Meeting of the Parliament 04 December 2018
It has been more than a year since we last debated access to T3 for people who suffer from thyroid conditions. That begs the question: what has changed? I fear that all the changes that have been described are not matched by reality. I welcome the opportunity that has been given to members by the Public Petitions Committee bringing the subject to Parliament for debate once again, because the problem has not yet been fixed.
As Elaine Smith said, the problem is an issue of women’s health equality. Some 3 million people in the UK suffer from a thyroid problem: 95 per cent of them are women. Hypothyroidism is a crippling illness. Many people are being failed by poor diagnosis and poor treatment, and some are left with no diagnosis and no treatment at all.
On average, patients in the UK wait three times longer for treatment than patients in the United States, and because the condition progresses slowly, it can be many months, if not years, before treatment begins. T4 is the standard treatment for patients, although some patients get no benefit from T4 at all, but thrive on T3. There is no clinical reason for not prescribing T3: it is simply a matter of cost.
I have no doubt that the drug company that is responsible for the manufacture of T3—Concordia International—is engaged in excessive profiteering. The Competition and Markets Authority found that Concordia had abused its dominant position by increasing the charge to the NHS by 6,000 per cent in the last decade. Concordia should be ashamed.
When we last debated the subject, the cost of 100 T3 tablets in the UK could be as much as £900. In Turkey, they cost the equivalent of £1.25 and in Greece, they cost the equivalent of £3.24. That is a shocking difference. I know that the pricing of medicines is reserved, but it has been more than two years since the Competition and Markets Authority expressed that view. We still do not have a final decision and little has changed on the ground.
As we have heard from numerous members, there are very real and serious physical and mental health challenges for women who cannot access T3. However, despite that knowledge, as well as guidance from the Scottish Government, health boards are withdrawing T3 because of the cost. There is little regard for the consequences for individuals: that is simply not good enough. I want to know, in practical terms, what the Scottish Government will do now.
When we last debated the issue, I spoke about a constituent who was on a combination of T4 and T3. She is watching the debate from the gallery. She has a genetic condition that makes T4 largely ineffective. Her consultant knew that, but tried to increase the dose of T4, although there was no clinical reason for doing so. Her condition worsened and she had to give up her job as a university lecturer. After a long fight, she is now on T3, but her consultant is trying to reduce the dosage. Again, the decision is based on cost, rather than on clinical need.
The cabinet secretary is aware of all that, because I wrote to her about it, just as I wrote to her predecessor. In a rather formulaic response, she said that it is a matter for health boards. That is an abdication of responsibility. How can it be right that people in the NHS Grampian area cannot get T3, but people in the NHS Greater Glasgow and Clyde area can? Where is the fairness and equity in that? I am sure that the minister is not suggesting that women should move to another health board area, or perhaps book a flight to Turkey or Greece. Although it would be ludicrous, it would undoubtedly be cheaper to prescribe T3 with a dose of sunshine.
The minister set out some actions that are being taken, but what he set out is not matched by experience on the ground. The Scottish Government cannot stand by and watch health boards do their own thing. Will the minister write to health boards this week to tell them to allow T3 to be prescribed? Will he monitor what happens afterwards? It is not enough to issue guidance and hope that the health boards follow it. The minister needs to be robust.
The NHS was founded on the principles of meeting everyone’s needs, being free at the point of delivery, and being based on clinical need and not the ability to pay. It is time for the Scottish Government to deliver on those principles and to stop presiding over the postcode lottery in care, which has such dreadful consequences for the women who are affected.
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