World Diabetes Day 2014

– in the Scottish Parliament at on 12 November 2014.

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Photo of John Scott John Scott Conservative

The final item of business is a members’ business debate on motion S4M-11158, in the name of David Stewart, on world diabetes day 2014. The debate will be concluded without any question being put. I invite members who wish to speak in the debate to press their request-to-speak button now.

Motion debated,

That the Parliament acknowledges that 14 November 2014 is World Diabetes Day, which is being led by the International Diabetes Federation and its member associations, including Diabetes UK, and is recognised as an official United Nations Day; understands that World Diabetes Day was established in 1991 by the International Diabetes Federation and the World Health Organization in response to concerns about the escalating health threat that diabetes poses; understands that there are almost 268,000 people who have been diagnosed with diabetes in Scotland and that access to good healthcare and treatment is key to helping them manage their condition; welcomes the launch of Diabetes UK’s campaign that focuses on children and young people and its aim to increase awareness of the symptoms and warning signs for type 1 diabetes; believes that, in many cases, type 2 diabetes can be prevented through healthy eating and physical activity, and welcomes this year’s parliamentary reception, which is scheduled for 18 November, to mark World Diabetes Day 2014.

Photo of David Stewart David Stewart Labour

I thank each and every member here today for their commitment to the cause of diabetes prevention and for sharing the International Diabetes Federation’s vision of living in a world without diabetes. I also welcome to the gallery a group of lead diabetes nurses who had a conference today, which I had the pleasure of speaking at.

I quote the International Diabetes Federation, which said that world diabetes day is a day that

“unites the global diabetes communities to produce a powerful voice for diabetes awareness and advocacy.”

The IDF’s theme for this year’s world diabetes day is healthy living and diabetes.

The day was created in 1991 by the IDF and the World Health Organization in response to growing concerns about the escalating health threat that diabetes poses, and it became an official United Nations day in 2007. The campaign draws attention to issues of paramount importance to the diabetes world and keeps diabetes firmly in the public spotlight.

We are facing a global epidemic: 382 million people live with diabetes, and a further 316 million are at high risk of developing the disease. The IDF diabetes atlas confirms that 80 per cent of people who have diabetes live in low and middle-income countries and that the socially disadvantaged are at the most risk.

By last year, diabetes caused more than 5 million deaths worldwide—every six seconds, a person dies from diabetes—and cost more than $600 billion in healthcare spending. Without co-ordination and systematic action to prevent diabetes, in less than 25 years almost 600 million people will be living with diabetes.

However, during the past two years, progress has been driving political change for diabetes. Following the 2011 United Nations declaration on non-communicable diseases, the World Health Assembly in May last year saw the unanimous adoption by member states of a global action plan. There have been other international initiatives as well.

A few short months ago, I strolled in the Melbourne summer sun from my hotel to the Victoria State Parliament House. I was due to speak to an unusual audience of almost 100 national champions for diabetes from as far afield as Russia, Ukraine, Nigeria and Canada. South Africa sent its first lady. All were elected members, all were advocates for diabetes, and all represented their own countries. It was a privilege to be asked by the International Diabetes Federation to represent Scotland at the first ever global forum of parliamentary champions for diabetes. The next forum will be in Canada in 2015, and I hope that Scotland will be represented again by members such as Nanette Milne, who convenes, along with me, the cross-party group on diabetes.

The conference concluded with the signing of the Melbourne declaration, which committed Parliaments across the globe to ensuring that diabetes is high on their political agenda. The declaration called on nations to put a higher emphasis on preventative work, early diagnosis, management and access to adequate care, and to ensure that treatment and medicines are available for all those who live with diabetes. The declaration was the brainchild of the IDF, whose president is Sir Michael Hirst, former member of Parliament and ex-chair of Diabetes UK.

I was proud to talk to the conference delegates not only about Scotland but about issues of international significance for diabetes, and I am proud to come from a nation that has a strong track record in innovation and discovery. After all, Alexander Fleming discovered penicillin, and he was a Scot; James Watt created the steam engine, and he was a Scot; and Alexander Graham Bell invented the telephone, and he was a Scot, too. However, international collaboration is where real strides can be made. In 1922, Professor John Macleod from Aberdeen, working with two other outstanding scientists, Dr Banting and Charles Best, discovered insulin, and in 1923 Macleod and Banting won the Nobel prize for medicine, which was shared with Best.

There have also been more recent political developments here in Scotland, and strong, positive steps have been made in the care of people with diabetes, including the provision of insulin pumps to under-18s. However, the number of people with the condition is rising, and that will have a serious effect on Scotland’s immediate future. Beyond the grave social cost of the condition for individuals and families, there is the huge economic cost to the NHS in Scotland. That cost is estimated at £1 billion annually, and 80 per cent of that money goes on managing avoidable complications.

With the Melbourne declaration’s focus on diabetes prevention, the Scottish Government must have a focus on the condition that properly reflects the size of the problem. For example, more people in Scotland are living with diabetes than are living with coronary heart disease, and two and a half times more people have diabetes than all those with cancer combined. Every year in Scotland, about 1,900 people have emergency admissions for diabetic ketoacidosis, a critical, life-threatening condition that requires immediate medical attention, and more than 40 per cent of those admissions are of people under the age of 25. People with diabetes account for almost a fifth of hospital in-patients at any given time, and a person with diabetes can face a reduced life expectancy of up to 14 years in Scotland. Diabetes is the leading cause of blindness in working-age people and is a main contributor to kidney failure, amputations and cardiovascular disease, including heart attack and stroke. People with diabetes should be receiving their 15 healthcare essentials checks from the national health service, and previous action plans have been instrumental in taking forward that critical goal.

As I said, the theme of world diabetes day is healthy living and diabetes. In that respect, I recently met Michael Matheson, who will respond to the debate, with Jane-Claire Judson of Diabetes Scotland to talk about changes in Government procurement. For example, the new ferry contract could ensure that menus on ferries make clear the calorie, fat and carbohydrate content of all food that is served, which would be good for those dealing with diabetes as well as for those managing their weight.

We in Scotland have a great chance not only to raise the bar in healthcare but to contribute to scientific and medical understanding across the globe. World diabetes day is an international opportunity for diabetes to be put centre stage, with the focus on awareness, advocacy and best practice across the globe. We have to tackle this ticking time-bomb. I believe that all we need is, as Sir Walter Scott said,

“The will to do, the soul to dare”.

Photo of Aileen McLeod Aileen McLeod Scottish National Party

I congratulate my colleague Dave Stewart on securing this debate; I also congratulate Diabetes UK on its very helpful briefings. I should also say that I am a new member of the cross-party group on diabetes, having just joined the other week, and I very much look forward to working with my colleagues on it.

I want to focus on an issue that Dave Stewart has highlighted in his motion, which is the experience of parents whose children are diagnosed with type 1 diabetes and the importance of promoting education in and awareness of the early-warning signs and symptoms of diabetes in children and young people. There is no question but that a child receiving a diagnosis of type 1 diabetes is a heartbreaking and life-changing experience for any parent. The amount of care that a child with type 1 diabetes needs can be very significant. Parents speak of having to test blood glucose levels multiple times an hour through the night after an adverse event, and maintaining good blood glucose levels can be a daily struggle, with parents fearing for their child’s safety should those levels rise too high or drop too low. It can be a constant—and sometimes nerve-wracking—juggling act.

That said, we should note the support and assistance that are now very often available to parents. For example, the roll-out of insulin pumps is regarded by many parents—and by Diabetes UK—as a very positive step forward.

Pump therapy not only removes to a very large extent the need for multiple daily injections, but the flexible way in which the pump can be set to deliver insulin can benefit overall wellbeing. I do not wish to be too technical, but an insulin pump can be calibrated very precisely according to the amount of carbohydrate in a meal and the pre-meal blood glucose level, which allows for the very precise delivery of insulin and, ideally, improved control of blood glucose levels.

Some health boards—Dumfries and Galloway NHS Board, for example—use Diasend technology so that the insulin pump’s data can be uploaded over the internet. That enables the diabetes team to examine it and recommend changes without the need for hospital appointments. The information will also be there for parents and their child to see, which empowers them to take greater control over the management of the condition.

The increasing prevalence of type 1 diabetes presents us with a significant public health challenge, of course. There is as yet no cure, so sound management of the condition is a key tool that is available to help us tackle the serious complications that the condition can cause.

As the incidence of the condition is on the increase, it is all the more important that parents are aware of the warning signs. Sudden unexplained weight loss, extreme tiredness, raging thirst and frequent urination are the key warning signs that parents should be aware of.

I warmly welcome Diabetes UK’s campaign to raise awareness of the warning signs of type 1 diabetes and to explain not only how children with diabetes will be treated, but the support and advice that that organisation can offer, through the provision of local support groups, on a wide range of issues, including care for a type 1 diabetic when they start school.

With the imminent publication of the diabetes improvement plan, the debate has been a particularly timely one on an important issue. I congratulate Dave Stewart once again on bringing the debate to the chamber, I look forward to reading the improvement plan, and I very much look forward to participating in the future work of the cross-party group on diabetes.

Photo of Hanzala Malik Hanzala Malik Labour

I thank David Stewart for securing this debate on diabetes.

It is important to recognise the importance of diabetes in Scotland and its impact on people’s lives, and to promote the ways in which people with that medical condition can learn to continue their daily lives.

Figures from Diabetes UK show that nearly a quarter of a million people in Scotland have diabetes and the number who have been diagnosed with it has increased at an alarming rate over the past few years: according to Diabetes UK, the number of Scots who were diagnosed with diabetes increased by some 26 per cent between 2006 and 2011.

It has become essential that we recognise Scots with early undiagnosed diabetes, that we make those citizens aware of their medical condition, and that we provide the appropriate care to ensure that their daily lives are not complicated as a result of their condition.

In many ethnic minority communities, diabetes is not often acknowledged as a serious risk that could hinder one’s daily life and affect one’s surrounding family. Many south Asian communities in Scotland have a higher risk of developing type 2 diabetes, and people in them are likely to be diagnosed at an earlier age than people in the indigenous community.

There are a number of voluntary organisations in my Glasgow constituency, such as the Glasgow south voluntary group that is associated with Diabetes UK and the cheeni kum—which means less sugar—at home project, which is administered by the Health and Social Care Alliance Scotland. Those organisations tend to people who have been newly diagnosed with diabetes and their families. Information and various supports are provided that enable people to continue their daily life in a manner that caters for their new medical condition.

Although there is some education on that health matter in my constituency, Scotland wide the educational courses on diabetes are scattered, at best. Providing education and support for a healthy lifestyle to people who have been diagnosed with diabetes is an essential component in ensuring that Scots who have diabetes have high standards of life and betterment.

As a diabetic, I am aware of the problems that diabetics suffer and the lack of treatment through Scottish Government and NHS policies—for example, the refusal to fit gastric bands to people who suffer from diabetes. My understanding is that doing that would reduce numbers in the diabetic community by nearly 80 per cent at a stroke. Excuse the pun.

It is important that we realise that we have a serious problem with diabetes and a growing dependency on the NHS because of it, because we know that diabetes results in kidney failure and many other ailments, including ailments that affect eyesight. I have had an operation for my eyesight because I am diabetic. Those are challenges that face us today.

We need to address the issues that we have in treating diabetes and in treating it seriously as an issue. We must recognise its implications for our communities and consider how we can take the message to them about diabetes. Minority communities in particular suffer greatly from diabetes, so it is important that we are more rigorous in taking that serious message to them. I know that attempts have been made to communicate the message about diabetes, particularly in the larger cities, but rural areas clearly suffer from lack of information about diabetes. I look forward to the minister’s comments on how he intends to deal with that issue.

Photo of Nanette Milne Nanette Milne Conservative

I am pleased to be taking part in a debate to acknowledge this year’s world diabetes day. I congratulate David Stewart on again securing parliamentary time to bring to our attention this international event, which since its inception in 1991 has been important in raising the profile of diabetes around the globe.

David Stewart has acknowledged Sir Michael Hirst’s invaluable work in diabetes, but David himself has been a tireless campaigner for people with diabetes in Scotland throughout his parliamentary career, both in Westminster and as a member of this Parliament. He is also very active as co-convener of the cross-party group on diabetes, in which we have worked together in recent years alongside Diabetes Scotland to raise awareness of the condition in an on-going effort to prevent its development where possible, and to mitigate its long-term and very serious complications.

With 382 million people worldwide currently living with diabetes, and that number predicted to rise to 592 million by 2035, the condition is reaching pandemic proportions. Beyond the people who have already been diagnosed, it is thought that a further 316 million people are at high risk of developing type 2 diabetes. In Scotland, more than 268,000 people have been diagnosed and will need help to manage the condition in order to avoid its complications.

However, what is really concerning is that many people with diabetes still go undetected and their condition is unrecognised until they begin to develop its serious and life-threatening complications. Globally, it is thought that up to 50 per cent of such people remain undiagnosed, which is a very serious challenge for all of us. It is estimated that in Scotland one in five people either has diabetes or is at high risk of developing it, which costs our NHS £1 billion each year, 80 per cent of which goes on dealing with potentially preventable complications.

We all know that types 1 and 2 diabetes are distinct entities. Type 1 generally starts when people are young, and is unavoidable, but type 2 is generally a condition of later life, the onset of which can often be prevented by leading a healthy lifestyle. It is very important to be able to recognise the symptoms of diabetes, whatever its type, because the earlier it is diagnosed and properly managed, the less likely are its complications to appear. Diabetes Scotland’s campaign to raise awareness in children and young people by highlighting the symptoms and warning signs, and encouraging them to eat healthily and exercise regularly is to be commended and supported.

A regime of physical activity and healthy eating is important to all of us, of course. By leading that type of life we can help to avoid the pitfalls of obesity, one of the most serious being the development of type 2 diabetes. In modern western society there are very many people—the numbers are, sadly, increasing—who are significantly overweight, which undoubtedly leads to earlier onset of type 2 diabetes. Some people in their teens now have the condition, and the earlier the onset, the sooner people are likely to develop the complications of kidney, eye and cardiovascular disease. Those not only compromise their health and wellbeing, but might result in their premature death and, in the process, put a great deal of pressure on NHS resources.

Everyone living with diabetes should have equal access to appropriate health services, but that is not yet the case.

The message of the world diabetes day 2014 campaign is a simple one—that the healthy choice can actually be the easy choice. The campaign aims to inform children and young people about how to make the right choices about what they eat—one of the most valuable being to start the day with a healthy breakfast. By educating them now in a fun and engaging way on the importance of a healthy diet and regular physical activity, we will help to protect the health and wellbeing of young people and future generations, and we will achieve better health outcomes for people who currently suffer from diabetes and those who are at risk of developing it.

I commend the campaigning work of Diabetes Scotland, which we will celebrate in the Parliament next Tuesday at this year’s parliamentary reception for world diabetes day, and I thank David Stewart once again for leading the debate.

Photo of Chic Brodie Chic Brodie Scottish National Party

I, too, thank David Stewart for bringing the motion to the chamber for debate this evening, and I congratulate him and Nanette Milne on the work that they do in the cross-party group on diabetes.

As the motion states, Friday is world diabetes day, which is led by the International Diabetes Federation. It will be the 23rd world diabetes day.

Diabetes poses serious concerns to one’s health. I have type 2 diabetes, although I do not suffer from it. I am one of the 238,750 people in Scotland who are in the same position, all rattling round Scotland to the tune of Metformin and other like tablets. I like to think that I complement or avoid that with my five a day, augmented by a daily bowl of porridge, cholesterol-lowering spread and 15 minutes of exercise every day. However, that does not hide the fact that I am diabetic. I know that my slimline figure would deny it, but that is the harsh fact, and had I lived less healthily and been subject to the oppression of deprivation, I would have been in a terrible place. That is why I welcome the call, yet again, to focus on the issue.

Diabetes affects people in areas of deprivation disproportionately. The deprivation rates in areas of Scotland vary from 7.9 per cent to 26 per cent, and those in the most deprived areas have reduced life expectancy, higher smoking rates and, unfortunately, lower engagement with the health services. That has to change. I applaud the nurses who are with us in the public gallery today, because 12 per cent of the in-patient budget goes on treating diabetes.

I believe that the Scottish Government’s action plan and the impending diabetes improvement plan will help strategically with the need to address the problem by promoting self-management of the condition through effective education, minimising the impact of potentially serious complications, increasing the availability of intensive insulin treatment for people with type 1 diabetes, as Aileen McLeod mentioned, and creating a stronger emphasis on screening and prevention of diabetes.

I again congratulate David Stewart and Nanette Milne on their unstinting efforts in pursuit of promoting the need for doctors to use the tools that are available to them to ensure that everyone with diabetes in Scotland receives timely data on matters affecting their condition. I confirm personally the regular demands to attend retinopathy tests, and I have on my desk a card that allows me to test my diabetes condition and cholesterol levels on the internet.

The early identification of diabetes is key and I welcome the work of the Scotland diabetes group and others to deliver that. There must be an emphasis on education, accessibility and services in the area. The best way to tackle the growing epidemic of diabetes is to tackle the issue in childhood, so I commend the live for it! joint venture between Diabetes Scotland and the Edinburgh international science festival. So far, the project has worked in 18 schools and reached 1,191 pupils. The programme is designed to tackle childhood obesity and ties into the health and wellbeing area of the curriculum for excellence. It is delivered in schools in areas of high deprivation, which is important.

The world diabetes day campaign underpins all that. The slogan “Diabetes: protect our future” will raise the profile of the 2014 campaign, which focuses on healthy living.

I hope and believe that, with all the emphasis on raising awareness and the support of people such as those we have with us in the public gallery, the message will get through more and more strongly. I welcome this evening’s debate.

Photo of Rhoda Grant Rhoda Grant Labour

I congratulate David Stewart on securing the debate, which itself raises awareness of both types of diabetes.

Awareness is important, because early diagnosis is crucial in the treatment of diabetes. Late onset or type 2 diabetes is much more likely to be picked up, because it happens to adults who can communicate to their general practitioners the symptoms that they are experiencing. The GP can work on the information that the patient gives, as well as looking at the person’s age, weight and lifestyle.

Type 1 diabetes is much more difficult to identify. As Aileen McLeod said, often it is a very young child who becomes unwell, who might not be able to communicate how they are feeling. It can be hard to diagnose the disease, and sometimes a crisis is reached before that happens, which is not ideal.

Innovations in the treatment of diabetes, such as insulin pumps for type 1 patients, have helped people to take better control of their condition, although they have not changed the person’s condition or their dependence on insulin.

Whether a person has type 1 or type 2 diabetes, they tend to depend on some kind of drug therapy for the rest of their life. They must also be careful about what they eat and when, and things like going for a drink with friends have to be planned, because of the impact of alcohol on blood sugar levels and diabetes control.

It sometimes feels as though we have not come far in the treatment of diabetes, although new drugs might help people with the condition—we must wait to see how things pan out. We need a lot more research and development in relation to causes, treatment and medication, particularly for type 1 diabetes, the cause of which is difficult to identify.

Diabetes is dangerous, not just because blood sugar levels fluctuate to a degree that can be lethal if left unmanaged but because of its impact on overall health. Hanzala Malik talked about kidney failure and the impact on sight; diabetes can also lead to heart disease, circulation problems and difficulty in healing, which sometimes results in amputation. The outcomes can be extremely serious for diabetics.

New medications can help to alleviate the problems, but we need to do an awful lot more to develop treatment. We need to stress the importance of diet and exercise, to keep people fit as they get older. It can be difficult to say to someone whose joints are beginning to creak a bit that they should take more exercise, but there are activities that are valuable and do not have the impact that other activities have.

We need to inform people about diet. We all have busy lives and we are probably all a wee bit dependent on fast food, microwave meals and the like. We need more information about nutrition and we need to know how to use that information. Young people are no longer taught in school about what is good for them and what makes for a balanced diet.

We need to review how we provide care and support. When the minister sums up, it would be good if he gave us an update on how best practice is being rolled out, how our managed clinical networks are working and how the excellent work of the diabetes audit and research in Tayside study is informing health boards and improving the care and treatment of people with diabetes.

We should also perhaps work with schools, especially when very young children with type 1 diabetes first go to school, and inform teachers how to manage their condition by, for instance, ensuring that they eat before they take part in physical education lessons and the like. A little information and input from teachers could make the lives of parents and children a lot better.

I welcome the debate, as it shines a spotlight on diabetes. It is important that that happens because, as other members have said, diabetes is on the increase and we need to look at prevention and cure.

Photo of Michael Matheson Michael Matheson Scottish National Party

Like other members, I congratulate Dave Stewart on securing time for the debate to mark world diabetes day. I recognise the expertise in the area that he brings to the chamber, being the co-chair, along with Nanette Milne, of the cross-party group on diabetes in the Scottish Parliament. He has also undertaken work at an international level with the parliamentarians for diabetes global network in Melbourne. I confess that the idea of a stroll in the Melbourne sunshine is very appealing at this time of the year.

The debate gives us an opportunity both to underline the serious challenge that diabetes presents in Scotland and to outline the work that we have done to improve the lives of those who live with diabetes.

As members have mentioned, the International Diabetes Federation has estimated that one in 10 of the world’s population will be living with diabetes by 2035. As Nanette Milne highlighted, the Scottish figures for 2013 saw the number of people with diabetes increase to more than 268,000, which is 5 per cent—one in 20—of our population. Those figures, along with the figures that Dave Stewart and others cited, are sobering, and they demonstrate the significant challenge that we face.

In Scotland, we are particularly well placed to answer that challenge. Earlier this year, we hosted our diabetes in Scotland conference, which saw more than 300 members of the Scottish and international diabetes community come together to discuss how we can improve services and make life better for people with diabetes and to share good practice. The conference also highlighted how fortunate we are in Scotland to have strong clinical leadership engaged in our diabetes teams and an active patient voice. I pay tribute to the lead clinicians who have chaired the Scottish diabetes group over the past decade—Professor John McKnight, Professor Donald Pearson and Professor Andrew Morris—and who made the event such a success. I note their work to ensure that the diabetes services in Scotland are second to none.

Our national diabetes programme has helped to co-ordinate safe, effective and person-centred diabetes care across Scotland for over a decade. Many members will be familiar with our diabetes action plan—indeed, some members have already referred to it. Over the past few years, the plan has been absolutely key to driving forward improvements in a number of important areas of diabetes care, including the delivery of state-of-the-art e-health solutions to monitor progress; improvements in foot care services; increased access to insulin pump therapy; and enhanced knowledge and skills among our staff.

It is important that we build on that work and strive to continually improve our diabetes services year on year. That is why, earlier today, I agreed to the publication of our new diabetes improvement plan, which will be published by the end of the month.

Our improvement plan aims to build on the existing work of the diabetes action plan by focusing on key priority areas, and it challenges the Scottish diabetes community to deliver continuous improvement in the quality of the care that is available to people with diabetes. A key part of that will be to build on the work that has been identified, particularly for those who are at higher risk in our ethnic minority communities, in order to see continued improvements.

Although I do not have sufficient time to go into great depth on all our diabetes programme’s successes or to set out all the areas that our new improvement plan will cover, I will take the opportunity to set out some of our work to date.

A key measure of diabetes care is our Scottish diabetes survey, which is perhaps the most comprehensive national record of its kind in the world. A major success to highlight from the most recent survey is that the percentage of people with both type 1 and type 2 diabetes who have had their foot risk recorded has more than doubled between 2008 and 2013 to about 80 per cent. That will have a major impact in reducing foot ulcers and lower-limb loss. That is evidence that our world-leading foot risk triage system, which was developed by our diabetes foot action group, is working to ensure that people with diabetes who are at most risk of developing foot complications are receiving the care that they need and that a preventative approach is taken.

A second area to highlight are the very substantial improvements that we have made to insulin pump access, which several members mentioned. I am very pleased to note that we have made significant progress in this area. Making that progress across all health boards has not always been easy, as Dave Stewart and others will recognise. However, we have seen a significant increase in the number of insulin pumps being made available to adults and children.

We have met our overall aim of ensuring that 25 per cent of people under 18 have access to insulin pumps. To put that into context, we have gone from 8.4 per cent of our under-18s with diabetes having access to an insulin pump in 2011 to 27.5 per cent across the country being on an insulin pump. However, I reassure those in the chamber that we are not complacent; indeed, we want to ensure that, by March 2015, the target is met consistently across all health boards.

Improving services for people who have diabetes is not enough. We need to address the underlying risk factors that lead to the development of type 2 diabetes and identify diabetes among young people earlier if we are to safeguard the future health of Scotland.

Earlier this year, the World Health Assembly announced its global target to halt the rise in diabetes and obesity by 2025. That is an ambitious aim, but rightly so. It very much complements our focus on preventing type 2 diabetes and our progress in working on the marked factors that can influence the risk factors in someone developing type 2 diabetes.

We are working to encourage people to make lifestyle changes, such as—Rhoda Grant correctly highlighted these as key components—adopting a healthier diet, managing their weight and increasing their physical activity. We have committed £7.5 million in the current spending period to healthy eating projects to support people in making healthier eating choices. In addition, we have provided improvement funding to several stakeholders over the past year, including Diabetes Scotland, to support projects that encourage healthier eating and lifestyle choices.

We are also committed to continuing our positive engagement with the food industry about our proposals to improve dietary health. Last month, I met Diabetes Scotland and Dave Stewart, along with the Food Standards Agency, to explore that matter further in relation to public procurement. We will continue that dialogue to see whether there are further measures that we can take.

It is essential not only to support people in making healthy living choices to avoid diabetes but to identify people with diabetes earlier. Type 1 diabetes tends to present more acutely than type 2 does, but a key part of the work that we will be doing is to ensure that we continue to make progress on earlier identification. Our paediatric and adolescent group is developing a range of materials for general practitioner surgeries and admitting departments that are designed to support healthcare professionals to recognise the symptoms of diabetes in young people much more quickly to ensure that an earlier diagnosis is made. We will look to roll out those materials over the coming months.

In addition, I have set in motion work that will involve our public health sector playing a much more proactive role in the prevention of conditions such as diabetes. Last week in Aviemore, I announced that there will be a review of public health services in Scotland, the initial findings from which will arrive with ministers in 2015, with a view to continuing to improve public health provision. The preventative agenda is at the centre of that.

It is clear that the NHS in Scotland has delivered real improvements in the care of people with diabetes in the past few years. Now more than ever, we need to ensure that we move forward by making a stronger collaborative effort that involves all stakeholders and agencies to create a health-promoting and diabetes-aware culture in Scotland. I assure members that our new improvement plan will look to build on that progress in the coming years.

Meeting closed at 17:46.