13/12/2016 Scotland 2016

Breast cancer patients in Scotland are refused a drug available

Campaigners say it's the ultimate postcode lottery.

Why are cancer patients in Scotland being refused a drug available

on the NHS in England, Wales and Northern Ireland?

New figures show an overall rise in teacher numbers here,

but 12 areas are still struggling to recruit staff.

And is gin set to become the new whisky?

The Scottish Medicines Consortium has refused breast cancer sufferers

routine access to a treatment available to patients

The SMC says it has concerns about the long-term survival

benefits of the drug Perjeta - a decision campaigners have branded

Earlier we spoke to mum-of-two Lesley Graham.

She was diagnosed with cancer but was denied access

to a life-prolonging drug on the NHS.

She eventually won her fight to get the treatment,

but has described the current system which decides who gets access

March, 2015, I was diagnosed with breast cancer. Primary breast

cancer. And they underwent chemotherapy, followed by,

-- followed by a masectomy. I had a routine blood test in April and it

showed a liver abnormality and so they had to investigate that, and on

further investigation, it ensured that the cancer had come back, or

who knows if it ever went away. My doctor said that there was a drug

which could help me, but it is not funded on the NHS. My response to

him was, how do we get it then? He told me it was a very expensive drug

and the best route would be to apply for the drug to be used. We were

told that I was not going to be given it, and I believe the reasons

for it were that they did not know that the cost of the drug to the

benefit of the drug would be worth it. My response to that is, no way,

I am not having any of that. Everyone deserves a chance at life,

and that is why I asked them to appeal for the drug, and they came

back and said, they would approve the drug for me. I started the drug

in May, and the response is that nobody has shown to the drugs has

been fantastic. I would just urge anyone out there, do not take no for

an answer, explore every avenue, every possibility, at the end of the

day, the people that make these decisions and the people that decide

what is going to happen to you, our public servants, they are paid from

the public purse, and therefore you have every right to question what

has been said or what has been offered. If you do not question it,

you will never know. If I had not questioned it and pushed and pushed,

I really do not know where I would have been today. I think it is

barbaric, and I think that somebody must be held accountable, if they

have produced or can access a drug which can help somebody who has been

handed, at this moment in time, an incurable diagnosis, if there is

something there that can offer that person any amount of time longer

with their family, and that person wants to do that, then I think that

they should be given the chance. I am a mother of two young girls, and

it is vital, it is important but it is vital to me that I am here to get

my girls through their childhood and teenage years and be here for as

long as I possibly can. Because your family is everything. My family are

so precious to me. Well, earlier this evening

I spoke to Allyson Pollock, professor of public health research

and policy at the Queen Mary Leslie, who we just heard from

there, had her drug refused on the basis of value for money. The

Scottish Medicines Consortium regularly has to make these are

important and very difficult decisions about drugs, and

ultimately it becomes a balancing act between cost and benefit. How do

they decide? The first thing is a drug really should not be proved by

the regulator unless it has shown clear evidence of therapeutic

benefit -- approved. But often there is a great deal of uncertainty about

the therapeutic benefits, because the clinical trials themselves are

very small, they are not generalised to the population that needs them,

and the outcome measures that the use do not sure real evidence of

benefits. In the case of cancer patients, what you want is people

having disease-free survival and improves quality-of-life, but the

trouble is the drug companies are moving the goalposts, to introduce

what is called Sara get end points, where there is no clear evidence of

disease-free survival -- Sara get end points. In the case of

Pertuzumab, that was turned down because of the end points been used

by companies, which was looking at tumour shrinkage rather than

disease-free survival, which is the important one. That is very common

in cancer and oncology drugs. That is the first issue, is there

evidence of benefit. Second, if there is evidence of benefit, do

they outweigh the harm is and are be cost-effective? Will they actually

result in greater benefits than other treatments or other therapies,

for example? That requires a lot of economic monitoring. Perjeta, the

drug you are referring to, the breast cancer drug denied for use

here, that has been approved in the rest of the UK. That is very

surprising and it shows you something about the extraordinary

lobbying by the drug companies, because they put the regulator and

NICE under a great deal of pressure to approve drugs and recognise new

end points which are not always very clear. NICE itself has said that

there is a great deal of uncertainty about the benefit of these drugs,

and one of the reasons why NICE in the end gave in, was because the

company did a deal to reduce the cost of the drugs, we do not know

how much they have discounted at it, but they have done a deal on

reducing the cost. There is a bigger issue, we really need to understand

the quality and the nature of the clinical trials data, which is often

not in the public domain, and often not therefore patients to judge

whether the evidence is good enough to have approved these drugs. But

patients in a desperate situation who think that there is a chance,

and your cases, we have just heard one, we're a drug can make a

difference, money will make no difference to them and it becomes a

motive and the idea that there is a postcode lottery, that

you cannot just even be given the chance to try something because of

where you live, is hugely difficult to swallow.

We would not really want people to be given snake oil if there is no

evidence of benefit. Where there is a great deal of uncertainty, we have

to have proper randomised controlled trials. One of the problems with

these drugs is that they are very small trials and they're not

generalisable and there is huge uncertainty and no evidence of

benefits. Remember that has to be balanced against the other claims on

the NHS budget, so palliative care, rheumatology, arthritis treatments,

all sorts of other treatments. So it is a balancing act, and what we

should be doing is introducing medicines and technology so that we

know there is clear technology that works, and then funding them

properly. That Israeli where we need to be going. We need to make

priorities with our public health system and public health money and

we should really not be giving in to big pressure from the drug

companies, but we should be funding things where there is clear evidence

of benefit. There is a lot of movement in the NHS between the

countries of the UK. Is there a case with these decisions to be made on a

UK wide basis, despite the fact we have our own health system here in

Scotland? Would it be seen to be fairer, would be more effective if

it was made across the UK? One of the problems is that England no

longer has an NHS, it is dismantling its NHS. Indeed, it is ironic that

the struck has been given the go-ahead at a time when three

quarters of the hospitals are in serious financial difficulties and

was a ?30 billion shortfall over the next couple of years. Hospitals and

services are closing rate across England at a time when they are

giving approval for treatments which NICE have said are hugely uncertain

in terms of their benefits. So actually Scotland still has got an

NHS and it should still be making proper decisions about how to

prioritise medicines and treatments. These decisions are not easy, but we

should start by having clear evidence of benefit, and that relies

on the clinical trials that are being given to the drug companies to

show this clear benefit, and they have not in the case of Perjeta.

Now, almost 51,000 teachers are working in Scottish schools,

according to the official statistics out today.

They reflect an overall rise, after two years of decline.

But many councils have told BBC Scotland

that they're finding it hard to fill some vacancies.

The largest percentage decrease was in Moray.

Our reporter there is Craig Anderson.

One local authority, Moray Council, is sane and particularly hard to

attract teachers. Currently there are seven posts for primary school

head teachers. The council has tried a variety of ways to bring in new

blood. We have had a major advertising

campaign, we have used social media quite extensively to try to attract

teachers from here and elsewhere to try to come and work in Moray. We

have been involved in a partnership with a local building developer and

we have provided six months of rent-free accommodation to teachers.

He provide very generous relocation packages, so we have done quite a

lot already. It emerged today that senior pupils

at one highland secondary will set their prelim exams and competing

studies next month but have not been tot by a qualified teacher in the

subject and last summer because the school has not been able to recruit

such a specialist. Some of our schools have a number of significant

retirement throw coming up in the next few months. We need to be able

to offer subjects to young people, and that is something which we will

discuss early in the New Year. I do think there are serious consequences

for attainment. Education chiefs say the goal of improving educational

role will not be achieved unless there is a national strategy to

address the problem of teacher recruitment.

Well, with me now is English teacher and writer James McEnaney, who made

When I finished teacher training I did what is called ticking the box

which means you can be sent anywhere in the country. I went to Arran. I

did not know what to expect, but I went there for my probation and

loved it, and the end of that first year I was very lucky in that a

permanent job opened up and I got it and was able to stay. And you only

left for personal reasons, your partner needed access to different

health care. But how was that, as a rural experience? We're hearing that

Derek shortages in some rural areas. It appealed to you. Why do you think

it did not appeal to others? They're always going to be people for whom

it is not appealing to live outside the central Alps. I don't think it's

a problem. I loved my time there and I didn't really want to leave, I had

to leave for personal reasons. I still have a lot of friends there

who love it. But there is no getting away from the fact that it is very

difficult, so the cost of living in somewhere like Arran aural areas of

Scotland is extremely high. There are significant problems with

housing, which is a theme that comes up again and again. There are

incentives in place, though, to try to redress that. Are they working?

There are in some places. There were none for me. When I moved to Arran

there was nothing. I was lucky in that a friend of mine was also sent

there and we shared a flat. Some areas, areas like Moray, do things

to attract people and I think they are doing the best they can in many

ways, but I don't think that what amounts to short-term solutions are

enough to get people to move. It's definitely not going to be the

solution. What about career progression? Do people gravitate

towards local authorities where the attainment might be higher, if they

are looking to have a fast ascent in their career, if they want to be a

headteacher for example? I don't know if they go somewhere where

attainment is necessarily higher, but when I have been speaking to

people about this, one thing you hear a lot is that people look at

rural schools or schools are more isolated areas and if they want to

go on to be the head of a department or a headteacher, they worry that

because there are fewer progression routes, because more schools have

faculties, there are fewer options for them within those schools and if

they want to leave it is one thing, if you live in Glasgow and want to

move schools, but it is different if there is only one school in a given

area. The issue with progression was probably always there but it has

certainly been exacerbated by the cost-cutting scheme of forcing

schools into using faculties. Do you and some of the people you qualified

with feel good about the decision that you made going into teaching? I

love teaching. It is a brilliant job, and most of the people I

trained with, most of the people I knew through that period are still

doing it. But there is an increasing feeling that it is becoming more and

more difficult because it is becoming hard for teachers to work

in a situation whereby they feel as if they are not being supported by

Government and whether it is more pressure on them to sit solve

problems. It used to be known

as Mother's Ruin, but it seems gin is continuing its resurgance

in popularity, so much so that sales of gin

are set to outstrip blended Scotland now produces 70%

of the gin consumed in the UK, and dozens of micro distilleries

have opened here over Data from the research company

Euromonitor has found blended Scotch whisky sales are expected to drop

in the next three years, while gin Earlier, I spoke to Simon Fairclough

about how gin is taking over from Scotch.

It's quite a thought isn't it. This is the home of so much distilling

heritage and history and here we are with so many gin is being produced,

and I think the key lies in the fact that we are so renowned across the

low before our distilling expertise, and we have at home to the

International distilling at Herriot Watt University, helping a lot of

people to learn to distil. And of course gin is a lot quicker than

whisky. It can be done in 24 hours rather than waiting for years for it

to mature. You need deep pockets and long time horizons for Scotch

whisky. And Scotch isn't even Scotch until it has been aged in oak in

Scotland for three years. Gin doesn't have to mature, it can be

rested gently in tanks and then bottled relatively quickly. You are

talking weeks rather than years. And why has it become fashionable?

It is not the drink it used to be. It is being enjoyed by a whole new

generation of drink is. And thank heavens for that! I think any gin

fans out there will be joyously celebrating that fact. We grew up, I

think, this generation, with gin being something that your

grandparents drank, and it wasn't very trendy. All the old styles of

gin, many of them have disappeared along the way. Now they are being

reintroduced, aged gin is an citrus flavoured Jens, there through the

nine teams and earlier parts of the 20th century, and there has been so

much innovation by distillers across Scotland, as long as it is Juniper

baste it is gin. You have a background in whisky so you have a

glass in each hand, lets say. Do you think whisky is due a new image,

maybe a bit of a makeover, to bring it back? Until last year, sales were

on a decline. I think Scotch whisky has an immovable place across the

globe as really ace fantastic spirit. And it can only be made in

Scotland, by definition. So I think it has a great future. Back in the

80s, when it was just coming out of the doldrums, there were lots of

concerns, certainly in the company I used to work for, about getting new

drinkers involved in whisky and interested in whisky, and I think

there is still a hesitation for people to take to Brown spirits. Ron

might have its day coming up, that is something that is coming off the

drawing board -- ROM. First it was a vodka that seemed to be the rage.

You could do anything you like, you could put gold flecked in to give it

an extra edge. But gin is something that has always been a base for

cocktails and it is an easy drink to enjoy. Perhaps easier than our

native drink. But they all have their places, that is a fact. Thank

you for joining us. Well, to discuss that and the rest

of today's stories I'm joined by the former editor of the Times

in Scotland, Magnus Linklater, and the editor of Common Space

website, Angela Haggerty. Good evening to you both. On the

subject of gin, Magnus, Scotland seems to have a new national drink.

You say it is new but of course gin goes way back. In the 18th-century

Scots were producing huge amounts of gin. Juniper plantations were

planted all over in the 18th century. It was very exported all

over the place. In England it became Mother's Ruin. Then they had to

introduce a duty on it to phase out the epidemic of gin drinking. It is

an argument for minimum pricing for alcohol. Gin goes back a long way in

Scotland. And now it has a new twist. It is very much part of the

cocktail culture. Angela, have you noticed how many bars and shops have

strung up? I'm not a spirit drink, I'm more of a wine drinker. But it

is good to see this. One of the squid is as is of the Scotch whisky

industry is that his cities such a huge multinational industry and

Scotland does not always reap the full reward of that industry, but if

you are seeing more small independent companies springing up

then you can see a real boost for communities. And they are very

local, aren't they? I think every island now in Scotland seems to be

reducing a distillery and a new gin. The economic benefits are still

probably to trickle through. Small distilleries are all over the place.

I was in Caithness the other day. They produce a beautiful gin called

Rock Rose. Each one has its own individual flavour. It is an

interesting industry growing up at a new level. Moving on to politics,...

Would the SNP ever let politics, candidates stand in England?

That was the question put to the First Minister of Scotland

by actor Alan Cumming, during a candid interview

The magazine called the exchange "a Hollywood meets Holyrood love-in"

and this is what Nicola Sturgeon had to say.

What would you say, you know how in the last election, people were

saying, oh, I wish we could have SNP candidates in England. What you say

to people when they suggest that? I'm tempted. Could you do that? I

look at the situation in England just now and I think it is quite

tragic that there is no effective opposition to the Tories, and I

think there are a lot of people in England right now who feel

disenfranchised and there is nobody speaking up for them. On that side

of it, part of me feels the rest of the UK needs people to stand up to

the Tories, but on the other hand we are the Scottish National Party, we

exist to represent Scotland's interests and I think we would be

guilty of far reaching ourselves to stand candidates in England.

Angela, we thought it was important to assess show that in its full

context. It can be easy to read the con text -- transcript and not get

the context. It is all with you been raised, the appeal of the SNP in

England. I saw people sharing this on social media and they were taking

it very seriously. I don't go realised it was a bit of fun. But

there was something she said in the interview where she talked about

Brexit and how people were fighting back against austerity and poor

conditions and I think that is a good point. We hear a lot about

immigration and it is think it is fair to say that immigrants have

been scapegoated for a lot of those problems, but the root problems for

many people across England are the same is very anti-austerity,

antiestablishment tone. That was Nicola Sturgeon's position in the

general election debates and she came out to be very popular. There

is the mood for an antiestablishment party in England, for an effective

opposition, and Labour does not seem to be showing up. Magnus, is there a

golf? They have an antiestablishment party called Ukip already. I'm glad

Nicola at the end said it would be overreaching themselves. She has

quite a job on her hands running things in Scotland. And I don't

think an SNP candidate south of the border would attract much support,

but who knows? We may be wrong. Perhaps just the idea of a left a

party that is not labour, for those who are feeling a bit

disenfranchised? Interestingly, just after the European referendum, in

Southport, they had a petition to join Scotland because they were so

appalled at that they all voted remained and they wanted to join

Scotland because they thought it would give them the best chance of

staying in Europe. So who knows? There may be some traction there.

Let's touch now on loneliness. This has been identified as as big a

goblin as smoking or obesity, and the Scottish Government has

committed to tackling social isolation. And at this time of year,

this issue becomes bigger for people who are suffering. I think it is

good to hear this but you have to address the root causes and some of

those will be related to poverty and a lot of the things we are seeing in

the country politically, but also with a rise of technology and the

way it changes the way we communicate and the way that we live

our lives, the way that even the labour market will protest in the

future will be heavily influenced by technology. I think it is good we

start to re-evaluate how we measure quality of life people because I

think, in the future, this will become a really big issue. Magnus,

do you think it is an issue has become more problematic? Yes. The

break-up of families, the breakdown of immunities. Loneliness is a real

issue of the modern age. Whether Government is the best way to

approach it is another matter. I think it is far better approached at

the grass roots, at local level. Where people can get together and

form groups and the problem is the local authorities themselves are

being squeezed, perhaps do not have the resources. Thank you both.

I'm back again tomorrow night, usual time.