Commissioning in Scotland

The population of Scotland is approximately 5 million (less than one-tenth that of England), and NHS Scotland takes a different approach to commissioning: specialist services are provided through its National Services Division (NSD). As in England, commissioning services for people with rare disorders aims to ensure equal access and optimise outcomes by securing funding, avoiding duplication and preventing excessive costs falling on an individual health board. Which services qualify for specialist status is determined by a national designation process.

Haemophilia services are commissioned at a national level from six haemophilia treatment centres (in Aberdeen, Dundee, Edinburgh, two in Glasgow and Inverness). On their behalf, NSD manages funding for clotting factor concentrates through a risk sharing agreement (details are not currently available online). The six centres work to a common protocol that specifies the provision of home delivery of factor concentrates, data management, stock management in hospitals and product administration procedures. These standards are set by the Scottish Inherited Disorders Bleeding Network (SIDBN), one of several national managed clinical networks in Scotland. SIDBN has responsibility for the care of people with haemophilia A, haemophilia B, von Willebrand disease, acquired haemophilia and other related bleeding disorders, and other rare forms of inherited bleeding disorders. It has three work streams: stakeholder engagement and communication; best practice, policies and protocols; and quality improvement, audit and data. However, online information is either out of date or not available.

The Scottish Medicines Consortium (SMC) is responsible for appraising new medicines for NHS Scotland. Factor replacement therapy normally falls outside the SMC’s remit, but it has the option of assessing a new technology if health boards need to know whether it is cost effective.