Hansard

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 not represented at all—because diabetes is very serious and important health issue, the complications of which, as Nanette Milne has made clear, have massive consequences for not only individual suffering but the cost to society.

Over the past 20 or 30 years, diabetic care has improved substantially, and the shift to primary care has been fundamental in ensuring a much more proactive and individualised approach. The creation of care plans, for example, has been important, but we are still some way from the establishment of key workers, which I think is also fundamental to the delivery of good care.

In the early 1990s, during the time of fund holding, I was among those who were invited to carry out a study on how fund holding and commissioning could be used to drive forward a retinal screening programme in my locality. In two years, the subsequent programme increased the level of screening from 60 per cent to 92 per cent. What levers are available nowadays to deliver on these matters? The information that we have received makes clear the extreme range of provision. For example, the figure for those with diabetes who have insulin pumps is 0.1 per cent in Ayrshire and Arran, but 2.7 per cent in Tayside. I am glad to say that two out of the three health boards in my region of Mid Scotland and Fife—NHS Tayside and NHS Fife—are doing quite well in that respect.

I should also point out that Tayside has the most highly developed diabetic programme in Scotland. In identifying diabetics and ensuring more integration of care, the diabetes audit and research in Tayside Scotland study, which involved the Tayside medicines monitoring unit, has helped to drive up care levels in that area in a way that perhaps has not happened elsewhere in Scotland. It is therefore no surprise to me that the figure in Tayside for those with insulin pumps is 2.7 per cent, a full 1 percentage point above any other area.

I suggest that the benchmark for Scotland should be in the region of 2.5 per cent and that we invite the Cabinet Secretary for Health and Wellbeing to use every available means to hold health boards, particularly the outliers, to account and to ask them to explain these massive discrepancies between one area and another—to her, to the Government and to the Parliament.

Pumps are not suitable for everyone, but for people for whom they are suitable, particularly those who are unstable and require a background delivery of insulin, savings can undoubtedly be delivered.

One of the problems for the health service is the demand that we place on it to achieve efficiency savings. That demand is entirely appropriate, but it is far too often recognised only in the short term. We need a system that allows health boards to invest the savings that they make and encourages them to invest for future savings. We need to raise people's sights and horizons to savings that could be made down the line, which will involve thinking beyond the spending cycle that, to a large extent, governs our actions. In the 1980s, I made proposals to eliminate a nine-month waiting list for vasectomy that I said would have a one-off cost that would be paid for in six years. The health board's response was that it did not think that far ahead. We need to think that far ahead.