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Diabetes

– in the Scottish Parliament at 5:01 pm on 18th November 2004.

Alert me about debates like this

Photo of Trish Godman Trish Godman Labour 5:01 pm, 18th November 2004

The final item of business is a members' business debate on motion S2M-1837, in the name of Karen Whitefield, on diabetes in Scotland. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes the rising numbers of people with diabetes in Scotland as evidenced in the recent report from Diabetes UK Scotland, Diabetes in Scotland and the UK 2004, which shows that there are 148,000 people in Scotland diagnosed with diabetes, a rise of 28,000 since 1996; is concerned that at least 65,000 people in Scotland are undiagnosed, as highlighted in the report, and that this number is rising year-on-year; recognises that diabetes is associated with chronic ill-health, disability and premature mortality and that long-term complications, including heart disease, strokes, blindness, kidney disease and amputations, make the greatest contribution to the costs of diabetes care, and believes that many of these long-term effects could be avoided with earlier identification and more effective treatment.

Photo of Karen Whitefield Karen Whitefield Labour 5:09 pm, 18th November 2004

As members may be aware, it was world diabetes day a few days ago. I am pleased to have secured this debate to highlight the emerging epidemic of diabetes in Scotland, and indeed across the world. I want to thank all those who signed my motion and those members who have come along to take part in the debate.

This is our first debate on diabetes since the Parliament was reconvened in 1999. Since that time, it is estimated that more than 70,000 people have developed the condition, including some members of this Parliament. The figures for Scotland are alarming. According to Diabetes UK Scotland, there are more than 200,000 people in Scotland with diabetes, at least 65,000 of whom people are undiagnosed. The University of Edinburgh recently published a study that suggests that possibly half of those with diabetes are undiagnosed. That means that in my constituency of Airdrie and Shotts there could be about 1,700 people who have diabetes but do not know it yet. The impact of undiagnosed diabetes can be seen in the people who present to the health service with complications such as heart disease, kidney problems, foot problems and eye problems.

People from poorer communities are more likely to develop diabetes and they have a mortality rate that is more than twice the national average. By the time that people are diagnosed with type 2 diabetes, more than 50 per cent of them will have evidence of cardiovascular disease. In addition, diabetes is the leading cause of end-stage renal failure and of blindness in the working population. Diabetes is among the five leading causes of death in this country and the situation is worsening. The number of people with diabetes is doubling with each generation.

What can we do to tackle the problem effectively? Prevention is, of course, vital and the Executive's commitment to improving the health of people in Scotland through, for example, the physical activity strategy and the eating for health strategy is to be commended. An improved diet and increased physical activity can reduce the risk of type 2 diabetes by as much as 60 per cent. However, the number of people with the condition will continue to rise in the foreseeable future and it is equally important that we look to ways of identifying people with the condition, especially those who are most at risk. According to Diabetes UK, targeted screening is not only appropriate but imperative. Diabetes UK is convinced that a targeted screening programme for people who are at high risk could go a long way towards preventing complications.

My motion focuses on what can be done to identify people with diabetes at the earliest stage in order to ensure that they can live full lives with the condition. Once diabetes has been diagnosed, it can be controlled and the dividends for people with diabetes are very persuasive. For example, effective control of type 2 diabetes can reduce the risk of heart disease and stroke by almost a half and that of kidney and eye disease by a third. Targeted screening of high-risk groups will happen. The review of the "Scottish Diabetes Framework" was published last Friday at a joint conference between the Scottish Executive and Diabetes UK and calls for a report on options for the future. However, there continues to be a need to improve diabetic retinopathy screening services.

In the meantime, there is nothing to hinder that other mainstay of early identification—raising awareness among the public. Today's debate is part of that process and I look forward to listening to the speeches that colleagues will make. Diabetes is an illness that has affected many of us, either as sufferers or as a friend or a relative of a sufferer.

Earlier in the year I met health professionals to discuss the effects of diabetes in Lanarkshire. They raised with me their desire to have procedures for early identification, the demands that that will place on the health service and the need to give diabetes a higher profile. What I had not expected was their number 1 demand: that we ban smoking in public places. Every professional, whether they were a nurse, a consultant or a health service planner, believed that that was vital in the fight to improve health and reduce levels of diabetes. I have agonised over that issue and had some real reservations, probably because as a daughter of a publican I know better than many the implications that the ban will have for the licensed trade. However, those professionals made me think: what would my dad have thought? I know that he would have argued against a ban and fought against it, but the point is that he died at 55 of heart disease—a complication of late-onset type 2 diabetes. I am sorry for the tears and the emotion, but that illustrates how important the debate is. I am convinced that his death was in part related to years of working in a smoky environment. The Executive's move to ban smoking in all enclosed places is absolutely the right thing for us to do. [Applause.]

Diabetes UK has played a vital role in raising awareness of diabetes. I congratulate the organisation on the excellent work that it does on behalf of those who are affected by diabetes. In particular, I thank Alan McGinlay for his assistance in developing the themes for this debate and for providing invaluable assistance to those of us who are members of the proposed cross-party group on diabetes.

For some years, Diabetes UK's missing million campaign was an important step forward in raising awareness of the numbers of undiagnosed diabetes sufferers. The challenge for us now is to respond to a developing epidemic, but we are not starting from scratch. The "Scottish Diabetes Framework" has helped to make progress in diabetes care over the past few years and we should and must acknowledge the hard work and professionalism of our health-care professionals who respond to the needs of diabetes patients every day.

People with diabetes and their carers are organised at a local level through voluntary groups. They contribute to local health planning, they raise funds for research and they support people locally. There is huge support on which to build progress. I look forward to working as a member of the cross-party group on diabetes to ensure that Scotland has effective systems in place to prevent, diagnose and treat diabetes.

Photo of Trish Godman Trish Godman Labour

A considerable number of back benchers wish to speak, so I ask for three-minute speeches.

Photo of Christine Grahame Christine Grahame Scottish National Party 5:16 pm, 18th November 2004

I congratulate Karen Whitefield and advise her that she should never apologise for emotion that propels political argument. It is one of the best propellers in life.

Karen Whitefield and I are both to be vice-conveners of the cross-party group on diabetes— we were dragooned into it by David Davidson, who will be the group's convener.

I, too, became involved with diabetes for personal reasons. If someone had asked me 20 years ago whether anyone of my near acquaintance had type 1 or type 2 diabetes, I would have thought it a strange question. Today, however, two of my close friends have type 1 diabetes and two people in my direct family have type 2 diabetes—that is just in my tight circle of friends and family.

As Karen Whitefield said, the number of diabetes sufferers who are as yet undiagnosed is 65,000 and that is probably just the tip of the iceberg, with the real figure being much higher.

I will focus my comments on early diagnosis and screening. There is much to say about the condition but, as with all illnesses, we know that the sooner it is detected, the better for the individual and society and the cheaper for the national health service. By the time that people are diagnosed with type 2 diabetes, 50 per cent of them have complications. Those complications—they were referred to by Karen Whitefield and will no doubt be listed by David Davidson and others—are distressing. Diabetes has no cure, although it can be managed in different ways; type 2 is sometimes managed by controlling diet and type 1 is managed by insulin.

Apart from the importance of screening, I will focus on the reaction to the Executive's consultative review of the "Scottish Diabetes Framework". That document says that the Executive is

"setting out current practice in Scotland and options for the future".

However, according to Alan McGinlay's background briefing paper, on which I compliment him,

"Diabetes Scotland is concerned about the lack of urgency in that approach."

The Minister for Health and Community Care is the man who looks after the purse, so the sooner that we get on to screening and early diagnosis the better it will be for the finances of the NHS as well as for individuals.

In my final seconds, I mention the young people who are being diagnosed—the figures are quite upsetting. The total number of cases of type 2 diabetes diagnosed in children under the age of 15 has risen from two in 1997 to 21 in 2004. That increase can be linked directly to obesity and lack of exercise by our young people. When we look at screening and early diagnosis, let us also look at the diet of our young people and the exercise that they take. Let us educate them about the fact that they are not immortal, as none of us is. When we are 15, and even when we are 30, we think that we are immortal. However, young people might be laying the foundations for shortening their lives through the contraction of diabetes.

Photo of David Davidson David Davidson Conservative 5:19 pm, 18th November 2004

I congratulate Karen Whitefield on securing the debate. As she said, she is one of my vice-conveners in the new cross-party group on diabetes. I recommend the group to any member who has an interest in the subject; they might want to join us. I am grateful for all the industry and charity support that we received to start the group.

Karen Whitefield talked about the personal experience of her family, which brought the matter home to us. In my family, as far as I am aware, I am the only diabetic in my generation. I was diagnosed with type 1 diabetes 30 years ago. We think that we are invincible until we suddenly find out that we are not and that our lives are as long as the period for which the next injection will control the diabetes—it is as simple as that, but that is a brutal thing to have to tell a child.

One of my children, who is an international sportsman, became diabetic at 23. His diabetes is well controlled. However, the difference between the time when I became diabetic and now is that there are screening programmes and facilities. We need the will to implement the screening programmes. For example, the Men's Health Forum Scotland uses the programmes when it goes to factories—it gets invited to all sorts of places to check for all sorts of things. It is important to consider diabetes, which is not just something that happens to children. I suppose that I was flattered to be told that I had juvenile-onset diabetes, but although people tend to think that diabetes is a childhood problem, it is not; it can happen at any stage of life. I echo comments that members have made about the delay to the rolling out of the "Scottish Diabetes Framework".

We must address stigma, by explaining to children that diabetes is not a bad thing and that many people have diabetes. Teachers should not tell children that they cannot bring needles to school. People should be open about the condition. I have always been open about my diabetes; given the simplistic treatments that were available 30 years ago, I had to rely on the fact that my friends knew what my symptoms would be if I became hypoglycaemic, for example if I was slurring but had not had a drink—I added that before the minister could say anything. We rely on little things. I am lucky in that I have never been in a diabetic coma, but I have come close and a passer-by recognised my symptoms. Children and parents should be made aware of the symptoms that they should look out for.

We can all mention statistics, but it is amazing that apparently 6 million working days might be lost through illness from the side effects of diabetes and other diseases that develop. Audrey Burke gave a presentation to the cross-party group about the numbers. I should feel quite privileged, because allegedly I should last only 10 years less than anyone else. Given the length of time that has passed since I became diabetic, I must be running on borrowed time.

Spectacular advances have been made in the treatment of diabetes in my short life. We must ensure that general practitioners and specialist nurses are up to speed. We must introduce decent programmes and child health screening in schools. We must ensure that teachers understand what is involved—whether the pupil is asthmatic or has diabetes and must look after themselves. Society has a collective responsibility to do that.

I look forward to hearing members' comments. I will have to leave to catch a train at about 6 o'clock and I apologise for that.

Colin Boyd (The Lord Advocate):

I congratulate Karen Whitefield on securing the debate. I know how hard the debate has been for her.

It is nearly two years since I was diagnosed with type 2 diabetes. My reaction was one of first shock, then devastation, then—frankly—a feeling of shame that this had happened to me. Although I read a book that reassured me that it was not my fault, it is a fact that type 2 diabetes is closely linked with lifestyle and obesity. In my case, ministerial cars, airport lounges, fast food, official dinners and long hours all contributed to an unhealthy lifestyle. I was overweight and, at times, highly stressed. I did not take enough exercise. However, I proved to myself that I did not need to be like that. I am lucky in that I am one of the 20 per cent of type 2 diabetes sufferers who control the condition through diet and exercise. I have lost weight, I take better care of myself and I take exercise. Although I have not entirely shunned the car, I walk far more than I did before. In the summer I set myself the goal of walking the west highland way and in doing so I enjoyed the splendour of Scotland and one of the finest walks in Europe—I have not felt so fit for 10 years.

Both types of diabetes are complex conditions that involve both genes and environmental factors. However, it is the large increase in type 2 diabetes that is especially worrying. The evidence shows a clear link between the onset of type 2 diabetes and obesity, which is a major health problem that has been described by clinicians as an epidemic.

Britain has the fastest-growing rate of obesity in the developed world.

Karen Whitefield and others have outlined the major risks and complications of diabetes. Eighty per cent of people with diabetes die from cardiovascular problems. Diabetes is the leading cause of blindness among people of working age in the United Kingdom. It is the leading cause of end-stage renal failure. The risk of lower-limb amputation among people with diabetes is 15 times that of people without diabetes.

I believe and hope that I can manage my condition in such a way that I can avoid such complications—certainly in the near future. However, I know that for the rest of my life I will live with the increased probability of developing any of those conditions. It is not just me who will have to deal with that; it is my family too. That I could probably have avoided this is one of the hardest things to face.

I thought long and hard about speaking in the debate. I do not suppose it is often that a Lord Advocate speaks in Parliament on matters that are not his direct concerns. I have not hidden the fact that I am diabetic, but I have not talked about it in public. I know too that my situation is far from unique and that I am lucky to have been diagnosed fairly early and thus to have a better chance of avoiding complications. However, I got inspiration from reading about and listening to others who had diabetes, and from learning about how they had managed their condition. Listening to David Davidson today was inspirational. If this debate, and my modest contribution to it, can help others who may be at risk of developing diabetes to take preventive measures, or can give heart to those who have recently been diagnosed that the condition can be managed effectively, it will have been worth it.

Once again, I commend Karen Whitefield for her initiative. I look forward to the rest of the debate.

Photo of Mike Pringle Mike Pringle Liberal Democrat 5:27 pm, 18th November 2004

I, too, congratulate Karen Whitefield on securing this debate on a topic that is very important and, for me, very personal—as it is for Colin Boyd. I fully support the motion today but want to speak on a personal note about the need for early diagnosis. As many members might know, I was diagnosed with type 2 diabetes shortly after being elected last year. I want to share with the chamber my example of what early testing can do.

A while ago, I was invited to visit Lloyds Pharmacy in Ferniehill in my constituency to see its new, free, diabetic testing service. Lloyds should be given huge praise for that service; it offers it still and should be given praise still. Lloyds has made a significant contribution, along with other pharmacies and Diabetes UK.

I went along all innocent. To my horror, I discovered that I was well over the glucose limit. I then had to fast before going for another test, which was even worse. I was referred immediately to my GP. He told me that, from blood tests, it could be estimated that my diabetes had started possibly six months earlier. That was about the time of the 2003 election, so perhaps that had something to do with it.

On average, people who have type 2 diabetes have it for between five and 10 years before diagnosis. Life expectancy is reduced by an average of 10 years by then.

Karen's motion says that 65,000 people in Scotland remain undiagnosed with diabetes. However, research by the University of Edinburgh has hinted that that might be an underestimate. The figure could be as high as the number who are known to have diabetes, which is 148,000 in Scotland.

Like many people in Scotland today, I could have lived with the condition unknowingly for five or six years, or perhaps more, before I developed complications. By that time, it would have been too late. I would have needed medication and would probably have had eye problems, feet problems—which, for me, would have been particularly serious—and an increased chance of heart and kidney disease. Early intervention has saved me my health.

I have had to go through a bit of a lifestyle change. I lost a stone under the instructions of the doctors. As members can imagine, taking exercise is a little difficult for me. However, losing weight has brought my diabetes under control. In the long run, that will save the NHS time and money as I do not need expensive medication and frequent doctor's visits. Of course, that might change in future.

Although the Executive is to be commended for the "Scottish Diabetes Framework", which has just been published, I am concerned about the lack of urgency in the consultative review. It may be good to target those who are at greatest risk, but the focus should be on early diagnosis for everyone—even people who are not thought to be at risk, as I was not. That requires funding now, but it will save time and money in the long term. Early diagnosis for all is a classic case of spend to save.

I also want to raise the issue of self-testing. One of my constituents contacted me today with a query. He had been told by his GP that people on medication do not need to self-test any more. However, many sufferers feel that the rigours of testing stand them in good stead for the time when they must use insulin. Could the minister investigate the thinking behind the removal of frequent self-testing from patients? I would be happy to pass on the correspondence to my constituent.

I want everyone in the chamber—those of us on the floor of the chamber and members of the public in the gallery—to promise that, after today's debate, they will have a diabetes test and then go on to spread the word. It is only by increased publicity about the need for early diagnosis that the increase in diabetes will be controlled. Keith Raffan will be the first to go and get himself tested.

Photo of Shiona Baird Shiona Baird Green 5:31 pm, 18th November 2004

My Highlands and Islands colleague, Eleanor Scott, wanted to speak in the debate tonight, but she has had to leave early. She had to catch a train up north this evening because of an early appointment tomorrow morning. The Green group wanted one of its members to be at the debate, given that it is on a subject of such importance and seriousness. We also wanted to congratulate Karen Whitefield on securing the debate.

Although I have not prepared a speech, I said that I would come to the debate and say a few words on behalf of our group. Quite honestly, I think that the only family connection that I have with diabetes is a niece, once removed. I do not have immediate knowledge of the subject.

The speeches that we have heard so far have been sobering. I was most alarmed by what Mike Pringle said and I will take up his instruction to go and get tested. I will also spread the word.

The most telling part of Karen Whitefield's motion is the part that says that

"at least 65,000 people in Scotland are undiagnosed".

That figure is a ticking time bomb of people who are going about their daily lives not knowing what they might have to face in future. Today's debate and the work of the proposed cross-party group on diabetes will continue to highlight the seriousness of the issue.

When I was quickly putting together some background notes for the debate, I read coverage of

"a poll of more than 100 nurses" which

"found that 60% felt that there was a lack of understanding in patients with the condition that it was not only long-term but also potentially fatal."

That is also a sobering thought. Until today, my understanding of diabetes was that it is not such a major problem and that it is easily controlled. Until I started looking at the information, I had no idea of the seriousness of the complications. Debates such as this are important, as they give us time to reflect on the issues.

We need to ensure that our diet in Scotland is better and to start by encouraging children to eat more healthily while they are at school. We also need to ensure that all of the campaigns that the NHS is rolling out are fully supported and fully funded. Surely prevention is better than cure. We must do absolutely everything that we can to prevent the ticking time bomb from going off.

Photo of Stewart Stevenson Stewart Stevenson Scottish National Party 5:34 pm, 18th November 2004

I add my congratulations to Karen Whitefield on securing the debate on this important topic.

As far as I am aware, I am not related to anyone who has diabetes. One of my nephews-in-law, who is a professor of immunology, works in the field of type 1 diabetes. He hopes soon to bring forward for human trials a vaccine that will prevent the development of certain types of type 1 diabetes. Although his contribution is of great value, it is unfortunate that it will be of value only to a proportion of the 10 to 15 per cent of our population who suffer from type 1 diabetes. I am sure that it will be welcome, nonetheless.

We have heard a little about the role of targeted screening in early detection of diabetes, which is universally acknowledged as being important. It was interesting to hear of Mike Pringle's experience at Lloyds Pharmacy. Because I fly, I have to have a medical every year, which includes a test for diabetes—so far, so good. However, many people do not have that opportunity. Because of the Executive's munificence, free dental checks for people over 60 will start in 2006, which by coincidence is the year that I will become 60, so I thank the Minister for Health and Community Care very much. However, it is curious that we do not test universally for diabetes, although it is simple to do so with a urine test. I am slightly surprised that that has not yet appeared on the agenda, so I encourage the minister to include it.

David Davidson mentioned that 6 million days at work are lost every year as a result of diabetes, which means, when that is added to the £320 million that it costs the national health service to deal with diagnosed diabetics, that the total cost in Scotland of diabetes may be £1 billion a year. Undoubtedly, it is worth investing in the problem. With the potential that more than one in four adults will be obese by 2010, we can see that the problem will grow.

I want to touch on an aspect that no one has yet mentioned: mental health, which is an issue about which I speak from time to time. Long-term illness has mental health implications. The association with early erectile dysfunction and the relative paucity of services in the health service for addressing it means that we end up with men of advancing years who have significant problems that the present system does not really address.

I will end with a message from the "Scottish Diabetes Framework", which states:

"'You shouldn't have to tell your history over and over again.'"

It is time that we did something about patient records to ensure that every part of the health service has access to basic information about patients who present.

Photo of Nanette Milne Nanette Milne Conservative 5:37 pm, 18th November 2004

I, too, congratulate Karen Whitefield on securing the debate, which is well timed, given that it comes just after the inauguration of the cross-party group on diabetes.

The rapid rise in the incidence of diabetes, particularly type 2 diabetes, is reaching almost epidemic proportions in the United Kingdom. If unchecked, it will put enormous strain on the NHS, which will struggle to cope with the long-term complications. Diabetes is a serious medical condition—it is more serious than many people realise. It is the fourth leading cause of death in most developed countries, and the life expectancy of people who have type 2 diabetes is reduced by an average of 10 years. Even when it is controlled, the condition can result in long-term cardiovascular problems and premature death.

The incidence of type 1, or insulin-dependent, diabetes is fairly constant in the population and usually has early onset in childhood or adolescence. However, the increasing incidence of insulin-resistant, or type 2, diabetes causes most concern at present. The condition is usually late in developing and is commonly diagnosed in people who are over 50. However, it is worrying that it now appears much earlier and that increasing numbers of teenagers are testing positive for it.

Photo of Stewart Stevenson Stewart Stevenson Scottish National Party

I refer the member to "Diabetes in Scotland: Current Challenges and Future Opportunities", which suggests that in the past 10 years the incidence of type 1 diabetes in children has risen dramatically.

Photo of Nanette Milne Nanette Milne Conservative

I was not aware of that. I thank Stewart Stevenson for informing me.

Even more worryingly, it is certain that, as we have heard, many people in Scotland have diabetes that remains undiagnosed. About half of those who have the condition already have complications at the time of diagnosis. Research data from Tayside suggests that the prevalence of diabetes is increasing by about 8 per cent per annum. We are facing a serious problem. If complications are to be prevented or delayed, it is crucial that diabetes is diagnosed early and that blood sugar levels are brought to, and kept within, normal levels. People must be encouraged to have their blood sugar checked at regular intervals, even if they are symptom free. I point out to Stewart Stevenson that the urine test is not as accurate as the blood test—it produces many false negatives.

I, too, have been impressed by the Lloyds group of community pharmacies, to which Mike Pringle referred. About six months ago, I visited a Lloyds Pharmacy project in Aberdeen as an MSP and found—somewhat to my surprise, even though I have family history of type 2 diabetes—that my fasting blood sugar was marginally raised. It was fortunate for me that a subsequent glucose-tolerance test ruled out overt diabetes, but I now know that I must watch my weight and lifestyle and have my blood sugar checked annually as a precautionary measure. The blood test is painless and takes only a couple of minutes of one's time. I take my hat off to Lloyds for instigating the service and, like Mike Pringle, encourage everyone to take advantage of it. It could save their lives.

Predisposing factors for type 2 diabetes include family history, gender, ethnic background, age and obesity. The last of those is the one factor on which we can act and it is also the main reason for the increasing numbers of young people who are developing the disease, as more and more of them become overweight and obese. One of the biggest public health challenges in Scotland today is to make people aware of the risks that are associated with excessive weight gain and to persuade them to adopt a healthier lifestyle, to eat sensibly, to control their alcohol consumption and to exercise regularly. If we could succeed in that, the incidence of type 2 diabetes would fall dramatically. Until then, we must ensure that it is picked up early and we must treat it before complications arise. It is vital that we raise awareness; as MSPs, we have a great role to play in that. The public health challenge is enormous, but we must rise to it.

Photo of John Swinburne John Swinburne SSCUP 5:41 pm, 18th November 2004

I thank Karen Whitefield for initiating the debate. I have type 2 diabetes, which I self-diagnosed in 2002. I went to my doctor and he asked, "What are you in for?" I said, "I've got diabetes," and he said, "I'm the doctor; I'll tell ye whit ye've got." However, his tests proved quickly that I had type 2 diabetes.

I was 15 stone at that time, but I am now 12 stone. My wife is a nurse and, with her diet and persuasion, I brought my weight down to 12 stone inside three months. By maintaining a strict diet and becoming a bit more athletic—it is not possible to be athletic at 15 stone—I have managed to keep the symptoms at a manageable level for the past two and a half years. I check my blood sugar every morning; my wife can tell by my blood sugar count whether I have stepped out of line in my dietary programme for the previous day. Heaven help me if I do so.

Losing weight has other advantages. When I was overweight, I also had a problem in that I needed to have both hips replaced. Three months after I lost the weight, I went to see about having my hips replaced and the doctor said, "You're so fit, I'll do the two at the same time." Had I been 15 stone, I would have had the second done six or nine months after the first. Since my hips were replaced, I have done a Munro, so I am fit in every sense of the word—touch wood. Long may it continue.

My problem, like that of one of the earlier speakers, was obesity. I was overweight and my job lent itself to my going out and junketing, which I miss, although I prefer life to greed. I am happy to toe the line and follow the stringent diet that is put before me. I eat well; I eat more food now than I used to but I eat the right type of food.

Hairmyres hospital must be complimented for the manner in which it deals with diabetes. It has a diabetes clinic that is second to none, but the staff there know that diabetes patients should be called in more often—every six months—for check-ups. I regularly go 15 months between appointments at Hairmyres, although I am fortunate that I have a nurse who can keep a close eye on what I am and am not doing. That is the only complaint that I have about Hairmyres. It has every possible facility and our health service is to be complimented for the manner in which it treats people with diabetes.

Photo of Keith Raffan Keith Raffan Liberal Democrat 5:44 pm, 18th November 2004

I join other members in congratulating Karen Whitefield on securing this important debate, which has shown the Parliament at its best, particularly in the speeches by members who spoke from personal experience, such as David Davidson and Mike Pringle. I am glad that the Lord Advocate also took the opportunity to speak in the debate, which is important in raising awareness.

My interest in the subject stems from my period as health spokesman for my party and I am well aware of the epidemic of diabetes. It is interesting that the issue of hepatitis C is also coming before the minister at present, because it, too, is at epidemic proportions, although on a smaller scale—Christine Grahame will know that because she attended the cross-party group meeting that I chaired last night, which included people who are involved with hepatitis C. That disease has serious implications for the health service and the three headings that we have talked about today—raising awareness, targeted screening and early diagnosis and treatment—are the same issues as we discussed last night in relation to hepatitis C.

The point that I wish to make in this debate is on treatment. One of the most valuable constituency days that I have spent in the past five years was at the Bellyeoman surgery in Dunfermline in my regional constituency. I was fortunate to be invited to the practice by a specialist nurse, Nicky Credland, who is distinguished in her profession. I was shown the valuable work that our specialist nurses do and I am grateful to her and particularly to her patients, who allowed me to sit in while she spoke to them. As a specialist diabetes nurse, she can spend much more time with patients than a GP can. She can spend 30 to 40 minutes going through diet—my mother was a consultant on diabetes in the latter part of her medical career and I know how important diet is in the control of diabetes.

Specialist nurses do terrific work. I spent the evening with 12 of Nicky Credland's colleagues from throughout Fife—they are the most formidable women I have met since I spoke to Mrs Thatcher on her own. The GPs pay tribute to the amount of work that those staff do and say openly that, because the specialist nurses see diabetic patients all the time, they are, in some ways, more knowledgeable than the GPs are. That is of tremendous importance to the minister, not just in his present incarnation, but in his previous one. There is the sheer humanity of making sure that people are diagnosed early and treated effectively, but there are also long-term financial consequences for the health service, as Nanette Milne said.

Nicky Credland showed me a graph of the sharp reduction in the number of hospital admissions of diabetic patients from her practice. Because the patients are monitored so closely and given such good advice on diet and related issues, they do not have to go to hospital, which reduces the pressure on the acute sector. That shows that the Executive's policy is absolutely right. We need more specialist nurses, who do a tremendous job, particularly in the management of chronic diseases such as hepatitis. I hope that the minister will take that on board. We must increase the number of specialist nurses because that will help diabetic patients and reduce pressure on the acute sector, which is something that we all want.

Photo of Andy Kerr Andy Kerr Labour 5:48 pm, 18th November 2004

I commend all the members who have spoken for the content of their speeches. It is vital that we share our personal experiences on these occasions, because that provides an example to the rest of the community and demystifies the issues. I welcome many of the contributions that have been made and will refer to some of them in my closing remarks.

The debate highlighted the serious nature of the challenges that individuals and the Executive face in relation to diabetes. We heard about the life changes that are involved and the shock that people feel in their personal lives when they develop diabetes. We also heard about the high social cost to individuals and the fact that we need to change lifestyles, with the complications that that brings. It was inspiring to listen to many of tonight's contributions, which set an example for others about how to deal with diabetes.

Of course, as members have said, diabetes also has a high public cost. When I became Minister for Health and Community Care, I was taken aback by the statistic that 160,000 people in Scotland have been diagnosed with diabetes, by the warnings about the prevalence of diabetes and by the cost, which is reckoned to account for about 5 per cent of NHS costs.

I will reflect on two aspects of the issue: improving the care of people with diabetes and improving the health of the general population in order to minimise the number of people who develop diabetes in the future. Tackling those issues will require a long-term commitment, which the Executive has made.

As we have heard, many cases of type 2 diabetes are the consequence of being overweight or obese. The best long-term approach to that is prevention, particularly in childhood. Critical to that is improving diet and increasing physical activity levels. We have discussed that throughout the day—at question time and in this debate.

Dealing with obesity is a priority in Scotland's action plan to tackle health improvement, entitled "Improving Health in Scotland—The Challenge". Key to that is creating the climate for change and stimulating enthusiasm and demand among the population for healthy food and active lifestyles. Research shows that we are making an impact on that.

Working through local joint health improvement plans and local planning processes, communities can mobilise action that involves patients in lifestyle changes. As for bigger quality-of-life issues, we must promote walking, cycling, the right food choices, physical activity in schools and a plethora of other measures that the Executive is happy to support and will continue to support. Such measures will make a significant difference to obesity, which is a determining factor in the matters that we are discussing. We are making the right moves in the general strategy, but we can always do more and we will seek to do more in partnership with all the interested parties.

As for improving care for people with diabetes, we have outlined a national strategy—a framework—and set in train several initiatives to improve services. We must recognise some of the successes. People have rightly said that we could do more and do it better, but we must reflect on some of the good work that has been achieved with patients, the voluntary sector, clinicians, the Health Department and industry. That has been a productive collaboration, as I saw at first hand at the Diabetes UK event last Friday to which Karen Whitefield referred.

That is an encouraging start. I have heard about the managed clinical networks in every health board area, which bring together clinicians from the primary, secondary and tertiary sectors. Good progress is being made towards single-system working. NHS Quality Improvement Scotland has set out and reviewed the standards for diabetes and diabetes services have been local and national leaders in giving patients a voice.

At the Diabetes UK event in Glasgow, I was taken by discussions about the involvement of patients in the management of diabetes and about some of the great voluntary work in the diabetes community, especially on reducing the stigma for young children, making them feel confident and helping them with a difficult part of their lives—self-medication and other matters. I saw much good practice at that event.

People have mentioned investment in information technology. We are working towards creating a fully electronic diabetes patient record that will be available at all stages of diabetes management. We are taking on that challenge, because it is essential and rests at the heart of how we redesign our services to meet needs.

Good progress is being made towards providing comprehensive retinopathy screening for all people with diabetes by March 2006. That is an ambitious target. We will probably be the first country to employ such a mechanism.

We recognise that more must be done. The framework, which set out the first stage of a 10-year programme, is being refreshed and we are undertaking that work with the involvement of all interested parties. Initial conclusions were set out at the conference last week. The framework review sets demanding targets for the Executive and suggests interesting work that we need to undertake. It suggests that we put a stronger focus on type 1 diabetes, that psychological support for patients needs to be improved—Stewart Stevenson referred to that—and that the role of community pharmacists should be enhanced. Lloyds Pharmacy has emerged well from the debate. It is to be commended for the absolute impact of its involvement in testing hundreds of thousands of people. We want to ensure that our priorities are met.

The review also highlights the challenges that lie ahead, some of which I have touched on. They include the need to help individuals to improve their health to avoid diabetes; identifying people with diabetes early; and redesigning services. The document is an attempt to open up some of those matters.

The thorny issue of national screening has been mentioned. It is only right to say that the UK national screening committee has rejected universal screening for diabetes at the moment. However, our review document says:

"It is proposed that the Scottish Diabetes Group should commission a report on screening people at high risk of developing diabetes, setting out current practice in Scotland and options for the future."

We are trying to deal with some of the issues.

I will run briefly through members' speeches. I thank Karen Whitefield again for introducing the debate by speaking powerfully to her motion. I also thank Christine Grahame for raising relevant issues related to diagnosis and prevention. We will try to deal with some of the health improvement issues that have been raised and the perceived lack of urgency in the Executive's work.

David Davidson raised the issue of support for children. I have referred to some of the charitable work that the Executive supports. Men's health is another important issue in this context. Colin Boyd offered a powerful reflection on his personal circumstances, allowing people to see that many people in public life are affected by diabetes. That allows us to demystify some of the issues, as I said.

Mike Pringle was right to praise Lloyds Pharmacy. The self-testing work that it is doing is to be commended and I recognise the impact that that work is having on a large number of people. Stewart Stevenson raised the issue of mental health, which has been considered in the review of the strategy. Nanette Milne spoke about the development of the continuous strategy, which we are seeking to pursue in partnership. I hope that we are responding to the needs of the diabetes community.

John Swinburne offered impressive figures for diet and weight loss. It sounds as if it would not be a bad idea for his wife to act as personal trainer to us all. However, that is John Reid's territory—I will not go there. Keith Raffan spoke about patient involvement in treatment. The message that I received at the Diabetes UK event last week was that we are involving patients at the front line of service redesign and delivery. I am confident that we are doing that, but I accept the principle that we can always do more.

With the speeches that members have made tonight, we have set a good example. We have recognised the extent of diabetes in Scotland and some of the problems that exist. I hope that, in my response, I have gone some way towards indicating what the Executive is doing.

In my reading on the issue, I found out that world diabetes day is the birthday of Frederick Banting, who along with Charles Best discovered insulin. Perhaps we should also celebrate that birthday on such a day.

Meeting closed at 17:56.