An online diabetes cross-party group (CPG) was held on 3rd December 2024. The purpose of this group is to provide a platform for parliamentarians to discuss all issues relating to diabetes; to liaise with those affected by the condition, organisations representing their interests and health workers dealing with diabetes; and to promote good practice and raise specific issues of concern.
During the meeting several questions were asked that there was no time to answer, including many about the cost of continuous glucose monitors (CGMs) and access to the devices in Scotland.
Diabetes Scotland collated answers to the questions as published below.
We are hearing that certain HBs no longer have the funds to start people on Dexcom even if it is the most appropriate CGM for an individual. Can you tell us how this issue is going to be resolved?
The Scottish Government has provided ring-fenced funding to support better access to hybrid closed-loop systems (HCL); this is over and above health boards existing budgets. NHS Boards were provided with an equitable allocation of the initial investment, depending on how many people are waiting for a HCL, and are able to order any CGM as part of this for under-18s.
CGM costs for adults were not provided in the initial allocation of funding as it was widely accepted that the price variation between brands was not value for money. This does not mean that Health Boards are unable to use Dexcom – we have not stipulated to health boards or clinical teams which devices they should use and the financial allocation is flexible should a HB wish to purchase a specific brand of CGM for adults.
Any decision about brand choice is based on a discussion between the individual and their healthcare team. We would encourage any individual who feels there is a specific need to be on a specific device to discuss this further with their healthcare team. While we understand that services are operating in difficult financial circumstances, there is a strong consensus between clinical leads that all CGM options are safe and effective.
Some HBs are taking people off their Dexcom CGM to replace for more cost-effective option, we were told that this would not happen so what can we do when it does?
As above, the decision on which devices are used is determined locally. We are aware that in some board areas there has been a decision to utilise the most cost-effective options. This has been done to ensure as many people as possible benefit from this transformative technology. Some health boards may have cost pressures from technology they funded previously but we would expect all decisions on device changes to be made with patient consent.
As previously stated, we would encourage any individual who feels there is a specific need to be on a specific device to discuss this further with their team.
In some HBs Children and Young people are being put onto CGM that does not have ‘follow me’ function, is there a strategy in place to avoid this happening?
As stated the funding for this programme has ensured that all young people and their families can have a choice of brand. It is our understanding that all health board offer HCL with follow me function in under-18s via a tethered pump. If families are seeking a patch pump they may be offered a CGM that does not have a follow function – however this should be a discussion between the family and clinical team.
Again there is a consensus that these options are absolutely safe, however the national policy remains that choice should be provided.
We are aware that several HBs are not giving patients the choice of HCL as per recommendations from SIGN and SHTG, what is Scottish Government doing to resolve this issue?
We expect all health boards to be following clinical guidelines. It is our understanding that all health boards in Scotland offer a choice of tethered or patch pumps. While we appreciate there are less options for CGM in adults, this will be changing in the coming months as more brands become compatible with pumps. The Scottish Government and NHS Health Boards have a responsibility to ensure cost effectiveness and these decisions are made by clinical staff.
If individuals have concerns about a clinical guideline not being followed, that should be raised with the local health board.
Can we have assurances that Scottish Government have negotiated the best possible deal that enables equity of access and choice of HCL?
The entirety of the Scottish Diabetes Community, lead by NSS Procurement, have been and remain actively involved in negotiating the best possible deals for NHS Scotland. We are led to believe by suppliers that Scotland have been able to negotiate very competitive deals. We would however welcome any evidence where this isn't the case as we would be keen to use this to inform ongoing negotiations.
Funding has been allocated to NHS Boards specifically to tackle inequalities across regions. That has meant that those local boards with the least access were given the most funding. Moving forward, we expect to be able to move to a system of population based funding as these gaps will have been reduced significantly.
