PE1920/A – Introduce more thorough follow-up care for women with diabetes
Women’s Health Plan
Women’s Health is a key priority for this government which is why we published an ambitious Women’s Health Plan in August 2021.
The Women’s Health Plan underpins actions to improve women’s health inequalities by raising awareness around women’s health, improving access to health care for women across their life course and reducing inequalities in health outcomes for girls and women, both for sex-specific conditions and in women’s general health.The life course approach emphasises the importance of identifying opportunities to prevent disease and promote health at key stages of life from pre-pregnancy through pregnancy, childhood and adolescence, to adulthood and later life.
Promoting health and disease prevention can include ensuring women have information about the benefits of building and maintaining a healthy lifestyle including being physically active and maintaining a healthy weight.
It also recognises that the social determinants of health shape our health and wellbeing throughout life, and that if we can improve the conditions of daily life we can reduce health inequalities throughout a person's life.
The petitioner specifically mentions the risk of multi-morbidity for women living with diabetes. Research shows that women with symptoms of heart disease are under investigated and are less likely to have appropriate management of cardiovascular risk factors such as diabetes and high blood pressure.
Our Women’s Health Plan contains a set of actions to improve outcomes and quality of life for women at risk of or living with heart disease. This includes raising public awareness of heart disease symptoms and the risks for women, as well as, improve awareness and education amongst healthcare professionals in presentation and management of heart disease in women of all ages.
More information on the Women’s Health Plan can be found here: Women's health plan - gov.scot (www.gov.scot)
Policy context
Diabetes is a clinical priority for the Scottish Government and we are committed to improving the care and outcomes for everyone living with diabetes.
In February 2021, we published a refresh of the Diabetes Improvement Plan. The Plan outlines our commitments for diabetes care in Scotland and sets out an ambitious programme of work to deliver the aims and priorities of providing safe, effective and person-centred care, treatment and support to everyone living with diabetes in Scotland.
The Plan outlines eight priority areas and a focused set of actions overseen by the Scottish Diabetes Group. The priority areas are:
Through the delivery of our Plan, we are committed to designing and developing services that meet the needs of everyone living with diabetes, with a focus on those that are experiencing health inequalities.
To improve outcomes, we will increase support for people with diabetes to enable them to effectively self-manage their condition, provide access to ongoing mental wellbeing support and upskill healthcare professionals in all aspects of diabetes care.
We recognise the health challenges that women with diabetes face, specifically those issues raised by the petitioner. The following outlines what the Scottish Government is doing to address these issues.
Self-Management
We recognise that self-management is an important part of diabetes management and we want to enable and empower people with diabetes to safely and effectively self-manage their condition.
There are a number of resources available to people living with diabetes, and for healthcare professionals supporting people manage their diabetes.
For example, DAFNE (Dose Adjustment For Normal Eating) and DESMOND (Diabetes Education and Self-Management), have specific training modules that provide the necessary skills to enable everyone living with diabetes to live their lives well and to enable people to self-manage their condition. DAFNE also provide training to healthcare professionals to further increase their knowledge in the management of diabetes.
Other resources can be found on My Diabetes My Way website which is an interactive diabetes website to help support people with diabetes and their families. Diabetes Scotland also have a wide range of materials on their website available to people with diabetes and provide advice and training for healthcare professionals.
A key commitment in our Diabetes Improvement Plan is to ensure that people living with diabetes have timely and appropriate access to a variety of high quality person-centred educational and support resources, including online learning, remote health pathways to enable and empower them to self-manage their condition.
We are working closely with people living with diabetes, care providers and third sector who will support the development of any new resources materials and review of existing resources as outlined above to ensure that they are fit for purpose and help identify any potential gaps. Any new resources developed will include wellbeing, emotional and mental health support and will be in a range of formats and languages to ensure equitable access for all who would benefit from them.
Mental Health
Living with diabetes can impact on a person’s mental health and wellbeing. Through the Diabetes Improvement Plan, we are committed to working with NHS Boards, clinicians and third sector to promote good practice and reduce variation in access to mental health support across the country, so that everyone has the opportunity to live well with diabetes.
Our national advisory group, the Scottish Diabetes Group, has established a Short Life Working Group of key stakeholders including clinical psychologists and Diabetes Scotland to progress this commitment.
The group are focussing on identifying a Patient Reported Outcomes Measure (PROM) for mental health and wellbeing for people living with diabetes that are experiencing depression, anxiety or diabetes distress that can be incorporated into routine clinical care.
Once this work is completed, the group will work with NHS Boards to ensure that they have a robust pathway from screening to support for those that need it. We will also ensure that healthcare professionals are supported to recognise and have conversations about mental health and wellbeing and can signpost people to the right services and support.
The importance of mental health, and specific mental health challenges faced by women, were raised throughout the development of our Women’s Health Plan, in particular through the lived experience engagement with women themselves.
The Scottish Government recognises that across most aspects of mental health, outcomes for women and girls are poorer than for men and boys. The Mental Health Transition and Recovery Plan published in October 2020 in response to the Covid-19 pandemic commits to making women and girls’ mental health a priority.
It sets out specific actions to address women and girls’ mental health including engaging with women’s organisations to better understand and respond to the gender-related mental health inequalities that have been exacerbated by the Covid-19 pandemic.
Diabetes Technologies
Diabetes technologies is a rapidly evolving area and we aim to ensure that people, including women, who would benefit from these therapies have access at the earliest opportunity.
Through the Diabetes Improvement Plan we have committed to further increase access to existing and emerging diabetes technologies that can significantly benefit people with type 1 diabetes improve their quality of life.
Our national approach is to support the increase in provision of Insulin pumps and Continuous Glucose Monitors for all ages. We have provided additional funding to Boards to ensure timely and affordable access to such technologies.
Diabetes in Pregnancy
We have also commitment to improving gestational outcomes for women with diabetes planning for and during their pregnancy.
We have made additional funding available to NHS Boards to ensure that all pregnant women with type 1 diabetes can access CGM to enable them to manage their condition during their pregnancy.
We are working closely with diabetes and pregnancy clinical systems to improve links by developing pregnancy specific improvement measures that will help identify inequalities in accessing care.
We are also working with key stakeholders to ensure that appropriately structured patient education is available for women with diabetes during their pregnancy and women with gestational diabetes have access to information and follow-up support to help prevent development of type 2 diabetes.
Our Framework for Early Detection, Intervention and Prevention of Type 2 Diabetes, published in 2018, has been designed to provide delivery partners with guidance to implement a specific weight management based pathway for those ‘at risk’ of or diagnosed with type 2 diabetes.
Within the Framework, patients diagnosed with gestational diabetes or previous gestational diabetes are considered high risk of developing type 2 diabetes post-partum. As a result, those with a gestational diabetes diagnosis should be offered dietary and lifestyle advice and treatment during pregnancy.
Six to 13 weeks following child birth, patients should be offered a blood sugar test to ensure they have not developed type 2 diabetes or pre-diabetes. Appropriate dietary and lifestyle advice including access to weight management programmes should be offered to minimise weight gain between subsequent pregnancies to avoid future gestational diabetes and potential development of type 2 diabetes.
Sexual Health
The Scottish Government understands the importance of ensuring that the people of Scotland are provided with accurate health information, including those with specific conditions, such as diabetes, which could potentially impact on their sexual health.
The COVID-19 pandemic brought unprecedented challenges in many areas, and the impact on the provision of services, including sexual health care has been significant.
In support of the recovery of services as part of wider NHS remobilisation, on 4 August 2021, we published Reset and Rebuild: A Recovery Plan for Sexual Health and Blood Borne Virus Services to address the impacts of the COVID-19 pandemic on sexual health services.
The plan which was developed in co-production with our partners, takes stock of the impacts of COVID on sexual health services and people that use them. It provides an opportunity to reflect on the challenges and build on the positive reforms, while identifying recovery priorities.
The Recovery Plan will also inform the outcomes and approach in next multi-year Sexual Health and Blood Borne Virus Framework which is due to be published in 2022.
Conclusion
We will continue to work with key partners and stakeholders including third sector to ensure that everyone living with diabetes in Scotland receives high quality, person-centred care and support to manage their condition.