 Y Sh answers CIF this time in a debate. The final item of business today is a member's business debate on motion number 11158 in the name of David Stewart on world diabetes day 2014. This debate will be concluded without any questions being put. I would invite those members who wish to speak in the debate to please press the request to speak buttons now or as soon as possible. That's it, Mr Stewart. If you're ready, I would invite you to open the debate. You have seven minutes, so thereby to do so, please. Thank you very much, Presiding Officer, and I want to thank each and every MSP here today for their commitment to the cause of diabetes prevention, and they're sharing the vision of the International Diabetes Federation to live in a world without diabetes. I also welcome to the gallery this evening a group of lead diabetes nurses who've had a conference here today, in which I had the pleasure of speaking. The World Diabetes Day, and I quote the International Diabetes Federation, is a day that unites the global diabetes community to produce a powerful voice for diabetes awareness and advocacy. The idea theme for this year's World Diabetes Day is healthy living and diabetes. The day was created in 1999 by the IDF and the World Health Organization in response to growing concerns about the escalating health threat that diabetes poses. The day became an official United Nations Day in 2007, and the campaign draws attention to issues of paramount importance to diabetes world and keeps diabetes firmly in the spotlight. We are facing a global epidemic. 382 million people are living with diabetes. A further 316 million are at high risk of developing the disease. The IDF Diabetes Atlas confirms that 80 per cent of people with diabetes live in low and middle-income countries, and the socially disadvantaged are the most at risk. By last year, diabetes caused over 5 million deaths worldwide. Every six seconds, a person dies from diabetes and over 600 billion in healthcare spending. Without co-ordination and systematic action to prevent diabetes, in less than 25 years' time there will have been nearly 600 million people living with diabetes. Over the past two years, progress has been made driving political change for diabetes. Following the 2011 UN declaration of non-communicable diseases, the World Health Assembly in May last year saw a unanimous adoption by member states of a global action plan. There have been other international initiatives as well. A few short months ago, I strolled in the Melbourne summer sun from my hotel to the Victoria State Parliament house. I was due to speak to an unusual audience. Nearly 100 national champions for diabetes from far afield is Russia, Ukraine, Nigeria and Canada. In Africa, we had their first lady. All were elected members. All were advocates for diabetes. All represented their own countries. It was a privilege to be asked by the International Diabetes Federation to represent Scotland at the first-ever global forum of parliamentary champions for diabetes, and the next forum will be in Canada in 2015. I hope that Scotland will be represented again, perhaps by other members such as Annette Milne, who convenes the cross-party group on diabetes. The conference concluded with the signing of the Melbourne Declaration, which committed parliaments across the globe to ensure that diabetes is high in their political agenda. The declaration called on nations to have a higher emphasis on preventative work, on early diagnoses, management and access to adequate care and to ensure treatment and medicines available for all those living with diabetes. The association was the brainchild of the IDF, whose president is Sir Michael Hurst, former MP and ex-chair of Diabetes UK. I was proud to talk to the conference delegates about Scotland, but also about issues of international significance for diabetes. I'm proud to come from a nation with a strong track record on innovation and discovery. Scots like Fleming discovered penicillin, Scots like Watt, who created the steam engine and Scots like Bell, who invented the telephone. The association is where real strides can be made. In 1922, Professor John McLeod from Aberdeen, working with two other outstanding scientists, Dr Banting and Charles Bess, discovered insulin. McLeod and Banting win a Nobel prize for medicine in 1923, shared with Charles Bess. There have been other more recent political developments here in Scotland as well. Strong positive steps in caring for people with diabetes, such as the provision of insulin pumps to those who are under 18, but the number of people with the condition is rising, which will have serious effect on Scotland's immediate future. Beyond the grave social cost of the condition on individuals and families, there is a huge economic cost to the NHS in Scotland. Estimated at £1 billion annually, 80 per cent of that goes in managing avoidable complications. With the Melbourne declaration diabetes focus on the prevention diabetes, the Scottish Government must have a focus on the condition that properly reflects the size of the problem. For example, there are now more people living with diabetes in Scotland than with chronic heart disease. Two and a half times more people with diabetes than all cancers combined. Every year in Scotland, about 1,900 people have an emergency admission for diabetic K.A. A critical life-threatening condition that requires immediate attention. Over 40 per cent of those admissions are people under the age of 25. People with diabetes account for a fifth of hospital in patients at any given time, and a person with diabetes can face a reduced life expectancy of up to 14 years in Scotland. Diabetes is the leading cause of blindness on working-age people and the main contributor to kidney failure, amputation and cardiovascular disease, including heart attack and stroke. People with diabetes should be receiving their 15 healthcare essential checks from the NHS and previous action plans have been instrumental in taking this critical forward. The theme, as I said, is healthy living and diabetes. For example, I recently met Michael Matheson, who is speaking here this evening, with Jane Claire Judson from Diabetes Scotland. We talked about changing procurement for government, such as the new ferry contract, ensuring that when all food is served it should have carly, it should have fat and carbohydrate contents made clear in the menu. Good for those who are dealing with diabetes and good for those who are managing their weight. In conclusion, we have a great chance in Scotland not only to raise the bar in healthcare but to contribute to scientific and medical understanding across the globe. While Diabetes Day is an international opportunity for diabetes to be central stage with the focus on awareness, advocacy and best practice across the globe, we have to tackle the ticking time bomb. All we need to paraphrase Sir Walter Scott is the will to do and the soul to dare. Thank you very much. I now call on Eileen McLeod to be followed by Hanzala Malik. Four minutes or thereby please. Thank you, Presiding Officer. I would like to begin by congratulating my colleague Dave Stewart on securing this debate, as well as Diabetes UK, for the very helpful briefings and to say that I am now a new member of the cross-party group on diabetes, having just joined the other week and I am very much looking forward to working with my colleagues on the group. I wish to focus on one of the issues that Dave Stewart highlighted in his motion, and that is the experience of parents whose children are diagnosed with type 1 diabetes and the importance of promoting education in an awareness of the early warning signs and symptoms of diabetes in children and young people. There is no question that receiving a diagnosis of type 1 diabetes for a child is a heartbreaking and life-changing experience for any parent and the amount of care that a child with type 1 diabetes needs can be very significant. I mean, parents speak of having to test blood glucose levels multiple times an hour through the night should an adverse event occur. Maintaining good blood glucose levels can be a daily struggle with parents fearing for their child's safety. Maintaining good blood glucose levels rise too high or drop too low and it can be a constant, sometimes nerve-wracking juggling act. Having said that, we should also note the level of support and assistance that is now very often available to parents. The roll-out of insulin pumps, for example, is regarded by many parents and indeed by diabetes UK as a very positive step forward and not only does the pump therapy remove to a very large extent restrictions but the flexible way in which the pump can be set to deliver insulin can benefit overall wellbeing and without wishing to be too technical an insulin pump can be calibrated very precisely according to the amount of carbohydrate in a meal and the pre-meal blood glucose level allowing for a very precise delivery of insulin and ideally improved control of blood glucose levels. Some health boards, Dumfries and Galloway, for example, use Dyson technology so that the insulin pumps data can be uploaded over the internet and this enables the diabetes team to examine it and recommend changes without the need for hospital appointments and the information is also there for parents and their child to see empowering them to take greater control over the management of the condition. Of course, the increasing prevalence of type 1 diabetes presents us with a significant public health challenge there is, as yet, no cure so sound management of the condition is a key tool available to help us tackle the serious complications which the condition can cause and since the incident of the condition is on the increase it is all the more important that parents are aware of the warning signs like sudden unexplained weight loss extreme tiredness, raging thirst and frequent urination are the key warning signs that parents should be aware of. So I warmly welcome Diabetes UK's campaign to raise awareness of the warning signs of type 1 diabetes and also to explain how children with diabetes will be treated as well as the support and advice that the organisation can offer on a wide range of issues including care for a type 1 diabetic when they start school and the provision of local support groups. So in conclusion, with the imminent publication of the diabetes improvement plan there has been a particularly timely debate on such an important issue as diabetes and I congratulate Dave Stewart once again for bringing this debate forward to the chamber this evening and I look forward to reading the improvement plan and I very much look forward to participating in the future work of the cross-party group on diabetes. Thank you very much, Presiding Officer. Thank you. I now call on Hans Anna Mallick to be followed by Nenette Milne. Thank you very much and good evening, Presiding Officer. First please allow me to thank Dave Stewart for securing today's debate on diabetes. It is important to recognise the importance of diabetes in Scotland and the impact that it has on one's life and to promote the ways in which people can learn to continue their daily life with this medical condition. Figures from diabetes UK show that nearly a quarter of a million people in Scotland have diabetes. Scots diagnosed with diabetes have increased at an alarming rate over the past few years. According to Diabetes UK between 2006 and 2011 the number of Scots diagnosed with diabetes has increased by some 26%. It has become essential to recognise the Scots with early undiagnosed diabetes and to make these citizens aware of their medical condition also provide the appropriate care to ensure that their daily lives are not complicated due to this medical condition. In my many ethnic communities diabetes is not often recognised as a serious risk and could hinder one's daily life and one's surrounding families. Many South Asian communities in Scotland have higher risk of developing type 2 diabetes and are likely to be diagnosed at an early age than the indigenous community itself. In my constituency of Glasgow there are a number of volunteer organisations the Glasgow South group that is associated with diabetes UK and Chini Come meaning in English less sugar at home administered by Health and Social Care Alliance Scotland. These organisations tend to people that are newly diagnosed with diabetes and their families it provides information and various supports that would enable one to continue a daily life in a manner that caters to their new medical condition. Although there is some education and this health matter in my constituency but the education courses on diabetes across Scotland wide are scattered at best. Providing education and support of health lifestyle to those diagnosed with diabetes is essential component in ensuring Scots with diabetes to have a high standard of life and betterment. As a diabetic I am aware of the problems we suffer and the lack of treatment through Scottish Government and NHS policies for example refusing to fit bandings to people who suffer from diabetes my understanding is that that would reduce nearly 80% of the diabetic community at a stroke and excusing the pun and also I think it is important that when we realise that we have a serious problem we realise that there is a growing dependency on the national health service when we know the diabetes results in kidney failure and many other ailments like eyesight for example which I have already gone on an operation already as a diabetic. These are challenges that face us today and we need to address some of the issues that we have in not only treating diabetes but actually treating it seriously in terms of recognising the implication it has on our communities and how we then take the message to them. I think the fact that minority communities in particular suffer largely I think it is important that we take that message home more seriously and more vigorously. I know that at times it has been made particularly in larger cities but the rural areas quite clearly suffer from that lack of information and I would look forward to the minister's comments on how he intends to deal with that issue. Thank you very much. Thank you. I now call on Annette Milne to be followed by Chief Brody. Thank you Deputy Presiding Officer. I will be taking part in a debate to acknowledge this year's World Diabetes Day and congratulate David Stewart on once again securing parliamentary time to bring to our attention this international event which since its inception in 1999 has been important in raising the profile of diabetes across the globe. David Stewart has acknowledged Sir Michael Hurston valuable work in diabetes but David himself has been a tireless campaigner for people with diabetes in Scotland throughout his parliamentary career both in Westminster and as a member of this Parliament we have worked together in recent years alongside Diabetes Scotland to raise awareness of the condition in an on-going effort to prevent its development where possible and mitigate its long-term and very serious complications. With, as we know, 382 million people worldwide currently living with diabetes and that number predicted to rise to 592 million by 2035 the condition is reaching pandemic proportions and beyond those already diagnosed it is thought that a further 316 million people are at high risk of developing type 2 diabetes. In Scotland over 268,000 people have been diagnosed and will need help to manage their condition in order to avoid its complications. What is really concerning is that many people with diabetes still go undetected their condition unrecognised until they begin to develop its serious and life-threatening consequences. Globally it is thought that up to 50% of those people remain diagnosed a very serious challenge for all of us and in Scotland it is estimated that one in five people either have diabetes or are at high risk of developing it costing our NHS £1 billion each year 80% of which goes on potentially preventable complications. We all know that types 1 and 2 diabetes are distinctive entities with type 1 generally starting when people are young and it is unavoidable whereas type 2 is generally a condition of later life and its onset can often be prevented by leading a healthy lifestyle. It is very important to be able to recognize the symptoms of diabetes whatever its type because the earlier it is diagnosed and properly managed the less likely are its complications. Diabetes Scotland's campaign to raise awareness in children and young people by highlighting the symptoms and warning signs and encouraging them to eat healthily and exercise regularly is to be commended and supported. The same regime of physical activity and healthy eating is important to all of us of course and by leading this type of life we can help to avoid the pitfalls of obesity one of the most serious of course being the development of type 2 diabetes because in modern western society there are very many and sadly an increasing number of people who are very significantly overweight and this is undoubtedly leading to an earlier onset of type 2 diabetes with some people in their teens now having the condition and the earlier the onset the sooner people are likely to develop the complications of kidney, eye and cardiovascular disease. These not only compromise their health and wellbeing they may also result in premature death and in the process put a great deal of pressure on NHS resources. This gives us in Scotland a particular challenge because despite improvements in life expectancy and health outcomes there are still significant differences for people with diabetes depending on deprivation ethnic population and life circumstances. Everyone living with diabetes should have equality of access to appropriate health services and this is not yet the case. The message of world diabetes day 2014 campaign is a simple one that the healthy choice can actually be the easy choice. The campaign aims to inform children and young people how to make the right choices about what they eat one of the most valuable being to start the day with a healthy breakfast. By educating them now in a fun and engaging way on the importance of a healthy diet and regular physical activity we will help to protect the health and wellbeing of young people and future generations and also achieve better health outcomes for people who currently suffer from diabetes and those at risk of developing it. To conclude, I commend the campaigning work of Diabetes Scotland which we will celebrate here next Tuesday during this year's World Diabetes Day's parliamentary reception. I thank David Stewart once again for leading the debate. Thank you. Many thanks. I now call on Jack Brody to be followed by Rhoda Grant. Thank you, Presiding Officer. I also add my thanks to David Stewart for bringing this motion to the chamber this evening and also to congratulate Annannette Milne on the work that they do in the cross-party group. As the motion says, Friday is World Diabetes Day led by the International Diabetes Federation and this is the 23rd World Diabetes Day. Diabetes poses serious concerns to one's health. I have, I don't suffer from but I have Diabetes Type 2. I'm one of the 238,750 in Scotland who are in the same position all rattling around Scotland to the tune of Metaformin and other light tablets. I like to think that I complement or avoid that with my 5 a day augmented by daily bowl of porridge cholesterol lowering spread in 15 minutes of exercise every day. That doesn't hide the fact however that I am diabetic. I know my underlying figure would deny that but the harsh fact is that I do. Had I lived less healthily and been subject to the oppression of deprivation I would have been in a terrible place and that's why I welcome this call again to focus on the issue of diabetes. Diabetes affects people disproportionately in the areas of deprivation. The deprivation rates in Scotland vary from 29% to 26% in various areas. Those in the most deprived areas have reduced life expectancy higher smoking rates and unfortunately lower engagement with the health services which has to change. I applaud the nurses who are with us because there are 12% of the inpatient budget on treating diabetes. The Scottish Government's action plan impending Diabetes Improvement Plan will help strategically to address the problem and through promoting self-management of the condition, through effective education and minimising the impact of potentially serious complications increasing availability as Aileen McLeod mentioned on intensive insulin treatment for people with type 1 and creating a stronger emphasis on screen and prevention of diabetes. In all of this I congratulate David Stewart and Nanette Millon for their unstinting efforts in the pursuit of promoting the needs of doctors to use the tools available to them to ensure anyone with diabetes in Scotland receives timely data on matters affecting their condition. For example, I confirm again personally the regular demands to attend my retinopathy test and I have on my desk a card which allows me to test my diabetes condition and cholesterol levels on the internet. The early identification of those with diabetes is key in all of this. I welcome the Scottish Diabetes Group working with others to deliver us because there must be emphasis on education accessibility to services in this particular area. The best way to tackle the growing epidemic of diabetes is to tackle the issue in childhood. I commend the Live for it joint venture between Diabetes Scotland and the Edinburgh International Science Festival. The project so far has reached 1,191 pupils and has worked in 18 schools. Importantly, the programme is designed to tackle childhood obesity and ties into curriculum for excellence in health and wellbeing and is delivered to schools in areas of high deprivation. The World Diabetes Day campaign underpins and will underpin all of this and the slogan Diabetes Protect Our Future will raise the profile of the 2014 campaign with its focus on healthy living and diabetes. In hopes and one beliefs that will all the emphasis and continue to raise the profile with the support of those that we have in the gallery today and others that the message will continue to get through more and more strongly and I welcome the debate this evening. Many thanks. I now call on Roda Grant after which I moved the closing speech from the minister. Thank you, Presiding Officer. I want to add my congratulations to David Stewart for securing this debate and the debate itself raises awareness of both types of diabetes and I think that that is really important because early diagnosis is crucial to the treatment of diabetes. Late onset or type 2 diabetes is much more likely to be picked up because it happens to adults. They obviously experience the symptoms and are able to communicate them to their GPs with that information to work on as well as looking at things like age and weight and lifestyle of the patient. However, with type 1 it is much more difficult, as Eileen McLeod said it is often very young child that becomes unwell. They may not be able to communicate how they feel properly and it can sometimes be quite hard to diagnose in sport and sometimes it needs to reach a crisis before a diagnosis takes place which is not ideal. There are some innovations in the treatment of diabetes for example insulin pumps for type 1 that have helped people to take better control of their condition that has not really changed their condition or indeed changed their dependence on insulin but it does allow them some better control. For both types of diabetes you tend to be dependent on some kind of drug therapy for the rest of your life. You also have to be very careful about what and when you eat and things like going out for a drink with friends also have to be planned because the impact that alcohol can have on blood sugar levels and that can impact on your diabetes control as well. It sometimes feels like we haven't come very far on the treatment of diabetes although there are some new drugs now available that could help the condition and we wait to see how they will pan out but we do need a lot more research and development into the medication treatment and causes of diabetes especially type 1 diabetes which is very difficult to identify what exactly causes it. Diabetes is not just dangerous because of the fluctuating blood sugar levels that can left unmanaged actually be lethal. It's also dangerous because of the impact it has on your overall health. Hanzala Malik mentioned kidney failure and the impact on your side but it also can lead to heart disease, circulation problems, difficulty in healing and at some points amputation which can be extremely serious for the diabetic. New medications can help to alleviate that but we need to do an awful lot more in bringing forward medications and treatments to help. We also need to stress the importance of exercise ways of keeping people fit as they get older and it's sometimes difficult saying to people who are getting older and their joints are beginning to creak a bit to take more exercise but there are other activities that can provide the same value and maybe don't have the same impact and we also need to inform people about diet. I think we're all a wee bit dependent and we've got busy lives we depend on fast foods, microwave meals we need better nutritional information but also the knowledge of how to use that nutritional information young people aren't taught for instance in school anymore about what is good for them and what actually leads to a balanced diet. We need also to review the way we provide care and support and it will be good maybe to get an update from the minister as he sums up how best practice has been rolled out how our managed clinical networks are working and indeed how the excellent work carried out by the diabetes audit and research and Tayside has been used to inform other health boards and to improve the care and treatment of those with diabetes so therefore we need to really look at how we roll out best practice. We also maybe need to look at schools especially for very young type 1 diabetics when they first go to school and inform teachers about how to manage their condition for instance making sure they eat before they take part in PE lessons and the like. Just a little bit of information and a little bit of input from teachers can actually make the life of parents and children a lot better. Presiding officer just in summing up I really welcome this debate because it actually does shine a spotlight on diabetes and it's very important that that happens because as we've heard from other speakers diabetes is on the increase and we really need to look at prevention and cure. Many thanks. I now call the minister to close the debate on behalf of the Government. Minister seven minutes are thereby. Thank you Presiding Officer. Can I like others of my congratulations to do in securing time for this debate in marking world diabetes day but also to recognise expertise he brings to the chamber in his contribution to the area as along with the net mill and the co-chair of the cross-party group here in the Scottish Parliament. I also want to recognise the work that Dave Stewart has also undertaken at an international level with the parliamentarians for diabetes global network in Melbourne. I must confess the idea of our Strone in Melbourne sunshine at this time of the year in Scotland is very appealing I should say. This debate I do believe gives us an opportunity to underline the very serious challenge which diabetes presents us in Scotland but also to outline the work that we have taken forward to improve the lives of those who live with diabetes. Some members have made reference to already the International Diabetes Foundation have estimated that one in ten of the world's population will be living with diabetes by 2035 and as the net mill highlighted in her contribution the Scottish figures for 2013 saw the number of people with diabetes increase to over 268,000 that's 5% or one in 20 of our population. Those figures along with the figures that Dave Stewart and others have highlighted in their own contributions I think are very sobering and they do demonstrate the significant challenge that we face. However in Scotland I do believe that we are particularly well placed to answer this challenge. Earlier this year we hosted our Diabetes in Scotland conference which solved over 300 members of the Scottish and international Diabetes community coming together to discuss how we can improve our services to make life better for people with diabetes and to share good practice. How fortunate we are in Scotland to have such very strong clinical leadership engaged through our Diabetes teams and with a very active patient voice on how that is taken forward. I want to therefore take this opportunity to pay tribute in particular to the lead clinicians who have chaired the Scottish Diabetes group over the past decade. Professors John McKnight Donald Pearson and Professor Andrew Morris who made this particular event such a success and to know their work which is aimed at ensuring Diabetes services in Scotland are second to none. Our national Diabetes programme has helped to co-ordinate safe, effective and person-centred Diabetes care across Scotland for over a decade now. Many of you will be as some have already referred to familiar with our Diabetes action plan. Over the past few years, this plan has been absolutely key to driving forward improvements in a number of important areas of Diabetes care including delivering state-of-the-art e-health solutions to monitor progress, to improve foot care services, to increase access to insulin pump therapy and to enhance knowledge and skills among our staff. It's important that we build on this work going forward to strive to continually improve our Diabetes services year on year here in Scotland. That's why earlier today I agreed to the publication of our new Diabetes improvement plan, which will be published by the end of this month. Our improvement plan aims to build on the existing work of the Diabetes action plan by focusing on key priority areas and challenges of the Scottish Diabetes community to deliver continuous improvements in the quality of care available to people with Diabetes. A key part of that will be building on the work that has been identified, particularly those at higher risk within our ethnic minority communities in order to see continued improvement going forward. Although I don't have sufficient time to go into great depth all of the successes of our Diabetes programme or to set out all the areas of the new improvement plan and what it will cover, but I would like to take this opportunity to set out some of our work today. A key measure of Diabetes care in Scotland is our Scottish Diabetes survey, perhaps the most comprehensive national record of its kind possibly in the world. One of the major successes is to highlight from the most recent survey is that the percentage of people with type 1 and type 2 diabetes who have had their foot risk recorded has doubled between 2008 and 2013 to around 80 per cent. That will have a major impact on reducing foot ulcers and lower limb loss. That is a result of the evidence taken forward by our world-leading system of foot risk triage system which was developed by our Diabetes foot care action group here in Scotland. Working in a way to make sure that people with diabetes who are at most risk of developing foot complications receive the care that they require and that it's a inventive approach that is taken forward. The second area to highlight is the very substantial improvements that we have made in accessing insulin pumps which several members have made reference to. I am very pleased to note that we have made a significant level of progress in this area. That hasn't always been easy in moving forward this area of progress across all health boards within the country as Dave Stewart and others will recognise, but we also have a significant increase in the level of insulin pumps being made available to adults and children. We have now met an overall aim of ensuring that across Scotland 25 per cent of people under 18 have access to insulin pumps. To put this in some context we have gone from some 8.4 per cent of our under 18s with diabetes having access to an insulin pump in 2011 to 27.5 per cent across the country being on an insulin pump. However, I want to reassure the chamber that we are certainly not complacent and we want to ensure that the target is met on a consistent basis across all of our health boards by March 2015. However, improvement services for people who already have diabetes is not enough. We need to address underlying risk factors that lead to the development of type 2 diabetes and to identify diabetes among young people earlier if we are to safeguard their future health in Scotland. Earlier this year the World Health Assembly announced its global target to help the rise of diabetes and obesity by 2025. This is a very ambitious aim, but rightly so it very much complements our focus on preventing type 2 diabetes and it complements our work in taking forward factors that can influence the risk factors on someone developing type 2 diabetes. We are working to encourage people to make lifestyle changes such as adopting a healthier diet, managing their weight and increasing their level of physical activity as was correctly highlighted as being key components of our contribution. We have committed spending of some £7.5 million in the present spending period on healthy eating projects to support people to make healthier eating choices. In addition to that, we have provided improvement funding to several other stakeholders over the past year including Diabetes Scotland to support projects to encourage healthier eating and lifestyle choices. We are also committed to the industry about proposals to improve dietary health in last month. I met with Diabetes Scotland and Dave Stewart along with the Food Standards Agency to explore this further in public procurement and we will continue that dialogue to see if there are further measures that we can take forward. It is not only essential to support people in making healthier lifestyle choices to avoid diabetes but also to identify those who have diabetes earlier. Type 1 diabetes tends to present more acutely than type 2. However, a key part of the work that we have taken forward is to make sure that we continue to drive forward earlier identification. Our paediatric and adolescent group are developing a range of materials for GP surgeries and admitting departments designed to support healthcare professionals. Recognise the symptoms of diabetes in young people much more quickly to ensure earlier diagnosis and we will be looking to roll that out over the coming months. I have also said in motion the work for our public health sector to take a much more proactive role in prevention of conditions such as diabetes. As a result, I announced last week that there will be a review of public health services in Scotland with the initial findings arriving with ministers in 2015 with a view to continue to improve public health provisions in Scotland with the preventive agenda being at the centre of it. On my remarks to a close, it is clear that our NHS in Scotland have delivered real improvements in the care of people with diabetes in the last few years. Now more than ever, we need to make sure that we work forward in a stronger collaborative effort with all stakeholders and agencies to make sure that we create a health promoting and diabetes-aware culture in Scotland. I can assure members that our new improvement plan will look to build on that progress in the coming years. I thank you all and I now close this meeting of Parliament.