Chamber
Plenary, 21 May 2008
21 May 2008 · S3 · Plenary
Item of business
Insulin Pumps
I am pleased to take part in the debate and I commend David Stewart on lodging the motion. Since I entered Parliament five years ago, my focus and that of many others has been on the frightening increase in the incidence of type 2 diabetes in our population, following what is almost an epidemic of obesity that affects younger and younger age groups. Because type 2 diabetes is such a great public health concern, it is easy to forget that the incidence of type 1 diabetes in Scotland is among the highest in the world.
As we know, diabetics depend on a successful insulin regime to keep their blood glucose under control. The better and more consistent the control is, the less likely it is that they will suffer the long-term complications of type 1 diabetes, such as retinopathy, arterial disease and renal failure. Many people adapt to their changed lifestyles after diagnosis without too many problems, but others find it hard to achieve a normal blood glucose level and fluctuate widely between hyperglycaemia and hypoglycaemia, both of which are dangerous for the patient in different ways.
There appears to be no doubt that better control of blood sugar, with fewer fluctuations and complications, can be achieved by many people who use insulin pumps, and that the quality of life of patients and their families is improved as a result. As David Stewart said, children in particular have been shown to adapt well to the use of insulin pump technology.
Clearly, any device that can improve blood-glucose control in diabetes will lead to long-term benefit, not only to the patient's health and wellbeing but also to the NHS, which will be faced with fewer complications to treat, and will experience reduced hospital admissions and less medical staff time being used in primary, secondary and tertiary health care settings.
Not every type 1 diabetic is considered suitable for, or wants, an insulin pump, but even under the fairly stringent eligibility criteria that have been recommended by NICE, which are currently under review, there are significantly fewer pump users in Scotland than in the rest of the UK, and many fewer than in the diabetic populations of the rest of the European Union and in the United States. Now that all health boards in Scotland have strategies in place for prescribing insulin pumps, their use is on the increase, but there is still significant regional disparity in the provision of pumps. Many more people could benefit from them.
The pumps do not come without cost, and their effectiveness depends on a sufficient number of health practitioners having been trained to support patients in their use. However, the long-term savings could be very significant. It is indeed a spend-to-save provision that concurrently leads to improved quality of life for successful users of the technology.
Several recent members' debates have illustrated the patchy provision of life-enhancing equipment in Scotland. There was Trish Godman's debate on wheelchair provision, mine on alternative and augmentative communication aids, Alison McInnes's on school book provision for visually impaired pupils, and now David Stewart's on the availability of insulin pumps. All those debates have concerned people for whom improved provision would make a huge difference to the quality of their lives. I am sure that there are many other long-term conditions for which treatment could be improved by technology or by more specialist nurses or other staff within the community.
Taken together, the improved quality of life for many people, and the resultant decrease in use of highly specialist secondary and tertiary NHS facilities and other public services, could only be of long-term benefit to our society, both physically and financially.
In supporting David Stewart's plea for greater provision of insulin pumps, I suggest to the cabinet secretary that a good deal of work needs to be done by, and with, the Long-term Conditions Alliance Scotland, to consider how provision could be improved across the board, with the ultimate goal of eliminating postcode lotteries in Scotland and improving the quality of life for all patients with chronic conditions who currently receive less than optimum care—including type 1 diabetics. [Interruption.]
As we know, diabetics depend on a successful insulin regime to keep their blood glucose under control. The better and more consistent the control is, the less likely it is that they will suffer the long-term complications of type 1 diabetes, such as retinopathy, arterial disease and renal failure. Many people adapt to their changed lifestyles after diagnosis without too many problems, but others find it hard to achieve a normal blood glucose level and fluctuate widely between hyperglycaemia and hypoglycaemia, both of which are dangerous for the patient in different ways.
There appears to be no doubt that better control of blood sugar, with fewer fluctuations and complications, can be achieved by many people who use insulin pumps, and that the quality of life of patients and their families is improved as a result. As David Stewart said, children in particular have been shown to adapt well to the use of insulin pump technology.
Clearly, any device that can improve blood-glucose control in diabetes will lead to long-term benefit, not only to the patient's health and wellbeing but also to the NHS, which will be faced with fewer complications to treat, and will experience reduced hospital admissions and less medical staff time being used in primary, secondary and tertiary health care settings.
Not every type 1 diabetic is considered suitable for, or wants, an insulin pump, but even under the fairly stringent eligibility criteria that have been recommended by NICE, which are currently under review, there are significantly fewer pump users in Scotland than in the rest of the UK, and many fewer than in the diabetic populations of the rest of the European Union and in the United States. Now that all health boards in Scotland have strategies in place for prescribing insulin pumps, their use is on the increase, but there is still significant regional disparity in the provision of pumps. Many more people could benefit from them.
The pumps do not come without cost, and their effectiveness depends on a sufficient number of health practitioners having been trained to support patients in their use. However, the long-term savings could be very significant. It is indeed a spend-to-save provision that concurrently leads to improved quality of life for successful users of the technology.
Several recent members' debates have illustrated the patchy provision of life-enhancing equipment in Scotland. There was Trish Godman's debate on wheelchair provision, mine on alternative and augmentative communication aids, Alison McInnes's on school book provision for visually impaired pupils, and now David Stewart's on the availability of insulin pumps. All those debates have concerned people for whom improved provision would make a huge difference to the quality of their lives. I am sure that there are many other long-term conditions for which treatment could be improved by technology or by more specialist nurses or other staff within the community.
Taken together, the improved quality of life for many people, and the resultant decrease in use of highly specialist secondary and tertiary NHS facilities and other public services, could only be of long-term benefit to our society, both physically and financially.
In supporting David Stewart's plea for greater provision of insulin pumps, I suggest to the cabinet secretary that a good deal of work needs to be done by, and with, the Long-term Conditions Alliance Scotland, to consider how provision could be improved across the board, with the ultimate goal of eliminating postcode lotteries in Scotland and improving the quality of life for all patients with chronic conditions who currently receive less than optimum care—including type 1 diabetics. [Interruption.]
In the same item of business
The Deputy Presiding Officer (Alasdair Morgan):
SNP
The final item of business is a members' business debate on motion S3M-1888, in the name of David Stewart, on increasing access to insulin pumps. The debate ...
Motion debated,
That the Parliament notes the considerable benefits that insulin pumps have for diabetics to help them to manage their condition; notes with concern the curr...
David Stewart (Highlands and Islands) (Lab):
Lab
I welcome the opportunity to debate increased access to insulin pumps specifically, but also the bigger picture of diabetes and its role in health care manag...
Nanette Milne (North East Scotland) (Con):
Con
I am pleased to take part in the debate and I commend David Stewart on lodging the motion. Since I entered Parliament five years ago, my focus and that of ma...
The Deputy Presiding Officer:
SNP
I am sorry—I do not want to be a spoilsport, and I should have said this earlier—but applause from the public gallery is not permitted.
Karen Whitefield (Airdrie and Shotts) (Lab):
Lab
I welcome the opportunity to speak in this evening's debate and congratulate David Stewart on securing a members' business debate on this important topic.Som...
Dr Richard Simpson (Mid Scotland and Fife) (Lab):
Lab
I, too, congratulate David Stewart on securing this debate. I am slightly disappointed that there are not more members in the chamber—indeed, one party is no...
James Kelly (Glasgow Rutherglen) (Lab):
Lab
I welcome the opportunity to take part in this evening's debate on the provision of insulin pumps and congratulate David Stewart on bringing the issue to the...
The Deputy First Minister and Cabinet Secretary for Health and Wellbeing (Nicola Sturgeon):
SNP
I thank David Stewart for bringing the issue to the chamber, and I thank those in the public gallery who have attended to hear the debate. Like other members...
Cathy Jamieson (Carrick, Cumnock and Doon Valley) (Lab):
Lab
We heard during the debate of the poor figures for Ayrshire and Arran. Given that, does the cabinet secretary feel it appropriate to get in touch specificall...
Nicola Sturgeon:
SNP
I am always happy to follow up issues individually with health boards, and I will return to the issue of variability across boards in a minute.As members are...
Meeting closed at 17:42.