Item 5 is next, and that's a statement by the Minister for Health and Social Services: quality statement for diabetes. I call on the Minister to make the statement—Eluned Morgan. 

Diolch yn fawr, Dirprwy Lywydd. Today, as part of Diabetes Week, I have published the quality statement for diabetes, setting out the key service priorities for the development of better diabetes care across Wales.

Diabetes has a significant impact on our population. Around 7 per cent of the population is registered with a diagnosis of diabetes. That's around 207,000 people and their families affected. It's estimated that the NHS uses around 10 per cent of its budget to treat diabetes and the serious complications it can cause. The same study that was undertaken in, I think, 2012 predicted that that would rise to 17 per cent by the mid 2030s, given the likely growth in the number of people with diabetes. So, it's clearly a very serious problem for our population and the future sustainability of our NHS. We can already see how the NHS is struggling to meet increased population need for treatment and care. These pressures will only get more difficult to deal with and have yet more serious consequences if we don't act as a society, if we don't come together to address the risk factors associated with conditions such as diabetes, cardiovascular disease and cancer.

Let me be absolutely clear that type 1 diabetes, which affects around 16,000 people in Wales, cannot be prevented. People with type 1 diabetes tend to be diagnosed during childhood and have to manage through adolescence and into adulthood with vital support from our NHS. But the link between obesity and type 2 diabetes is firmly established. Without a healthy diet and appropriate exercise, obesity can lead to type 2 diabetes over a relatively short period of time. We know reducing body weight, by even a small amount, can help improve insulin sensitivity and lower the risk of developing conditions such as type 2 diabetes, heart disease, and some cancers. We know obesity and physical inactivity are more prominent in areas of greater deprivation. If we're going to avoid some really difficult decisions down the line about what the NHS can provide more broadly, then we need to address these risk factors and their determinants. This includes what we can do in Government; what local government does to enable people to live healthier lifestyles; the role of industry, and in particular the food industry; and how every single person lives their life. We must all pull in a healthier direction if we are to have a sustainable NHS.

Our approach to prevent and reduce obesity rates is set out in our 10-year 'Healthy Weight: Healthy Wales' strategy. We've continued to invest more than £13 million between 2022 and 2024 to improve access to treatment and increase the focus of partners on prevention. We're using a mix of funding, policy and legislation to drive change.

The Deputy Minister for Mental Health will be making an oral statement on 27 June, and this statement will set out our next steps with regard to price promotions on foods and where those foods are located in shops. As part of the strategy, we have also invested £1 million per year into the all-Wales diabetes prevention programme. This programme is being piloted across Wales to help those on the cusp of developing diabetes, to put a bit of distance between them and the condition. There have been more than 800 consultations through the programme, and I recently visited the programme in Cardiff and Vale, alongside Lynne Neagle, to see for ourselves how it works.

As well as this primary prevention, the quality statement for diabetes focuses on NHS support for people with the condition. It includes the development of so-called 'remission' services, where some people with a recent diagnosis can be supported through radical changes to their diets and their lifestyles to reverse the development of type 2 diabetes. The statement places a great deal of focus on good supportive care, to help people manage their diabetes well, including the delivery of routine reviews, diabetes technology and education programmes. This support will help people to avoid the serious complications of damage to the heart, kidneys, eyes and feet.

And finally, we've also included tertiary prevention, where we monitor for early signs of other disease, such as retinopathy, through the diabetes eye screening Wales service. Ultimately, our aim is to prevent people from developing type 2 diabetes, and, for those who do develop the condition, to ensure that the NHS is providing the support that people need to manage their condition as best they can. The quality statement is intended to guide the consistent planning of NHS services through the setting out of national expectations and clinical pathways of care. We will work closely with the NHS to implement this through our local planning processes. Progress will be measured through the national clinical audits for diabetes, and we will increasingly make this information public so that we can all see what progress has been made, and where we need to focus our improvement efforts. And we will ensure that these expectations are realised through the NHS accountability arrangements. Thank you very much.

Can I thank the Minister for the statement today? I'm pleased that we have a quality statement for diabetes in Wales, because I think we need something for Government policy to orientate around a set of guidance or aims that will help focus policy makers in every sector to eliminate preventable diabetes. I think it is significant, isn't it, that one in 13 people in Wales live with diabetes. That's roughly the population of Wrexham, Barry, Llanelli and Merthyr Tydfil combined. So, I think that does give us some perspective of the problem at hand. And Wales is on track to see a third of its population reach obesity and 10 per cent developing diabetes. We already, of course, also have the highest prevalence of diabetes of all UK nations. 

So, one of the ways to review the current level and status of care for people living with diabetes in Wales is the national diabetes audit. NDA data is a measure of the effectiveness of delivery of diabetes care against the National Institute for Health and Care Excellence guidelines. So, the data is, I think, pretty crucial in monitoring, identifying and recognising good and less good care. So, I wonder if the Minister could tell us what she expects the NDA data for this year to be. Has she any indication that Wales is now performing better and will be back to, perhaps, pre-pandemic levels at least? So, a sense of where she thinks that is or going to be. 

I should also note that the NDA data does not cover children, so we are relying on the Royal College of Paediatrics and Child Health report. Their most recent report for England and Wales in 2022 found that incidence of type 1 diabetes increased significantly by 21 per cent in just one year, and half of children with type 2 diabetes were assessed as needing additional psychological support. Now, as I've understood it, Minister—I might be wrong here—but Wales only releases its data at health board level every 18 months. And as I've understood it, in England it is quarterly and can be seen at GP cluster level. So, I wonder if that is correct and the Minister agrees with that position. Does the Government have any plans to change the way data is released and how often we can see it, because such levels of scrutiny would be, I think, welcomed in Wales to help determine how best to improve services in Wales to ensure that people receive equal access and treatment, no matter, of course, where they live? 

Last month, Public Health Wales released the latest child measurement programme for six health boards within Wales for school years 2021-22, and across five of these, the proportions of children with obesity were higher compared to the proportions reported in 2018-19. Now, as the Minister has pointed out in her statement, given the link between obesity and diabetes, I wonder if the Minister perhaps can tell us how she's working with the education Minister to communicate the links between diabetes and diets to pupils, teachers and parents. I know the Minister touched a little on that in her statement. 

Moving on to the parent experience, I wonder if the Minister is confident that the new quality statement will make life easier for those already with diabetes. A survey by Diabetes UK earlier this year found that over half of its respondents in Wales experience difficulties managing their diabetes, with those from the more deprived areas more likely to have experienced such hardships. 

And finally, I would like to raise the issue of technology. The survey found that technology made diabetes management, and thus life, much easier for people, but access, affordability and knowledge of these vary across health boards. We even see the healthcare professionals using paper notes and the different referral systems failing to communicate between clusters of GPs and health boards, so this means that some local health boards are unable to read the data from the newest technologies, which renders the tech, of course, useless in terms of improving virtual consultations and improving access to good diabetes management. So I wonder if the Minister can use this opportunity to commit to harmonising systems across Wales, Welsh healthcare, jurisdictions and bodies, and ensuring equitable access, funding and training to them to ensure that we do not develop a postcode lottery, which we don’t want to see. Thank you, Deputy Presiding Officer.

Thank you very much. I think the situation is very, very serious, and as a nation, we need to take this very seriously, because frankly if we don’t, the situation will be unsustainable for the NHS, and the costs will run away from our ability to pay for it. So, everybody needs to take this seriously, and what we’re trying to set out here are some expectations in terms of what those people with diabetes can expect across every health board as a quality standard, so we’ll get away from a postcode approach.

One of the things you talked about is the transparency and the access to data, and that’s certainly something that I’m interested in seeing—how can we make sure that we get more access to the data? Because I think transparency, actually, helps to shine a light on those areas that are perhaps falling behind. So, that’s certainly something that I’ve talked to my officials about.

Just in terms of where we’re at, in terms of the national diabetes audit, we’re still not back to where we were pre pandemic, so that’s not good enough and we need to see improvements. So, I am expecting the data to be better, but part of what we’re trying to do here is to make sure that everybody has a very clear understanding of what the expectations are. It has not been consistent in terms of which GPs have gone back to the national diabetes audit that is expected and that was happening pre pandemic. So, there are pockets, they’re varied, and we need to see better consistency.

Just in terms of children, of course type 1 diabetes, that’s usually actually detected whilst people are children, so we need to make sure that all of that—. It’s very different, and I think we probably should deal with it very differently from type 2 diabetes. One of the things that we do have to take seriously also is the psychological support. It’s very interesting—Lynne Neagle, the Deputy Minister, and I went to visit a project yesterday in Cardiff where we met a woman who was very, very anxious because of her diabetes situation, and the course that she’d been put on in Cardiff and the Vale had helped her not just in terms of her ability to get a better grip on weight loss and how to approach that issue, but also she’d been given psychological support, and the mental health issues that she’d been experiencing were actually alleviated hugely by the support that she’d been given.

Just in terms of the child measure programme, frankly the pandemic didn’t help; people were locked up for a long time. The cost-of-living crisis doesn’t help, and as we know, there is a larger issue in relation to obesity in more deprived areas, so the cost-of-living crisis does not help with this, frankly.

Just in terms of where we’re heading, I think self-management has got to be part of where we get to, and some of that will involve apps, some of that will involve making sure that people use technology to monitor their own health. So, I think we’re all beginning on a journey here. I think some people are way ahead on that journey in terms of their use of self-management of health issues, but we need to drive those improvements, and that is quite difficult at the moment, frankly, because we haven’t got as much money as we’d like to invest in the transformational digital space.

Thank you to the Minister for her statement. I welcome much of what we've heard from the Minister today. There are questions as to how appropriate quality statements are in and of themselves in making a difference. What we'll be looking at now is, what happens once we have had that quality statement, in order to ensure that that quality standard is reached. Otherwise, they are only words. So, we look forward to holding the Government to account on how that quality statement will be delivered.

Hearing the statistics again from the Minister is very striking indeed. The figure of 10 per cent of all NHS expenditure being spent on diabetes is a decade and more old now, and it's possible that up to 17 per cent of the budget will be spent on diabetes by 2030. It strikes me, therefore, that there is a question around the resources pledged today, to fund the work of diabetes prevention. The Minister will well know that I am pleased to hear her talking about the preventative and the importance of that. But I was looking at figures that suggested that some 2.8 per cent of health expenditure across the EU is preventative. A report by the WHO suggests that some 3 per cent of expenditure is on preventative services in effective health services. If we think that £9 billion is spent on health, and 10 per cent of that on diabetes, well, we should be spending more than £1 million per annum on trying to prevent diabetes in the first instance. So, I would like to hear from the Minister whether this is the beginning of the journey, and whether it is the intention to ramp that figure up over time in order to ensure that we are investing in something that will bring financial benefits in years to come, never mind the health benefits.

Just a few other things. I am very pleased to see the commitment to ensuring that care is based on individual need. Providing regular support is extremely important. Research clearly shows how important that is. It is a little concerning for me that the latest statistics from the National Diabetes Audit show that less than a third—29 per cent—of people living with diabetes in Wales have received all of the crucial check-ups in 2021-22, and that is quite a bit lower than it was pre COVID. So, how confident is the Minister that that figure can be increased, and what's the plan for ensuring that those statistics are improved?

Finally, a question on technology. The quality statement makes a number of references to technology. I know how crucial technology is. A recent survey by Diabetes UK Cymru of patients who do live with type 1 diabetes say that 85 per cent had reported that technology is a great help for them in managing the condition. So, what will be done, therefore, to ensure that the technology is available to everyone in order to ensure that equitable care is provided to all those who suffer, but also to ensure that the care is of as high a quality as it can be?

Another quick word on the preventative. I welcome that. Just a few words on the Nifty 60s in my constituency, where people come together, over 60 years of age, and get substantial health benefits from keeping fit and doing exercise. Those who had type 2 diabetes previously have now found that they are no longer sufferers. That is the benefit of the preventative, and I just want to see the investment increasing as a result of that. 

Thank you very much. Just a few issues there. In terms of the quality statement, part of what we will be doing with the NHS executive is to ensure that we do monitor now that the quality statement is achieved. So, they know exactly where they should be reaching, and the role of the NHS executive will be to demonstrate that. And of course, we will have an opportunity through the IMTPs to see what they have in mind in terms of how they are going to achieve this quality statement.

With regard to resources, there is a problem when it comes to resources. There is a resources problem in the NHS at present. It's serious, and so we do have to consider every penny that we spend. You will be aware that we have just awarded a great deal of money to those who work in the NHS, and that's the right thing to do. But it does mean that there is less money available for services, and that's a challenge for us.

We have to ensure, therefore, that we do understand that this is a partnership. So, we have to do it with the public. I think that we have to reach a point where people aren't perhaps overly dependent on the services, but that we are there to help them through, holding their hand—but we're not going to do it for them. We can't do everything for people in the future; we have to do it with them. People have to take responsibility, and what we understand is that it's difficult. It's really, really difficult for many people to lose weight, and that's why we have to stand alongside them through this preventative phase to prevent type 2 diabetes from developing. So, in every health board there is a pre-diabetes programme—that's located in every health board by now. We're just starting on a journey that will have to be accelerated at some point, when we do have the funding to do so.

In terms of the national diabetes audit, I have been speaking to Diabetes UK about this. I do think that we have to improve the number of check-ups that have taken place, but chronic condition management is part of the core element of the GMS contract. So, that's another opportunity for us.

With regard to the technology, I am very eager, because I do think that this is an opportunity for us to release many people who work in the NHS. If we get people to help themselves through the technology, that's going to release people to do other things. Our problem, once again, is that we are financially challenged at present, and that is an issue for us.

So, I do think that there is a great deal that communities can do—so, things like the Nifty 60s. It's not just good for people's physical health, it's really good for people's mental health and for seeing communities coming together. So, I'm eager to see a great deal more of that happening in our communities.

I'm very grateful to the Minister for this very welcome statement today, and, as chair of the cross-party group on diabetes, it's really positive to hear the focus Welsh Government is giving to diabetes, the measures being taken and the expectations to address the needs of many who are living with diabetes. The Minister has already outlined the scale of the challenge ahead of us and the scale of the problem for people living with diabetes.

Earlier this year, Diabetes UK asked people living with diabetes to complete a survey as part of the Diabetes Is Serious campaign, and it's good to see that this quality statement reflects many of the concerns raised by respondents in Wales, including on equity, psychological support and the need to utilise technology. I'm glad to see those recognised today.

This statement builds on the good work already happening in the all-Wales diabetes prevention programme, the remissions programme—they're all deserving of recognition, but what's always clear, through every campaign or meeting we have as a cross-party group, is the importance of early diagnosis and early engagement. Does the Minister agree with me that we need to do all we can to promote the knowledge about the signs of diabetes, the difference between the types of diabetes and the risks that lead to type 2 diabetes? It must be reiterated that asking for support is important, whether for type 1 or type 2 diabetes, and people should engage as early as possible if they have symptoms of type 1 or type 2 diabetes. Diolch. 

Thanks very much, Jayne, and thanks very much, in particular, for your work with the cross-party group on diabetes. I think it's really important having these cross-party groups, because it does bring pressure to bear on us as Government Ministers, and I actually welcome that. I think it's important that we're held to account.

I'm really pleased that we've been able to respond to some of the points made by people across Wales, and some of the things I outlined in my presentation, psychological support—it's really serious. People get very upset, and we need to be there and we need to give them that support. Technology and equity—I think all of those are well understood.

So, early diagnosis—I think you're absolutely right, and part of what we have to try and expose is, as you say, what are the early signs. What are the early signs? What should people be looking out for? And also do people really understand the risks? Having diabetes—right, okay, well, I've got to start doing this, that and the other. Actually, the consequence of not managing it properly can be quite serious.

Now, I do think it's really important we distinguish between type 1 diabetes and type 2 diabetes, and there's another type of diabetes, which is quite rare, that very few people talk about, and, obviously, we recognise that as well. So, I think promoting and helping people to understand those early signs of diabetes is probably not a bad idea, and I'll go back and ask what more we can do in that space. Thank you.

I'm very grateful to the Minister for bringing this quality statement for diabetes forward today, and she just touched in her previous answer around the more rare form of diabetes, type 3c. I declare an interest, Dirprwy Lywydd, as my father was diagnosed with type 3c diabetes following a nasty bout of necrotising pancreatitis, one of the causes of type 3c diabetes. And back in October of last year, I used a business statement to call for a statement to be brought forward specifically on raising clinical awareness about type 3c diabetes and how individuals living with the condition can be supported, and I remember the Minister nodding along as I asked that question and when the Trefnydd answered as well, and she's nodding along today, and I'm grateful for that, and it's often misrepresented as being another type of diabetes, when, in fact, it's its own type. And while there is no specific mention of type 3c diabetes in this statement—and I'm not expecting the Minister to give a full answer, given the rarity of it; approximately 8 per cent of all diabetes sufferers are type 3c diabetes sufferers—could I just get, possibly, a written statement from the Minister, just focusing on type 3c diabetes and what the Welsh Government is doing to support those patients living with that form of diabetes? Diolch, Dirprwy Lywydd.

Thanks very much. As I mentioned in the point I made to Jayne, we absolutely recognise that there is a third pillar that people don't talk about so much, and I was very grateful to you for bringing that debate to the floor of the Chamber, and that gave us an opportunity to air that issue and, certainly, I know that that is something that is recognised by experts in the field, and that again—. I think it's slightly different from the kind of enormous challenge that we have in relation to the more general, type 2 diabetes. That's where the major, major challenge is for our nation and for our NHS, and that's why I've concentrated today on those areas. But the quality statement itself covers all three types of diabetes.

Thank you, Minister, for your statement. I really welcome in particular your emphasis on good supportive care. This can make all the difference in ensuring that the one in 14 people in Wales with diabetes can best manage their condition. Yesterday, I was fortunate to meet with the Cwmbach Diabetes UK group at their information stand in Ysbyty Cwm Cynon. They do excellent work in raising awareness of what it's like to live with diabetes, helping break down barriers by offering a friendly face for anyone newly diagnosed with this condition and supporting self-management strategies. Minister, will you join with me in paying tribute to these volunteers, and how do you imagine such local groups fitting into your vision of improved care and support, particularly in terms of offering that peer support mentioned in the quality statement?

I was also able to have a catch-up about the work of the all-Wales diabetes patient reference group, chaired by my constituent Wendy Gane MBE, who I know have contributed to the development of this statement. The value of the patient reference group is paramount in ensuring that diabetes services and resources are co-produced with people who have diabetes. This completely chimes with the person-centred approach set out in the quality statement, so how will you ensure that the patient reference group and the lived experience of its members are an integral part of this process moving forward?

Thank you very much, and I'd like to thank Vikki for her work, and it just amazes me, Vikki, how you manage to get around so many community groups. Almost every time you speak, you've just been to see somebody in relation to that, so you've done it again. So, thank you very much for that, and thank you also to the people in that Cwmbach community diabetes group, because I actually think that having groups come together, sharing their experience—. I think people can encourage each other, and there are lots and lots of examples where some people have managed to get their diabetes into remission through catching it early enough. And that's the space for the big win here, I think, is to really try and catch it early. But if you do have a more advanced form, then self-management is going to be key, because if you aren't managing it well, then that is more likely to lead to more difficult and more complicated health issues.

So, this quality statement is very much focused on the NHS, what is the NHS's responsibility. So, really, this bit is not about communities; that's more covered in the 'Healthy Weight: Healthy Wales' approach, which is understanding that there's a broader issue for us all as a society to understand what our responsibilities are, and, as I said, Lynne Neagle will be making a statement very soon on the kind of environment that encourages, frankly, people to eat a lot of junk food, food that we know is not healthy, not good for us, and I know that she will be making a statement in the next few weeks about that.

We very much valued the work and the input of the diabetes reference group into developing this programme. That's partly why we've got this person-centred approach. I think what's going to be important moving forward is that we make sure that that voice continues to be heard. Now, we have got this new organisation, Llais, which is the voice of the public in relation to the interaction and the voice of the patient in relation to the NHS, so I'm hoping that they'll find a way through that mechanism, and, if they're not satisfied with the services that they've got, that they will use that as a method to go in.

And finally, Joel James.

Thank you, Dirprwy Lywydd, and thank you, Minister, for your comprehensive statement today about the future of diabetes care in Wales. As you may recall, I recently brought up in this Chamber with the First Minister the SEREN programme, which is an accredited and structured education programme for children and young people with type 1 diabetes, which has been developed in Wales to help with the transition from primary to secondary education. The First Minister responded to my question by saying that, and I quote, the

'NHS Executive has been asked to look at how best to sustain the programme' and that the health Minister

'will be making an oral statement on the future of diabetes services and these new arrangements in front of the Senedd in June.'

I recognise that in point 18 of the quality statement it mentions that health boards will provide

'at regular intervals an accessible structured diabetes education programme', but the statement and yourself haven't specifically mentioned the SEREN programme. With this in mind, and given the success of the programme, especially in delivering a reduction in HbA1c levels and the dedication shown by staff who have developed and implemented the programme, I'm keen to know whether it is your intention to fund the SEREN programme going forward, and, if so, if that is more long-term funding. Thank you.

Thanks very much, Joel. There's a reason why I haven't mentioned the SEREN programme, and that's because this is an NHS quality statement. The SEREN programme is very much an education programme for children and young people, so it's not directly NHS in that sense, and that's why I haven't mentioned it directly.

We recognise that, actually, there is a huge amount of work that we need to do in different areas to bring this to people's attention, but this quality statement is very much an NHS statement, rather than the broader approach, and some of that will be already covered in the 'Healthy Weight: Healthy Wales' programme and will be perhaps covered in the statement that the Deputy Minister will be making very soon.

I thank the Minister.