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).

Information on the number of successful and unsuccessful Individual Patient Treatment Requests made to NHS Boards 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).

Guidance on IPTR arrangements was published on 17 May 2010 and took full effect from 1 April 2011. This was followed up by the issue of good practice guidance on 18 March 2011 and further advice on 13 February 2012 following a clinical group review of extant guidance. The Scottish Government has also committed to monitor NHS board progress in implementing guidance on the introduction and availability of newly licensed medicines in the NHS in Scotland.

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 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.

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.

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.

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.

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.

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.