WHEN compared to the rest of Europe, it has to be said that the UK does not have the greatest record on the diagnosis and treatment of ovarian cancer. Which makes this week’s news about the clinical trials of the new drug niraparib particularly promising.

What the trials have shown is that in some women whose ovarian cancer has relapsed, niraparib can keep the disease at bay for twice as long as chemotherapy alone, which can mean living for more than nine months compared to under four. It is still early days, but it looks like a breakthrough with the power to prolong, and make a big difference, to women’s lives. This is not a cure, but it is an encouraging step forward.

What happens next, though, is far from settled. The good news is that the drug has now been licensed, which means that it is safe and legal to use, although the circumstances in which women will have access to it will remain extremely limited for now. For private patients, niraparib will be available immediately, but on the NHS patients will only have access to the drug if they make an Individual Patient Treatment Request and convince their health board to fund the treatment.

The consequences of that are obvious: in some cases, women will succeed in their treatment requests, in other cases they will fail, which means that two women in similar circumstances in different parts of the country will be treated differently – one receiving the potential benefits of niraparib, the other being refused them. This is clearly a breach of what should be one of the basic principles of the National Health Service that there should be consistency in treatment and service across the country.

The issue then will be whether niraparib will be approved by the Scottish Medicines Consortium (SMC). The way has been paved for the manufacturer to submit an application, which is expected next year – at which point they will suggest a price. But the SMC has a difficult job to do to ensure resources are spent where it is believed they can have the best effect. A strict cost/benefit analysis also has to be made in every case so NHS budgets are not inflated to accommodate whatever drug companies choose to charge. All of this balancing act will apply when the time comes to consider niraparib.

It may be that when the time comes the SMC approves the drug for all patients – that is certainly what we all hope will happen given the excellent results in the clinical trials.

But, as we have seen in the case of other drugs, the outcome is by no means certain. We know the NHS budget is not bottomless and resources have to be rationed, but as more drugs offer more and better outcomes for patients, it is also right to ask whether the NHS has the resources it needs. The Scottish Government says it is committed to increasing access to drugs for terminal conditions; is it also committed to tackling the fact that we spend less per head of the population on health than most of our European neighbours?