Burning Issue

Published on Sunday 22 February 2009 22:24

Are decisions to fund new cancer treatments in Scotland made fairly?

Yes

DR DAVID DUNLOP

Clinical director of the Beatson West of Scotland Cancer Centre in Glasgow

WE SHOULD be glad that we're getting these new treatments for cancer. The progress that has been made in the last ten to 15 years with medical cancer treatments, surgical cancer treatments and radiotherapy has been phenomenal.

However, access to these new treatments needs to be sensitively managed, very mindful of the needs of individual patients, but also a fiscal responsibility because there isn't a bottomless pit of money in the health service in Scotland, or in England and Wales. So there has to be an infrastructure in place to manage the introduction of these new drugs into clinical practice quickly, and with proper assessment of how much value they will give to cancer patients, and that is where the Scottish Medicines Consortium (SMC) comes in.

If a drug has not been assessed and approved for use by the SMC, then that drug will not be in the cupboard for a doctor to prescribe, unless there are exceptional circumstances.

There is a very robust and transparent process in place in our health board, and in most other health boards, to facilitate this process.

A doctor, in partnership with an individual patient, can apply for a drug to be used in exceptional circumstances. These would depend on an individual patient.

We are very sensitive to the needs of patients and realise that for individual patients a small gain in life can be extremely important for that patient, and that has to be balanced against that drug's likelihood of helping them.

Somebody has to have that difficult job of standing back and objectively assessing that value. We do not discriminate against anyone.

No

TINA MCGEEVER

Campaigner whose husband died after a battle to get a cancer drug on the NHS

IDO not believe that decisions on funding drugs are made fairly. There does not seem to be any real criteria about what they will and will not fund. I get the impression that they are changing the goalposts every time and changing their minds about what they will or will not pay for.

A lot of patients are actually having to pay to prove that a treatment works. In the case of Cetuximab (a drug to treat bowel cancer), it is widely used across Europe. Yet it cannot be approved in this country. Why do we split up different countries in making these decisions and why can't they all work together?

These decisions are based on cost. The experts will say decisions to approve drugs are based on QALYs (quality adjusted life years), but part of that is about cost and that is a major problem.

The cost-effectiveness of new drugs is not based on the right of someone to live – it's based on money, as far as I can see.

I don't think that is very equitable.

The processes for exceptional funding, where a patient applies for a treatment not approved for use on the NHS, are also unfair.

There are people now not getting access to drugs who are dying due to this system because decisions are not being made.

At the moment, the exceptional circumstance criteria in each health board are different. They all make up their own idea of how they will deal with exceptional circumstances.

The boards are not making it clear to patients what they need to do. There need to be clear guidelines that are followed across the whole of Scotland to make sure patients are given fair access to treatments.