Hansard

I will deal with some of those points later in my speech.

Thousands of medicines in various doses and formulations are available to clinicians in the UK. In Scotland, around 15,000 medicines can be prescribed by our doctors for various conditions. The Scottish Medicines Consortium appraises around 60 new medicines each year and publishes advice for NHS boards on their clinical effectiveness and their cost effectiveness. A significant number of those medicines are described as “me too” medicines, which means that they are one of many that are available to treat a particular condition.

The SMC was given the important task of providing national advice for NHS boards in Scotland on which medicines offer the clinical outcomes that clinicians require and represent value for money. In providing such advice, the SMC recognises that when a new medicine is one of many that are available to treat a particular condition, local clinicians are best placed to decide whether that newly launched medicine should be added to the formulary list of medicines that are available for routine prescription for the patient population, or whether there is a preference for prescribing those medicines that they have experience of using, and for which the safety profile is known and trusted.

When an NHS board chooses not to add a new SMC-accepted medicine to its formulary, clinicians may still seek NHS board agreement to prescribe it for individual patients through an extremely straightforward non-formulary request. When the SMC does not recommend a new medicine, NHS boards are not expected to routinely prescribe it, but NHS clinicians can pursue access to such medicines on a case-by-case basis for individual patients when they believe that they can provide a robust clinical case to support it. Those are local clinical decisions, which are based on the clinical circumstances of each patient.

I have listened to concerns that some clinicians and patient groups have raised about differences between the availability of medicines—cancer medicines in particular since the Department of Health launched the cancer drugs fund in England—in Scotland and their availability in England. Although I can fully understand those concerns, it is important to note that comparisons between the medicines that are available in England and those that are available in Scotland are not always valid. Indeed, there are some medicines that have been approved for use in Scotland that have not been approved in England.

Lists of medicines do not tell the whole story about available treatment for cancer or improvements in cancer care. Some improvements are the result of earlier diagnosis or developments in technologies other than medicines. The National Institute for Health and Clinical Excellence, which is the equivalent down south of the SMC, looks at a limited list of new medicines, but the SMC looks at all new medicines. That means that there are SMC-approved medicines available in Scotland that are not available in England. For example, imatinib, which is used for the treatment of certain gastrointestinal tumours, has been accepted for restricted use by the SMC in Scotland but has not been recommended by NICE. Another example is mercaptopurine, which is used for the treatment of certain leukaemias. Although it has been accepted by the SMC, there is no NICE advice for it. That can lead to significant variation in the use of the medicine in the NHS in England, never mind between Scotland and England. The appraisal of new medicines is dynamic, with new and updated advice published every month north and south of the border.

Scotland’s decision not to introduce a cancer drugs fund reflects our policy position that ring fencing funding for a single disease area effectively diverts resources away from other conditions, including those that are severe or life limiting. For the record, I point out that the fact that it was proposed by a Tory Government had nothing to do with our policy decision in Scotland.

In providing advice to the Public Petitions Committee in the Scottish Parliament just over a year ago—and well after the introduction of the cancer drugs fund in England—key cancer charities including Breakthrough Breast Cancer, Macmillan Cancer Support Scotland and Myeloma UK recognised that a cancer drugs fund was not a necessary policy measure in Scotland. The view is also shared by the Welsh Government.

That said, I remain committed to considering any way in which we can genuinely improve access to clinically and cost effective medicines that might improve outcomes for patients in Scotland. That is why I have asked Professors Routledge and Scott to oversee a review of how new medicines are introduced in the NHS in Scotland from national appraisal by the SMC through to local NHS board decision making, including IPTRs. I recognise the concerns that have been expressed about how the IPTR process is working and the review—and, no doubt, the review by the Health and Sport Committee—will want to address them.

Finally, the substantial amount of money that is needed to create a separate cancer drugs fund will have to come from elsewhere in the health budget, and those making this proposal must tell us where that money will come from and how much they want to put into the fund so that we know what the policy choices are. It is a difficult decision that politicians are going to have to face up to, but I hope that across the chamber we can at least recognise that, although we might express different points of view on this subject, we should do so in a tone that is appropriate for the patients who are looking on.

I move amendment S4M-05654.2, to leave out from “potentially” to end and insert:

“for all aspects of access to new medicines are subject to an ongoing review; welcomes the introduction of the £21 million Rare Conditions Medicines Fund as an interim measure in response to advice by Professor Charles Swainson, who is undertaking the review of individual patient treatment request processes; accepts that routine approval of individual drugs is rightly a matter for the SMC and that, should the review highlight areas where these processes can be improved, these should be enacted quickly, and believes that the actual benefit to the patient and their quality of life must be the key consideration in determining the use of any new treatment or medicine and that the voices of patients and clinical experts must be heard in the assessment process.”

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