Prescription charges – time to abolish them

The Citizens Advice Bureau, together with organisations such as the Macmillan cancer charity are calling for the scrapping of prescription charges. They report that patients who need long term medication are endangering their health by not taking the drugs they need because they cannot afford to pay the prescription charges. They estimate that as many as 800,000 have not been getting the drugs prescribed for them. This group includes people with cancer, asthma and HIV, which are not on the list of exemptions from charges. The list apparently dates from 1968.

 

The government, fending off criticism about their reforms has often said that the NHS will continue to provide treatment “free at the point of delivery”. Yet not all treatment is free at the point of delivery. Unless you have direct or family experience, you may not know the fact that patients suffering from cancer have to pay for some of their treatment. For instance, if you receive chemotherapy intravenously in hospital you don’t have to pay. Yet usually a cocktail of drugs is taken in conjunction with the chemotherapy. For these the patient has to pay £7.10 per item. In fact, if the chemotherapy is in tablet form, you have to pay for that as well. Patients can buy a pre-payment card for £100 a year, but, of course, not everybody can afford to stump up the money up front. That people with life-threatening illnesses have to pay for their treatment is a scandal which should be brought into the open.

 

According to the government 88% of prescriptions are free but most of those are for children and for pensioners. In 2001 the government admitted that in the age group 18-59, 80% had to pay. According to the Observer they have declined to update these figures.

 

In July 2006 the Parliamentary Health Select Committee called on the government to review prescription charges. They promised to produce this in July 2007. When this deadline passed, it was announced that it would prepare a paper for the autumn of 2007; another deadline missed. Last week in the House of Commons Kevin Barron, chair of the Health Select Committee, ventured to ask when the long delayed paper would be ready. He was told it should be “some time this summer”.

 

Nobody should expect good news though, even if it is produced. The Department of Health said in a statement that:

 

“Prescription charges provide a valuable contribution to the NHS in England… Abolishing them would significantly reduce the money available to deliver other health priorities.”

 

Among those “health priorities”, of course, has been paying private companies for work they have taken off the NHS (paying them higher rates than NHS organisations receive for the same work). Moreover, these companies have been given guaranteed payment irrespective of the amount of work they have been contracted to do. Hence they have been paid money for operations they have not done!

 

Last year prescription charges raised for the Treasury £430 million. Frankly this is peanuts. Moreover, people in England see that it is possible for Wales and Scotland to abolish prescription charges, and ask why not here?

 

Explaining their abolition in Wales, Dr Brian Gibbons, Welsh Health Minister in a Labour/Plaid Cymru coalition, said:

 

“Making prescriptions free for all is a major part of our drive to reduce inequalities in Wales and make health services accessible to everyone.

 

Free prescriptions for all is the simplest and most effective way of resolving any inequalities and inconsistencies in prescribing. To introduce exemptions to certain groups would be complex to introduce and implement. Our proposals are straightforward and effective. This way everyone benefits, from the chronically ill to the low paid.

 

Research shows that many people are put off taking regular medication that would help them live healthier lives because of the cost of paying for regular prescriptions. If patients cannot afford the medicines they need to treat their condition, the long-term costs to the NHS could be far greater in terms of avoidable hospital treatment. Making prescriptions free for all is a simple way of addressing this issue.”

 

In Scotland the cost of prescriptions is being progressively decreased, with abolition in 2011. Nicola Sturgeon, Health Minister in the SNP minority administration, told the Assembly:

 

“The reason for that commitment is clear. This government believes that prescription charges are a tax on ill health. We also believe that they are a barrier to good health for too many people. The fact is more and more of us are living with long term conditions. Many of those long term conditions can, with the right support and medication, be self-managed by patients in their own homes, enabling them to go on enjoying a good quality of life. The problem is that many people with long term conditions that are not already exempt from charges simply can’t afford the right medication.

 

In October, I attended a conference organised by the Parkinson’s Disease Society. I spoke with sufferers of Parkinson’s disease who told me that they did not always take prescribed medication because they could not afford their prescriptions. Presiding officer, I believe that is unacceptable.

 

This government believes that people should not be penalised financially because they fall ill. They should not have to make choices about whether to obtain essential medicines. No-one should avoid seeing their GP because they know they can’t afford the cost of their prescriptions.

 

I want the NHS to help people make the choices that are good for their health and wellbeing. I also want the NHS to be true to its founding principle: the principle of healthcare free at the point of need. That was the principle espoused and defended by Aneurin Bevan. It is a principle that this SNP government – by abolishing prescription charges – will be proud to restore.”

 

What both these administrations have concluded in taking these decisions is that means testing and a list of exemptions is both a waste of time and resources. For the Westminster leaders of New Labour means testing is a central plank of their approach; supposedly directing resources to the ‘most needy’. In fact means testing wastes a fortune because of the complexity of the systems which the government has introduced. Universal services are simpler and cheaper.

 

The trades unions, including those whose members work in the NHS, should join forces with the CAB and Macmillan to demand that prescription charges are dropped and the cost covered by taxation. The government’s line has been that “those who can afford to pay should”. But the means test for benefits is a monumental waste of resources. Moreover, as the case of Working Tax credits shows, the system is so complicated that many people do not apply for it. Indeed it is estimated than more than £4 billion is not claimed by those who qualify for it.

 

That people who are seriously ill ask, as the CAB records, which of the drugs they are supposed to take, are most important, is a terrible indictment of the Health Service.

 

We should demand a return to universal provision and a return to a progressive taxation system, whereby the better off pay more tax to fund the NHS in an equitable fashion. £430 million is easily affordable. It is just a matter of priorities.