Hansard

I welcome the opportunity to debate access to insulin pumps and thank members throughout the chamber who signed the motion and who have deferred travelling to their constituencies and regions to be here this evening.

I warmly welcome to the gallery members of the insulin pump awareness group and representatives of Diabetes UK. On a quick personal note, I welcome my son, Andrew, to the gallery. He is doing a PhD in neuroscience at the University of Edinburgh. This is his first time in the Parliament. I hope that he is not after my seat.

Why have another debate on diabetes? As members are aware, Scotland has the third highest incidence of diabetes in the developed world. Diabetes is the main cause of blindness in those of working age in Scotland. Also, half of all non-traumatic lower limb amputations are due to diabetic complications. According to NHS Quality Improvement Scotland, diabetic care now costs £1 billion, which is 10 per cent of the national health service budget. As members will be well aware, diabetes is a condition where the body cannot use glucose properly. If untreated, it l can led to heart disease, stroke and kidney complications.

There are, of course, two forms of diabetes: type 1, or early onset diabetes, which—as the name suggests—usually develops in younger people, and type 2 or maturity onset diabetes, which in the main affects people over 40 and which is the most prevalent form of the condition.

Many members will be aware of my campaign, and that of Diabetes UK, for a high-risk screening programme for type 2 diabetes for those who are over 45 and have a family history of diabetes or are overweight.

The purpose of the debate is to argue for the greater use of continuous subcutaneous insulin infusion or—as is perhaps easier to pronounce—insulin pump therapy for eligible type 1 diabetics. The campaigning slogan from Diabetes UK Scotland is pump up the volume—it is about ensuring that those who could benefit from the improved quality of life provided by a pump are not denied one.

In its submission to the Government's consultation on better diabetes care, Diabetes UK Scotland quoted the mother of a 13-year-old boy with type 1 diabetes, who said:

"Scotland is in the dark ages as far as access to pumps is concerned. This must be addressed. Rates of type 1 diabetes on pumps is amongst the poorest in Europe—there is a real postcode lottery."

What does an insulin pump do? The pump is an external device that continually infuses insulin into the user's body and controls glycaemic levels, which many users would otherwise struggle to do. With the pump, insulin levels can be increased simply by pressing a button on the pump instead of using a pen needle, which can be embarrassing for individuals, particularly when they inject in public. I heard earlier from the pump action group that it is greatly reassuring for parents whose children have pumps to know that they have their pump with them when they are out and about at weekends and so on—that is especially the case with teenagers.

Insulin pumps empower users to have greater control over their condition as it gives them a more flexible and reliable means of managing their glycaemic levels. Improved control over health means an improvement in the quality of life, fewer hospital visits, a more productive work life and less stress at home. Fewer hospital admissions and a reduction in primary care contacts mean that there is less strain on the national health service.

Diabetes UK Scotland has argued that more than £23,000 could be saved over two years, which would comfortably offset the initial cost of providing pump therapy. It is important to consider the big picture and to compare the cost with that of poorly controlled diabetes: a one-night stay in hospital following admission to accident and emergency for a diabetic emergency costs about £410, one course of laser treatment for retinopathy costs about £850, one procedure of dialysis treatment costs £500 and renal dialysis for one year costs more than £15,000.

The National Institute for Clinical Excellence guidelines estimate that between 10 and 15 per cent of Scotland's 27,500 type 1 population is eligible for pump therapy, yet only 1.6 per cent of type 1 diabetics—roughly 448 people—have a pump. The English figure has been estimated by one consultant to be around 5 per cent. Why is there such a disparity? Do people with type 1 diabetes in Scotland have a lesser need than patients over the border? The user group for insulin pumps tells me that more than 40 per cent of eligible type 1 patients at a paediatric clinic in Leeds are on pump therapy.

I did a little international comparison. In the United States, 40 per cent of eligible type 1 diabetics have a pump. In Israel, the figure is 20 per cent, and in Germany it is 18 per cent. As the minister will be aware, in July 2009 I asked a parliamentary question on pumps. It was a simple question about the percentage of type 1 diabetics who are users of pumps, broken down by health board area. I shall give a quick summary of the response—I am glad that I have Cathy Jamieson next to me; she has taken an interest in the issue. The figure for NHS Ayrshire and Arran was a disgraceful 0.1 per cent—a dunce's cap for that health board. In NHS Greater Glasgow and Clyde it was 1.9 per cent, in NHS Fife it was 2.4 per cent, in NHS Lothian it was a bit better at 3.2 per cent and in NHS Tayside it was 4.2 per cent. I am sure that Mary Scanlon will take an interest in the figure for my local NHS board—a pitiful 0.9 per cent. I ask the simple question: if it is good enough for Hollywood, Honolulu and Houston, why is it not good enough for Highland?

Type 1—or early onset—diabetes has a peak age diagnosis of around 10 to 14 years, so those with type 1 will have a lifetime experience of the condition. A close relative of mine was diagnosed with type 1 when he was 12. He died in 2007, aged 75, having had 63 years' first-hand experience of the condition. He told me about the regular pen needle injections and having to balance each dose.

As we all know, too little insulin can lead to hyperglycaemia, coma or death. Insulin pumps give greater control over blood glucose levels, which reduces the chance of diabetics developing complications. Pumps give precise doses, which lowers blood glucose and increases life expectancy, as was confirmed by the recent diabetes control and complication trial study.

An insulin pump is about the size of a pager—and, as someone recently said to me, it is probably less irritating. It is also the closest substitute to the body making and delivering its own insulin. I accept, of course, that the cost is initially higher than the alternative, but in the long term there will be savings through fewer hospital admissions.

The big picture is to seek an end to postcode prescribing. We need to monitor what health boards are doing more closely. I am sure that the minister will mention that in her summing up. We need to ensure that health boards implement national targets.

In its response to the "Better Diabetes Care" consultation, Diabetes UK Scotland said:

"The difficulty appears to be the result of a number of pressures to the system: local resources are inefficient, business cases are slow to be made; there are pockets of professional scepticism about the effectiveness of pump therapy that spring more from a historical basis … It appears that questions around costs and accuracy of quality of life measurement remain with the health service."

I think that I have made the benefits of pumps clear. They are simply these: a decrease in blood glucose levels; a reduction in insulin levels; a reduction in severe hypoglycaemia episodes; and a fall in the number of hospital admissions.

I ask the minister to pump up the volume, to spread the word on the effectiveness of insulin pumps and to give hope and confidence to our young people and to diabetics of all ages about being able to live their lives free of diabetic complications.