Malcolm discusses improvements in cancer treatment and their implications
Debate on cancer drugs Malcolm Chisholm (Edinburgh Northern and Leith) (Lab): I very much welcome the debate, which highlights dilemmas that we face now, and which will become far more acute in the near future.

On a recent visit to the labs at the Edinburgh cancer research centre, I heard David Cameron - the very highly regarded David Cameron, who is the new professor of oncology at the University of Edinburgh - describing how new cancer treatments are targeting specific subtypes of cancer, which means that the already expensive cancer drugs are likely to become far more expensive in the future because they will be used on smaller subgroups of patients rather than on everyone who has a particular type of tumour. He highlighted what difficult choices we would have to make as the drugs budget increases exponentially in the next decade.

My second general point is one that the cabinet secretary made: drugs are not the only weapon against cancer. In a recent talk, Professor Alan Rodger, who was director of the Beatson oncology centre until quite recently, gave figures on the contribution that different treatments make to curing of cancer. For surgery, the figure was 68 per cent; for radiotherapy, it was 28 per cent; and for chemotherapy, it was 4 per cent. That is not to downgrade or to devalue in any way the role of chemotherapy, but we need to see cancer treatment in that broader context.

We can justifiably be proud of the Scottish Medicines Consortium, which is the foundation of our system for cancer drugs. I remind members that the director of Cancer Research UK said at the Public Petitions Committee on 29 April 2008 that

“the SMC is the envy of clinicians who work in England”, and that it is “a model of good practice”. [Official Report, Public Petitions Committee, 29 April 2008; c 709.]

We can justifiably be proud of it - without being complacent.

Some years ago, guidance on the Scottish Medicines Consortium was issued that, I think, said that NHS boards should ensure that recommended medicines are made available to meet clinical need. I am concerned that there still seem to be issues with NHS boards’ implementation of SMC decisions. The briefings from Cancer Research UK and from Breakthrough Breast Cancer, Macmillan Cancer Support and Myeloma UK highlight the need for more transparency not only on decisions but on boards’ implementation of them. I am sure that everybody would like that to happen.

The briefing by Breakthrough and others also makes the key point that they want recent initiatives to have the chance to bed in. The cabinet secretary should be commended on the announcements that she made in 2009 on exceptional prescribing becoming more transparent. She talked about

“greater transparency in the flexibility that can be used by the SMC” and “a national framework for assessing ... patient access schemes”. [Official Report, 25 March 2009; c 16129-30.]

That was all good but, in the interest of transparency, it would also be good if the developments on those policies could be explained to MSPs and the wider public - the cabinet secretary will probably not have enough time in her closing speech to address that point. For example, I am told that guidance on exceptional prescribing was issued in March 2011, but most people probably do not know the contents of that guidance or how it is operating. If there was more confidence in exceptional prescribing, there might be less demand for the drugs fund.

In many ways, I sympathise with what Murdo Fraser said and can see exactly where he is coming from. However, as Cancer Research UK reminds us, we should remember that a cancer drugs fund could exacerbate regional inequalities and may be doing that in England. Therefore, guidance on exceptional prescribing may be a more equitable way to deal with the problem.
September 29th 2011