Chamber
Meeting of the Parliament 29 September 2011
29 Sep 2011 · S4 · Meeting of the Parliament
Item of business
Cancer Drugs
Back in 2009, in response to the Public Petitions Committee inquiry, the cabinet secretary outlined three steps that her Government would take to improve access to medicines on the NHS, and we welcomed that approach. She said at the end of that debate:
“My objective is to ensure that we have a system in place that is, from end to end, robust, fair and well understood. Such a system should ensure that, when a patient can derive demonstrable benefit from a drug, it is available on the NHS through either SMC approval or exceptional prescribing.”—[Official Report, 25 March 2009; c 16130-31.]
The situation in Scotland that Murdo Fraser has outlined is that
“patients in Scotland are now three times less likely than patients in England to gain access to a cancer medicine that is not routinely available”.
There are geographical variations in the rate of exceptional prescribing applications as well as variations in patients’ chances of making a successful application. Those variations are not acceptable. Relying on the exceptional prescribing process can, of course, also be stressful and time consuming.
The Rarer Cancers Foundation report entitled “The Scottish Exception? An audit of the progress made in improving access to treatment for people with rarer cancers” says that an increasing number of Scots have to rely on exceptional prescribing applications, that nearly a third of NHS boards have no written policy governing exceptional prescribing applications, and that NHS boards use variable criteria to assess exceptional prescribing applications. It is therefore clear that more work is needed to ensure that a transparent system is in place that is
“from end to end, robust, fair and well understood.”
Expenditure on drugs amounts to almost 10 per cent of the NHS budget in Scotland. I understand that tough decisions will always need to be made in the area. Weighing up effectiveness against resources is an extremely difficult task, and it must be done in a rigorous and scrupulously objective way. It may well be that the criteria that are used to make those decisions need to be examined to see whether they disadvantage drugs that are designed to treat rare diseases, but the Scottish Liberal Democrats do not agree with the argument that we should bypass the Scottish Medicines Consortium for cancer drugs. That argument is intellectually unsound, unsustainable and unfair for people who suffer from other conditions. Politicians should not second guess the SMC.
Like Macmillan Cancer Support, Breakthrough Breast Cancer and Myeloma UK, we do not support the creation of a separate cancer drugs fund. The SMC’s role is to make objective decisions about individual drugs, and recent initiatives should be given a chance to demonstrate their efficacy. Cancer Research UK has admitted that the bigger prize is the achievement of a decent settlement in negotiations about value-based pricing. I urge the Scottish Government to engage with the UK Government to ensure that the new scheme meets the needs of patients in Scotland.
The evidence that we have seen is that record keeping in NHS boards is still poor. Nearly two thirds of NHS boards do not hold information about the costs associated with funding exceptional prescribing applications. I would like to see that change. In order to help to make progress, the Government must increase transparency throughout the system and should consider commissioning research into what factors contribute to situations in which drugs are seen to be safe and effective but not cost effective and clinically evidenced.
One step that the cabinet secretary outlined in 2009 was the introduction of a set of modifiers that the SMC can apply when considering new medicines. Has an assessment been made of the impact that that more flexible approach is having on access? Have, as a result of the modifiers, any drugs been approved that would not have been approved under the standard methodology?
We seek a much greater contribution from the pharmaceutical industry, which should work with the Scottish Government to encourage patient access schemes and risk-sharing approaches. In our manifesto, we focused on improving early detection rates to increase survival and we set out plans for a new target on urgent referral for cancer diagnosis: every patient should expect to see a specialist within two weeks. We must focus on increasing early detection in order to tackle the unacceptably high number of cancer cases that are detected for the first time only during emergency admission to hospital. The subject is emotive, but it benefits from the calm and impartial consideration that the SMC can bring.
I move amendment S4M-00956.1, to leave out from “through” to end and insert:
“and that patients in Scotland are now three times less likely than patients in England to gain access to a cancer medicine that is not routinely available; notes that the Cabinet Secretary for Health, Wellbeing and Cities Strategy made a statement to the Parliament on 25 March 2009, outlining three steps being taken to improve access to new medicines, during which she said “All the developments that I have announced today will, individually and collectively, improve patients’ access to medicines on the NHS”; recognises that an earlier RCF report, The Scottish Exception? An audit of the progress made in improving access to treatment for people with rarer cancers, published in March 2011, found that increasing numbers of Scots are having to rely on exceptional case applications, that nearly a third of NHS boards have no written policy governing exceptional case applications in place and that NHS boards use variable criteria to assess exceptional case applications; believes that more work is needed to ensure that there is a system in place that is, from end to end, robust, fair and well understood, and calls on the Scottish Government to outline its response to the findings in the RCF reports, work with the Scottish Medicines Consortium and NHS boards to increase transparency around decision making and work constructively with the UK Government to ensure that the new value-based pricing scheme meets the needs of patients in Scotland.”
09:36
“My objective is to ensure that we have a system in place that is, from end to end, robust, fair and well understood. Such a system should ensure that, when a patient can derive demonstrable benefit from a drug, it is available on the NHS through either SMC approval or exceptional prescribing.”—[Official Report, 25 March 2009; c 16130-31.]
The situation in Scotland that Murdo Fraser has outlined is that
“patients in Scotland are now three times less likely than patients in England to gain access to a cancer medicine that is not routinely available”.
There are geographical variations in the rate of exceptional prescribing applications as well as variations in patients’ chances of making a successful application. Those variations are not acceptable. Relying on the exceptional prescribing process can, of course, also be stressful and time consuming.
The Rarer Cancers Foundation report entitled “The Scottish Exception? An audit of the progress made in improving access to treatment for people with rarer cancers” says that an increasing number of Scots have to rely on exceptional prescribing applications, that nearly a third of NHS boards have no written policy governing exceptional prescribing applications, and that NHS boards use variable criteria to assess exceptional prescribing applications. It is therefore clear that more work is needed to ensure that a transparent system is in place that is
“from end to end, robust, fair and well understood.”
Expenditure on drugs amounts to almost 10 per cent of the NHS budget in Scotland. I understand that tough decisions will always need to be made in the area. Weighing up effectiveness against resources is an extremely difficult task, and it must be done in a rigorous and scrupulously objective way. It may well be that the criteria that are used to make those decisions need to be examined to see whether they disadvantage drugs that are designed to treat rare diseases, but the Scottish Liberal Democrats do not agree with the argument that we should bypass the Scottish Medicines Consortium for cancer drugs. That argument is intellectually unsound, unsustainable and unfair for people who suffer from other conditions. Politicians should not second guess the SMC.
Like Macmillan Cancer Support, Breakthrough Breast Cancer and Myeloma UK, we do not support the creation of a separate cancer drugs fund. The SMC’s role is to make objective decisions about individual drugs, and recent initiatives should be given a chance to demonstrate their efficacy. Cancer Research UK has admitted that the bigger prize is the achievement of a decent settlement in negotiations about value-based pricing. I urge the Scottish Government to engage with the UK Government to ensure that the new scheme meets the needs of patients in Scotland.
The evidence that we have seen is that record keeping in NHS boards is still poor. Nearly two thirds of NHS boards do not hold information about the costs associated with funding exceptional prescribing applications. I would like to see that change. In order to help to make progress, the Government must increase transparency throughout the system and should consider commissioning research into what factors contribute to situations in which drugs are seen to be safe and effective but not cost effective and clinically evidenced.
One step that the cabinet secretary outlined in 2009 was the introduction of a set of modifiers that the SMC can apply when considering new medicines. Has an assessment been made of the impact that that more flexible approach is having on access? Have, as a result of the modifiers, any drugs been approved that would not have been approved under the standard methodology?
We seek a much greater contribution from the pharmaceutical industry, which should work with the Scottish Government to encourage patient access schemes and risk-sharing approaches. In our manifesto, we focused on improving early detection rates to increase survival and we set out plans for a new target on urgent referral for cancer diagnosis: every patient should expect to see a specialist within two weeks. We must focus on increasing early detection in order to tackle the unacceptably high number of cancer cases that are detected for the first time only during emergency admission to hospital. The subject is emotive, but it benefits from the calm and impartial consideration that the SMC can bring.
I move amendment S4M-00956.1, to leave out from “through” to end and insert:
“and that patients in Scotland are now three times less likely than patients in England to gain access to a cancer medicine that is not routinely available; notes that the Cabinet Secretary for Health, Wellbeing and Cities Strategy made a statement to the Parliament on 25 March 2009, outlining three steps being taken to improve access to new medicines, during which she said “All the developments that I have announced today will, individually and collectively, improve patients’ access to medicines on the NHS”; recognises that an earlier RCF report, The Scottish Exception? An audit of the progress made in improving access to treatment for people with rarer cancers, published in March 2011, found that increasing numbers of Scots are having to rely on exceptional case applications, that nearly a third of NHS boards have no written policy governing exceptional case applications in place and that NHS boards use variable criteria to assess exceptional case applications; believes that more work is needed to ensure that there is a system in place that is, from end to end, robust, fair and well understood, and calls on the Scottish Government to outline its response to the findings in the RCF reports, work with the Scottish Medicines Consortium and NHS boards to increase transparency around decision making and work constructively with the UK Government to ensure that the new value-based pricing scheme meets the needs of patients in Scotland.”
09:36
References in this contribution
Motions, questions or amendments mentioned by their reference code.
In the same item of business
The Presiding Officer (Tricia Marwick)
NPA
Good morning. The first item of business is a debate on motion S4M-00956, in the name of Murdo Fraser, on cancer drugs and their availability in Scotland. I ...
Murdo Fraser (Mid Scotland and Fife) (Con)
Con
We have all seen newspaper headlines such as “Scots ‘worst’ for cancer survival”, “Lung cancer survival among the lowest in Europe” and Scotland “has the low...
The Deputy First Minister and Cabinet Secretary for Health, Wellbeing and Cities Strategy (Nicola Sturgeon)
SNP
I welcome the debate. As all of us in the chamber will recognise, the issues are complex, emotive, sensitive and often very challenging. Because of that, how...
Murdo Fraser
Con
I entirely understand the cabinet secretary’s point about equity. However, at the heart of that very question is the fact that we are where we are in relatio...
Nicola Sturgeon
SNP
I have already challenged that proposition and am happy to do so in greater detail in discussion with Murdo Fraser.The second key equity issue is the risk of...
Alison McInnes (North East Scotland) (LD)
LD
Back in 2009, in response to the Public Petitions Committee inquiry, the cabinet secretary outlined three steps that her Government would take to improve acc...
Jackie Baillie (Dumbarton) (Lab)
Lab
I, too, thank the Conservatives for bringing the debate on access to cancer drugs to the chamber, because it gives us all an opportunity to consider how well...
Nicola Sturgeon
SNP
This is a point of information rather than a question, but Jackie Baillie will be aware—if she is not, she will be soon—that as part of the improvements that...
Jackie Baillie
Lab
That will be helpful. I hope that we can access the information soon.I encourage the Scottish Government to make further improvements. I pose the question wh...
The Presiding Officer
NPA
We move to the open debate. I remind members that speeches should be of four minutes. Time is really tight.09:40
Dennis Robertson (Aberdeenshire West) (SNP)
SNP
The debate is an emotive one. I thank Breakthrough Breast Cancer, Macmillan Cancer Support and Myeloma UK for their briefing.Murdo Fraser used the word “mora...
Malcolm Chisholm (Edinburgh Northern and Leith) (Lab)
Lab
I very much welcome the debate, which highlights dilemmas that we face now, and which will become far more acute in the near future.On a recent visit to the ...
Alex Johnstone (North East Scotland) (Con)
Con
For a country that is reputedly obsessed with sport, Scotland’s health record is not good and we all know it. For much of the time that the Parliament has ex...
Alex Johnstone
Con
I will not take an intervention because I have only four minutes and need to get one key principle across.Some years ago, I visited a research unit at the Un...
George Adam (Paisley) (SNP)
SNP
I know that my time is limited so I will try to be brief. This debate is on another emotive subject and I take on board the story of Murdo Fraser’s constitue...
Murdo Fraser
Con
If the member had read our fully costed manifesto he would have seen that, among other things, we do not think that it is right to be giving free prescriptio...
George Adam
SNP
I am glad I did not read the manifesto. The people of Paisley have an entirely different idea. They do not want to have to decide to pay either for their mes...
Kevin Stewart (Aberdeen Central) (SNP)
SNP
Everyone has said that the debate is very emotive, and it is. There is probably no one in the chamber or watching the debate who has not been touched by canc...
Alex Johnstone
Con
Would the member concede that, although it is not the job of politicians to decide what drugs should be available, it is certainly the job of politicians to ...
Kevin Stewart
SNP
I listened to yesterday’s debate on mental health in which there seemed to be agreement that it was up to clinicians to decide what to prescribe. For the sit...
Mary Scanlon (Highlands and Islands) (Con)
Con
Will the member give way?
Kevin Stewart
SNP
I have given way once and I have only four minutes.I wish the debate was more about prevention than about setting up a separate drugs fund. We have heard abo...
The Presiding Officer
NPA
The member really needs to wind up.
Kevin Stewart
SNP
Thank you, Presiding Officer.We should think about prevention rather than necessarily having to deal with cures all the time.09:58
Mary Fee (West Scotland) (Lab)
Lab
I welcome the opportunity to speak in such a sensitive but crucial debate. The Scottish Conservatives are right to bring the issue to the chamber today. I su...
Mark McDonald (North East Scotland) (SNP)
SNP
Like many in the chamber and in wider society, I have experience of losing a family member to cancer. It is worth noting that none of us in the chamber is im...
The Deputy Presiding Officer (Elaine Smith)
Lab
Mr McDonald, will you conclude?
Mark McDonald
SNP
I will conclude with one final quotation from the oncology commission journal of The Lancet:“prevention is also essential and this too demands political will...
The Deputy Presiding Officer
Lab
We turn to closing speeches. I call Alison McInnes, who has kindly offered to take less than her allocated time.10:05
Alison McInnes
LD
I listened carefully to the cabinet secretary’s speech this morning and found it illuminating. The situation is not as clear-cut as the Conservatives have su...