Terminally ill people in Scotland are being given the best new cancer drugs, while those in the rest of the UK are being deprived of them.
This apparently unfair difference stems from the way drug provision by NHS England and NHS Scotland is regulated, with Scotland's drug monitoring body making it much easier for expensive drugs to pass cost-efficiency tests.
The National Institute for Health and Care Excellence (NICE), which advises the NHS in England, Wales and Northern Ireland on which newly licensed drugs to use, currently dictates that only those falling under the limit of £20,000 to £30,000 per quality-adjusted life year (QALY) can be provided on the NHS. QALY is a weighting of the cost of using a drug for a year against the extent to which a person's life can be extended and improved.
Scotland's equivalent, the Scottish Medicines Consortium (SMC), has placed far fewer restrictions on drug acceptance by the NHS ever since 2013, when the Scottish government said it should try to be more open to new medicines, even if they cost a little more.
Following the review, it also advised SMC to reduce the length of the approval process to a maximum of 12 weeks, compared to what can sometimes take years in the case of NHS England, and to work more closely with the drug companies providing it with medicines. On top of this, Scotland now has a £21m fund to cover the cost of medicines for patients with very rare conditions.
The government took on board all these comments, and decided to change the regulation process to make more high-quality medicines available for Scottish people.
Rare cancer drugs for Scotland
It is important to be careful with drug approval, of course – in 2005, the British government spent £200m on Tamiflu, an antiviral flu drug manufactured by Roche, only to discover from later studies that it neither cut hospital admissions nor reduced symptoms.
But mistakes like this are rare, and so far the Scots have only benefited from the medical innovations no one else in the UK has access to. The most recent example of this is three rare cancer drugs that have just been approved by SMC for use in Scotland, while only one of these has been approved by Nice. In all cases, they are not cures but drugs taken to improve and lengthen life among the terminally ill.
According to the most recent figures, England's public health service spends less as a proportion of its GDP on new medicines than the average across Europe.
The effects of this attitude are being felt by the general public, with a recent report estimating 8,000 cancer patients are likely to have their lives cut short by a recent de-listing of 25 cancer treatments, which Nice said were too expensive to continue using.
Nick Bruce, a health director at the UK arm of Pfizer, told City A.M. it was time for the government to have a rethink about its approach to drug regulation.
We have seen patients in Scotland benefit from medical innovations not routinely available for patients in England, Wales and Northern Ireland. The UK Government aspires for patient outcomes that meet or beat the best in Europe, but how can we achieve this if we have a medicines cabinet that is stuck in the past?Whoever is in Government come 8 May needs to prioritise a long-term solution to ensure that patients throughout the UK can access the innovative medicines they need when they need them.
Damage to the pharmaceutical industry
But it's not just the patients who are losing out – Pfizer UK is one example of a company whose cancer treatments have been made available in Scotland much more than in the rest of the UK over recent years. The UK is home to some of the world's biggest pharmaceutical industries, boasting companies such as GSK and AstraZeneca, and these are set to suffer more and more if the system carries on this way.
Austerity measures already dictate that the companies must reimburse the NHS for treatments costing more than the current cap allows, and as drugs become more complex and therefore more expensive to manufacture, this could ultimately result in less research investment. Big pharmaceutical companies thrive off the invention of new drugs, but their success relies on those drugs being purchased at the end of the line.
“The pharmaceutical industry which has delivered great innovation over a sustained period measures its success on returns on R&D and needs to be rewarded for innovation,” Ketan Patel, investment analyst at Ecclesiastical, told City A.M.
Healthcare in the UK is a devolved matter with England, Scotland, NI and Wales all having their own systems of publicly funded healthcare. The general election in May will bring this system under a greater level of scrutiny, with taxpayers asking why the access to expensive drugs is determined by geography - only heightening the inequity for patients.