Chamber and committees

As outlined in the answer to S3W-28278 on 19 November 2009, the Scottish Government intends to review the implementation of the policy framework following a period of operation.

In addition, active consideration is being given to monitoring arrangements which will underpin this guidance.

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/Apps2/Business/PQA/Default.aspx.

The Difficult Decisions Short Life Working Group was an NHS Board group and there has been no direct involvement of ministers or Scottish Government policy officials. The remit of the group was to develop a framework that NHS boards can use when making difficult decisions, both in planning at a population level and when making decisions about individual patients.

The membership was chaired by Dr Gina Radford, Director of Public Health, NHS Fife (now working in NHS Cambridgeshire) and included the following members:

Ms Ailsa Brown, Principal Health Economist, NHS Quality Improvement Scotland

Mr Brian Devlin, Interim Head of Strategic Support and Ethics, NHS Highland

Dr Sara Davies, Consultant in Public Health Medicine, Scottish Government

Professor John Haldane, Professor of Philosophy and Director, Centre for Ethics, Philosophy and Public Affairs, University of St Andrews

Professor Graeme Laurie, Professor of Medical Jurisprudence, University of Edinburgh

Ms Liz Macdonald, Senior Policy Advocate, Consumer Focus Scotland

Ms Jackie Sansbury, Director of Strategic Planning, NHS Lothian

Secretariat: Dr Graham Mackenzie, Consultant in Public Health, NHS Lothian

The workplan was to:

build on discussions and conclusions from the Difficult Decisions national workshop (22 February 2008);

consider the published literature on making difficult decisions in NHS boards;

survey difficult decision making in planning and for individual patients across NHS boards and regional planning groups in Scotland;

review key concepts within the group;

assess the legal and ethical frameworks within which decisions must be made, and

draft a report and circulate to members.

The Hospital Medicines Utilisation Database will provide access to high level cost and volume data on medicines use in hospitals. This has been developed and piloted and will cover all NHS boards during 2010 with the exception of NHS Highland who are currently reviewing their pharmacy system and are therefore outside the scope of phase one of the programme.

The Scottish Government has been working with NHS boards to review local processes and is preparing guidance for NHS boards which sets out the policy framework with regard to the introduction and availability of new medicines in the NHS in Scotland. A key requirement within the guidance is the need for NHS boards to have written policies describing the systems and processes for the managed entry of new medicines and that these should be publicly available. It will be for NHS boards to ensure that this is delivered.

In responding to the draft framework, the majority of responses from NHS boards and stakeholders welcomed the work being done to improve consistency in availability of new medicines across NHSScotland and acknowledged the complexity of the issues involved. A number of issues were raised in responses and these will be addressed either as part of the final published framework or as part of a further phase of work.

The Difficult Decisions Short Life Working Group is an NHS board group and did not provide a separate response.

Prescribing information derived from prescriptions dispensed in the community by community pharmacists and dispensing doctors is available at www.isdscotland.org/prescribing. These data can be used for monitoring trends and utilisation. Detailed prescribing information is available to NHS boards through PRISMS “ the Prescribing Information SysteM for Scotland which is a web-based information system on all prescriptions dispensed in the community over the previous five years. NHS boards have prescribing advisors who monitor the use of medicines by GP practices using PRISMS information and who can provide expert interpretation of the data and assess the clinical appropriateness of prescribing.

Variations in prescribing practice across Scotland can be influenced by a number of different local factors, for example, population size, patient demographics and deprivation and it is therefore important not to draw definitive conclusions from national data alone.

As well as NHS boards, the draft framework was circulated to 37 stakeholder and patient groups as follows:

Academy of Medical Royal Colleges

British Medical Association

Royal College of Nursing

Scottish Cancer Coalition

Scottish Long Term Conditions Alliance

Scottish Medicines Consortium

Scottish Independent Hospitals Association

Scottish Partnership Forum

Scottish Workforce and Staff Governance Committee

Scottish Partnership for Palliative Care

Regional Cancer Advisory Groups

Consumer Focus Scotland

Scotland Patients Association

Citizens Advice Scotland

Association for International Cancer Research

Bowel Cancer UK

Breakthrough Breast Cancer

Breast Cancer Care Scotland

Cancer BACUP

Cancer Care Research Centre, Stirling University

Cancer Research UK

CLIC Sargent

Leukaemia Care in Scotland

Macmillan Cancer Support

Maggie''s Cancer Caring Centres

Marie Curie Cancer Care

Myeloma UK

Parkinsons'' Disease Society

Prostate Scotland

Rarer Cancers Forum

Roy Castle Lung Cancer Foundation

Scottish Association of Prostate Cancer Support Groups

Scottish Breast Cancer Campaign

Scottish Cancer Foundation

Taktent Cancer Support

Teenage Cancer Trust

The Prostate Cancer Charity.

Further to the Area Drug and Therapeutics Committees and Exceptional Prescribing Leads event facilitated by the Scottish Medicines Consortium on 12 May 2009, the Scottish Government has asked the Scottish Medicines Consortium to facilitate another event in the spring 2010. This will provide an opportunity to bring these groups together to consider issues related to the managed introduction of new medicines within NHSScotland, particularly around how best to achieve consistency of approach in relation to individual patient treatment requests.

As outlined in the answer to S3W-27698 on 5 October 2009, work is progressing on the information leaflet for patients as commissioned by the Scottish Government from Health Rights Information Scotland. The draft leaflet has been tested with patients and the public and will be published in due course.

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/Apps2/Business/PQA/Default.aspx.

The Scottish Government is committed to ensuring equitable access to medicines across Scotland, based on clinical need. The Scottish Government expect NHS boards and clinicians to take full account of Scottish Medicines Consortium (SMC) and NHS Quality Improvement Scotland (NHS QIS) recommendations in the planning and provision of NHS services. Where there is evidence that an SMC or NHS QIS accepted medicine (or its equivalent) is not being made available, these will be addressed directly with the NHS board concerned in order that appropriate action is taken where necessary.