need to address shortcomings in respect of the diabetes technology that could help them to lead better lives. I join campaigners in welcoming the financial commitment that the Scottish Government made last June, but also in believing that that is only one part of a long-term approach.
I look forward to working with members on all sides of the chamber to help to make that goal a reality, and I am eager to see what positive changes we can bring about in 2025 for people who are living with diabetes.
17:37
I thank my colleague Foysol Choudhury for securing the debate; his motion could not be more timely. The progress that has been made on diabetes technology illustrates the very best of human ingenuity. Before 1921, a diabetes diagnosis was a death sentence. Now, just over 100 years later, we have modern technology—such as the hybrid closed-loop system, which can monitor and administer insulin without any input from the patient—that allows those with type 1 diabetes to live longer lives and to eat what they want, and even to win Olympic medals. Diabetes no longer has to be the burden that it once was. The technology is incredibly effective. It can fundamentally change a patient’s life and can bring blood sugar down to safe levels, thereby avoiding further complications.
The problem is, however, that the tech is not making its way to patients quickly enough. I constantly receive correspondence from constituents who are simply unable to access that life-changing technology. My own freedom of information request revealed that there are almost 1,000 people who are sitting on waiting lists for an HCL system in NHS Lothian. It is incredibly disappointing that, even in our own capital city, we are unable to make progress on rolling out HCL systems at the scale that is needed. It is vital that we invest in that technology, and we must not let the up-front costs of such tech cloud the massive impact that it has both on patient outcomes and on the NHS more widely.
We all know that our NHS boards are under immense pressure and that staff are doing their best in challenging circumstances. However, if we could roll out the technology faster, the benefits to our NHS would be extraordinary. The statistics that I was given by Dexcom last year show that diabetes costs NHS Scotland £1 billion a year, £800 million of which is spent on treating avoidable complications associated with diabetes. That is why investing in the tech is vital: it saves money and capacity across the NHS.
I appreciate the minister’s collaborative approach to the issue and I have corresponded with her on many occasions, but we need to keep pushing for action, because patients do not feel that they are getting the support that they need. One of my constituents thought that he had been on the waiting list since 2021; it was only on inquiring that he found out that he had not been added to the list until 2023. Another constituent has been unable to get access to the HCL system, as only one manufacturer offers the device in Scotland.
Yet another constituent of mine was on a trial for the HCL system and was amazed at how life changing it was. Her haemoglobin A1C levels dropped, and she saw vast improvements in her glucose levels. On completion of the trial, however, she was told that she would not be able to keep the HCL system, and she had to revert back to her previous system instead.
Those with diabetes already have greater pressures placed on them, whether it is the extra financial cost of ensuring that their snacks and emergency glucose are always supplied or the pressure—which both Emma Harper and Foysol Choudhury mentioned—of having to make 180 extra decisions a day. Access to diabetes tech is not just about people’s health; it is about giving people a much greater quality of life.
We must keep working on the issue together, and I hope that the Scottish Government continues to work constructively with members and with health boards to ensure that the tech is rolled out as soon as possible, because it cannot be right that people in Lothian who are on low incomes are less likely to be able to access diabetes tech. It is life-changing tech: it keeps people well and healthy and enables them to be economically active. In addition, it is an investment that will pay back and will save our NHS money. We therefore need those patients who could benefit from such tech now to receive it as soon as possible.
17:41
I, too, congratulate the member on securing the debate.
I take members back to a time when the only method to manage diabetes—indeed, it is still the case for too many—was the constant pricking of fingers to obtain a blood sample, checking it and then having to inject insulin to redress falling blood glucose levels. That had to be done not just once in the course of a day—a person’s type 1 diabetes dictated their daily life.
I have had colleagues, and I have family members, with type 1 diabetes who were once required to use that system. Often, it was only when they became aware that their levels were falling that they tested their glucose levels. If the level had gone too far, there was the danger of a hypo, with all the health problems that would follow. That was a particular worry for children with diabetes.
Today, there are very welcome technical devices—I am not good on technicalities, so I will tread warily. For example, there is the flash glucose monitor and there is the continuous glucose monitor, and there are hybrid variations thereof. With a CGM, as I understand it, a person’s latest sugar levels show up on their device or mobile phone automatically, transmitted by Bluetooth. With a flash glucose monitor, it is only when they wave or scan their device over the sensor—the little white button on their arm—that they get their sugar readings. I have seen that in operation with a family member, who has also added to it an automatic pump for insulin. That is what I mean by talking about hybrid variations.
Those systems have to be tailored to the individual; it is not simply a matter of the NHS handing over the devices. First, they must be clinically recommended, and then an individual must be taught how to use them and must feel confident in their use. However, it makes such a difference to everyday living, as I have observed with my family member. Managing diabetes becomes an everyday thing, without a constant and inhibiting concern about blood sugar levels. With experience and the right technical device, the technology takes care of itself. As I said, I have seen that with the experience of my family member, who has—as I explained—a hybrid flash device plus the automatic pump, which is very discreet. For parents and carers of children, it is a godsend. As members will appreciate, the technology can be accessed and monitored by a parent or carer, including overnight, when worries may grow.
Last year, the Scottish Government provided Scotland-wide funding of £8.8 million for the expansion of access to diabetes technologies to support the purchase of new kit, although that funding is not allocated directly to NHS boards but is, as I understand it, part of their overall support. I very much welcome the investment, not only—as others have mentioned—as preventative spend, but, more importantly, because it releases those who are living with diabetes from the worry and travail of the old methods.
I know that issues remain with the supply of pumps and associated technologies, as others have mentioned, so I will check again with NHS Borders the position for 2025, and I await the minister’s comments in her summing up. Enabling access to such technologies seems to be the right and decent thing to do for people with type 1 diabetes, and it will prevent more serious health issues in the mid to longer term.
17:44
I, too, congratulate my colleague Foysol Choudhury for bringing the debate to the chamber. Most people know that I have a long-standing interest in health technology generally and in diabetes specifically. Emma Harper and I co-convened the cross-party group on diabetes in the previous parliamentary term, which is when I began to really understand the importance of technology in the treatment of diabetes, and the cross-party group pushed hard for the adoption of such technology.
I have a specific interest because I used to coach somebody with type 1 diabetes. Along with him, I had to learn how to manage his condition while he was training. He would do a finger-prick test when he arrived at training to understand his blood sugar level, which he would manage with a certain fizzy drink. He had to do finger-prick tests throughout the training session to continually manage his blood sugar level. He was very successful—he medalled at Scottish level in the 1,500m. As members are aware, I am an advocate of managing health with exercise and diet, and I feel that being a sportsperson gave him an incentive to manage his condition as well as he could using that method.
I also have a friend whose daughter was born with type 1 diabetes, and she had to do the pin-prick test on her stomach. I tear up every time I think about the fact that my friend used to pin-prick his stomach at the same time, so that it was a shared experience—he is a wonderful parent.
Back when I was co-convener of the cross-party group on diabetes, about five or six years ago, we were pushing the issue and the Government provided money for a trial of the technology. As members have said, the positive impact on people’s quality of life is obvious. For example, parents do not have to wake their children in the middle of the night to test their blood sugar level. It means that much more normality in life is possible.
As has been said about the cost to the NHS, something like 10 per cent of the Scottish health budget is spent on treating diabetes and its complications. We could take all that money and reinvest and reinvest and reinvest. We need a programme that pushes the approach further upstream, so that we get to a stage where those who suffer from type 1 diabetes specifically have access to this technology. It is such an obvious thing to do, and it worries me that it is taking this long. Here we are, still talking about the issue five or six years on from my time as co-convener of the CPG.
I will move to a slightly different area and mention type 2 diabetes. Exercise, diet and changing behaviour can, in many cases, not only prevent type 2 diabetes—it can certainly prevent it from deteriorating—but even put it into reverse. That is important because saving money that is spent on treating type 2 diabetes will release even more money in order to develop a cure and treatments for type 1 diabetes.
I will stop there. I again congratulate my colleague Foysol Choudhury on bringing the debate to the chamber, and I thank him for allowing me to speak on diabetes once again.
17:49
I thank Foysol Choudhury for bringing the debate to the chamber. I was really interested to see it on the agenda and to hear from members tonight.
We have spoken previously in the chamber about diabetes and diabetes care, so I know that there is enthusiasm among members for advancing the issue, and I know that some members bring expertise to the debate. I hope that Emma Harper knows that I have great respect for the work that she has done on the cross-party group and the way in which she tells her stories.
From a previous role, I, too, have some experience of working with people who have diabetes. I spent many years working as a dietician in the NHS and, in my early career, I covered diabetic clinics along with a specialist diabetic nurse and other members of a multidisciplinary team. Diabetes is a condition that patients manage and live with, and I learned much about the adaptability, resilience and humour of people following the diagnosis of such a life-changing condition.
The work also gave me a lifelong admiration for the dedication of NHS staff in building up relationships with patients who have enormous hurdles to overcome in their many years of treatment. I would like to give a big shout out to all those staff, including those who work in the background in research and medicine development and, as we are discussing tonight, medical technology.
In a previous debate, we spoke about insulin and its relationship to diabetes and we all agreed that it is one of the greatest medical breakthroughs in history. It changed the lives of many millions of people by ensuring that the diagnosis of type 1 diabetes was no longer a death sentence and by enabling them to have a life worth living. I still think about our responsibility to make life all that it can be for people and how, as medical technology advances, we must make sure that it works for those who need it most.
As we have heard from members, and in the words of the motion, the Parliament recognises
“the vital importance of medical technology”.
Tonight, we are focusing on real-time continuous glucose monitoring and how it can transform the lives of those who use insulin and help them to manage their condition.
Other members have mentioned the research that is being done at Stanford University, and we understand that people who have diabetes make about 180 more decisions each day about their care and health than those without it. Access to diabetes technology can and will help to reduce that burden. If we want people to live full lives, we have a responsibility to use the technology. Foysol Choudhury explained that eloquently when he shared Jane’s story.
Managing lifelong conditions can take its toll on individuals and their families, so it is important that, as parliamentarians, we acknowledge our role in fighting for services and for having every possible advantage made available to people as quickly as possible, so that they get maximum benefit—and, of course, for those services being made accessible to all.
There are many elements that we could bring to tonight’s debate, including diabetes diagnosis, treatment and life with diabetes in general, but this short debate gives us the chance to raise only one or two issues. In the time that I have left, I want to talk a little bit about tackling the inequalities around diabetes care, particularly the link between inequality and diabetes outcomes.
From years of research on the realities of living with diabetes, particularly for those who come from a more deprived background, we know that those who live in the most deprived homes are up to twice as likely to develop complications from diabetes as those who live in the least deprived homes. The stark figures show that, for many, the reality is that where they were born unfairly lays out their future, particularly when it comes to health and health outcomes.
Technology can play its part in tackling health inequalities. So, as we fight for those technologies to become part of mainstream care, I want us all to reflect on the availability of and access to medical care, treatment and technology. Let us ensure that technology in diabetes care is at the forefront of reducing health inequalities and that it helps to improve the lives of many of our constituents.
17:54
I thank my Lothian colleague and friend Foysol Choudhury for securing the debate this evening. It is an important debate, and I welcome and support the campaigning that he has been doing on the issue for some time. For those of us who are lucky enough to represent Lothian and constituencies that are covered by NHS Lothian, this is an important issue, and I hope that the minister will hear my call for action this evening.
I welcome the constituents who are in the chamber with us. The service levels that are being provided in Lothian are falling way below what any of us would expect, and that has to be addressed by ministers. I have spoken to many constituents who have now given up on the idea that the technology will be available to them in their lifetimes—other members have raised that issue—and that has to change.
The Government has said that it wants the technology to be made available—I have several letters from ministers that say just that—but those of us who attend NHS Lothian briefings know that that is not the case. The financial situation that the health board faces, with a projected shortfall of £133 million, means that it has looked for cost savings in this area—now, only pregnant women and children will be able to access the technology. We need that to change, and I hope that ministers are acutely aware of the situation in Lothian and the need for that issue to be addressed. In its diabetes improvement plan, which was published in February 2021, the Government said that it was committed to providing the technologies to improve the quality of life for people living with type 1 diabetes.
It was interesting to listen to some of the stories, because one of my good friends from school had type 1 diabetes. We worked in a pub together, and I was just thinking of the way in which she went about her working life in the pub. I was in the kitchen with her at the time, and she would test and grab a drink and then go back to work.
The technology that we now have can transform lives. I welcome Emma Harper’s advocacy—she is living proof of the technology’s use, and we should all want our constituents to have access to it. It is estimated that the technology can add another 10 years to people’s life expectancy. However, it is about not just life expectancy but potential cost savings, because we know that diabetes can lead to additional accident and emergency department admissions, and blindness, and those of us who visit hospitals—I previously had the health portfolio—have talked to patients who have had amputations because of their type 1 diabetes. Therefore, we know that the issue will cost the NHS even more in the future.
I hope that the debate has presented the opportunity for, as the Diabetes Scotland charity has called for, the Scottish Government to consider matching the actions that are being taken in England, where a five-year implementation plan has been funded and the roll-out of the closed-loop systems has been announced. It was put to me that, if this was a drug, not a piece of technology, there would not be discrimination in different health boards, especially in NHS Lothian, in my region. I hope that ministers will take that on board. If the technology is to be provided, it must be provided on an equitable basis across our country. There is a lack of provision of the technology for my constituents in Lothian. In fact, it has been suggested to me that it is likely that only 30 adults will receive a pump in the next two years. The waiting list currently stands at 1,200, so we need action.
I hope that the debate has presented the opportunity for ministers to hear our concerns, especially those of Lothian members, and that, in the minister’s summing-up speech, we will hear exactly what the Scottish Government intends to do.
17:58
I, too, thank Foysol Choudhury for bringing the motion to the Parliament. He has reminded us clearly of the daily challenges that people who are living with diabetes face and how technology can transform their lives.
I thank colleagues across the chamber for their contributions and for sharing their experiences of living with diabetes or supporting people who do. I always think that it is helpful when someone who does not live with diabetes shares their experiences, so I thank Brian Whittle for that.
It has been a very informative debate, and I have been heartened to hear that members across the chamber recognise the importance of expanding access to diabetes technology. I thank all those who have travelled here tonight, those who are watching and those who have generously shared their stories with me and colleagues. I also thank Carol Mochan for raising the importance of not forgetting about inequalities and for setting out how diabetes can impact on different areas of Scotland.
It remains the Scottish Government’s ambition to make diabetes technology available to everyone in Scotland who would benefit from it. The Scottish Government has committed to doing that for all children and young people, as well as to working towards universal access for adults. I regularly hear from people who are living with diabetes about the importance of continuing to work towards making the technology available to all.
I would like to reflect briefly on where things were just one year ago. Many members told me of the considerable waiting lists that constituents were facing and that many of them had a sense of hopelessness about the lack of protected funding. Miles Briggs, Foysol Choudhury and Sarah Boyack all talked about the situation in NHS Lothian. I am aware of that situation and I am pleased that my officials are working very closely with NHS Lothian. We discuss that issue a lot.
I recognise that there is more to do, and I am under no illusion that the job is complete. Before I touch on some of the key issues that have been raised, I would like to outline the significant progress that we have made since last year. However, before I do that, I thank the local services and give them credit for their unwavering commitment to the programme. The process has been no mean feat, so I highlight the work that each and every diabetes team has had to put into it. As Emma Harper did, I also thank the staff for the non-judgmental support that they provide to people who are living with diabetes.
This year, we entered a new phase of delivery by establishing a national programme. The primary aim of it was to remove the postcode-lottery elements of care that many people were experiencing. The programme began in May last year, with an initial investment to support 2,100 individuals to receive an insulin pump or a continuous glucose monitor, or both, and to create a hybrid closed-loop system. That was on top of the £29 million that we have invested in diabetes tech since 2016.
The initial focus of the programme has been to provide a closed-loop system to all children and young people who want it. As it stands, 64 per cent of children who are living with type 1 diabetes have access to a closed-loop system, and we expect the figure to be around 80 per cent by the end of this financial year. Some health boards have already exceeded that target. We know that access for young people in Scotland is catching up with the situation in the rest of the world. I reiterate how life changing that will be for many families, which Christine Grahame spoke about.
One reason why we have been able to do that at pace is that we commissioned a new national onboarding service. That team is comprised of highly experienced diabetes clinicians and, whih is most important, peer-support staff, who all help people to learn to navigate living with their new normal, which is their living with a closed-loop system.
Although I am proud to outline to members the significant progress, I also recognise the challenges that remain for many people. As others have said, more than 35,000 people are living with type 1 diabetes in Scotland, and demand for diabetes tech currently outstrips the capacity in the system.
I will respond to Annie Wells’s concerns about brand choice for children. I am aware that there is growing concern that children cannot access the most appropriate technology for their needs, but I reiterate that the national programme has provided adequate funding to allow all local services to provide any of the CGM brands that are available on the market. However, it is important to note that a prescribing clinician might feel that they can maximise access to the kits, while providing safe and effective care, by using more cost-efficient brands. I cannot discuss the cost details, but there are significant differences. Our clinicians may offer a lower-priced brand to allow more of their patients to access the technology, although individuals and families should continue to have conversations with their clinician team. I again reassure members that the national programme is committed to supporting brand choice for children and young people.
Mr Choudhury and others asked about the plan. Although other nations have published strategies and targets, we were fortunate in Scotland to be able to kick-start a significant roll-out programme as soon as funds were released. We have also found that negotiating with suppliers to secure bulk national deals has allowed us to secure the best deals; setting targets for the numbers might have prevented us from achieving the current prices.
We are also able to work with officials to secure appropriate investment year on year and to ensure that it reaches as many people as possible. I reassure members that, although we do not have a formal publication, we are rolling out at pace, which is, I am sure, what matters to most people who are living with diabetes.
Brian Whittle’s comments allow me to talk about the preventative side and the work that we are doing on the population health framework with the Convention of Scottish Local Authorities and in collaboration with Public Health Scotland, directors of public health and key local, regional and national partners. I look forward to working closely with Mr Whittle and others on a clear focus on prevention of type 2 diabetes. I completely understand that different approaches are required for people living with type 1.
People with type 2 diabetes are sometimes blamed for their condition, with people saying that it is a lifestyle issue. That is wrong. I know perfectly well that that is not the case, because a member of my family who is as fit as a fiddle and who has a handicap of 2 at golf was diagnosed with type 2 diabetes. I just want to put that on the record. There is a blame game attached, sometimes.
I agree with Christine Grahame. I have a close friend who lives with type 2 diabetes, which I would suggest is nothing to do with her lifestyle.
I will close by mentioning the continued push for a faster and firmer commitment to diabetes tech. I want to be clear that the Scottish Government continues to strive for universal access but, unfortunately, neither the system nor the finances can support that happening overnight. Advances in technology are frequent, and we want to be ready to pivot to any opportunity to provide support at pace. I am unable to confirm the expansion rate for the next financial year, but we continue to work with all stakeholders to understand what support is required to do that. However, the funding that we set aside in May is continual.
I reiterate my thanks to the type 1 community across Scotland, which has enabled this transformational change, and I hope that we can continue to work together to support access to tech for all.
I know that Jenni Minto is closing, but can she confirm that that funding is recurring? Is that correct?
Yes—the £8.8 million is recurring.
As Sarah Boyack has asked for, I will continue to work collaboratively with members from across the chamber and with health boards to ensure that we give those who are living with type 1 diabetes the right support at the right time.
Meeting closed at 18:07.Air ais
Decision Time