Framework outlines for change to NHS treatment

Concern has been rising among patients and doctors for many years that access to new medicines in Scotland lags behind other countries in Europe, in some cases meaning families have to pay themselves or move house.

But now the Scottish Government has outlined what it described as a “step change” in the system for deciding what treatments should be funded by the NHS, including more involvement from patients and doctors.

Campaigners welcomed the changes, pointing out that previous rejections had resulted in patients missing out on extra time with their families.

The Scottish Medicine Consortium (SMC), which makes recommendations on new treatments, was asked by the Scottish Government to launch a review to establish more flexible approaches in evaluating medicines for end of life care and the treatment of rare conditions.

These drugs are those most often rejected because they are deemed not cost effective due to the way costs and benefits are measured.

But under new plans, from May this year patients and doctors will also be given the chance to take part in meetings where the decisions about new drugs are made.

The Scottish Government said this Patient and Clinician Engagement (PACE) meetings would give patient groups and doctors a stronger voice in the decision making process.

In another change, the SMC will widen its assessment of drugs to treat rare conditions - those affecting around 100 people in Scotland - so these decisions are not based on cost and direct health benefits alone.

Instead it will explore the nature of the condition, the impact of the medicine, the impact of the technology beyond direct health benefits and its value for money.

The plans will also see drugs companies being allowed to submit schemes aimed at reducing the costs of medicines - such as offering to fund part of the treatment - at any stage of the assessment process, rather than only at the start as happens currently.

And a new system to replace the current process where patients can appeal for drugs not recommended by SMC - known as the Peer Approved Clinical Systems (PACS) - will also come into force from May.

This is set to see doctors leading decisions, with more consideration of personal circumstances than is currently part of discussions.

Health Secretary Alex Neil said the SMC had calculated that the changes would cost around £70 million in the first year and benefit up to 1,500 patients.

Asked whether the plan meant that the previous system was unfair to patients, Mr Neil said: “This is an evolving situation.

“The rate at which new drugs are coming on the market and the degree of sophistication is increasing all the time.

“We have got to adapt to changing circumstances.

“The SMC has a fantastic international reputation and many other countries try to emulate the processes of the SMC.

“The SMC themselves have recognised there is a need for reform and further improvement in the process.”

Mr Neil said if he had any criticism of the current system it was that it did not involve patients and clinicians enough at the decision-making stage.

He said funding for the system would come from the £20 million Rare Medicines Drugs Fund, which has been extended to 2016, as well as from future savings due to the greater use of generic drugs, which are cheaper than those still under licence.

And he said increased access to medicines could also save money by reducing hospital admissions.

The plans follow a Scottish Parliament health committee investigation last year into access to new drugs which called for change.

James Jopling, director for Scotland at charity Breakthrough Breast Cancer, welcomed patients being given more of a say in the decision-making process on new drugs.

“By giving more weight to the value and benefit offered to patients by new medicines, we believe more drugs will be made available to those in their time of need,” he said.

“Last year, two very clinically effective medicines for secondary breast cancer were rejected for use on the grounds of cost, despite being highly valued by patients.

“These medicines would have given women precious additional quality time with their families and loved ones.

“We hope that the new system will allow drugs like these to be approved, giving hope to secondary breast cancer patients in Scotland.”

Professor Angela Timoney, SMC chair, said: “These changes will mean that patients in need of end of life care or who have very rare conditions will be able to access more new medicines.”