CAN the way in which newmedicines are made available to NHS patients in Scotland be improved?

Two independent reports published today by the Scottish Government suggest that it can.

Since it was set up in 2001, the Scottish Medicines Consortium (SMC) has been charged with making difficult and often controversial decisions about which new drugs to recommend, decisions that have to balance benefit to patients against the cost, which can be considerable. The first report, from Professor Philip Routledge, praises the SMC for developing a "fast, efficient, robust and independent process" that has proved capable of adapting to changing circumstances. By comparison, the deliberations of the equivalent body in England, the National Institute for Health and Clinical Excellence (Nice), are often more drawn out. For example, while SMC cleared the use of Lucentis to treat wet age-related macular degeneration, the leading cause of sight loss in the UK, in 2006, patients in England and Wales were still unable to access the treatment three years later.

On the other hand, the SMC has been accused by pharmaceutical companies, consultants and patient groups of denying Scottish patients life-saving or life-extending treatments available elsewhere in the UK. This applies particularly to drugs for those with extremely rare conditions. If Scotland wants to be seen as a place that fosters innovation, it is important that patients have access to new drugs.

There is also unhappiness about the way different Scottish health boards implement SMC decisions and deal with requests from individual patients whose consultants believe would benefit from a treatment the SMC has blocked. Professor Routledge's main recommendation is that the SMC should meet in public, as Nice does. Within sensible limits, the transparency such a move would introduce is desirable. It would enable patients, health professionals and the pharmaceutical industry to witness the appraisal process and better understand how such difficult decisions are arrived at.

Also a "Citizens' Council" would explore specific issues in relation to the availability of new medicines. This too would be welcome, because health professionals need to heed public opinion on what to prioritise, although (rightly) the SMC would continue to make decisions about particular drugs on the basis of professionally assessed, evidence-based judgments. Implementation of its recommendations by health boards is just as important as the operation of the SMC. As the second report makes clear, this is marred by inconsistency and post-code lotteries, as well as confusion and ignorance about prescribing lists. Plenty of room for improvement here.

Given a finite NHS budget, it is inevitable that the SMC and health boards will continue to have to make tough decisions and some patients will lose out. A national body making decisions on the basis of often uncertain data will always have a difficult line to tread. Greater transparency should foster greater understanding of that process.