Hansard

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 aware, our national policy is set out in the diabetes action plan. Each NHS board area should have an insulin strategy covering the full range of insulin use, including, where appropriate, the use of pumps. Local implementation of that insulin strategy is the responsibility of each NHS board, working closely with its diabetes managed clinical network to ensure that it complements the other services for people with diabetes. That approach allows the diabetes MCNs to monitor regularly the availability of pumps, and to report their findings to the Scottish diabetes group. The group arranged for advice on the subject to go to all the diabetes MCNs in spring of last year. It also organised a national meeting of MCN representatives to share best practice around insulin pump therapy. A working group then produced a national educational curriculum, which is available to all NHS boards. The diabetes lead clinician intends to ensure that progress is a standard item on the agenda for the regular meetings that he has with the networks' clinical leads.

There has been a growth in the use of pumps across Scotland. We should acknowledge that progress, but we must recognise that there are two main concerns about current performance, the first of which is the variation in provision across NHS boards. The motion, quite rightly, draws attention to the disparity in uptake of pumps across NHS boards. A number of members have touched on that in relation to specific boards: NHS Ayrshire and Arran, and NHS Lanarkshire. I assure members that I will continue to press boards on that issue.

Another concern that has been highlighted in the debate is that, on current criteria, as set out by NICE, our use of pumps is at the lower end of the spectrum. There are 263 people on an insulin pump, whereas applying the NICE criteria suggests that the number should be somewhere in the range of 260 to 530. As we have heard, NICE is reviewing its technology assessment, which might mean that around 15 per cent of people with type 1 diabetes could be considered eligible for an insulin pump.

I want to introduce an important factor that is not mentioned in the motion but which was touched on by, I think, Richard Simpson. For people with type 1 diabetes, it is a case of determining the insulin regime that is best suited to each person's circumstances. We also need to take into account the type of regime that commands the confidence of the team that provides diabetes services. As members know, the main options are insulin injections, which might need to be administered between two and four times a day, and insulin pumps, which are now technically much more reliable than they used to be. The choice of insulin regime should be agreed between the person who has type 1 diabetes and the team that supports their diabetes care.

The benefits to patients of insulin pumps were well described by David Stewart and other members, but it is important to put on record that insulin pump therapy is not always an easy option and requires determination and commitment on the part of the patient, coupled with a structured education course. Insulin pump therapy improves patient satisfaction in some cases, but it does not inevitably lead to better control of blood glucose levels. Children who are on insulin pump therapy need continuing care, especially during the transition to adolescence and adulthood. However, as many members said, insulin pump therapy can offer people with diabetes increased freedom and flexibility and a better quality of life. We would not want to reduce such an issue to a crude cost benefit analysis, but points about cost savings were well made by members.

We will encourage boards to continue to increase the number of people who use insulin pumps, but we need to acknowledge that that must be a managed process, in part because a key factor is the availability of staff to deliver the education programmes that are needed before pump therapy commences, to ensure that the regime is used optimally. Structured education is very important in maintaining and improving blood glucose control in all 27,000 people with type 1 diabetes and is an important adjunct to insulin pump therapy.

I repeat my thanks to everyone who took part in the debate. I acknowledge the importance of the issue and I support the thrust of the motion. I will ensure that I and the Scottish diabetes group continue to monitor closely insulin pump programme availability throughout Scotland and on a board-by-board basis, particularly when the new NICE criteria are available. I have no doubt that the Parliament will also want to monitor the issue closely.