Access to treatment

Some bowel cancer treatments haven’t been approved for use on the NHS (in England, Scotland and Wales) or the Health and Social Care service (in Northern Ireland).

After a treatment has been tested through a clinical trial, it is reviewed by the Medicines and Healthcare Products Regulatory Agency (MHRA). They decide what the treatment should be used for and the correct dose. This process is known as licensing. After a treatment is licensed, it still needs to be approved by other organisations before doctors can prescribe them:

• The National Institute for Health and Care Excellence (NICE) in England and Wales 

• The Scottish Medicines Consortium (SMC) in Scotland 

• The All Wales Medicine Strategy Group (AWMSG) in Wales 

• The Department of Health in Northern Ireland  

Your healthcare team can apply for funding for a treatment that is not approved if you both agree that you would benefit from it. They will have to show that your circumstances are exceptional.

This page describes the application process for each nation in the UK. 

England

The National Institute for Health and Care Excellence (NICE) reviews all new cancer drugs and makes recommendations for their use on the NHS. They will give one of five recommendations: 

• Recommended for use on the NHS 

• Not recommended for use on the NHS 

• Recommended for use in research studies  

• Optimised recommendation – this means that the treatment is recommended for a specific group of patients  

• Recommended for use in the Cancer Drugs Fund 

If a treatment is approved for use in the Cancer Drugs Fund (CDF) it may be made available to treat patients while NICE does more research. The treatment will be available through the CDF for up to two years. After this, NICE will make a final recommendation on whether the treatment can be approved for use on the NHS. 

A list of the treatments funded by the CDF can be found on NHS England’s website. This provides details what type of cancer and the stage at which the treatment can be used. Your healthcare team can submit an online application if the drug is suitable for you.

If a treatment is not provided by the NHS in your area, or is not available through the CDF, your healthcare team may submit an individual funding request (IFR) for you. To do this, your healthcare team will need to provide information about you and provide reasons explaining why this treatment may be helpful

Scotland

The Scottish Medicines Consortium (SMC) decides whether treatments can be made available on the NHS. They will give one of the following decisions: 

• Accepted  

• Accepted with a restriction – this means that the treatment is recommended for a specific group of patients 

• Not recommended 

• Accepted on interim basis – this means that the treatment can be used while the SMC does more research 

If you and your healthcare team think you would benefit from a treatment which that has been reviewed by the SMC but is not recommended, or the treatment is to be used in a different way to the SMC approval, your specialist can submit a Peer Approved Clinical System (PACS) request to your local NHS board.

For other treatments that have not been reviewed by the SMC, your healthcare team may submit an individual patient treatment request (IPTR). Your healthcare team will discuss this with you.  

If this request is not accepted, your specialist can ask for the decision to be referred to the National Review Panel.

Wales

NICE decides whether to recommend a treatment for use on the NHS. If NICE hasn’t made a decision, the All Wales Medicines Strategy Group (AWMSG) will decide whether to make the drug available on the NHS. This decision could be changed if NICE produce guidance in the future.

Your healthcare team can apply to your local health board for a treatment that hasn’t been approved, if you both agree that you would benefit from it. This is called an individual patient funding request (IPFR). Your doctor will need to provide information about you to show that you and provide reasons why they believe you would benefit from the treatment.

If the request is not accepted, your healthcare team can ask for it to be reviewed.  

Northern Ireland 

The Department of Health makes decisions on what treatments Health and Social Care can use in Northern Ireland. They review decisions made by NICE to decide whether treatments are suitable for use in Northern Ireland.

If a treatment isn’t available through Health and Social Care, your healthcare team can apply to the local health board for you to have it. This is called an individual funding request (IFR).

If the request is not accepted, your healthcare team may submit further evidence or ask for it to be reviewed by another panel. 

Support for you 

Applying for treatment funding can be a difficult process and it’s not always successful. If your request is turned down, you may find the decision difficult to cope with. Macmillan Cancer Support has information on what you can do if a treatment is not available.

Clinical trials sometimes offer the opportunity to have a treatment that is not yet routinely available. Further information on clinical trials is available on our clinical trials webpage.

 

Updated November 2025 

Next review November 2028