Scotland has a particularly high incidence of heart disease.
That ought to make the country an international leader in the treatment of heart attacks. Instead heart attack patients in Scotland are being denied the most effective techniques which are standard in the rest of the UK and Europe.
Cardiologists in Scottish hospitals have been waiting 18 months to start using a drug approved by the Scottish Medicines Consortium after hearing evidence that it would save 200 lives a year. The delay in agreeing national guidelines about who should receive it has probably already cost lives.
Professor Keith Oldroyd, director of research and development at the Golden Jubilee National Hospital, Scotland's national centre for advanced heart failure, has cited this as just one example of Scottish patients not receiving treatment until several years after the rest of the UK.
A particularly troubling case involves a patient who died following open heart surgery despite the view of two surgeons that he needed a less invasive valve operation available only in England.
The problem is cost and it has become so severe across the NHS that the Scottish Parliament has launched an inquiry into access to medicine. This is long overdue. Last year the chief executive of Scotland's largest health board, Argyll and Clyde, said in a report into a particular case that Scottish Government criteria for the provision of certain drug treatments had created a north-south divide in access to medication across the UK.
Clinicians can use some drugs not approved for general use if they can argue an exception is justified by a patient's condition and circumstances. Inevitably this has led to claims from the families of people denied treatment that variation between boards amounts to a "postcode lottery".
In his evidence to the health and sport committee, Prof Oldroyd has shown that this is not special pleading but a statement of fact. For example, heart attack patients in Aberdeen are given a stent if they reach hospital within 120 minutes of a heart attack, while in the rest of Scotland they won't receive the treatment unless they arrive at an emergency angioplasty centre within 90 minutes. The variation is unacceptable.
When it comes to saving lives, clinical judgment should be able to outweigh general guidelines. Yet some health boards insist on a rigid interpretation.
Cost cannot be ignored and it is increasingly clear that the greatest challenge for the NHS is how to provide a universal service as the availability of new drugs means budgets can never keep pace with demand.
The Scottish Government's commitment to protecting NHS budgets despite the overall reduction in public spending is admirable.
However, as the population ages and research makes new treatments possible, the dilemma of how to meet the cost will become even more acute. But it must be tackled. And the inquiry into access to medicine should consider what Scotland could learn from the rest of the UK.
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