Why are SNP stalling on simple, cost-effective and life-saving tests for pre-eclampsia? To prove their 'independence'? – Susan Dalgety

Imagine a disease so deadly that, across the world, it kills one young woman every six minutes. A disease that strikes in the prime of life during pregnancy, and if left untreated can cause seizures which can leave a woman brain damaged. A disease that kills 1,000 babies a year in the UK.

A simple test for pre-eclampsia that is available in England is not currently being used in Scotland (Picture: Christopher Furlong/Getty Images)

Imagine then that scientists had developed simple and cost-effective tests to diagnose this condition so that treatment can begin early, dramatically increasing survival rates.

Imagine a rich country with one of the best health services in the world and easy access to these tests, refusing to use them. Impossible, you say. Why would any health minister or chief medical officer rule out a simple diagnostic test that would save lives and ensure safe, happy pregnancies?

Why indeed? I am afraid I don’t have the answer to that question. That is for the Cabinet Secretary for Health, Humza Yousaf, and the Chief Medical Officer, Gregor Smith, to answer.

Or perhaps Maree Todd, the minister with “women’s health” in her job title, could throw some light on the Scottish Government’s stubborn refusal to follow England’s lead and use the tests?

NICE, the independent diagnostic advisory committee, has just recommended that midwives in England can routinely use one of four tests available to diagnose pre-eclampsia, which usually occurs between 20 and 36 weeks of pregnancy.

This move will, according to NICE, lead to “better care for the mother and her unborn baby”. The only cure for pre-eclampsia is delivery of the baby, so women with the condition have to be carefully monitored to avoid serious complications. Previously the tests, which have been available in England since 2016, had been used to help rule out pre-eclampsia, but new evidence shows that they can help diagnose it too.

Jeanette Kusel, acting director for medtech and digital at NICE, said the development was “a step change in the management and treatment of pre‑eclampsia”, adding that “expectant mothers can now have increased confidence in their treatment plans and preparing for a safe birth”. But not if they live in Scotland.

It’s not as if the Scottish Government is unaware of the issue. Ministers and senior NHS staff have been comprehensively briefed on the efficacy of the tests. And as Covid began to strike in March 2020, the issue was debated in Holyrood after Conservative MSP Miles Briggs tabled a member’s motion calling on the Scottish Government to address the disparity with England. A disparity that has only widened with NICE’s recent decision to recommend widespread use of the tests.

The chamber sat in silence as they listened to SNP member, Kenneth Gibson, tell of the loss of his baby son from pre-eclampsia. “My wife Patricia and I endured our own personal nightmare with NHS Greater Glasgow and Clyde when the entirely preventable loss of our son at full term occurred due to a failure to diagnose pre-eclampsia in Patricia, who was 41 years old at the time, pregnant with her first baby and therefore known to be at increased risk. Patricia nearly lost her life, too, and spent 19 days in intensive care and high dependency after her liver ruptured.”

As well as the human cost of the disease, Mr Gibson revealed that using the tests could save the NHS in Scotland thousands of pounds per patient, pointing out that NICE’s economic evaluation suggests a potential cost reduction of between £2,488 and £2,896 per patient, compared to standard clinical assessment.

But still no movement from the Scottish Government, not even when Maree Todd published her ‘Women’s Health Plan’ last August. Pre-eclampsia is mentioned twice in the document, but only to highlight that it is linked to a greater risk of heart disease later in life. No mention of better diagnosis or treatment during pregnancy.

I am not the only person confused by the government’s reluctance to use the tests. Professor James Walker, who pioneered treatment for pre-eclampsia at the Glasgow Royal Maternity Hospital, was at a loss to explain why they are not available to Scots women when he spoke to a newspaper earlier this week.

“Scotland has always been resistant to offering mothers what is a vital part of antenatal care. I do not know why, because it saves lives and is cost effective. It is simply good logic,” he said.

Women who have suffered the disease are equally perplexed. One woman, Jo, pointed out on Twitter that having spent the last four weeks of her first pregnancy in hospital before a forced early delivery, she too would like to know why the test isn’t being offered in Scotland. “I don’t understand why things haven’t moved forward,” she said.

Writer Eileen Reid, whose daughter suffered from pre-eclampsia, was blunt in her response. “Why on Earth wouldn’t Scotland adopt the simple blood test to detect it? Bewildering.”

Bewildering indeed. The Scottish Government response sheds little light on the matter. As well as stressing that the Women’s Health Plan was the first in the UK – as if a 48-page document is more important than actual treatment – a spokesman says the government will continue to “work with Perinatal Network to examine testing for pre-eclampsia”.

No doubt this group, which according to its website is the “umbrella for the National Maternity Network and the National Neonatal Network” and includes “senior managers, clinicians, nurses, scientists and patient representatives,” does some amazing work.

But NICE has done all the work required to validate the pre-eclampsia tests. There is no clinical reason why they cannot be used now in Scotland, just as they are in England – which suggests there is politics at play.

But surely Scottish ministers would not risk the lives of women and their unborn children to prove their independence?

A message from the Editor:

Thank you for reading this article. We're more reliant on your support than ever as the shift in consumer habits brought about by coronavirus impacts our advertisers.

If you haven't already, please consider supporting our trusted, fact-checked journalism by taking out a digital subscription.