Chamber and committees

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.

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

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.

I have corresponded with the Secretary of State for Health several times concerning both the earlier consultation and on the need for full involvement in the design of the proposed value based pricing initiative. I have received assurances that the UK Government and the devolved administrations will continue to work closely together in developing a value based pricing approach. Officials have also been involved in UK-wide discussions concerning the value based pricing of medicines.

Information on the number of patients who have been given access to cancer medicines that were approved by the Scottish Medicines Consortium under a patient access scheme since 2011 broken down by (a) NHS board and (b) medicine is not held centrally.

Information on SMC advice for medicines accepted with a patient access scheme is available on the SMC website via the following link:

http://www.scottishmedicines.org.uk/Submission_Process/Submission_Guidance_and_Templates_for_Industry/Patient-Access-Schemes.

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.

In its response to the Scottish Parliament Public Petitions Committee in relation to PE1108 regarding the availability on the NHS of cancer treatment drugs, the Scottish Government advised that its focus was to improve access to all newly licensed medicines and not just those to treat cancer. On that basis, no assessment was made of the use of the quality adjusted life year (QALY) health economics tool specifically for small cohorts of poor prognosis patients.

Instead the Scottish Government advised the Committee that the use of QALYs is currently the accepted method in health economics used by both the Scottish Medicines Consortium (SMC) and the National Institute for Health and Clinical Excellence (NICE) to compare between very different medicines and patient groups.

It also clarified that QALYs provide the basis for discussion about individual medicines by the SMC, the QALY alone does not determine the decision.

Guidance to further strengthen the safe and effective use of new medicines across the NHS in Scotland was published on 13 February 2012. This provides NHS boards with specific guidance on local NHS board consideration of medicines which have been accepted by the Scottish Medicines Consortium (SMC), including timescales for (i) reaching formulary decisions and (ii) publishing formulary decisions.

The guidance also clarifies that NHS boards are expected to maintain an overview of the effectiveness of their local arrangements for the introduction of new medicines, including NHS board formulary arrangements.

There are no plans to publish additional guidance for NHS boards on formulary arrangements.

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.