Postcode lottery revealed as cost and bureaucracy block use of approved, life-saving treatments
SCOTS suffering from life-threatening diseases are being denied many of the latest and most effective drugs because of foot-dragging by health chiefs and doctors.
Scotland on Sunday can reveal that 25 new treatments were recommended for use in 200
7 for conditions including cancer, HIV, heroin addiction, osteoporosis and anaemia, but in most areas around a quarter are either tied up in local bureaucracy or have been rejected.
Our investigation has proved that a health postcode lottery still operates north of the border, with one health board, Lothian, yet to formally approve 19 of the new treatments recommended, and another, Ayrshire and Arran, holding back 10 from its list of recommended drugs. Meanwhile Tayside is dishing out all but two of the new drugs.
Many of the new drugs are potential life-savers, such as Xeloda for advanced gastric cancer, which costs £320 a year per patient. Despite the decision to recommend the drug for use in Scotland from August last year, it is still not being prescribed in Lothian, Glasgow or Ayrshire. It is more expensive than existing treatments but is available in tablets, which makes it easier for patients to take.
The drugs were recommended for NHS use by the Scottish Medicines Consortium (SMC), which evaluates new treatments based on how well they work and whether they are cost effective. Its findings are handed out to health boards and doctors are expected to use the new treatments.
SMC insiders are angry that many new drugs are failing to get through to patients. One source said there should rarely be a delay of more than three months between recommendation and local use.
Scotland on Sunday used Freedom of Information legislation to obtain details from Scotland's 11 mainland health boards on which of the new drugs are being made available.
After Lothian and Ayrshire and Arran, NHS Lanarkshire and Forth Valley are the worst, holding back seven drugs each. In Borders, Grampian and Highland, six drugs are not being used. In Glasgow five of the new drugs are not prescribed. In Fife, four are not used and in Tayside two are not handed out. Dumfries and Galloway health board would not say which of the new drugs its doctors were prescribing.
The reasons are given for not providing the drugs to patients include:
• Doctors have not asked for them.
• Local "approval" committees are still discussing whether they should be provided, leading to delays of up to 12 months. It is technically possible for doctors to request these drugs in individual cases but it is unclear whether in practice this is happening.
• Health boards have ruled that existing treatments are suitable and have not used the latest drug options.
• In some smaller health boards, such as NHS Borders, some of the drugs are not required because it does not treat patients with the relevant conditions, sending them to larger hospitals.
But critics insist health boards should not use any excuses when it comes to providing the latest treatments.
A source at the SMC said: "We would expect any new drugs we approve to be added to local health boards' lists within two or three months of our recommendation. In situations where the options for a patient are not great and the treatment offers good value for money we would not expect drugs to be delayed. This certainly raises questions."
A spokesman for Macmillan Cancer Support said: "It is vital that once a drug has been approved it is available equally to all eligible patients, regardless of where they live."
Dr Jean Turner, executive director of the Scotland Patients' Association, said: "If the SMC recommends a drug as cost effective there should be no delays in using it. We are against postcode prescribing."
One drug not being requested in many NHS boards is Suboxone, an alternative to methadone treatment for heroin addicts. While some health boards have agreed to prescribe it, others have yet to make up their minds.
Another drug rejected in favour of more established treatments by most doctors is Dynepo, which treats anaemia in patients on kidney dialysis, despite the fact it is estimated to offer a cost saving compared with existing treatments of £52,000 a year.
The Scottish Medicines Consortium was set up in 2002 to put an end to Scotland's postcode health lottery. Some patient groups, such as those with Alzheimer's disease and cancer, have been particularly hard hit because of the cost of state-of-the-art treatments.
The plight of one cancer patient, 71-year-old William Jack, sums up the situation in Scotland. He believes he owes his life to a new drug, Sutent, which has treated his kidney cancer. However, he is only able to take it because he is part of a clinical trial, as the £2,500-a-month drug was not judged cost effective in Scotland, despite being approved in parts of England.
Jack said: "I was fortunate that my consultant had access to the drug trial and have been taking it since April 2006. It has meant I am able to live life normally. I am definitely very lucky."
Last night the Cabinet Secretary for Health and Wellbeing Nicola Sturgeon said: "The Scottish Medicines Consortium process is robust and evidence based and widely respected. If the Scottish Medicines Consortium recommends that a drug should be made available, we expect NHS boards to do this according to clinical need within a reasonable timescale.
"Drugs that are not recommended by the SMC may still be made available where there are exceptional circumstances relating to an individual patient. Each NHS Board has an exceptional prescribing panel to facilitate this."
Michele Caldwell, director of pharmaceutical services at NHS Ayrshire and Arran, said: "All medicines currently with our Medicines Resource Group have been available for prescription in NHS Ayrshire and Arran according to clinical need since their approval by the Scottish Medicines Consortium."
