IPAG Scotland

Members of IPAG attended the Scottish Parliament Members Debate on Insulin Pump Therapy yesterday afternoon. Below are the notes from this debate.

Insulin Pump Therapy

The Deputy Presiding Officer (Alasdair Morgan): 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 concluded without any question being put.

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% and 14% of people with type 1 diabetes meet the criteria for eligibility for insulin pump therapy under current clinical guidance; notes the variation in financial provision across NHS boards for insulin pump therapy, whereby in Fife funding has been allocated for 10 pumps per year, whereas in Highland there is no separate budget despite all NHS boards having received funding for access to insulin pumps; further notes the differences in waiting times for eligible patients whereby in Lothian the average waiting time including waiting for training and education is estimated to be around 12 months and in Grampian and Orkney the current waiting time is six months; notes with concern the low level of insulin pump usage in Highland, which, at 0.9 per cent is the second lowest in Scotland, after Ayrshire and Arran; believes that further steps are required to monitor NHS boards to avoid a postcode lottery for patients with insulin-dependent diabetes, and looks forward to renewed commitment to action on diabetes in Scotland in 2010 and beyond.

17:02

David Stewart (Highlands and Islands) (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 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.