The Politics Show Scotland
The National Health Service has record amounts of money but doctors are always having to make tough life or death choices about how it is spent. Is NHS rationing about to get worse?
Take the case of Mike Gray from Buckie. He is 52-years-old and has bowel cancer. He has been told he is dying with months to live.
He believes there is one drug, Cetuximab, that could help prolong his life.
But the Scottish Medicines Consortium has not approved this drug and as a result, NHS Grampian will not pay for it.
So he is scraping together the cash from family and friends.
With tighter NHS budgets in the coming years - Mike's story could become a lot more common.
Mike tells the Politics Show: "It is a drug that has a one-in-four chance of extending my life.
"We're paying for it as a family through my 86-year-old mother, my 97-year-old mother-in-law and other family members and ourselves.
"It's about £3,600 for each cycle of the drug - that comes to abut £12,000 for the treatment."
This is one individual's story - but could it become one that we hear more often?
By the end of this financial year, over £65bn will have been spent on health in Scotland since devolution.
Scotland is still ahead an estimated £2,000 a year per person - compared to England at around £1,800.
But England is catching up.
In the Scottish budget, health went up by 1.4% in real terms but in the Comprehensive Spending Review - spending went up by 3.9% in England.
So with a tighter than expected UK budget settlement and a smaller pot of money available across all services - how will the NHS cope?
Patients representatives believe it is perfectly reasonable for them to have high expectations of the national health service.
Dr Jean Turner, Scotland Patients'Association says: "They know what treatments are out there and they expect to get it in on the NHS.
"When it happens to you, you expect to get it.
"Yes they know they are going to be cut but they don't want to see themselves cut."
The Scottish Medicines Consortium makes decisions about which drugs are viable - but they have to draw the line somewhere.
Dr Ken Paterson of the Scottish Medicines Consortium says: "Any decision we make that allows a drug to be used always brings with it an opportunity cost.
"The fact that something else will not happen in the health service if we spend it on that drug.
Will drugs like Cetuximab eventually be made available through the NHS?
"The same issues apply in everything else the health service does. We cannot do everything that we possibly could do and it makes sense to look to see the things we're doing are giving us the most health gain the most improvement for patients that we can possibly get for the money that we're spending."
Other areas of the NHS face tough choices.
Dr Ken O'Neill practices in Glasgow's Ibrox Health Centre.
Some of his patients live in some of the poorest areas in Scotland and face problems of health inequality.
He says money alone is not the answer: "If we remain a sickness service that always responds to people being unwell the demand will always be there and just get bigger and bigger for us.
"We need to be thinking more about being a health service - a well service that works to help people remain well."
Professor Sir John Arbuthnott, the outgoing chair of NHS Greater Glasgow and Clyde, which is the country's largest health board says the money since devolution has been well spent but it may be time for a wider debate on priorities.
"People pay tax and the fundamental basis of the NHS is that the delivery of that service is through taxation and should be free at the point of delivery.
"That already is an over simplification as we can't deliver our services in NHS Greater Glasgow or anywhere else without fantastic co-operation from patients, their families and their carers and volunteers... There is a complicated compact."
Mike fights on
For Mike and Tina, the fight goes on
Mike Gray and his wife Tina will continue fighting his cause for NHS funding.
NHS Grampian has taken the Scottish Medicines Consortium's advice not to fund the drug but they have told Mike that they do have a mechanism in place to consider exceptional cases.
If it can be shown that the clinical circumstances of a particular patient may benefit more from the treatment than could normally be expected, funding can be made available.
Mike celebrates his 53rd birthday tomorrow. But for his family and him, this is about the here and now.
"I would like my friends to be able to not to have to contribute to private health care when they think it's an appalling position to be put in and I would like the Chief Executive to understand the human side of the decisions that he and his health board are making."
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