[Inaudible.]—which is the Member debate under Standing Order 11.21, and it's on type 2 diabetes, and I call on Jenny Rathbone to move the motion.

Motion NDM7552 Jenny Rathbone, Dai Lloyd, Jack Sargeant

Supported by Andrew R.T. Davies, Darren Millar, Helen Mary Jones, Jayne Bryant

To propose that the Senedd:

1. Notes:

a) that Wales has the highest rates of type 2 diabetes anywhere in western Europe, with over 200,000 diagnosed, an estimated 65,000 with undiagnosed type 2, and a further 500,000 at risk of contracting diabetes;

b) that caring for people with diabetes already consumes 10 per cent of the NHS budget;

c) the heightened risks of catching COVID-19 for citizens who have diabetes as a pre-existing condition; and

d) the success and cost effectiveness of the award-winning Nutrition Skills for Life programme piloted in the Afan Valley.

2. Urges the Welsh Government to mainstream the Nutrition Skills for Life programme throughout Wales as a central element of a Welsh diabetes prevention plan.

Motion moved.

Thank you, Deputy Presiding Officer. As the motion highlights, Wales has the highest prevalence of diabetes in western Europe. It currently gobbles up 10 per cent of our NHS budget—that's £950 million of next year's health budget.

This debate isn't about type 1 diabetes, a complex medical condition that normally hits young people in adolescence, the triggers for which are complex and not linked to diet. The rates of type 1 diabetes remain largely unchanged from year to year. Type 2 diabetes is another matter. This debate is about the veritable epidemic of type 2 diabetes: over 200,000 people already diagnosed, many more undiagnosed, and even those diagnosed predicted to rise to over 300,000 people by 2030, unless we do something about it.

Wales has over 0.5 million people who are overweight or obese, who are at risk of developing type 2 diabetes. And let's face it, that problem can only have got worse as a result of the lockdown, as we've all eaten more than we should. But the most sobering fact is that one third of all the people who have died of COVID have also had diabetes. So, what can we do about this, and what can we do to prevent people getting diabetes in the first place?

Wales is the only country in Britain not to have a national diabetes prevention programme. England has one, Scotland has one, but not Wales. And as the most obese nation in Europe, that seems to me careless, imprudent, and urgently needs to change, particularly when we have a cost-effective, award-winning, made-in-Wales solution on our doorstep. A brief intervention piloted in the Afan valley by a cluster of nine GP practices, in collaboration with nutritionists at Swansea Bay University Health Board and Cardiff and Vale University Health Board, has been run for over three years and has been trawled all over by Swansea University's Swansea Centre for Health Economics to make sure that the numbers stack up.

It's cost effective because the patients are identified by their GP practice who are at risk of developing type 2 diabetes and they never need to go anywhere near a hospital in order to get this intervention, and, in the context of all the problems we're going to have with waiting lists for people who need hospital treatment, that's a very important fact. It's also very effective, because it's delivered by non-medical practice staff who've been specially trained by dieticians in nutrition skills, and that makes it easy to roll out across the country. It's cost effective because the brief intervention consists of exercise, dietary advice and information sheets, and costs a mere £44 per patient. If you compare that to the English intervention, run by specialist experts, that costs £240 to £290 per patient. It's also entirely cost effective because nearly two thirds of the people taking part in this programme did not go on to get diabetes. So, Swansea University has calculated that rolling out this programme nationally would save each health board over £6 million per year, and that's not counting the personal benefits to the patient of not getting diabetes and not running the risk of loss of sight, loss of limbs and early death. 

Little wonder, then, that the Afan valley brief intervention programme won the UK-wide Quality In Care diabetes award last year. This really is prudent healthcare in action. What is stopping us rolling it out? It has the multidisciplinary approach to a chronic disease where, unfortunately, we're top of the league tables for the whole of Europe. How can we afford not to be doing this? I hope therefore to hear that this is a very high priority for the Minister, given the very high numbers of people who are at risk of type 2 diabetes, and the serious implications arising from this disease.

Can I thank my colleague Jenny Rathbone for bringing this issue to the Senedd today? I think it clearly shows the importance of the issue and reaffirms that type 2 diabetes is a very serious problem across Wales. We know that type 2 diabetes impacts a startling number of families here in Wales. According to data published in 2019 by Diabetes UK, over 8 per cent of people aged 17 and over live with diabetes in Aneurin Bevan University Health Board, which serves my constituency. The vast majority of these cases are type 2. In real terms, this means that almost 40,000 families are directly affected, and the true number is likely to be even higher.

Diabetes has a life-changing impact on people's lives, and we know, as Jenny Rathbone has made clear, that treating type 2 diabetes places an extraordinary strain on the NHS in Wales, not least at the present time. Not only are those suffering from type 2 diabetes more at risk from serious illness if infected with COVID, they're also placed at risk of suffering from other major health issues, including heart disease, stroke, kidney disease and sight loss. The difficulty of dealing with these complex problems for patients and practitioners alike cannot be understated.

But we also know that there are things we can do to ease the burden. In the majority of cases, type 2 diabetes is preventable. Encouraging people to make healthier choices is the obvious first step, but more can and must be done. I'm proud to be the chair of the cross-party group on diabetes and of the work the cross-party group has achieved throughout the Senedd term. We'll be conducting our final meeting on how mental health is impacted by diabetes next week. In this role, I've been pleased to hear about the success of the Afan valley pilot, and I'll be waiting with interest to see how these successes can be replicated across Wales. Anything we can do to ensure fewer people are left suffering from this illness for the rest of their lives is crucial. Encouraging people to understand their personal risk is one step we can all take right now. In 2018, I was proud to hold an event at the Senedd for people to understand their risk of contracting type 2 diabetes. Sadly, it's not been possible to hold a similar event in the last year, but I would encourage anyone who wants to know more about their risk level to visit the Diabetes UK website, which has a selection of tools and resources available.

I'd like to finish by quoting one of my constituents, Sarah Gibbs, who is living with type 2 diabetes. She has described the disease as 'relentless. It can affect all aspects of your life. I wish I'd had the chance and the support to prevent it.' Deputy Llywydd, we need to do more to offer this chance to people in Wales. Diolch. 

Thank you. Can I now call the Minister for Mental Health, Well-being and Welsh Language, Eluned Morgan?

Thank you very much, Deputy Llywydd. I'd like to start by thanking Jenny Rathbone, Dai Lloyd and Jack Sargeant for bringing this important debate on diabetes prevention before the Senedd today, and I'd also like to thank Jayne Bryant for the work that she's been doing with the cross-party group.

This is an important motion, and I know that diabetes is a significant problem that is growing globally, and also in Wales. We must tackle this very serious situation that has an impact on so many lives and so many individuals in our nation. In 2019-20, around 192,000 people in Wales had diabetes, as Jenny mentioned, and that's around 7 per cent of our adult population. It's also important, as Jenny said, to differentiate between the two types of diabetes: type 1, which is not preventable, and type 2 diabetes, where there is a great deal we can do to prevent the condition from developing.

Now, in the latest figures that we have, the cost of treating diabetes for the health service is topping around £126 million or 1.9 per cent of the NHS budget. If we also bear in mind those patients that are treated for cardiovascular disease and other complications arising from diabetes, then we do reach that figure of 10 per cent that Jenny referred to. So, you're quite right in noting that figure in your motion, and this highlights the importance of secondary prevention, namely preventing the complications from arising by managing the condition well—not just prevention, but also investment in those services that prevent those complications from arising.

Now, the scale of the challenge facing us has been highlighted by the pandemic. We've seen how people suffering from diabetes are over-represented in the deaths related to COVID. Although people with diabetes aren't necessarily at greater risk of catching COVID, it does appear that diabetes risk factors and complications mean that the outcomes are likely to be worse if they do contract the virus. We know that obesity or high blood pressure, ethnicity or deprivation are some of the multiple factors that contribute to the development of serious COVID conditions.

Our national approach to diabetes is outlined in the delivery plan for diabetes in Wales, and this has been extended for a further year so that we can develop a follow-on programme. What we know is that there is a clear and significant link between type 2 diabetes and obesity. And studies suggest that around 90 per cent of adults with type 2 diabetes weigh more than they should in order to be healthy, or are obese. And we also know that obesity is linked to a range of other serious health conditions, like cancer, heart disease and stroke.

Now, in addition to the significant impacts on quality of life, it has a significant impact on mental health too. And that's why it's crucial that we continue to focus on prevention and reducing the rates of obesity. Over 60 per cent of adults, and one in four primary school children, are overweight or are obese here in Wales. So, that's why today I am announcing investment of over £6.5 million to help to tackle obesity and diabetes in Wales. And the funding will be targeted at children and older people, in order to help them to maintain a healthy weight. And this will help to deliver what will be announced on 18 March, namely our 'Healthy Weight: Healthy Wales' delivery programme for 2021-22.

Now, £5.5 million of the funding will be provided for specific programmes, under 'Healthy Weight: Healthy Wales'. And that will help to promote key developments across services, in order to prevent obesity and manage weight. And it includes almost £3 million additional funding for obesity services across our health boards. And this funding—and this is important to highlight—does include £1 million of additional funding per year over the next two years. And this will enable us to take early steps to prevent illness and to prevent the impact of ill health and inequalities, by supporting the work of developing prevention pathways, which is based on that model that you mentioned in the Afan valley. A pre-diabetes education pathway, provided by trained healthcare support workers, is provided for people who have had a higher glucose reading in the past, or who are at risk of developing pre-diabetes in the future.

So, the Afan valley programme is being evaluated by the Diabetes Wales research institute. And we know that some of the outcomes are very promising indeed—as you mentioned. And I'm sure that those who proposed the debate will be interested in knowing that an evaluation of efficiency and economic cost has been undertaken by Swansea University. And what we know is that it works, and that is why we are providing this additional funding, to ensure that we do see that pilot being developed across Wales. So, the pilot provided us with evidence; we can see that preventative intervention the length and breadth of Wales. This will allow us to meet the challenge, the increase in type 2 diabetes, to improve the health of those who are affected, and to provide healthcare that is based on value, as you noted, Jenny.

The expectation is that at least one healthcare cluster—

The Minister does need to wind up, please.

—will exist within each and every health board. So, I'm pleased that we are able to respond constructively to the motion tabled by you, Jenny. And thank you for bringing this debate forward.

Can I now call on Dai Lloyd to reply to the debate?

Thank you very much, Deputy Presiding Officer. And it's a pleasure to respond to this debate, as the Minister's just made that announcement—wonderful. People sometimes doubt the validity of having debates such as this one—we ordinary backbench Members are sometimes derided for doing so—but this is a dream come true for Jenny Rathbone, and to be fair to Jenny, she's been working on this preventative agenda for many years. I'm pleased to acknowledge the announcement made by Eluned Morgan today, because this is a very constructive way forward, and a very good use of this kind of debate in the Senedd. So, I'm happy to pay tribute to Jenny Rathbone for her determination over the years, in leading this agenda, and also to Jayne Bryant, as chair of the cross-party group on diabetes, which also does excellent work, and of course I also welcome the Minister's announcement. Six million pounds is a wonderful response to this debate, because this is the crucially important preventative agenda that we're talking about. 'Prevention is better than cure,' we always say it, but we don't always take action on those words, the preventative agenda. And I also want to pay tribute to many, many organisations who are doing this preventative work, such as Diabetes UK Cymru and the British Heart Foundation, the Stroke Association, and so on and so on. I don't have time to list them all.

And, of course, the key importance within the prevention agenda is preventing diseases from arising in the first instance. There are a number of behavioural factors, as Jenny mentioned, a number of behavioural and social factors that come together. And in the context of diabetes, which, of course, is one of those conditions that have a close link to COVID, and, as we've heard, in having diabetes you are more likely to suffer severe COVID. That's the relevance of this debate. You are likely to have more severe COVID if you are diabetic, statistically speaking. 

Therefore, promoting this preventative agenda is crucially important, as has been discovered in this project in the Afan valley—cooking skills, life skills, diet. Yes, we should all know that sugar is bad for us now, although we do eat it, but carbs—'starch', as we used to call it when I was in school in Lampeter—those are just as bad, because carbs do become sugar within our bodies. That's what the liver does. One of the many things that the liver does is to turn carbs into sugar. So, carbs can be just as bad if you eat too many.

And fat. Well, yes, fat, if we eat too much of it, is bad for us, but we need a level of fats in our diet too. So, the advice is very subtle, and this is the kind of advice that is available through that Afan valley intervention programme—what to eat, how to eat healthily, and how to keep fit. It's a successful project that's won awards. Therefore, we have that solution in the Afan valley, and in several other places. We need to roll it out and operate it at a national level, as the Minister has just outlined. So, I hope to see that aspiration delivered following that fantastic start in the Afan valley. 

So, in conclusion, may I thank everyone for their contributions? I particularly thank the Minister for making that announcement of the funding, and making us all think more constructively about these individual Member debates; they can deliver miracles. So, I congratulate the Minister, I congratulate the Government, and, most of all, I congratulate Jenny Rathbone on taking this agenda forward for so very long. Support the motion. Thank you.

Thank you very much. The proposal is to agree the motion. Does any Member object? I don't see any objections. Therefore, in accordance with Standing Order 12.36, the motion is agreed. 

Motion agreed in accordance with Standing Order 12.36.