The following amendments have been selected: amendment 1 in the name of Lesley Griffiths, and amendments 2, 3 and 4 in the name of Siân Gwenllian. If amendment 1 is agreed, amendment 2 will be deselected.

Item 8 is next and it's the first Welsh Conservatives' debate this afternoon on diabetes. I call on Russell George to move the motion.

Motion NDM8041 Darren Millar

To propose that the Senedd:

1. Notes that over 209,015 people in Wales live with diabetes and that Wales has the highest prevalence of diabetes of the UK nations.

2. Expresses concern about the rapid increase in the diagnosis of diabetes over the last 20 years.

3. Recognises the continued adverse impact of the coronavirus pandemic on waiting times, access to services, diagnostic tests, prevention and care for people with diabetes in Wales.

4. Acknowledges the need for a renewed commitment to improving outcomes for people with and at risk of diabetes to uphold the National Service Framework for Diabetes.

5. Calls upon the Welsh Government to publish the quality statement for diabetes before the end of July and commit to developing a new action plan for diabetes within 12 months.

Motion moved.

Diolch. Thank you very much, Deputy Presiding Officer. This is the first of two Welsh Conservative debate this afternoon, and I think the Minister will be pleased that our second debate isn't on health as well; she's had a busy afternoon, I know. I do move the motion in the name of my colleague Darren Millar this afternoon.

Diabetes is a ticking time bomb and I don't think that we have talked enough about it in this Chamber, and that's why this is the subject of our debate this afternoon. Eight per cent of adults in Wales suffer from the condition, and by 2030 the number of adults with diabetes in Wales is likely to grow further from 8 per cent to 11 per cent, and that's according to Diabetes UK Cymru. Wales also has the highest prevalence of diabetes of any of the UK nations. And I should really say that unless diabetes is tackled, of course, it can lead to such serious conditions that are preventable—sight loss, loss of limbs, stroke. It's a very serious disease that, with the right and treatment, is entirely preventable. And, of course, the other issue is that the increased trajectory of those suffering from diabetes in Wales puts a huge strain on the NHS. It's an enormous strain on the NHS at the moment: diabetes already costs it approximately £500 million a year—that's 10 per cent of the annual budget, and around 80 per cent of that is spent on managing complications, most of which can be prevented. So, there's a huge cost and a huge increase in the number of people potentially facing this disease. And as point 2 of our motion says today:

'Expresses concern about the rapid increase in the diagnosis of diabetes over the last 20 years.'

So, it seems to me completely reasonable for there to be an action plan produced to see how the Welsh Government intends to slow down this trend, not only, of course, for the good health of the nation, but also to take pressure off the NHS and allow it to focus on less preventable conditions. 

I did find it concerning to read that there is an estimated—this is according to Diabetes UK Cymru—over 65,000 people in Wales living with undiagnosed type 2 diabetes, and these people need help, of course, to manage the care that they face and prevent further health conditions occurring. Of course, if that's not dealt with, not only is it bad for their health, but of course, then, it's putting further pressure on health services as well. So, what really persuaded me that we needed to discuss diabetes this afternoon is when I looked at, 'Well, what's the Welsh Government's plan?' So, I did some research, I could see some research from Diabetes UK, and it seems to me that the Government hasn't got a plan for diabetes currently. I might be wrong. I'm looking to see if the Minister will say to me, 'Yes, there is a plan', but from my research, the only plan that I could find, or the latest plan that I could find, was the 2016-20 plan—that was the most recent plan that Welsh Government had brought forward, and there's currently no other plan, and that plan, of course, is now extremely out of date as well.

So, I want to hear Members' contributions this afternoon. I will say that we will be supporting Plaid's amendments today; they all add to our debate. I'm disappointed, of course, that the Government has deleted most of our amendment, even though I think it just is a factual position, not just a political view, but a factual position; we're having factual positions being deleted from our debate this afternoon. But unless—. I do really think, Minister, that we do need that plan. Having a plan for diabetes is not only good for people's health across Wales, but having that diabetes plan will also help to take pressure off our NHS staff and workforce as well. But it's such a serious condition, which is preventable. As I said, people can lose limbs, lose eyesight, a greater cause of stroke—all these issues that are absolutely preventable. So, I hope, Minister, you will agree to bring forward a plan this afternoon.

I have selected the four amendments to the motion. If amendment 1 is agreed, amendment 2 will be deselected. I call on the Deputy Minister for Mental Health and Well-being to move formally amendment 1, tabled in the name of Lesley Griffiths.

Amendment 1—Lesley Griffiths

Delete all after point 2 and replace with:

Recognises that work is underway to recover routine services for people with diabetes following the impact of the pandemic.

Recognises the commitment that exists within the NHS in Wales to:

a) ensure that people are supported to make healthy choices which reduce their likelihood of developing type-2 diabetes;

b) make progress towards offering those diagnosed with type-2 diabetes in the last six years the opportunity to access a remission service;

c) ensure accessible and patient-centred care for people with diabetes, as well as the use of technology and education to help them better manage their condition.

Notes that work is underway with stakeholders to develop a diabetes quality statement for publication in the autumn.

Amendment 1 moved.

Formally.

I remind Members that they have three minutes for contributions to this debate and the next. I call on Rhun ap Iorwerth to move amendments 2, 3 and 4, tabled in the name of Siân Gwenllian.

Amendment 2— Siân Gwenllian

Add as new point after point 4 and renumber accordingly:

Believes that investing in preventative measures could lead to a significant reduction in type 2 diabetes, and result in major savings for the NHS.

Amendment 3—Siân Gwenllian

Add as new point at end of motion:

Calls upon the Welsh Government to publish a diabetes prevention plan focused on diet and physical activity, with appropriate funding.

Amendment 4— Siân Gwenllian

Add as new point at end of motion:

Further calls upon the Welsh Government to increase availability of specialist and embedded psychological support for those living with diabetes.

Amendments 2, 3 and 4 moved.

Thank you very much, Dirprwy Lywydd. I move those amendments. This is a very important debate. It's a timely debate, and I'm very pleased that the motion was put forward by the Conservatives. I attended an event in Cardiff Bay earlier this month—the Deputy Minister spoke during that event—organised by Diabetes UK Cymru and sponsored by James Evans, where attention was given to a campaign to provide psychological support for people living with diabetes. And that was an eye-opener for me, because it gave me a new way to think about the impact of this condition. It's a condition that permeates all parts of the lives of those who live with it, and not having psychological support can lead to exceptionally negative impacts on the well-being of the individual, who, as well as that, has to live with the physical effects, of course. And I ask you to support amendment 4 by Plaid Cymru today that calls, in accordance with the campaign of Diabetes UK Cymru, for that specialist psychological support, and that that should be available to everyone as a default.

Let me remind you what we're talking about here today. Wales has the highest rate of diabetes in the United Kingdom. The number of people receiving a diagnosis of diabetes has doubled in 15 years and it continues to increase—diabetes type 2 is 90 per cent of those cases. And as Russell George said, there are tens of thousands who perhaps haven't yet received a diagnosis.

In terms of the cost to the NHS, it's a figure that we've talked about for years, that as much as 10 per cent of the entire NHS budget goes to dealing with supporting and providing treatment for those with diabetes, including for those serious complications associated with diabetes. So, in terms of the human cost and the financial cost, there is plenty of incentive to raise the game in our response to diabetes. You will have heard me talk about the need for a revolution in preventative care. According to Diabetes UK, half of the type 2 diabetes cases could be avoided by supporting people with changes to their lifestyle with regard to eating healthily, physical exercise and weight loss. That is shocking, and it should be an incentive to drive that revolution that I'm calling for. I'm calling upon you to support amendments 2 and 3 from Plaid Cymru today, which refer to the investment that needs to be made in preventative measures and to publish a diabetes prevention plan, a specific plan to prevent diabetes, based on encouraging a better diet, physical exercise, and to fund that. Think again about that figure: 10 per cent of the NHS budget goes on the response to those numbers that are far too high of people who are living with diabetes, and nothing demonstrates better the advantage of putting preventative policies in place that are innovative. 

Earlier this month, the all-Wales diabetes prevention programme was introduced. It's a step forward, but it isn't as robust as similar programmes in England and Scotland. It isn't funded to the same level as those programmes, but— 

The Member must conclude, please.

I'll conclude my contribution now. We have to make that shift from needing to spend a great deal because we fail to treat people in time to spending less through preventing these issues in the first instance, and this is an excellent example of that. 

Jayne Bryant. You are unmuted, Jayne.

Diolch, Deputy Llywydd. I didn't hear you call me. 

As the chair of the cross-party group on diabetes, I'd like to thank Darren Millar for bringing forward this important debate. As we've heard, diabetes directly affects hundreds of thousands of people in Wales, and that number is multiplied several times when you consider the families of those who are diagnosed. Despite the huge number of those affected, awareness, support and education on the disease is still sadly lacking, and I do believe that far more can be done. 

In terms of awareness, the key to avoiding the more severe complications with diabetes is good management of the condition, and this can only be achieved if the person knows that they have it. Early diagnosis for type 1 and type 2 diabetes is absolutely critical and seems obvious, yet one in four children in Wales are diagnosed with type 1 later than they could have been. We know that there have been improvements within our health service, but, as ever, more can be done. 

I was very pleased this week to receive an e-mail from the Aneurin Bevan University Health Board raising awareness of the symptoms. For type 1, especially in children, undiagnosed diabetes is a medical emergency.

Jayne, will you take an intervention, please?

Yes, of course. 

Thank you. I'm grateful for your taking the intervention. You've mentioned type 1 and type 2 diabetes, but one that makes up about 9 per cent of all diagnoses is type 3c diabetes, which is something that my father suffers from, and that goes far too often undiagnosed for those who suffer from pancreatitis and pancreatic cancer. What more do you think we can be doing to make sure that people are aware that type 3c diabetes is an ailment?

Absolutely, Sam, and I think that's a key point. And there are more than three types of diabetes as well. I think that that is something that many people need to understand, that there are other types. And the more that we can do to raise awareness of those and the symptoms, the better, I think. 

So, in terms of type 1, parents are urged to look out for the four t's: thirsty, tired, toilet and thinner. If parents notice any of the key symptoms, they need to make an urgent GP appointment, or contact their out-of-hours service. For type 2, Frances Rees, who is the primary care diabetes team leader at Aneurin Bevan University Health Board, says that recognising the symptoms of diabetes plays a significant part in preventing the development of complications. The sooner they're identified, the better the outcome. I'm glad that health boards are trying to get this message across, but more can always be done, and the Welsh Government can play a key role in this, as, for many, the false perception still remains that you're only at risk from diabetes if you're elderly or overweight. 

On top of awareness, I'd also like to focus on how Wales can improve the psychological support offered to those diagnosed. Given the additional burdens that people living with diabetes face across their life span, the negative impacts that these burdens have on psychological health and the complexities that diabetes can add to psychological and cognitive issues, it's clear that specialist psychological support and treatment should be available to all those who need it.

The inspirational Dr Rose Stewart, a consultant clinical psychologist at Betsi Cadwaladr University Health Board and a Diabetes UK champion, recently produced a value-based action plan for diabetes psychology in Wales titled 'From Missing to Mainstream', and she said a number of things in that plan that I think are really pertinent to the debate today. The action plan wants to see diabetes psychology becoming mainstream, embedded in routine care, accessible and flexible, so people living with diabetes feel supported in managing their condition, wherever they live. 

Jayne, you need to conclude now, please.

Okay. Thank you. Thank you, Llywydd. I'm pleased that Welsh Government have already committed to giving all people living in Wales with diabetes the best possible care and support, but actions need to follow words, and I hope that the latest review will include a greater commitment to psychological care, whilst also continuing the good work already being done on increasing awareness of this incredibly important issue.

You'll be pleased to know the chair of the cross-party group has taken a minute out of my speech, so you'll be glad to know about that. I'm very pleased to have the opportunity to speak in this debate today. Over 200,000 people in Wales live with diabetes, with over 0.5 million people at risk of developing type 2 diabetes. On those figures alone, we should all be be taking an active interest in this area of health and introducing the changes that we need to see to reduce the burdens of the wider NHS.

I was honoured to sponsor an event earlier this month for Diabetes UK Cymru to highlight the importance of delivering improvements for people with diabetes who have poor mental health and well-being. The event brought together medical professionals from across Wales and provided an opportunity for policy makers to listen to these experts and what we should be doing to address the pressures facing our national health service and helping our constituents who struggle with diabetes.

The event was to launch the campaign 'From Missing to Mainstream', to call for specialist psychological support for those living with diabetes in Wales. The need for psychological services was recognised in the Welsh Government's most recent diabetes delivery plan 2016-2020, with an estimated 41 per cent of people living with diabetes in Wales believed to have poor psychological well-being due to the challenges they face on a daily basis living with diabetes.

The Welsh NHS currently sets itself no measurable targets for how much psychological support is delivered to those who suffer with long-term conditions. The amount of service delivered across the country also varies hugely, and this is something that Welsh Government must address sooner rather than later. For those of you who attended the event, you will remember the poignant contribution from a sufferer of diabetes and the pressure the management of it placed on his mental health.

We should listen to Diabetes Cymru, who are calling for the funding for psychological specialists for diabetes patients. The initial cost of the specialist professionals is minimal and would soon be recouped with the savings from emergency diabetes interventions and emergency medical health support for people at crisis point. Deputy Llywydd, I think it's time for us to put the patients first and ensure we invest properly in diabetes care in Wales, both to address the physical and emotional effects on people suffering with diabetes. As somebody said at that event, people are dying because we are doing nothing. So, I would urge colleagues to support the motion today, and, as I said, let's put the patient first. Diolch, Deputy Llywydd.

I call on the Deputy Minister for Mental Health and Well-being, Lynne Neagle.

Diolch, Dirprwy Lywydd. Can I thank Darren Millar for bringing forward this motion for debate today? The number of people in Wales who are now living with diabetes, particularly type 2, is something we all need to be concerned about. The rise in diabetes is a worldwide issue. We only have to look at rates in the US, for example, where over 34 million people now have the condition and where, in some states, prevalence has reached 17 per cent, to see where we are heading unless we take action now. If we're to slow the upward trajectory of diabetes, then our focus must be on prevention.

The motion and amendments tabled today do little to recognise the good work that is happening across Wales right now. The amendments do not reflect the work already under way through 'Healthy Weight, Healthy Wales' and our social prescribing model to support preventative measures and healthy lifestyle choices that can help prevent or delay the onset of type 2 diabetes.

Our 'Healthy Weight, Healthy Wales' strategy is a key cross-Government approach to reducing obesity on a population scale. We're investing over £13 million over 2022-24 to support a whole-system approach to tackle it together. This includes action in the early years and for children and families to make healthier choices, enabling settings and environments to be healthier to support these changes. We've also launched two consultations recently to explore how to improve the food and drink environment in Wales, including promoting healthier shopping baskets and restricting the sale of energy drinks to children.

I officially launched the all-Wales diabetes prevention programme recently. It is based on two pilots in the Afan valley and north Ceredigion primary care clusters, and will offer targeted support and intervention to people who are at risk of type 2 diabetes. Trained healthcare support workers will provide help to individuals to understand their level of risk and support them to reduce it through key changes to their diet and level of physical activity. This is a really exciting project that we all hope will slow the number of people who go on to develop type 2 diabetes. 

For those who have been diagnosed with type 2 diabetes in the past six years, the all-Wales diabetes implementation group is working on introducing a remission service across all seven health board areas. Diabetes is largely a condition of self-management and something that people have to learn to live with. We must therefore do all we can to help support people through continued investment in educational programmes, as well as ensuring that the most up-to-date technology is made available to patients where there is clear evidence that this will help them to control and manage their condition.

I agree that the right level of psychological support should be provided to those living with diabetes and, like others, I recently attended a Diabetes Cymru UK event to discuss this. I spoke about the needs-based approach we have set out in the diabetes delivery plan for Wales. We expect people to be supported by their families, friends and by other people with diabetes, but also want people to have the support of fantastic and empathetic care from their clinical teams. It is our expectation that every member of the clinical team, whether in primary care or specialist diabetes services, is able to provide some psychological support as well as resources and structured programmes to help people. I am passionate about the role of psychology. I agree that the appropriate level of support should be accessible to people living with diabetes, but also to those living with a range of other chronic and life-threatening conditions.

There are already referral structures and pathways in place to ensure that those who need extra support can access it when and where they need it. We have included as a key priority in the 'Together for Mental Health' delivery plan the need to improve access to psychological therapies overall, and increased funding in this area. Officials are working with stakeholders on the development of a quality statement for diabetes. This will be published in the autumn. I understand that stakeholders are content with this timetable.

I have made my commitment to early intervention and prevention across my portfolio clear, and although there is a lot more to do, I'm encouraged by the progress and innovation I am seeing to improve the prevention and management of diabetes. I am determined to see that continue, and I hope Members will recognise today that we are serious and committed to supporting the physical and mental health of those living with diabetes in Wales. Diolch.

I call on Joel James to reply to the debate.

Thank you, Dirprwy Lywydd. I'd like to start by thanking everyone who has taken part in today's debate, and also to thank Jayne, really, our colleague, for the invaluable work that she does on the cross-party group for diabetes. We've heard today a great deal about some of the technical aspects of caring for those with diabetes, the secondary health complications that can be caused by diabetes, and we've heard about how, through much better support in terms of managing health and exercise, type 2 diabetes is both a preventable and curable disease. Thus, it is important that we recognise the necessity to reinforce the need for people to take responsibility for their health and lifestyle in order to play their part in reducing their risk of developing type 2 diabetes.

A major element of this is for individuals to be knowledgeable about what the risk factors are for diabetes, and most importantly, how to reduce them. The approach requires commitment from all partners, including local government, schools, industry, employers, the third sector, health boards, and most importantly the public. I would like to take this opportunity to urge the Government to place a requirement on public bodies and businesses to highlight the signs of diabetes and the preventable measures. This is already widely done for cancer and can be so easily achieved for diabetes.

Focusing on the preventability of type 2 diabetes, we have to be aware that there are many reasons people end up with a poor lifestyle, making bad food choices and not getting sufficient exercise. This comes from a variety of sources, with no one single identifiable cause. I would argue that the pathway to developing type 2 diabetes is likely to be very different across the spectrum of those who suffer it. For instance, for some, it might be mental health issues that have led to a sedentary lifestyle; for others, it could be a physical injury that has led to difficulty exercising. But, unfortunately, another prominent cause is poverty, and there is a prevalence of choosing highly calorific foods with low nutritional value because they are cheap.

I recognise there is unlikely to be a silver bullet that prevents type 2 diabetes, but I do believe that we need to take every opportunity to educate people regarding eating habits and allow them to develop greater knowledge and understanding of the nutritional aspects of the foods they eat. It is controversial that the hospitality industry should be made to provide nutritional information for every meal or snack that they provide—

Joel, will you take an intervention from Altaf Hussain?

Oh, I'm sorry, Altaf, yes, of course.

Thank you very much. We have the health Minister also here. It would be good to have this interaction, really. I worked on it very much, on the preventative aspect of diabetes type 2, and in that period of time, when the patient is seen by the GP and when he's referred to the dietician for the first time, we waste roughly about two or three months. And it is that time, if that is taken up by the health board, by the primary health, that you will be able to prevent diabetes in those patients, and I have worked on it. If the Minister wants, I would be grateful to discuss it further with you.

Thank you, Altaf, and thank you for that intervention and, as has already been discussed, one of the issues is the lack of diagnosis of type 2 diabetes and the unfamiliarity of the symptoms, so it's crucial to get them covered as well.

So, I have two final points I wish to make. The first is that diabetes, both type 1 and type 2, doesn't just affect the individual; it affects those families and friends who live with and support those who suffer from diabetes. Because not only do they have to watch their loved ones struggle with managing the condition, they have to live with the consequences as well, and there are many hidden aspects, as we have heard, of diabetes that rarely, if ever, come to the surface, for instance, the constant worry of low blood sugar, which is particularly prevalent at night-time or when exercising, when, unfortunately, just one mistake and not eating enough or doing too much exercise or dosing with a bit too much insulin can cause people to slip into a coma.

And lastly I want to use this opportunity today to give a huge offering of thanks to all those who work in hospitals, schools, charities and elsewhere, who give up so much time to help and to support those affected by diabetes. They are truly life savers. And, with that in mind, I would like to urge everyone to support this motion. Thank you.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Yes.

I can see Lynne putting her hand up. Okay.

I will defer voting on the motion until voting time. 

Voting deferred until voting time.