Hansard

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.”

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