Hansard

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 management. The motion has widespread support across the political spectrum and I thank members who supported it. As for those who have not, I always welcome sinners who repent.

First, I acknowledge the work of the cross-party group on diabetes, which Karen Whitefield convenes and of which I am a member. I warmly welcome the visitors in the public gallery, particularly the representatives of Diabetes UK Scotland.

Some may ask, why debate diabetes? I declare a personal interest, in that about 11 years ago I made a fascinating visit to Raigmore hospital in my constituency. I went to the diabetic specialist centre there, where I was encouraged by the staff to take a particular interest in the debate. I also had a family member, who is unfortunately no longer with us, who suffered from diabetes for more than 70 years, so I have first-hand experience of day-to-day family life with a diabetic. In my Westminster days, I was secretary of the all-party group on diabetes.

Members will be aware of the major causes of concern about diabetes. It is the main cause of blindness among people of working age; half of all non-traumatic lower limb amputations are due to diabetic complications; and diabetic care costs the national health service in Scotland the phenomenal sum of about £0.5 billion.

On type 2 diabetes, members will be aware that I have supported a campaign for high-risk screening for type 2, or mature onset, diabetes for people who are overweight, or who have a family history of diabetes or who are over 45. I hope to use the United Kingdom screening committee to give some support to that campaign.

What am I calling for? It is important that we have greater use of continuous subcutaneous insulin infusion—CSII—or, as it is also known, insulin pump therapy, which is slightly easier to pronounce, so I will use that term for the rest of the debate. As members will be aware, insulin pump therapy provides significant improvement in glycaemic control and quality of life for some people with type 1 diabetes—so-called early onset and insulin-dependent diabetes.

The pump is an external device that continually infuses insulin into the patient's body and thus controls their glycaemic levels, which many patients otherwise struggle to achieve. That alternative way of maintaining insulin levels can contribute to more stable wellbeing by reducing the risk of hypoglycaemia and replacing several daily injections with only two to three a week. With the pump, insulin levels can be increased by simply pressing a button on the pump instead of using a pen needle, which can be embarrassing for patients, particularly when they inject in public.

Insulin pumps empower patients to have greater control over their condition as they give them a more flexible and reliable means of managing glycaemic levels. Improved control over one's own health means improvement in the quality of life of many patients: it means fewer hospital visits, a more productive work life and less stress at home. Fewer hospital admissions and a reduction in primary care contacts also mean that there is less strain on the NHS.

Diabetes UK Scotland has argued that there is a saving of more than £23,000 over two years, which would comfortably offset the cost of pump therapy. Let us look at the big picture and compare the cost with the costs of poorly controlled diabetes: a one-night stay in hospital following admission to accident and emergency for a diabetes emergency costs £350; one course of laser treatment for retinopathy costs £850; one procedure of dialysis treatment for kidney disease costs £500; and renal dialysis for one year costs £15,000.

Despite the outlined benefits of insulin pump therapy, it is still rare in Scotland. That is particularly problematic considering Scotland's prevalence of type 1 diabetes, which is well above the European average. Less than 1 per cent of sufferers of type 1 diabetes receive insulin pump treatment. That is in stark contrast to other parts of the world, where rates of pump use are much higher. For example, in Germany and the United States 15 per cent to 20 per cent of patients enjoy the benefits of insulin pumps. What would it mean if we had the same rate as the USA and Germany? it would mean that another 4,000 to 5,000 people in Scotland would benefit. In my region—the Highlands—that would mean a jump from six users, which is very low, to 450. In the Western Isles, it would mean a jump from only one user to 33.

What is obstructing patients from accessing the treatment, which could potentially change fundamentally the lives of so many of them? Part of the explanation is that the criteria for qualification for insulin pump therapy are currently restrictive and exclude many patients who could otherwise benefit. If a patient does not fall into the set category, they have to fund the treatment themselves, which can run into thousands of pounds. Diabetes UK Scotland has criticised the criteria, which, as members are aware, are currently under review by the National Institute for Health and Clinical Excellence. It appears likely that the criteria will change and be relaxed, but that does not mean that our work is over—we must ensure that health boards have the funds to finance treatment for the additional patients.

A further concern is that only limited specialist centres in Scotland are able to deliver pump therapy, which means that some patients have to travel extensively. The answer to a recent parliamentary question from Christine Grahame showed that since February 2007 there has been an increase in the number of users of about 127. I give praise where praise is due: Lothian NHS Board and Tayside NHS Board should pat themselves on the back, because their levels of pump usage are well above those in England and the rest of Europe. I do not, however, have such a positive message to put out for Greater Glasgow and Clyde NHS Board and Ayrshire and Arran NHS Board, which are in the corner with dunce's caps for their low level of pump usage.

As with most things in life, we never really appreciate the devastating extent of a disease until we suffer it ourselves. That is why I will end my speech by telling members a story about a diabetic who can tell members first hand how life-changing the effects of insulin pump therapy can be. Her name is Dorothy, she is in the gallery today and she has had type 1 diabetes for 37 years. She has struggled to control her blood sugar level, which has affected her health and deprived her of sleep. She states:

"Within 4 weeks of starting the pump, my blood glucose levels came down to 7.5. I suddenly got my life back. My appetite returned and at last I could see the light at the end of the tunnel.

Despite feeling 100% better, I still have problems with my control and it's my belief that had I got the ‘pump' earlier, I would never have experienced these problems.

For this reason and many others, I strongly believe that continuous subcutaneous insulin infusion (CSII) should be available to everyone who would benefit from it and especially to young people who have their whole life in front of them.

It is my dearest wish that they may live their life free of all diabetic complications."

I call on the Cabinet Secretary for Health and Wellbeing to follow NICE guidelines and to encourage increased use of pump therapy, to provide a new era of hope for type 1 diabetics.