Chamber
Plenary, 03 Sep 2009
03 Sep 2009 · S3 · Plenary
Item of business
Insulin Pump Therapy
I, too, congratulate David Stewart on securing the debate and on his continued interest in the matter.
I must make a declaration of interest, Presiding Officer, but it is not one that you will find in the members' register of interests. Nevertheless, it is appropriate on this occasion. I have been a type 1 diabetic for 44 years. I am very sparing in the public contributions that I make to debates on diabetes, but I regard the issue as singularly important. I therefore elected to seek to contribute to the debate, and the Presiding Officer granted me permission to do so.
I am philosophically very opposed to categorising people into great cohorts. One real difficulty that arises from the tremendous surge in the numbers of diabetics is that people suddenly find that they have become simply a type 1 or a type 2 diabetic. If we are to treat people at all, we need to treat them as individuals. That could not be more true than in the case of diabetes, given that the individual who suffers from diabetes can exhibit a wide range of different symptoms. For example, I do not have a pump—I am not entirely persuaded that my medical advisers think that I am well-balanced, but that might be more to do with my mental state than with my balance in terms of an insulin regime. Individuals are different, and they need to be treated as individuals.
One or two issues need to be raised in any debate on pumps. We cannot simply take pumps in isolation. As an individual, I am increasingly concerned about the lack of awareness on the part of those who deal, very earnestly and honestly, with people who have a diabetic condition. There is sometimes a lack of understanding and awareness of the condition and the individual nature of the treatment. Some people in the health service are excellent—do not get me wrong about that—but I find too often that people do not understand the condition and therefore fail to communicate to the patient the necessary understanding of what diabetes is and what it is about. I am astonished that, even with the introduction of the excellent DAFNE—dose adjustment for normal eating—programme, I meet people who believe that they can control their diabetes only by insulin and by nothing else. They hopelessly misunderstand other elements that are necessary. Therefore, I believe that we cannot make progress on insulin pumps against a background in which those who give advice on diabetes do not communicate an adequate understanding of the condition to those who suffer from it.
Nevertheless, I am absolutely clear that the present number of people who have access to pumps, and the way in which that access is given, is—to be honest—totally and completely unacceptable. The new National Institute for Health and Clinical Excellence guidance has been an improvement, but there are two issues with the guidance, one of which Kenny Gibson mentioned when he talked about his constituent Jenny. The guidance suggests that people should become eligible for a pump where insulin therapy has "failed". There are good medical reasons for that, but the use of such phraseology is unfortunate. Insulin pumps should not be regarded as available only for those for whom insulin therapy has failed. The adjudication should be on the basis of individual need, not on a presumption of failure. In addition, the guidance suggests that insulin pump therapy should be made available to under-12s when multiple injections are regarded as "impractical or inappropriate". That recommendation acknowledges that a degree of subjectivity is involved, yet the guidance does not permit enough people to be eligible.
The insulin pump awareness group and Diabetes UK are to be congratulated on their recent campaign. The figures are unacceptable: far too many people are suffering who should not need to suffer. I hope that we can agree that, as well as widening our understanding of what diabetes is and what is necessary to control it, there ought to be a substantial increase in the number who are eligible to access pump therapy in Scotland.
I must make a declaration of interest, Presiding Officer, but it is not one that you will find in the members' register of interests. Nevertheless, it is appropriate on this occasion. I have been a type 1 diabetic for 44 years. I am very sparing in the public contributions that I make to debates on diabetes, but I regard the issue as singularly important. I therefore elected to seek to contribute to the debate, and the Presiding Officer granted me permission to do so.
I am philosophically very opposed to categorising people into great cohorts. One real difficulty that arises from the tremendous surge in the numbers of diabetics is that people suddenly find that they have become simply a type 1 or a type 2 diabetic. If we are to treat people at all, we need to treat them as individuals. That could not be more true than in the case of diabetes, given that the individual who suffers from diabetes can exhibit a wide range of different symptoms. For example, I do not have a pump—I am not entirely persuaded that my medical advisers think that I am well-balanced, but that might be more to do with my mental state than with my balance in terms of an insulin regime. Individuals are different, and they need to be treated as individuals.
One or two issues need to be raised in any debate on pumps. We cannot simply take pumps in isolation. As an individual, I am increasingly concerned about the lack of awareness on the part of those who deal, very earnestly and honestly, with people who have a diabetic condition. There is sometimes a lack of understanding and awareness of the condition and the individual nature of the treatment. Some people in the health service are excellent—do not get me wrong about that—but I find too often that people do not understand the condition and therefore fail to communicate to the patient the necessary understanding of what diabetes is and what it is about. I am astonished that, even with the introduction of the excellent DAFNE—dose adjustment for normal eating—programme, I meet people who believe that they can control their diabetes only by insulin and by nothing else. They hopelessly misunderstand other elements that are necessary. Therefore, I believe that we cannot make progress on insulin pumps against a background in which those who give advice on diabetes do not communicate an adequate understanding of the condition to those who suffer from it.
Nevertheless, I am absolutely clear that the present number of people who have access to pumps, and the way in which that access is given, is—to be honest—totally and completely unacceptable. The new National Institute for Health and Clinical Excellence guidance has been an improvement, but there are two issues with the guidance, one of which Kenny Gibson mentioned when he talked about his constituent Jenny. The guidance suggests that people should become eligible for a pump where insulin therapy has "failed". There are good medical reasons for that, but the use of such phraseology is unfortunate. Insulin pumps should not be regarded as available only for those for whom insulin therapy has failed. The adjudication should be on the basis of individual need, not on a presumption of failure. In addition, the guidance suggests that insulin pump therapy should be made available to under-12s when multiple injections are regarded as "impractical or inappropriate". That recommendation acknowledges that a degree of subjectivity is involved, yet the guidance does not permit enough people to be eligible.
The insulin pump awareness group and Diabetes UK are to be congratulated on their recent campaign. The figures are unacceptable: far too many people are suffering who should not need to suffer. I hope that we can agree that, as well as widening our understanding of what diabetes is and what is necessary to control it, there ought to be a substantial increase in the number who are eligible to access pump therapy in Scotland.
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-4723, in the name of David Stewart, on insulin pump therapy. The debate will be conclu...
Motion debated,
That the Parliament acknowledges the benefits that insulin pumps have for people with type 1 diabetes in assisting with the condition; notes that between 4% ...
David Stewart (Highlands and Islands) (Lab):
Lab
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 t...
The Deputy Presiding Officer:
SNP
We come to the open debate. As a substantial number wish to speak, I ask members to limit their contributions to four minutes.
Kenneth Gibson (Cunninghame North) (SNP):
SNP
I congratulate David Stewart on securing this debate on an issue of great importance for many families throughout Scotland. As we have heard, type 1 diabetes...
The Minister for Public Health and Sport (Shona Robison):
SNP
I have information on Ayrshire and Arran, which the member might find useful. As I understand it, a redesign of the dietetic resource is going on, to support...
Kenneth Gibson:
SNP
I am delighted to hear that. I was contacted by constituents about the issue only this week. If that redesign is taking place, I hope that people whose child...
The Deputy Presiding Officer:
SNP
The member should conclude.
Kenneth Gibson:
SNP
I will finish on that point, then.
The Deputy Presiding Officer:
SNP
I am obliged.
Karen Whitefield (Airdrie and Shotts) (Lab):
Lab
I welcome the opportunity to speak in the debate on insulin pump provision, which is an important issue, and I congratulate Dave Stewart on securing the deba...
The Deputy Presiding Officer:
SNP
That is a good point on which to conclude.
Mary Scanlon (Highlands and Islands) (Con):
Con
I, too, congratulate David Stewart on securing the debate. It is appropriate that we discuss insulin pump therapy again, given the commitment that the Cabine...
The Deputy Presiding Officer:
SNP
The member must conclude.
Mary Scanlon:
Con
I will leave it there.
Cathie Craigie (Cumbernauld and Kilsyth) (Lab):
Lab
As has been said, Parliament had the opportunity to discuss this important matter in May 2008. I thank Dave Stewart for securing this evening's debate and fo...
Ross Finnie (West of Scotland) (LD):
LD
I, too, congratulate David Stewart on securing the debate and on his continued interest in the matter.I must make a declaration of interest, Presiding Office...
Hugh Henry (Paisley South) (Lab):
Lab
I congratulate David Stewart on continuing to bring to our attention an issue that is of great significance to far too many people throughout Scotland.Let me...
The Deputy Presiding Officer:
SNP
At this stage, I would be prepared to accept a motion without notice to extend the debate by up to 10 minutes.
Motion moved,
That, under Rule 8.14.3, the debate be extended by up to 10 minutes.—David Stewart.
Motion agreed to.
Nanette Milne (North East Scotland) (Con):
Con
I, too, am pleased that David Stewart has secured the debate and thank him for his efforts in doing so. My comments will be fairly brief but, given that I ch...
Dr Richard Simpson (Mid Scotland and Fife) (Lab):
Lab
I, too, congratulate David Stewart on securing the debate, which is the third debate on diabetes in the Parliament. As Nanette Milne said, we received a help...
The Minister for Public Health and Sport (Shona Robison):
SNP
I acknowledge David Stewart's long-standing commitment to the issue in the Parliament. As members have said, the Cabinet Secretary for Health and Wellbeing n...
Karen Whitefield:
Lab
The Government is currently undertaking work to review the Scottish diabetes framework. I do not expect the minister to tell us what will be in the revised d...
Shona Robison:
SNP
I will come on to the framework in a minute.Some of the credit for the progress that has been made—albeit that there is still more to do—must be given to the...
Meeting closed at 17:53.