Improved systems in Scotland

The NHS in Scotland has made significant improvements to services but still requires better information to reduce its drugs bill.

Hospitals in Scotland need more sophisticated systems to better manage medicines budgets and monitor what drugs are being prescribed, according to a report from Audit Scotland, the public spending watchdog.

The report, Managing the use of Medicines in Hospitals: Follow-up Review, states that while the NHS in Scotland is doing more to make sure that medicines are used safely in hospitals and to plan for new drugs, the health service now needs better information on how medicines are used to further improve patient care.

"Medicines need to be used cost-effectively and high-cost medicines are a particular pressure on budgets," said deputy auditor general for Scotland, Caroline Gardner. "The NHS has got better at planning for new medicines and it is doing more to promote cost-effective prescribing. But it needs better information on what medicines are being used to treat what conditions," she added.

According to the report, with better information, the NHS could further strengthen patient safety and cost-effective drug use – hospital prescribed medicines currently cost the NHS in Scotland £222m a year, which represents a 76 per cent increase on the £126m bill in 2002. However, progress in developing information systems to support medicines management and help improve patient safety in hospital has been slow.

A Hospital Electronic Prescribing and Medicines Administration system is unlikely to be in place in all hospitals in the short to medium term. In the meantime, NHS National Services Scotland (NSS) is piloting a national hospital medicines database to provide some information on medicines used in hospitals.

The NHS has better information for planning medicines budgets, but boards still identified gaps, the report states. The Scottish Medicines Consortium (SMC) has made good progress in providing boards with information to help them plan and now produces annual reports that include an estimate of the impact on budgets of new medicines.

However, NHS QIS does not routinely produce budget impact assessments for its clinical guidelines or technology appraisals. In addition, there is no current national strategy for pharmaceutical services and although in December 2008, the Scottish Government announced plans to develop a national action plan for pharmacy and medicines, the role of hospital pharmacy staff in medicines management has already increased significantly.

According to the report, hospital care is changing but workforce planning for pharmacy staff has not kept pace with developments, resulting in some boards having difficulty in recruiting and retaining staff.