Thank you, Deputy Presiding Officer. I’m happy to move the motion on the paper and to have the opportunity to have this debate on a significant public health challenge for Wales, and to set out our progress in improving the quality of care, as well as to restate our expectation and ambition for further improvement.

I’ll briefly speak to the amendments. Unfortunately, I won’t be able to support amendment 1 tabled by Plaid Cymru, as we don’t think that it’s correct to state that children and young people are unable to access structured education. We know these services are available. But, I understand there is a very real concern about the recorded take-up of structured education and the figures that we get from our audit. All of our paediatric diabetes units offer self-management education to newly diagnosed children and young people. We want to improve what the audit counts to improve the accuracy of it, but patients aren’t referred to another setting to receive diabetes education: it is provided within the unit. We can say, though, that we’ve recently introduced a new all-Wales structured education programme for children and young people called SEREN. This programme is the first of its kind in the UK. So, we do expect to see the recording of participation in self-management education improving in future years, as well as, of course, wanting to drive up the numbers of people who do take part. So, there’s really an issue about wording, rather than our ambition and recognising we need to do more.

On amendment 2, I’m happy to welcome and to accept the amendment drawing attention to the importance of tackling obesity, and I’ll talk about that particular issue later in my contribution. But, at the outset, I want to recognise, of course, as people in this place will know, that there’s a difference between type 1 and type 2 diabetes. In type 1 diabetes, a much smaller group of people where there are no lifestyle factors linked to its development, whereas in type 2 we know that there certainly are. Much of our discussion on the growth of diabetes centres on the rise in type 2 diabetes across our country. But, diabetes in all of its forms, with all of its complications, is estimated to cost roughly 10 per cent of health spend here in Wales. And, without change, within the next 20 years we estimate that will rise to about 17 per cent of health spend. GP registers currently show that 7.3 per cent of the population aged over the age of 17 have diabetes and that numbers continue to rise. That’s nearly 189,000 of our friends, family members, colleagues and neighbours living with this disease, and others yet to be diagnosed.

So, in terms of demand, cost and direct suffering, diabetes already has a profound impact on our society and our health and care system. Numbers have increased over 17 per cent in just five years, and we estimate that more than 300,000 people will be affected by 2025. It’s important to recognise that, whilst we want to improve the care and treatment, there’s no magic pill to treat our way out of this diabetes epidemic. This is one of the great public health challenges facing Wales. It requires a significant shift in attitude and behaviour within each of the communities that we represent.

Our national approach here in Wales was updated in December last year and will take us through to 2020. On 21 April this year, we published a statement of progress and intent, and that statement draws attention to what we have achieved, as well as what we have yet to do. It sets out clearly the direction, leadership arrangements and areas of our national focus.

In addition to reducing the number of new cases of diabetes, we recognise the need for a continued focus on improvement in how we treat and support people to manage their diabetes. Many people affected by diabetes need intensive and wide-ranging support to manage their condition and to reduce the risk of blindness, foot disease, renal failure and heart disease. For the vast majority, this will be delivered in primary and community care, but others will need access to hospital and very specialist teams. That reinforces the need to work as a genuinely joined-up system. That’s why a key national priority is using informatics to deliver a unified diabetes record across different healthcare settings, and that unified diabetes record should help to deliver integrated, accurate and timely diabetes care wherever that patient accesses their healthcare. Put simply, it should help us to deliver better care for the citizen.

We’re working with primary care physicians, specialist nurses and allied health professionals to develop a new model of diabetes care fit for the twenty-first century. We’re not afraid to learn best practice both within and outside of Wales to do that. That will undoubtedly mean a further shift into primary care and reinforce the need to address local practice that is not good practice and does not properly prioritise patient outcomes.

All patients, though, with diabetes should be receiving their NICE-recommended key care processes, working towards individualised treatment targets. For all the progress we’ve made, we know we haven’t done that as consistently as we wished to do so. So, our primary care providers are already working on national audit data to tackle variation in care and improve standards. That’s proper reflection from professionals themselves about the need to further improvements.

We know from the audit that we can make progress on recent reports, which have shown six years of continual improvement in population level outcomes. We also have important work in train to support people with complex needs and those staying in hospital, as one in five in-patients have diabetes. That, again, highlights the importance of hospital service improvement programmes like Think Glucose and Think, Check, Act. Our in-patient diabetes audit confirms that hospitals are providing more personalised diabetes care, high levels of patient experience, and fewer people experiencing hypoglycemia whilst in hospital. Again, I accept there is more for us to do to seek and deliver further improvement. We have, though, to help deliver that, created a small group of national leaders to support health boards to implement the plan and tackle that variation in care that we recognise. So, using part of the annual £1 million allocation, we have a national clinical lead for diabetes, and a number of other leadership posts covering insulin pump therapy, foot care, and the transition to adult services and structured education. That national clinical lead has been widely welcomed, not just within the service, but across the campaigning third sector as well. So, the national implementation group that includes third sector colleagues will continue to set the strategic direction for diabetes and work to support health boards to continuously improve diabetes services.

Turning back to the nature of the challenge we face, we do think there is a role, for example, for more mandatory action, whether that be a sugar levy, advertising, and the availability of unhealthy food, drink and tobacco—particularly in reducing the level of type 2 diabetes and complications that go with diabetes. However, that Government intervention or compulsion will not resolve the national challenge that we face on its own. As I’ve said, we have a societal-wide problem. As a nation we do not exercise enough, we do not eat well enough, and we do not do anything like enough to minimise our chances of developing cardiovascular diseases and type 2 diabetes. We’ve known this for a very long time. We recognise the need for significant large-scale behaviour change, but we have not been successful enough at delivering that change with our communities. We won’t be successful, though, by simply lecturing people or making some of those behaviours more difficult or more expensive. That, in itself, isn’t going to be the answer that we need. We continue to need to make healthier choices easier choices to make, to understand, and to act upon. We need that societal shift in attitude and behaviour, and it goes without saying that isn’t easy. There’s no western society that has got this right, but we all face, broadly, a similar problem.

That does, though, mean a greater level of personal ownership, empowerment and accountability. Success will mean greater take-up of active travel, healthier behaviours, and providing healthy learning, working and living environments. But, of course, diagnosing the challenge and what we need to achieve is so much easier than how to do so. That’s why a key piece of joint-funded work between the diabetes, cardiac and stroke implementation groups is the national roll-out of the cardiovascular disease risk programme. It identifies those at the highest risk of cardiovascular disease and diabetes and invites those people proactively in to take part in local activities to help reduce their risk. And, crucially, it doesn’t take place all in a medicalised setting. There’s something here about behaviour change and how best to try and deliver and achieve that. This really is an innovative, multi-disease, national approach. And it’s a product not of a single politician, but it’s a product of our staff across our health and care service, making this a more social challenge, and, as I say, not simply confining it to a medical setting.

The programme is at the heart of how we’ll prevent future demand, alongside our broader approach to healthier lifestyles, and I look forward to learning from that approach as we go on. I won’t pretend to you today, or in summing up this debate, that we have all the answers in Government, because we certainly don’t. We need to understand what works in each community and how we successfully roll that out into different parts of our country, because, if we don’t, the cost isn’t just the financial terms that I set out at the start of this debate. There’s a much higher price to pay for individuals and their communities, and not just the social well-being of our country, but the economic well-being of our country, if we can’t see a significant shift in attitude and behaviour and do something more than just move the quality of care for the number of people who will acquire diabetes during their life and need not do so. I’m happy to move the motion.