Debate contribution: Diabetes Care

Debate contribution by Mr Mike Nesbitt on 28 April 2025.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

28 April 2025

Type

Debate contribution (made as a minister)

Business

Private Members' Business

Heading

Diabetes Care

Assembly identifier

Official Report component 4914178

Read the official Assembly record

Text

Deputy Speaker, thank you. I acknowledge some of the points and questions that have been raised by Members, including Mr Dickson, and will attempt to get as close as I can to providing a definitive answer to them over the next few minutes. I start by taking you back to 2016, when the Department launched the diabetes strategic framework. The Diabetes Network was established under the 'Health and Wellbeing 2026: Delivering Together' plan to deliver against the framework, with the aim of transforming diabetes treatment and care across Northern Ireland. The network has been working alongside partners, locally and nationally, including Diabetes UK, and with people who are living with diabetes to achieve that goal. One of the key drivers for change is a partnership approach to service transformation. It states:

"The person living with diabetes, and their interests should be at the centre of all relationships, with individuals recognised as partners in the planning of services and how their care is provided. Services should be integrated and based on collaborative working."

When I say "integrated", I mean regionally standardised services, and I acknowledge that, as raised by the proposer of the motion, that is not always the case with diabetes care. The role of people who are living with diabetes as service users, sharing lived experience, has set the direction of the network's efforts to improve treatment and care. Indeed, in the setting up of the network, provision was made for a collective leadership platform to support real change in improving outcomes for people who are living with diabetes. That is the ethos under which the network has been working over recent years in the development of a regional integrated pathway. That pathway aligns primary and secondary care through the creation of a community care model for type 2 diabetes. The process has not been easy. The number of people who are living with diabetes continues to grow, and, as Members have noted, almost 115,000 people here live with diabetes. Through the valuable contribution of lived experience and the clinical insights and commitment of healthcare professionals in the context of local and national best practice, the network has delivered a service model that will enable people who are living with diabetes to receive the right support in the right place at the right time under the right healthcare professional. Another key driver for change that is set out in the strategic framework is supporting self-management — empowering people through structured diabetes education. That structured education has been developed for people who are living with diabetes and meets nationally agreed criteria as defined by NICE, the National Institute for Health and Care Excellence. It has an evidence-based curriculum, which has quality-assured teaching standards and a regular audit. The aim of structured education is to improve the knowledge, skills and confidence of those who are living with diabetes. That, in turn, enables people with diabetes to take increasing control of their own condition and develop effective self-management in their daily lives. There are three agreed and quality-assured structured education programmes for Northern Ireland that are consistent with NICE criteria: the dose adjustment for normal eating (DAFNE) programme, the diabetes education and self-management for ongoing and newly diagnosed (DESMOND) programme and the CHOICE programme. I am sure that Health Committee members in particular are aware that the HSC loves a good acronym. DAFNE is a way of managing type 1 diabetes. Specifically for adults, it provides the skills necessary to estimate the carbohydrates in each meal and inject, therefore, the right dose of insulin. DESMOND is an NHS organisation that helps to deliver high-quality patient education to people with type 2 diabetes and those who are at risk of the condition. The CHOICE programme is specifically for children, young people and their families or carers. It aims to provide the skills and knowledge that they need to manage their diabetes and reduce the impact of the condition on daily activities and lifestyle. The delivery of those programmes across Northern Ireland is crucial in providing people living with diabetes and their carers with the knowledge and skills needed to manage the condition effectively, supporting self-management and empowering individuals. Key theme 5 of the diabetes strategic framework is:

"Services for People Living with Diabetes, Particularly Those Requiring Complex Treatment and Care".

One of the specific priorities identified within this theme is the:

"Transition to adult services for children and young people with Type 1".

In response, working with key stakeholders, a regionally agreed young adults transition pathway for type 1 diabetes has been developed. Consisting of three stages, it facilitates the smooth movement of children and young adults from paediatric services to adult services for their treatment and care. The paediatric preparation element is the first stage of the pathway, followed by the active progression stage, with stage 3 focusing on the provision of young adult services. The pathway supports and enables Health and Social Care trust clinical teams to identify young adults who should attend and the right time for them to attend. That identification is based on the young person's need as well on as their physical development, emotional maturity, local circumstances and all other relevant factors, so it is not based solely on age. The commissioning of young adult transition coordinator posts in each trust supports young people living with diabetes, ensuring that they have a clearly defined pathway of transition and providing a supportive, smooth and seamless transition to adult services. I assume that everybody here acknowledges the fragile health ecosystem in which we find ourselves. Today, however, we recognise what can be achieved when the parts of the system work together to support a common vision. I recognise that diabetes prevalence is rising in Northern Ireland, as it is in other nations. However, I have outlined examples of ongoing work in the nine years since the implementation of the framework that is directly improving treatment and care for people living with diabetes, improving their quality of life and their future health outcomes. The Department of Health remains committed to working towards participation in the National Diabetes Audit, as stated in that framework. However, there have been significant challenges in progressing that recommendation: the infrastructure required to participate fully in the audit is not currently in place. However, with the full implementation of Encompass, which is being rolled out across all the health and social care trusts, the provision of data that is available and extractable for the region will become apparent. That will support participation in the National Diabetes Audit in the future. Mr Dickson asked for a timeline. I can tell him that the two trusts that are currently not on Encompass will be on it on 8 May. Therefore, in just 10 days' time, all five trusts will be on it. There will need to be a period of embedding and validation. I am not entirely convinced that that will be done as quickly as it might be, but I certainly think that, within this calendar year, at the very outside, we should be harvesting the data that allows us to join that National Diabetes Audit. I make a commitment to the House to come back if there is any hint of a delay on that front. All currently available data on diabetes prevalence, treatment and care has been collated and reviewed in the development of the regional integrated pathway for diabetes. That was co-produced with stakeholders, including people with lived experience. Another key service development that has taken place in the last few years under that network and in line with the framework is the regional insulin pump service. In January 2022, former Health Minister Swann formally announced the setting up of the regional insulin pump service to mark the 100th anniversary of the use of insulin to treat diabetes. That announcement, which was supported by £2 million of funding from my Department, enabled that life-changing service to be established. That investment made provision for pump devices and the specialist workforce that is required to support people who are living with type 1 diabetes to receive insulin pump therapy. The aim of the regional service is to improve the lives of people who are living with type 1 diabetes. The regional pump service was co-produced by people who are living with diabetes alongside clinicians and healthcare professionals across all trusts and Diabetes UK. The goal is to provide equity, reduce variability and enhance outcomes for people who are living with diabetes. The service has established clear regional guidance and protocols in line with NICE and the Association of British Clinical Diabetologists (ABCD). Following a formal commissioning process, the Belfast Trust was selected to deliver the service. A regional multidisciplinary team delivers the insulin pump pathway, connecting with local trusts and providing a high-quality service. In year 1, the service began a rebalancing exercise across the region, directly supporting the ambition of equity as the chief priority. People who are living with diabetes and who were involved in the co-design of the regional insulin pump service reflected the need for quality of life to be a key indicator. Centrally, quality of life is a key consideration in pump decision-making; that is, clinical consideration of where provision would significantly improve quality of life for the person who is living with diabetes. The acceptance of that recommendation made Northern Ireland the first region among the four nations to use quality of life as a criterion. Following the endorsement of the National Institute for Health and Care Excellence's TA943, which is the provision that relates to hybrid closed-loop systems for managing blood glucose levels in type 1 diabetes, my Department has requested that work be undertaken to understand the implications, and an implementation plan is being drafted. Funding is, of course, required for devices in addition to recruiting and upskilling the workforce that is needed to offer hybrid closed-loop systems safely, effectively, equitably and sustainably across the region. Therefore, given the scale of investment that is needed, financial requirements are also being considered. The NICE hybrid closed-loop systems guidance states that the support of a trained multidisciplinary team that is experienced in insulin pumps and continuous glucose monitoring is required. In addition, the role of peer support is also to be considered. The importance of peer support has been a recurring theme throughout the conversations that have taken place on the different aspects of diabetes treatment and care. Sharing a lived experience, providing or receiving support from like-minded people or being able to talk with somebody who is going through a similar situation or has lived through it are empowering tools. The trained multidisciplinary team in the regional insulin pump service will enable the implementation plan, once approved, to be taken forward, although additional capacity will be required. That will support the integration of continuous glucose monitoring technologies into diabetes care, and updated information will be communicated to all stakeholders. The critical role of our diabetes specialist healthcare professionals was recognised in the diabetes programme of care strategic workforce review, which was led by the Public Health Agency (PHA) and commissioned by my Department. That review was the first multidisciplinary workforce review to be undertaken and was a recommendation in the framework. Now in the final stages of completion, it will inform our workforce planning needs, ensuring equitable access to specialist diabetes professionals right across the region. The Chair of the Health Committee mentioned the fact that the strategy expires in 2026. As Órlaithí Flynn pointed out, I am not particularly drawn to high-input plans but rather action plans for how we are going to deliver. She is quite right, but I assure Mr McGuigan that I am not envisaging any sort of cliff edge come 2026. I want us to focus particularly on two key developments: one is joining the national audit — I addressed that in my remarks already — and the other is a focus on that hybrid closed-loop system. Similar to the other UK nations, work has been taking place to develop an implementation plan in Northern Ireland. I hope that Members will understand that the establishment of any new clinical service to the required standards takes time. I have, however, recently supported the establishment of a clinical working group that will work with stakeholders across the trusts to develop that implementation plan.

That is being finalised, and it outlines an appropriate timescale for roll-out. I hope to have that as soon as possible.

The plan should provide equitable, sustainable and affordable access to the technology, targeted to optimise outcomes for those who are most likely to benefit from it. I have to put in the proviso, as always, that additional investment will be required for the devices and for the workforce. England has outlined a five-year implementation plan; in Northern Ireland, I am keen to emulate that in terms of the priority groups and the roll-out schedule, and I hope that that will be published in the near future. I hope that that gives some assurance to Members on this important issue, about which they are rightly passionate.

2,183 words. Text as published by the Northern Ireland Assembly.

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Assessed 21 October 2026 at 12:28 UTC by jev-1.13.0 (requested as typesafe/jev) under rubric 2026.10-r9, methodology 1.9.

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