Our team takes a look at the Scottish Genomics Medicine Strategy

In April, the Scottish Genomics Medicine Strategy was released. We’ve taken a look and our Policy and Influencing Team are sharing their analysis on what this means for bowel cancer patients in Scotland. 

We want to show that whilst genomics has the potential to improve the outcomes of people affected by bowel cancer, this can only be achieved with the right funding and structures in place. 

What is genomics and how does it relate to bowel cancer? 

Genomics is the study of a person’s complete genetic information (their genome) and how this influences their growth, development and functioning. In medicine, this information can predict a person’s risk, inform how best to personalise their treatment and more.  

For example, genetic testing helps to identify people with Lynch syndrome, an inherited condition that increases a person’s risk of developing bowel cancer to up to 80%. 

Genomics can also help clinicians decide which medicines are used to treat people with bowel cancer. One standout example is testing for the DPYD gene variant before starting bowel cancer chemotherapy as changes to this gene can increase a person’s risk of experiencing toxic side effects in certain treatment plans. 

As genomics is introduced into other areas it’ll produce a healthcare system that is better at predicting and personalising the treatment for people with bowel cancer, with the hope of improving health outcomes.  

What does the strategy say? 

The strategy describes the Scottish government’s vision for a person-centred genomics medicine service that will deliver timely, fair and high-quality care for a range of conditions, including bowel cancer. To achieve this, they’ve set out 13 strategic aims for developing genomics services across Scotland. These cover areas such as: 

• data and digital infrastructure 
• research and innovation  
• workforce education and planning 

This is all from the view that genomics is becoming a ‘core’ part of Scottish health care. However, for this to happen, current services need help in increasing their capacity and what they can achieve. This is to make sure that the correct resources are in place. To do this, the services need more funding so they can invest more into their work and do more on the day to day. 

What is our analysis? 

There’s a lot to like about this strategy. We support the vision of the strategy and appreciate that it recognises the need for developing these services. 

However, the phrasing of the actions and timescales is very broad and they don’t suggest any ways to measure performance. This could make it harder for the change to be effective.

Also, while the Scottish government does highlight that current arrangements are inadequate, they frustratingly do not change the way to fund the services. Instead, they admit to maintaining the commissioning model due to the ‘extremely challenging financial climate’ surrounding the strategy. This is disappointing as, unless the Scottish government closes this gap between ambition and funding, current genomics services will struggle to meet increasing demand.  

How will this impact the bowel cancer community in Scotland? 

The overall impact of this strategy on people affected by bowel cancer in Scotland depends on whether the Scottish government can put the resources in place to improve genomics services. 

We know that genomics has the potential to transform bowel cancer pathways by helping to identify and monitor those at a higher risk of bowel cancer, increase early diagnosis and personalise care. Yet, we also know from our recent report on Lynch syndrome that current Scottish genomics services are inadequate across the pathway. 

These issues can only be overcome by the government taking action for their ambitions. We therefore call on the Scottish government to commit to additional funding and structures to ensure that this strategy can be implemented effectively and the improvements be brought into reality. 

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