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The SMC published a policy statement which clarified how it uses a tool called the Quality Adjusted Life Year (QALY) as part of its decision-making as to whether or not a medicine is value for money for the NHS in Scotland.

The QALY is not the only criteria for decision-making. QALYs are an important tool in assessing the benefits of a medicine but the decision on whether to accept a medicine for use is a wider judgment on its clinical and cost-effectiveness. A link to the statement on the SMC website is attached:

http://www.scottishmedicines.org.uk/About_SMC/Policy_Statements/A_Guide_to_Quality_Adjusted_Life_Years.

The Patient and Public Involvement Group (PAPIG) has three public partners who are members of the Scottish Medicines Consortium and contribute to the decision making. Where there are Patient Interest Group submissions for medicines under assessment, these are included in the meeting papers sent to all members and one of the public partners presents a summary of the Patient Interest Group submissions verbally to the committee at the monthly SMC meeting. Further information on these arrangements are set out on the SMC website. A link is attached:

http://www.scottishmedicines.org.uk/Public_Involvement/SMC_Explained/Further_Reading.

The SMC website provides information on how patient interest groups can participate in the SMC appraisal arrangements. A link is attached:

http://www.scottishmedicines.org.uk/Public_Involvement/Template_and_Guidance_Documents.

Nursing and Midwifery Pre-Registration Education in Scotland is a devolved matter falling within the remit of the Scottish Government.

Since 2009, there has been an increase in the number of qualified nurses graduating because more students than ever before are successfully completing their studies. The student intake is set every year to make sure we have the right number of nurses and midwives for the future.

The number of Clinical Nurse Specialists (CNS) has increased in recent years as detailed in the following table.

The Scottish Government monitoring of implementation of the Scottish Government guidance CEL 17 (2010) and subsequent related guidance published in 2011 and 2012 is on-going.

The recently announced New Medicines Review to assess the current systems for making new medicines available across NHSScotland will include a strand of work to look at every aspect of the introduction of new medicines from national advice through to local decision-making to establish whether any further improvements can be made.

The review also captures the need to assess NHS boards’ compliance with the current guidance in relation to the introduction and availability of newly licensed medicines.

Any recommendations made as a result of the review will be considered early next year.

Figures relating to spend on orphan drugs can not be provided from data held centrally. The spend relating to branded and other medicines in each of the last five years can be found in the following table.

Figures relate mainly to primary care prescribing and dispensing, although some items may have been prescribed in a hospital setting.

Table 1: The Gross Ingredient Cost for branded and other medicines by financial year

Source: Prescribing Information System.

Further information on Prescribing can be found on the following ISD website:

http://www.isdscotland.org/Health-Topics/Prescribing-and-Medicines/.

The role of the SMC's Patient and Public Involvement Group are articulated on the SMC website. A link is attached:

http://www.scottishmedicines.org.uk/Public_Involvement/Role_of_Patient_and_Public_Involvement_Group.

The current Patient and Public Involvement Group members are listed on the SMC website. A link is attached:

http://www.scottishmedicines.org.uk/Public_Involvement/Who_We_Are.

Patient and Public Involvement Group members are recruited from the general public and are normally appointed for three years. Further information on how to apply for vacancies are set out on the SMC website. A link is attached:

http://www.scottishmedicines.org.uk/Public_Involvement/PAPIG/PAPIG_Recruitment.

Nursing and Midwifery pre-registration education in Scotland is a devolved matter falling within the remit of the Scottish Government.

Orphan medicines which have been accepted for use by the Scottish Medicines Consortium (SMC) are available to prescribers within NHSScotland in accordance with clinical need.

Where the SMC have not accepted a medicine, NHS boards are not expected to make it routinely available.

The Scottish Government has not undertaken an assessment of equity of access to orphan medicines between each NHS Board and the rest of (a) UK and (b) EU.

Recommendations regarding the numbers of commissioned places for nursing and midwifery education and training are made by Scottish Ministers on an annual basis and aim to ensure that the right number of nursing and midwifery students are being trained for our NHS. The decision to move to three pre-registration education midwifery education providers aimed to ensure a sustainable national model of pre-registration midwifery education provision and to further develop centres of excellence with a strong research and post graduate presence.

Mechanisms were agreed with relevant Universities to manage the impact of changes in intakes to pre-registration nursing and midwifery programmes; and to enable the transition to three pre-registration midwifery education providers. The Universities not selected to provide pre-registration midwifery education programmes were able to recruit additional nursing students; additional funding was also provided to Universities to expand the provision of post-registration education for NHS board nurses and midwives.