In hard-hitting submissions to Holyrood’s health committee, which meets this week, doctors from across the country describe the situation as a “tragedy” that will not only affect their patients but also runs the risk of ending Scotland’s global reputation as a centre of excellence for treating cancer.
Charities say there is also evidence of an emerging “post-code lottery” in which patients in some health board areas get drugs denied to patients in other areas.
Oncologists from the country’s top clinical centres, including the Beatson in Glasgow, are now calling for an overhaul of the way cancer drugs are made available on the NHS.
In England, a £600 million cancer drugs fund (CDF) means patients south of the border are getting access to new treatments not routinely available on the NHS.
Although the Scottish Government set up an Individual Patient Treatment Requests (ITPR) system with the same intention, clinicians have dismissed it as “burdensome and bureaucratic”, with strict criteria. Many doctors do not even bother to apply.
On Tuesday, MSPs at Holyrood will open an inquiry into access to newly-licensed medicines at a time when, according to figures released by the General Register Office last week, deaths from cancer in Scotland have reached their highest level for more than 30 years.
The doctors’ anger focuses on a range of new cancer treatments which they claim are being denied to Scottish patients. Lack of NHS availability of drugs such as Vemurafenib and Ipilimumab, which have “transformed” the treatment of skin cancer, and bowel cancer treatments such as Cetuximab, is crippling the morale of patients and doctors alike.
Describing the situation as a “tragedy”, Dr Colin Morton, chair of the Scottish Dermatological Society Skin Cancer group and skin cancer lead at NHS Forth Valley, says in a submission co-signed by eight colleagues: “We now, for the first time, have significant life-giving treatments for melanoma patients, yet have no access to this in Scotland.”
Another submission by Professor David Cameron, the director of cancer services at NHS Lothian, Professor Jeff Evans, the director of the Institute of Cancer Sciences at Glasgow University and Dr Marianne Nicolson, an oncologist with the North of Scotland Cancer Network, says: “The refusal to approve these medicines undermines 30 years of worldwide research efforts and is totally demoralising for both researchers and patients alike.”
Oncologists Stephen Harrow and Alexander McDonald, consultants at the Beatson cancer centre in Glasgow, warn in their submission, signed by 15 other cancer specialists around Scotland, that Scottish patients are missing out. “Our lack of a funding stream, such as the CDF, means that for the vast majority of Scottish NHS patients, access to such treatments is precluded.
“This is a source of great concern and anguish for our patients, their families as well as ourselves as their treating clinicians.”
They say the ITPR system is used only in rare cases as qualifying criteria are so restricted. They are “not submitted for the majority of patients” who might benefit when consultants know there will be “a negative outcome and no sensible option of appeal”.
Harrow and McDonald also warn of a brain drain of top medical practitioners.
“We have reason to pride ourselves on the standard of cancer medicine training in this country which has produced many of the UK’s most prominent cancer clinicians and engendered a culture of cancer research excellence.”
Clinicians are now prevented from accessing treatments viewed as “standard therapies” around the world, they add, which may “ultimately result in an efflux of talented physicians from Scotland and reluctance of trainees to seek experience in Scotland”.