Why SNP must urgently rethink 'devastating' funding cuts to life-changing diabetes treatment
In an open letter to Scottish ministers, Jennifer Hall of Diabetes Scotland, academics, NHS staff and others warn that the withdrawal of central funding for an advanced form of treatment leaves type 1 diabetes patients facing a crisis
Dear First Minister and Cabinet Secretary for Health,
Diabetes Scotland, together with the undersigned stakeholders, writes to you with deep concern regarding the decision to withdraw central funding for the provision of hybrid closed loop (HCL) systems for people living with type 1 diabetes in Scotland. This decision has serious implications not only for those directly affected, but also for the long-term sustainability, equity, and effectiveness of diabetes care across NHS Scotland.
An HCL system automatically adjusts insulin delivery using real-time glucose readings to help people manage their blood sugar levels safely and effectively. Guidance from the Scottish Intercollegiate Guidelines Network (SIGN) and the Scottish Health Technologies Group (SHTG) clearly states that this technology should be considered the standard of care for those with type 1 diabetes who wish to use it. Until now, national delivery has only been made possible through the Scottish Government’s commitment to fund and implement this technology at scale.
This has been achieved through the provision of both ring-fenced-funding and centralised delivery by the National Diabetes Closed Loop System Onboarding Programme. We acknowledge and value the investment that has enabled thousands of people across Scotland to benefit from HCL systems through the national onboarding team.
Longer waiting lists
The sudden loss of this investment is devastating for the diabetes community. There is a very real concern that local health boards are neither financially able nor operationally prepared to meet increased demand, resulting in insufficient capacity to deliver HCL systems to those who need them.
The timing of this decision is particularly concerning, as local budgets are already committed for this year and the year ahead and do not reflect the proposed change in funding and delivery arrangements. While we recognise the challenging financial pressures currently facing public budgets, the consequences of this decision are profound.
Ending central funding – particularly so abruptly – risks exacerbating a postcode lottery in access to this life-changing technology. Individual health boards are unlikely to be able to maintain the pace or scale of national delivery achieved to date. This will inevitably lead to longer waiting lists and reduced access, at a time when demand for diabetes technology continues to grow and services are already under severe strain.
Any reduction in access to HCL technology will have a direct and negative impact on both the physical and emotional wellbeing of people living with type 1 diabetes. Alongside the physical consequences associated with poorer glucose control, reduced access will increase stress, anxiety and diabetes-related distress for individuals and their families.
Access to HCL technology must be equitable, consistent, and based on clinical need – not determined by geography or funding-led decisions.
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Higher costs for healthcare
Beyond the significant human cost, there is also a compelling economic case for continued investment. Diabetes already costs NHS Scotland approximately £875 million every year, with around £475m spent on complications alone. Improved glucose control achieved through HCL systems reduces hospital admissions and the risk of serious complications such as retinopathy and neuropathy, delivering long-term cost savings.
While withdrawing funding may result in short-term budgetary relief, it risks substantially higher costs to the health system in the future. Those who do not have access to HCL technology may require more intensive and costly care, placing further pressure on services across the country.
Scotland has rightly been recognised as a leader in progressive diabetes care. This decision threatens to reverse that progress. At a time when technology is transforming the ability of people with long-term conditions to live healthier and more independent lives, it is essential that policy and funding frameworks keep pace with clinical and technological advancement.
Funding available in England
People with diabetes deserve the right to access life-changing technology based on clinical need; access and choice must not be driven by funding constraints. NHS England has committed to the continued rollout of diabetes technology through inclusion within its five-year funding and delivery plan.
The absence of a comparable long-term funding commitment in Scotland risks undermining progress that has already been made and jeopardises equitable access to HCL systems. Sustainable, multi-year investment is necessary to allow health systems to plan effectively, build capacity and deliver technology at scale in line with clinical guidance.
We stand ready to work constructively with the Scottish Government, NHS boards, clinicians, and other partners to identify a sustainable solution that protects access to HCL technology. We urge the Scottish Government to take immediate action to address this imminent crisis facing the type 1 diabetes community.
Specifically, we call on you to:
• reinstate or maintain central funding for HCL systems to ensure equitable, national access across all NHS boards;
• provide clear national leadership and accountability, including agreed targets, timelines, and expectations for health boards to deliver HCL systems consistently;
• publish a transparent and sustainable delivery plan that sets out how access to HCL technology will be protected, funded, and supported in line with national clinical guidance.
Avoidable harm
We respectfully ask the Scottish Government to reverse this decision as a matter of urgency and reaffirm its commitment to equitable, evidence-based diabetes care. Continued national funding for HCL is not only clinically justified, but essential to protecting the health, dignity and quality of life of people living with type 1 diabetes in Scotland.
We implore you to act now to prevent avoidable harm and safeguard Scotland’s hard-won progress in diabetes care.
Yours sincerely, Jennifer Hall, national director, Diabetes Scotland
Alison J Mackenzie, consultant physician, Forth Valley Royal Hospital
Alison Jamieson, nurse consultant, diabetes, NHS Shetland
Alison Templeton, IPAG Scotland and Tech Collective
Allana-Lee Gillies, paediatric dietician, NHS Borders
Alyssa Faulkner, IPAG Scotland, Pumptastic Scotland
Amani Yacoub, consultant paediatrician, NHS Ayrshire & Arran
Anna Duncan, paediatric diabetes nurse specialist, Victoria Hospital, Kirkcaldy
Anna White, consultant physician diabetes and endocrinology, Forth Valley Royal Hospital
Anthony Tasker, consultant paediatrician, Victoria Hospital, Kirkcaldy
Carolyn Kiddell, lead diabetes specialist nurse, NHS Forth Valley
Cheryl Crawford, diabetes specialist nurse, outpatients, Crosshouse Hospital Diabetes Centre
Claire Campbell, diabetes specialist nurse, NHS Fife
Clare Webster, consultant paediatrician
Colette Ross, diabetes clinical support worker, NHS Forth Valley
David Hill, consultant physician (diabetes and endocrinology), University Hospital Wishaw, NHS Lanarkshire
Denise Burns, lead diabetes nurse, NHS Fife
Diabetes Team Western Isles Hospital
Dr Alan Jaap, consultant in diabetes, NHS Lothian
Dr Alexander McNeil, clinical director and consultant paediatrician, Borders General Hospital
Dr Alison MacEwen, consultant diabetes and endocrinology, NHS Ayrshire & Arran
Dr Anna Dover, consultant diabetologist, Royal Infirmary of Edinburgh
Dr Berit Inkster, consultant physician in diabetes and general medicine, Royal Infirmary of Edinburgh
Dr Catriona Broome, ST6, NHS Lothian
Dr Catriona Farrell, consultant diabetologist, technology lead, NHS Tayside
Dr E Turtle, consultant physician, NHS Fife
Dr Fiona Green, consultant in diabetes and endocrinology, Dumfries Royal Infirmary
Dr Frances McManus, consultant diabetologist, Glasgow Royal Infirmary
Dr Fraser Gibb, consultant physician, Edinburgh Centre for Endocrinology and Diabetes
Dr Graeme Eunson, consultant paediatrician, Borders General Hospital
Dr H Cameron Munro, lead clinician, Tayside Diabetes MCN
Dr Ian Salt, deputy head of School of Molecular Biosciences, University of Glasgow
Dr Iqbal Malik, honorary consultant, diabetes and endocrinology, NHS Tayside
Dr James McLaren, consultant physician and endocrinologist and honorary clinical associate professor, University Hospital Wishaw
Dr Joel Milner, co-founder and committee member, IPAG Scotland
Dr Kashif Ali, GP partner and primary care lead, diabetes MCN
Dr Kenneth McHardy (retired), former consultant diabetologist and head of diabetes services, NHS Grampian
Dr Laura Jordan, consultant diabetologist, NHS Tayside
Dr Laura McLaren, diabetes consultant, NHS Forth Valley
Dr Louise Clark, consultant physician and diabetologist, University Hospital Hairmyres
Dr Louise Osborne, lead consultant for diabetes and endocrinology, NHS Forth Valley
Dr Louise Overend, consultant for diabetes and endocrinology, Dumfries and Galloway Royal Infirmary
Dr Nick Barwell, consultant physician, Forth Valley Royal Hospital
Dr Nicola Zammitt, consultant diabetologist, Royal Infirmary of Edinburgh
Dr Nives Gattazzo, acting D&E consultant
Dr Rajeeb Rashid, clinical lead for Glasgow Children's and Young Person's Diabetic Service, West Glasgow Ambulatory Care Hospital
Dr Ross Andrew Cairns, consultant in general medicine/endocrinology and Diabetes, University Hospital Hairmyres
Dr Sabine Grosser, consultant paediatrician with special interest in diabetes, Forth Valley Royal Hospital
Dr Sandeep Thekkepat, consultant physician, diabetes and endocrinology, clinical lead digital, University Hospital Monklands
Dr Scott Cunningham, senior lecturer, University of Dundee, and programme lead for My Diabetes My Way
Dr Scott Williamson, consultant paediatrician (endocrinology and diabetes), NHS Ayrshire & Arran
Dr Sharon Mackin, consultant diabetologist, NHS Greater Glasgow and Clyde
Dr Sheila Grecian, consultant diabetologist, NHS Lothian
Dr Stuart Ritchie, consultant physician, Edinburgh Centre for Endocrinology and Diabetes
Dr Victoria Franklin, consultant paediatric diabetologist, Raigmore Hospital, Inverness
Dr Zhuo Min Chong, consultant in diabetes and endocrinology, University Hospital Wishaw
Eleanor McCabe, advanced clinical diabetes specialist dietitian and team leader, NHS Lanarkshire
Elinor Kerr, diabetes clinical lead dietician, NHS Forth Valley
Elizabeth McMahon, diabetes specialist nurse, Crosshouse Hospital Diabetes Centre
Elizabeth Bayman, paediatric endocrinologist. NHS Lothian
Gail Caie, IPAG Scotland and Tech Collective
Geraldine Macrae, lead consultant nurse diabetes, Diabetes Centre, Western Isles Hospital
Gillian Boyd, insulin pump and diabetes technology administrator to the Adult Diabetes Specialist Nurse Team, NHS Ayrshire and Arran
Gordon Donaldson, podiatrist, NHS Ayrshire and Arran
Hannah Innes, senior nurse clinician in diabetes, University Hospital Wishaw
Hannah MacPherson, consultant physician, NHS Forth Valley
Har Simran Kaur, specialist diabetes dietician, Hairmyres Hospital Diabetes Centre
Heather Keary, paediatric diabetes nurse specialist, Crosshouse Hospital Diabetes Centre
Hjalte Hojsgaard, vice-President and general manager UK/BNLX/DACH, Insulet International
Isabel Howat, consultant physician, diabetes and endocrinology, University Hospital Monklands
Jacqueline Smith, IPAG Scotland
Jill Malcolm, advanced specialist dietitian, diabetes, Victoria Hospital, Kirkcaldy
Joseph Wales, general manager, mylife Diabetescare
Julia Hammac, general manager, UK and Ireland, Abbott Diabetes Care
Karen Duncan-Smith, paediatric diabetes team, University Hospital Crosshouse
Karen Moir, lead paediatric/transition diabetes specialist nurse, NHS Fife
Kathleen MacNeil, diabetic specialist nurse, NHS Western Isles
Kathriona Thomson, diabetes dietitian, clinical lead adult insulin pump service, NHS Ayrshire and Arran
Kathryn Stewart, diabetes specialist nurse, NHS Forth Valley
Kris Ward, market access manager, Dexcom UK
Laura-Jane Truesdale, diabetes MCN manager
Lauren Peck, diabetes specialist nurse, Western Isles
Lesley Ross, IPAG Scotland and Tech Collective
Lesley Walker, diabetes specialist nurse, University Hospital Wishaw
Lesley White, advanced specialist dietitian, NHS Fife
Lesley-Ann Reid, paediatric diabetes nurse specialist, NHS Ayrshire and Arran
Lindsay Robertson, advanced pharmacist, NHS GG&C
Mary Moody, IPAG Scotland and Tech Collective
Maryanna Ryan, diabetes specialist nurse, Borders General Hospital
Matthew Johnson, director of access and innovation, Roche Diagnostics UK and Ireland
Meg Park, lead nurse CCG2 elective medicine, Ninewells Hospital and Medical School
Mrs Danielle Main, advanced practitioner podiatrist, NHS Ayrshire and Arran
Paul Niven, IPAG Scotland and Tech Collective
Peter Ellingworth, chief executive, Association of British HealthTech Industries
Professor Brian M Frier, honorary professor of diabetes, University of Edinburgh
Professor Ewan Pearson, chair of diabetic medicine, Diabetes Endocrinology and Reproductive Biology, University of Dundee
Professor Mark Strachan, president, Royal College of Physicians of Edinburgh
Rebecca Reynolds, professor of metabolic medicine, Institute for Neuroscience and Cardiovascular Research, University of Edinburgh
Rory J McCrimmon, professor of experimental diabetes and metabolism, and NIHR senior investigator, lead clinician NRS Diabetes Scotland
Professor Shareen Forbes, chair of diabetic medicine, University of Edinburgh
Rachel Williamson, consultant physician, diabetes and endocrinology, Borders General Hospital
Rhona O’Neill, paediatric diabetes dietitian, NHS Ayrshire and Arran
Richard Collins, PDSN, NHS Borders
Sally Pattinson, specialist dietitian, NHS Dumfries and Galloway
Sara Redmond, chief officer of development, Health and Social Care Alliance Scotland (the Alliance)
Sarah Tobin, advanced podiatrist, Ayr Hospital
Scott Mackenzie, consultant physician, NHS Lothian
Sharon Irvine, community links worker for the Alliance based at Castlemilk Group Practice
Sheena McDonald, clinical manager, diabetes and endocrinology, Crosshouse Hospital
Sheila Trachsler, IPAG Scotland and Tech Collective
Siobhan Pacitti, consultant physician, diabetes and endocrinology, NHS Borders
Stephen Nixon, IPAG Scotland and Tech Collective
Tejesh Mistry, chief executive, Voluntary Health Scotland
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