Dr John Garner repeats misleading assertions about NHS Lothian's record in making new drugs available to patients (Medical Matters, 5 February).
NHS Lothian has never failed to make a drug approved by the Scottish Medicines Consortium available for clinicians to prescribe according to clinical need and it is misleading to suggest that NHS Lothian is in any way preventing patients from accessi
ng SMC-approved drugs. In fact the newspaper that carried that story has since printed a clarification. Once the SMC gives its views on a new drug, it is available for clinicians in Lothian to use immediately.
Dr Garner made reference to a "bureaucracy in each NHS Board that gives it a second bite at approving medicines". By this I understand he is referring to the way in which doctors can ask for any drug (regardless of the SMC process) to be provided to patients if proven clinical benefit can be established. In NHS Lothian, it is expert doctors on the frontline of clinical practice who assess whether a non-SMC drug is provided – not administrators or "managers". Doctors are the right people to assess whether a new medicine will provide a benefit and can be given safely.
Dr Garner also made a number of comments about relationships between clinicians and other healthcare staff, suggesting that doctors should take on the prime role in terms of managing Scotland's NHS. As he himself suggests, this is indeed a simplistic view on how people from all backgrounds work together to deliver modern healthcare. Many of the managers he stereotypes as bureaucrats are in fact highly-skilled clinicians who either still work at high level in practice or have moved into management roles to broaden their experience. In Lothian, our Lean in Lothian service development programme has been extremely successful precisely because it does not elevate one group of healthcare staff above another. By empowering frontline staff to spot opportunities for improvements, and then supporting them in making the changes needed, NHS Lothian is liberating the skills and creativity of all of the members of our team – and it is our patients who are seeing the difference in terms of faster treatment.
(DR) ALISON McCALLUM, Director of Public Health and Health Policy, NHS Lothian, Pleasance, Edinburgh
