Chamber and committees

Information on the number of successful and unsuccessful Individual Patient Treatment Requests made to NHS boards since 1999 is not held centrally.

NHS boards and clinicians are expected to take full account of advice from the Scottish Medicines Consortium and Healthcare Improvement Scotland in the planning and provision of NHS services. Where this advice clarifies that a new medicine is not accepted for routine use within NHSScotland, NHS boards are not expected to make it routinely available. However NHS boards have arrangements in place for the clinical consideration of “not recommended” medicines for individual patients in certain circumstances (Individual Patient Treatment requests).

The information available from the ISD Scotland Hospital Medicines Utilisation Database (HMUD) on expenditure on cancer medicines in the financial year 2010-11 is shown in the following table. Cancer medicines have been defined as Section 8.1 – cytotoxic drugs and Section 8.3 – sex hormones and hormone antagonists in malignant disease, of the British National Formulary (BNF).

Amount that the Hospital Medicines Utilisation Database recorded as being spent on cancer medicines for each NHS board in financial year 2010-11

Notes:

Figures cover April 2010 – March 2011, except for some boards with incomplete data:

1. NHS Dumfries and Galloway, data covers April 2010- February 2011

2. NHS Highland did not provide any data. Small amount shown based on reported information from other NHS boards

3. NHS Shetland, data covers April 2010 – December 2010

4. NHS Tayside, data covers April 2010 – July 2010.

The latest costs available relate to 2010-11 and are as follows:

(a) £27,599,833

(b) £59,647,022

(c) £8,583,106

More information on prescribing costs is available on the ISD Scotland website at:

http://www.isdscotland.org/Health-Topics/Prescribing-and-Medicines/Community-Dispensing/Prescription-Cost-Analysis/.

Data on the use of individual medicines by NHS boards is not held centrally. NHS boards are expected to maintain an overview of the effectiveness of their local arrangements for the introduction of new medicines, including NHS board decisions on SMC accepted medicines and management of Individual Patient Treatment Requests (IPTRs) for medicines not recommended by the SMC. NHS boards were reminded of their responsibilities in this regard in additional guidance for NHS boards published on 13 February 2012.

The Scottish Government committed to monitor NHS board progress in implementing the guidance on the introduction and availability of newly licensed medicines in the NHS in Scotland which was published on 17 May 2010. As part of these arrangements, NHS boards were asked to provide summary data on medicines funded through the Individual Patient Treatment Request (IPTRs) arrangements over the period 1 April 2011 to 30 September 2011. The data provided by NHS boards indicates that bevacizumab was prescribed for one patient and cetuximab was prescribed for five patients during this period.

I refer the member to the answer to question S4W-06539 on 23 April 2012. All answers to written Parliamentary Questions are available on the Parliament’s website, the search facility for which can be found at:

http://www.scottish.parliament.uk/parliamentarybusiness/28877.aspx.

Training in community sexual and reproductive health is a specialty training programme designed to produce consultants who would be specialists in community sexual and reproductive health. The training places would therefore be for junior doctors in training rather than consultants.

Training in community sexual and reproductive health is a relatively recent development. The medical speciality of community sexual and reproductive health was formally established in 2009, under the auspices of the faculty of sexual and reproductive healthcare of the Royal College of Obstetricians and Gynaecologists.

Prior to the development of the speciality of community sexual and reproductive health, training was available to doctors training in obstetrics and gynaecology who wished to sub specialise in sexual and reproductive healthcare. The sub speciality training programmes in sexual and reproductive healthcare were developed from around 2006, and training in this sub specialty has been provided in Scotland. Doctors training as sub specialists in sexual and reproductive healthcare gain a certificate of completion of training in obstetrics and gynaecology, but with recognition that they are sub specialists in this area.

Until November 2011 there were three doctors training in this sub specialty in Scotland. With two having achieved their Certificate of Completion of Training (CCT) there is currently one trainee undergoing training in this sub specialty area in Scotland. This training is not situated in an individual board, but is based in the West of Scotland region.

While there are currently no doctors training in the new specialty of community sexual and reproductive health in Scotland, we would expect to advertise training posts in this specialty programme from 2013.

The medical speciality of community sexual and reproductive health was formally established in 2009, under the auspices of the faculty of sexual and reproductive healthcare of the Royal College of Obstetricians and Gynaecologists.

Prior to the development of the speciality of community sexual and reproductive health, training was available to doctors training in obstetrics and gynaecology who wished to sub specialise in sexual and reproductive healthcare. The sub speciality training programmes in sexual and reproductive healthcare were developed from around 2006, and training in this sub specialty has been provided in Scotland. Doctors training as sub specialists in sexual and reproductive healthcare gain a certificate of completion of training in obstetrics and gynaecology, but with recognition that they are sub specialists in this area.

Consultants who have undergone sub specialty training in this area of activity are not identified separately in the national medical workforce statistics, and are classified under obstetrics and gynaecology. Published information showing whole time equivalent and headcount for consultants, broken down by specialty, are available on the ISD website at the link provided below.

http://www.isdscotland.org/Health-Topics/Workforce/Publications/2012-02-28/HCHS_by_specialty_D2011.xls

The Scottish Medicines Consortium published advice on 12 March 2012 to confirm that fingolimod for the treatment of highly active relapsing remitting multiple sclerosis is not recommended for use within the NHS in Scotland.

Further information about the SMC advice can be found on their website:

http://www.scottishmedicines.org.uk.

Nhs boards are expected to take full account of SMC advice. However, NHS boards have arrangements in place for clinically-led consideration of medicines which have not been accepted for use by the SMC, for individual patients in certain circumstances.

NHS boards are expected to maintain an overview of the effectiveness of their local arrangements for the introduction of new medicines, including NHS board management of Individual Patient Treatment Requests (IPTRs).

In addition, the Scottish Government will monitor progress in implementing its CEL guidance on the introduction of new medicines which took full effect on 1 April 2011.

As health is a devolved matter, decisions regarding the introduction of new medicines are taken by each of the UK countries through their own appraisal arrangements in line with established national priorities.

Scotland’s independent and robust arrangements for the appraisal of newly licensed, prescription-only branded medicines concentrate on the introduction of clinically and cost-effective medicines to treat all conditions, not just those to treat cancer or to treat cancer that has spread. This seeks to maintain a focus on the introduction of these throughout all parts of Scotland.