Hansard

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, however, there is an obligation on us all to debate the issues rationally, responsibly and accurately at all times.

First of all, comparisons between Scotland and England are not always valid; indeed, they are often extremely misleading. The simple fact is that lists of medicines do not tell the whole story of improvements in cancer care. One cannot simply say that, at any one time, a single fixed list of cancer medicines is being provided in England but not in Scotland.

I have studied the Rarer Cancers Foundation report; it is helpful in many respects. Furthermore, I respect the organisation’s work. Nevertheless, the report contains errors, and some of the claims that have been made and the basis on which the conclusions have been reached are open to serious challenge. For example, some of the medicines that have been listed as being not available in Scotland are, in fact, available. There has been double counting, and some of the “not recommended” decisions were made because the pharmaceutical company in question had not made a submission to the SMC. I will discuss those issues with the Rarer Cancers Foundation in due course.

There are, and will continue to be, differences between Scotland and England. There are drugs available in Scotland that are not available in England. The position changes rapidly because of the number of new medicines that become available. We should also remember that although the National Institute for Health and Clinical Excellence in England reviews only a selection of new drugs, the Scottish Medicines Consortium quickly reviews all new drugs that get a licence.

Of course, making such comparisons suggests that there is a uniform position across England. That is not the case. From what we can see from published policies on the interim cancer drugs fund, it appears that English regions are adopting different approaches to its application.

The key point is that the Scottish Government has been anything but complacent on the issue. We have worked collaboratively to put in place continuously improving and robust arrangements for assessment and introduction of new medicines. Indeed, that was demonstrated in the substantial amount of work that was carried out with the Public Petitions Committee. It is instructive that, in closing the petition in question, the committee highlighted improvements that have been made in the national health service in Scotland.

I say again—and will continue to say—what I have said previously: I am and always will be open-minded about what more can be done and I will always consider any ways in which we can further improve access to clinically evidenced and cost-effective medicines that improve patients’ outcomes. We are keeping the existing arrangements under review and will make changes where necessary.

We are also looking to the future. The position continues to evolve with, for example, the UK Government’s plans to introduce value-based pricing. I have written to the Secretary of State for Health and we are working with the Department of Health in England to ensure that our interests are fully recognised and that we can consider the wider implications for Scotland.

Our fundamental efforts remain focused on three principles: first, our having robust and independent national and local arrangements for timely assessment of new medicines to ensure that they are clinically evidenced and cost effective; secondly, our having consistent arrangements for consideration of individual cases where a particular medicine has not been recommended by the Scottish Medicines Consortium—I note that a vast majority of individual treatment requests are granted; and thirdly, there must be a clear focus on equity.

Although I absolutely understand the prominence that is given to cancer drugs and although I can, at first glance, see the attraction of a cancer drugs fund, my concern about equity leads me to agree with Breakthrough Breast Cancer, Macmillan Cancer Support and Myeloma UK. In a briefing for this debate—a briefing, I should point out, that recognises and welcomes the extent of the improvements that have been made and acknowledges the need for them to bed in—those respected cancer charities have said that, in their opinion, a cancer drugs fund is not a necessary policy for Scotland.

I have two key concerns about equity. First, I am concerned about the risk of a cancer drugs fund creating inequity between those who suffer from cancer and those who suffer from other serious conditions, such as Alzheimer’s and heart disease. We should continue to improve access to drugs; however, in my view, that should mean access to all drugs—not just to cancer drugs.