Chamber
Meeting of the Parliament 29 September 2011
29 Sep 2011 · S4 · Meeting of the Parliament
Item of business
Cancer Drugs
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 labs at the Edinburgh cancer research centre, I heard David Cameron—the very highly regarded David Cameron, who is the new professor of oncology at the University of Edinburgh—describing how new cancer treatments are targeting specific subtypes of cancer, which means that the already expensive cancer drugs are likely to become far more expensive in the future because they will be used on smaller subgroups of patients rather than on everyone who has a particular type of tumour. He highlighted what difficult choices we would have to make as the drugs budget increases exponentially in the next decade.
My second general point is one that the cabinet secretary made: drugs are not the only weapon against cancer. In a recent talk, Professor Alan Rodger, who was director of the Beatson oncology centre until quite recently, gave figures on the contribution that different treatments make to curing of cancer. For surgery, the figure was 68 per cent; for radiotherapy, it was 28 per cent; and for chemotherapy, it was 4 per cent. That is not to downgrade or to devalue in any way the role of chemotherapy, but we need to see cancer treatment in that broader context.
We can justifiably be proud of the Scottish Medicines Consortium, which is the foundation of our system for cancer drugs. I remind members that the director of Cancer Research UK said at the Public Petitions Committee on 29 April 2008 that
“the SMC is the envy of clinicians who work in England”,
and that it is
“a model of good practice”.—[Official Report, Public Petitions Committee, 29 April 2008; c 709.]
We can justifiably be proud of it—without being complacent.
Some years ago, guidance on the Scottish Medicines Consortium was issued that, I think, said that NHS boards should ensure that recommended medicines are made available to meet clinical need. I am concerned that there still seem to be issues with NHS boards’ implementation of SMC decisions. The briefings from Cancer Research UK and from Breakthrough Breast Cancer, Macmillan Cancer Support and Myeloma UK highlight the need for more transparency not only on decisions but on boards’ implementation of them. I am sure that everybody would like that to happen.
The briefing by Breakthrough and others also makes the key point that they want recent initiatives to have the chance to bed in. The cabinet secretary should be commended on the announcements that she made in 2009 on exceptional prescribing becoming more transparent. She talked about
“greater transparency in the flexibility that can be used by the SMC”
and
“a national framework for assessing ... patient access schemes”.—[Official Report, 25 March 2009; c 16129-30.]
That was all good but, in the interest of transparency, it would also be good if the developments on those policies could be explained to MSPs and the wider public—the cabinet secretary will probably not have enough time in her closing speech to address that point. For example, I am told that guidance on exceptional prescribing was issued in March 2011, but most people probably do not know the contents of that guidance or how it is operating. If there was more confidence in exceptional prescribing, there might be less demand for the drugs fund.
In many ways, I sympathise with what Murdo Fraser said and can see exactly where he is coming from. However, as Cancer Research UK reminds us, we should remember that a cancer drugs fund could exacerbate regional inequalities and may be doing that in England. Therefore, guidance on exceptional prescribing may be a more equitable way to deal with the problem.
09:47
On a recent visit to the labs at the Edinburgh cancer research centre, I heard David Cameron—the very highly regarded David Cameron, who is the new professor of oncology at the University of Edinburgh—describing how new cancer treatments are targeting specific subtypes of cancer, which means that the already expensive cancer drugs are likely to become far more expensive in the future because they will be used on smaller subgroups of patients rather than on everyone who has a particular type of tumour. He highlighted what difficult choices we would have to make as the drugs budget increases exponentially in the next decade.
My second general point is one that the cabinet secretary made: drugs are not the only weapon against cancer. In a recent talk, Professor Alan Rodger, who was director of the Beatson oncology centre until quite recently, gave figures on the contribution that different treatments make to curing of cancer. For surgery, the figure was 68 per cent; for radiotherapy, it was 28 per cent; and for chemotherapy, it was 4 per cent. That is not to downgrade or to devalue in any way the role of chemotherapy, but we need to see cancer treatment in that broader context.
We can justifiably be proud of the Scottish Medicines Consortium, which is the foundation of our system for cancer drugs. I remind members that the director of Cancer Research UK said at the Public Petitions Committee on 29 April 2008 that
“the SMC is the envy of clinicians who work in England”,
and that it is
“a model of good practice”.—[Official Report, Public Petitions Committee, 29 April 2008; c 709.]
We can justifiably be proud of it—without being complacent.
Some years ago, guidance on the Scottish Medicines Consortium was issued that, I think, said that NHS boards should ensure that recommended medicines are made available to meet clinical need. I am concerned that there still seem to be issues with NHS boards’ implementation of SMC decisions. The briefings from Cancer Research UK and from Breakthrough Breast Cancer, Macmillan Cancer Support and Myeloma UK highlight the need for more transparency not only on decisions but on boards’ implementation of them. I am sure that everybody would like that to happen.
The briefing by Breakthrough and others also makes the key point that they want recent initiatives to have the chance to bed in. The cabinet secretary should be commended on the announcements that she made in 2009 on exceptional prescribing becoming more transparent. She talked about
“greater transparency in the flexibility that can be used by the SMC”
and
“a national framework for assessing ... patient access schemes”.—[Official Report, 25 March 2009; c 16129-30.]
That was all good but, in the interest of transparency, it would also be good if the developments on those policies could be explained to MSPs and the wider public—the cabinet secretary will probably not have enough time in her closing speech to address that point. For example, I am told that guidance on exceptional prescribing was issued in March 2011, but most people probably do not know the contents of that guidance or how it is operating. If there was more confidence in exceptional prescribing, there might be less demand for the drugs fund.
In many ways, I sympathise with what Murdo Fraser said and can see exactly where he is coming from. However, as Cancer Research UK reminds us, we should remember that a cancer drugs fund could exacerbate regional inequalities and may be doing that in England. Therefore, guidance on exceptional prescribing may be a more equitable way to deal with the problem.
09:47
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...