Scotland’s Trial Boom Hits a Standard of Care Trap

Scotland’s commercial trial participation rose 21% year on year, even as the country ranked 11th in Europe for access to new medicines. Michelle Conway, Head of External Affairs at ABPI Scotland, told an NHS audience those two facts belong to one problem.

She was speaking after the NHS Scotland Event on 21 September 2026 at the University of Strathclyde’s Technology and Innovation Centre in Glasgow. The ABPI lunchtime session was billed as Scotland at a Crossroads: Securing the Future through Health Research and Innovation. The point she carried out of the room is that a site which cannot offer today’s standard of care is a weak bid for tomorrow’s protocol.

First-in-Europe Recruits Meet an 11th-Place Access Rank

On 24 September 2026, Professor Dame Anna Dominiczak, Chief Scientist (Health) at the Scottish Government, Professor Alison Strath, the Chief Pharmaceutical Officer, and Fiona Cochrane of NHS Research Scotland set out the trial numbers on GOV.UK. Commercial studies in Scotland had grown, with participation up by 21% against the previous year, and Scottish sites had secured five European firsts and one global first for patient recruitment.

Conway, writing on 12 October 2026, cited the same session and the same fifth-or-so rise. Sponsors still score a country on speed of set-up, reliable recruitment, data quality, and the care patients already receive. That last test is the one the access tables fail.

The European Federation of Pharmaceutical Industries and Associations’ Patients Waiting to Access Innovative Therapies report, covering EMA approvals from 2021 to 2024 and relayed by ABPI in May 2026, put Scotland 11th of 36 countries, with 53% of those medicines available on the NHS. England ranked 7th, at 61%. For cancer medicines Scotland fell to 19th, at 48%, against England’s 14th place and 59%. The gap is eight points overall and 11 points in cancer.

SCOTLAND AND ENGLAND ON THE W.A.I.T. TABLE

Scotland is 15 days slower than England from licence to an access decision, at 347 days. Speed of the paper decision has improved on the previous W.A.I.T. set. Availability has not caught the trial story.

Four Centres Now Push Trials Into GP Surgeries and Homes

The hardware behind the 21% figure is a UK-wide Commercial Research Delivery Centre network, funded through the Voluntary Scheme for Branded Medicines Pricing, Access and Growth. Scotland has four CRDCs based in Glasgow, Aberdeen, Edinburgh and Dundee, in NHS Greater Glasgow and Clyde, NHS Grampian, NHS Lothian and NHS Tayside. GOV.UK counted them inside a UK network of 35 centres. NHS Research Scotland puts the Scottish share of the VPAG investment at about £40 million over five years.

Each centre is paired with a medical school and is meant to run a hub-and-spoke model, including Practice Embedded Research Units in GP surgeries and the Scottish Decentralised Clinical Trials programme, which moves visits closer to patients’ homes. Penicuik Medical Practice was the first PERU to open.

THE FIRSTS ALREADY ON THE BOOKS

• NHS Greater Glasgow and Clyde: Recruited the first patient in Europe to a study of a new treatment for children with haemolytic uraemic syndrome.
• NHS Tayside: Recruited the first European patient for a gastro-oesophageal cancer trial and opened its first gene therapy study.
• NHS Lothian: Opened its first investigational CAR-T trial within 60 days and recruited within 7 days of opening, at the Western General Hospital centre.
• NHS Grampian: Set up its first advanced therapy trial.

Those firsts sit inside a wider recruitment jump that NHS Research Scotland published on 19 May 2026 for International Clinical Trials Day. Scotland recorded 42% more recruits than in 2024, with non-commercial recruits 47% higher and commercial recruits 16% higher. Cancer trials took 4,008 people, the most since 2016. Diabetes trials took 12,535, three times any previous year. The 16% rise in commercial recruits is not the same statistic as the 21% rise in commercial participation; one counts people through the door, the other counts how participation moved.

THE RECRUITMENT MIX IN THE ICTD FIGURES

• All recruits: 42% more than in 2024.
• Non-commercial recruits: Highest number recorded, 47% higher than 2024.
• Commercial recruits: Highest number recorded, 16% higher than 2024.
• Diabetes trials: 12,535 people, three times any previous year.

Dominiczak said the country’s research community should be inspired by that picture of activity, and that the work had to keep going if treatment options were to improve. A separate triple-helix project with AstraZeneca, the Scotland Renal AstraZeneca programme launched in 2024 with the Universities of Glasgow and Dundee, has tripled recruitment to renal trials. About one in ten people in Scotland live with chronic kidney disease.

An Old Standard of Care Can Knock Scotland off a Study

Many protocols compare a new product with whatever patients would get now. If that comparator is last year’s medicine, or an older class the rest of Europe has already left, the site cannot run the arm the sponsor wrote. Conway’s warning is that missing the latest treatment does not only delay care after a licence. It can stop the next study opening at all.

Bringing clinical trials to Scotland and making new treatments available to patients are two parts of the same challenge.

Michelle Conway, Head of External Affairs, ABPI Scotland, after the NHS Scotland Event 2026

Sponsors also ask, for ethical reasons, whether the health service will use a product if the trial works. A board that cannot staff a new diagnostic, or cannot buy the companion test, is a board that may never see the follow-on study. Precision medicines that need a genetic test are the sharp edge of that problem, because the test has to exist in the pathway before the drug is a fair comparison.

Set-up time is the other half of the same due diligence. John Lamont, MP for Berwickshire, Roxburgh and Selkirk, said on 5 October 2026 that world-leading cancer research still meets delays getting trials open, and that cancer patients in Scotland should have the same chance to enter those studies. A country can post first-in-Europe patients and still lose the next protocol on a slow start or a thin standard of care.

The Horizon Board Tracks Drugs That Cost £500,000 a Year

Strath’s answer in the Glasgow session was earlier warning, not a bigger assessment committee. Scotland already has the Scottish Medicines Consortium for health technology assessment, with extra flexibility on rare and end-of-life drugs. What boards say they lack is time to change a pathway before the first eligible patient is in clinic.

WHAT THE HORIZON BOARD WATCHES

• The trigger: New medicines or new uses that could disrupt services or board finances, at a cost greater than £500,000 per year nationally.
• The window: Products that could reach the SMC within 18 to 24 months if a company submits.
• The feed: The SMC’s confidential Forward Look, plus reports on advanced therapy products.
• The job: Give boards, specialist services and diagnostic leads a chance to plan staff, tests and clinic time before a routine-use decision.

The SMC has run horizon scanning since 2005 and issues an annual Forward Look report each October to chief executives and directors of medicine, finance, pharmacy and public health. A product is treated as high impact if the net medicines bill is expected to top £500,000 a year across NHS Scotland, or if it will force a major service change. HSAB sits on top of that report. It does not replace the SMC vote. It is supposed to stop a yes arriving as a surprise.

GOV.UK also said work is under way on a more formal national medicines readiness function, so that adoption is not left to 14 separate board arguments after the committee has spoken. That function does not yet exist as a finished operating model.

How Health Boards Pay After the SMC Says Yes

SMC advice is national. The invoice is local. Boards still hold their own medicines budgets, and Conway was plain that money and staff are already tight. A new product can need extra clinic slots, a companion diagnostic, different pharmacy handling, or training that research nurses then have to absorb on top of trial visits.

That is why the same people who recruit first-in-Europe patients can still delay a drug the SMC has accepted. Formularies are being pushed toward regional consensus, rather than 14 slightly different lists, but the cash still sits in board accounts. Industry’s ask, in Conway’s piece, is earlier notice of what is coming, so the NHS can price the test and the staff before the licence lands.

Professor Jann Gardner, chief executive of NHS Greater Glasgow and Clyde, argued at the session that research should be how the NHS trains people and improves services, not a side project that gets cut when the winter roster frays. Trial teams are often the only staff who have already given a product. If those posts go in a savings round, the next commercial study has nobody to open it.

None of the Glasgow speakers claimed adoption is easy. They argued that trial income, early access for patients, and later avoided care should be counted as an investment. That is a budgeting claim, and boards living through this year’s close will treat it as one.

Sponsors Still Ask Whether the NHS Will Use the Medicine

Conway listed four things companies weigh before they place a study. They are not a slogan. They are the scoring sheet a feasibility team actually fills in.

WHAT A SPONSOR SCORES ON A SCOTTISH SITE

• Set-up speed: How fast approvals, contracts and pharmacy release a first visit.
• Recruitment: Whether the site can find the patients it promised, including outside teaching hospitals.
• Data quality: Whether records and samples will stand up in a filing.
• Standard of care: Whether the comparator arm matches the protocol, and whether the system will use the product if it works.

Scotland’s integrated NHS is supposed to help on all four, because primary and secondary care sit in one service and the four CRDCs are sold as a once-for-Scotland front door. The W.A.I.T. rankings are the rebuttal a company can read before it ever phones Glasgow. A cancer medicine available to 48% of the licensed population is a weak signal that the follow-on product will be used.

Industry has a part in that signal. Conway said companies should share pipeline information earlier, so boards can see the diagnostic and the staffing need while the trial is still running. HSAB only works if that information is real, and if boards have cash to act on it.

Scotland Can Gather the Right People in a Room

Conway’s closing pitch is that Scotland is small enough to put the chief scientist, the chief pharmacist, a territorial board chief executive and industry in one hall, as they were on 21 September 2026. Over the next year she wants three habits: joined-up planning so pipeline knowledge shapes tests and pathways before patients need them; protected research posts, including the nurses who make recruitment possible; and better use of data on how medicines perform once they are in routine care.

The measure she set is not another European first. It is whether patients across the country get what the trials produce, once the last visit is done. The 21% participation rise and the five European firsts show the research door can open. The 53% availability rate, and a standard of care that can fail a protocol, show how quickly that door can close again.

A national readiness function is still only under consideration. Until it exists, the people who already sit together in Glasgow are the ones who have to make a yes from the SMC look like a comparator a sponsor will accept.

Disclaimer: This article is news reporting and analysis of clinical research policy and NHS medicine access in Scotland. It is for information only and is not medical advice, and it does not recommend any medicine, clinical trial, or treatment choice. Anyone thinking about joining a trial or starting a new treatment should speak with their own doctor or another qualified clinician who knows their case. Recruitment counts, availability percentages and waiting times reflect the official and industry figures cited here and can change when later data is published.