Hansard

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 lowest breast cancer survival rate”. The sad truth is that report after report tells us that Scotland lags behind a plethora of developed countries in survival rates for cancer. Norway, Sweden, the US, Canada and France are but a few examples of countries that boast better five-year survival rates than Scotland across a range of cancers.

I accept that, in recent years, there has been an improvement in the figures for survival rates in Scotland, but I wish to highlight that Scots also lag behind a significant proportion of Europe for access to new cancer medicines, even though successive price cuts and exchange rate movements have meant that United Kingdom prices are currently among the lowest in Europe.

It is our job as parliamentarians and as compassionate members of our society to ensure that, when a person is diagnosed with a terrible illness such as cancer, they have the best possible fighting chance of beating it, or—in the most extreme cases—of being able at least to extend for as long as possible the time that they can spend with loved ones.

Sadly, in June this year, one of my constituents, Gillian Bauld from Dunblane, died after being diagnosed with advanced metastatic breast cancer. Her husband had contacted me prior to her death to raise concerns about the difficulty his wife was having accessing lapatinib—a drug that is not approved by the Scottish Medicines Consortium, but which would have presented the best way of controlling the disease’s progression after her chemotherapy came to an end.

The Baulds made two separate exceptional prescribing requests, by two different consultants, and were rejected both times. As the drug was not approved by the SMC and because the exceptional prescribing route had been closed down to them, Gillian’s consultant advised that the only option would be to pay for the treatment themselves, at a cost of £10,000 for a 12-week course. That was unaffordable for that family, as it would be for many families across Scotland. It was a crushing blow at what was already a difficult and distressing time for the family.

The really devastating fact for Gillian was that, had she been living in England, she would have met the specific criteria that are laid down for access to lapatinib through the interim cancer drugs fund. As her husband wrote in The Scotsman:

“The ICDF is intended to help people like my wife. If we lived in England, then she would fully meet the criteria for funding, whereas in Scotland she isn’t considered worthy of further help.”

There are many cases all across Scotland like my constituent Gillian Bauld and I am sure members have dealt with, or are dealing with, similar cases.

According to a report that has been published by the Rarer Cancers Foundation, there are now 23 cancer treatments that are not routinely available in Scotland but which can be funded through the interim cancer drugs fund that has been set up by the Conservative-led coalition in England. The cabinet secretary will dispute the figure of 23 cancer treatment drugs. I have read the correspondence that she sent to my colleague David McLetchie yesterday, and I have seen the vigorous rebuttal from the Rarer Cancers Foundation that was sent to the health services research unit on 8 September.

I am not here to get into a dispute about whether the figure is 23 or some lower figure. I acknowledge that the cabinet secretary believes it is not 23 and may be as low as 12. It seems that that is not really the point; even the cabinet secretary will accept that cancer medicines that are available in England are not available in Scotland. If we cannot agree on the number, the principle is established.

The interim cancer drugs fund totals £600 million over three years, which is in addition to an initial £50 million. It has helped 5,000 patients in England to access the cancer medicines that they need. Such facts convince me that the Rarer Cancers Foundation is right to argue that about 14 treatment requests per million population are being approved in Scotland, in comparison with almost 48 such requests in England. Lapatinib—the drug that my constituent required for her breast cancer—has an approval rating in England that is nine times greater than that in Scotland.

If Scotland set up its own fund and achieved the same approval rate as England has for a host of drugs, the number of cancer patients in Scotland who could gain access to life-enhancing and life-extending treatment would increase by 235 per cent. We need to remember that we are dealing with many people who are reaching the end of their lives. Often, such drugs will not save their lives, but will prolong them and give them better quality of life when they need extra help.

I acknowledge that the fund south of the border is an interim measure, as such a fund in Scotland would be. The fund in England will run until 2014, when the Department of Health intends to replace the current pharmaceutical price regulatory system with a value-based pricing system for drugs which, I hope, the cabinet secretary will support for Scotland. That change will link the price of a drug to cost-effectiveness on the basis of clinical evidence. It is hoped that the new system will lead to more innovation and investment being focused on patient needs. However, until that time, morally we cannot accept a system in which Scottish patients—simply because of where they are domiciled—are being denied access to cancer drugs that are available to other United Kingdom citizens.

When the cabinet secretary gets to her feet, I am sure that she will extol the virtues of the individual patient treatment request arrangements, which form the Scottish Government’s default position when it is challenged on the availability of cancer medicines. However, as my constituent Gillian Bauld found out, even with that system, access to cancer drugs is still being denied, while such vital drugs are available in England.

The report “Nations divided? An assessment of variations in access to cancer treatments for patients in England, Scotland and Wales”, from the Rarer Cancers Foundation, highlights the fact that patients do not access the group of medicines that the SMC has declined through the IPTR route, which is why patients in Scotland are three times less likely to gain access to a cancer drug that is not routinely available than are patients in England. One clinician told me that bevacizumab—I hope that I pronounced it correctly—is a very good example of such a medicine. The drug has no SMC approval and no successful IPTR appeals, despite being the gold standard of treatment of advanced colorectal cancer in the western world and now in England, with the introduction of the cancer drugs fund. Again, a drug is being made available to patients in England and Wales but not to patients in Scotland.

Cancer Research UK welcomed the English drugs fund and said:

“This cancer drugs fund could make a real difference for some cancer patients, allowing them to get the treatments they need.”

I know that other cancer charities take a different view, and it is clear that opinion is divided, but patients in England are undoubtedly benefiting from the fund. That is why cancer sufferers, many clinicians and many experts can see the evidence of the £600 million cancer drugs fund working for cancer patients.

The Rarer Cancers Foundation has estimated that achieving a comparable level of access in Scotland would cost the Scottish Government £5 million. That amount is insignificant in the context of the health budget. In our manifesto for the Scottish election earlier this year, we identified where that money could be found from. It would be money well spent.

I, and we, do not believe that cancer sufferers in Scotland should be treated less well than those elsewhere in the United Kingdom. It is time for the Scottish Government to think again on the issue. I have pleasure in moving the motion in my name.

I move,

That the Parliament notes with concern the findings of the Rarer Cancers Foundation (RCF) report, Nations divided? An assessment of variations in access to cancer treatments for patients in England, Scotland and Wales, which states that there are now 23 cancer medicines not routinely available in Scotland that may be available in England through the Cancer Drugs Fund; recognises 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; further notes the comments of the RCF that the Scottish Government has displayed a concerning degree of complacency over access to cancer treatments, and calls on the Scottish Government to set up a Scottish cancer drugs fund to be reviewed once the current pharmaceutical price regulation scheme expires.

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