In our report on this petition we have made 10 recommendations to the Welsh Government. We believe these would assist the timely diagnosis and treatment of type 1 diabetes. The committee welcomes the fact that the Cabinet Secretary for Health and Social Services has accepted, at least in principle, all of our recommendations. We hope this indicates a shared commitment to making progress in this field, although I will be seeking some further information on some aspects of his response during this afternoon’s debate. 

As I have already said, timely diagnosis of type 1 diabetes is of critical importance. DKA is both a life-threatening condition and an extremely traumatic experience for children and their families. Indeed, the Welsh Government’s diabetes delivery plan highlights the need for an urgent blood glucose check and an immediate referral to specialist services if diabetes is suspected. However, our investigations identified several barriers to early diagnosis. These include: low general awareness and recognition of type 1; potential deficiencies in staff knowledge and training; and concerns over a lack of access to rapid testing equipment in primary care.

Our recommendations seek to address these barriers. Recommendation 1 calls for the Welsh Government to seek to ensure that the four Ts symptoms are routinely asked when unwell children present in primary care, and that appropriate testing is carried out if required. Our second recommendation relates to the implementation of the National Institute for Health and Care Excellence guidance on this subject. In accepting these recommendations, the Cabinet Secretary has endorsed the NICE guidance and emphasised the need for healthcare professionals to use their clinical judgment.

We are pleased, of course, that the Government has accepted the thrust of our recommendations. Nevertheless we know, not least from the case of Peter Baldwin, that clinicians do not always ask specifically about the four Ts and parents may not mention them without being prompted. I therefore want to reiterate the committee’s view that GP consultations represent a crucial opportunity to identify type 1 diabetes. We believe the Welsh Government should take all possible steps to ensure that the right questions are asked in primary care, in order to seek to avoid further cases where type 1 diabetes is not identified until it is too late.

In this regard, a major step forward during the lifetime of this petition has been the development of a national referral pathway for type 1 diabetes. It emphasises the four Ts and that any suspected case of type 1 diabetes should be treated as a medical emergency. Developed by the children and young people diabetes network, and piloted in Cardiff and Vale health board, this pathway has now been issued to all health boards. The committee welcomes the fact that this has been rolled out so quickly.

In accepting recommendation 6 in our report, the Cabinet Secretary has stated that the Welsh Government will seek assurances from health boards that the pathway is being adopted locally. I hope that he will also be able to confirm today that he expects health boards to offer training to GPs to accompany the new pathway, as we understand that this was a strength of the pilot exercise in Cardiff and Vale. 

Concerns were also raised with us about the availability of testing equipment in primary care. The petitioners have called for all GPs to have immediate access to finger-prick blood glucose testing equipment, and the committee recommended that the Welsh Government should seek assurances from health boards in this regard. We are pleased that the Welsh Government has accepted this recommendation. The Cabinet Secretary has stated that guidance has already been issued and that those assurances will be sought. The committee would welcome any update he can provide today on this work.

Recommendation 7 in our report referred to the need to monitor progress in relation to the diagnosis of type 1 diabetes. In his response, the Cabinet Secretary refers to the pre-existing national paediatric diabetes audit. The committee’s understanding is that this includes an indication of the number of cases diagnosed when DKA is already present. However, it doesn’t capture detail about the process of diagnosis and our recommendation seeks to challenge how the Government and health boards can monitor improvements at this stage of the process. Therefore, I ask the Cabinet Secretary to address how this monitoring could be conducted. One mechanism could be through the annual monitoring of the diabetes delivery plan. Whilst this plan highlights the importance of early detection of type 1 diabetes, the most recently published statement of progress lacks any detail about diagnosis. So, perhaps the Cabinet Secretary will consider how the Government can better report on progress in this area in future updates on the diabetes delivery plan.

The final matter raised by the Baldwin family and our report is public awareness of type 1 diabetes and its symptoms. We have recommended that the Welsh Government should do further work to highlight the symptoms of type 1 diabetes and to provide additional information in material provided to expectant and new parents, such as through the personal child health record, otherwise known as the 'red book'. 

Whilst both of our recommendations in this regard have been accepted in principle, the narrative supporting this does not appear to indicate much in the way of new or different activity. The justification given for us is that the symptoms of type 1 diabetes often appear some considerable time after birth. Well, whilst we acknowledge this is truth, however it is the committee’s view that parents are very receptive to child health messages in the early years and the four Ts are a simple message that can be easily retained, in the same way as has occurred with meningitis, for example. We and the petitioners would appreciate that the avenues for disseminating messages about the symptoms of type 1 diabetes to parents and others in contact with children and young people are fully explored. We consider this to be extremely important in the light of the need to act quickly when the signs of type 1 diabetes appear.

In conclusion, Llywydd, I want to emphasise that considering the circumstances of this petition has been both a very sobering and sad experience for the Petitions Committee but also a real privilege. The tremendous courage of Peter’s family in seeking to see positive change arise out of such terrible circumstances should command enormous respect. I thank them all on behalf of the Petitions Committee for their ongoing work. I also welcome the positive responses to our recommendations from the Cabinet Secretary, and I hope that he will give consideration to the additional points raised by the committee and by other Members this afternoon. Diolch yn fawr.