The UNISON Scotland Submission To the Scottish
Parliament's Health Committee on their call for Written Evidence
on the Abolition of Prescription Charges (Scotland) Bill
Scottish Parliament Health Committee
Call for Evidence: Abolition of Prescription
Charges (Scotland) Bill
UNISON Scotland welcomes the opportunity to respond
to the call for written evidence from the Scottish Parliament's
Health Committee on the Abolition of Prescription Charges (Scotland)
UNISON Scotland has over 150,000 members in Scotland
and in particular, over 50,000 employees in NHS Scotland, many
of whom work in GP surgeries, health boards and agencies, such
as Prescription Pricing.
UNISON Scotland supports the abolition of prescription
charges, as we believe them to be inherently unfair, inequitable,
illogical and inconsistent.
UNISON Scotland believes in a National Health Service
based on the ideals of a public service for healthcare which is
free at the point of delivery and accessible to all. These are
the principles which have underpinned the NHS over 50 years and
should still be the principle on which the current NHS is based.
Impact on People on Low Incomes
The current system of prescription charges is unfair
in that it adversely affects many more people on low incomes and
in chronic ill health. These are the people who find themselves
unable to afford the medicines they are prescribed.
There are believed to be approximately 75,000 prescriptions
in Scotland that are not dispensed each year, due to rises in
the costs of prescriptions. According to evidence from the Citizens
Advice Bureau this situation increases in line with every rise
in the charges. From April 2005 the situation was set to deteriorate
further as changes to incapacity benefit meant that many recipients
would no longer quality for an income support top-up and as a
result would no longer quality for free prescriptions.
Seriously ill people who have mistakenly claimed
for free prescriptions they believed they were entitled to, and
are currently being caught in an NHS crackdown on cheats will
also be affected by the changes to incapacity benefit which will
cause greater confusion over their eligibility to exemption from
Although children are exempt from prescription charging,
as are various adults on Income Support, in receipt of Child Tax
Credit, etc., the Child Poverty Action Group points out that the
current system disadvantages a significant number of working poor
families with inevitable effects on their children.
Impact on Health
Over a number of years, five separate studies of
the effects of charging for prescription medicines have concluded
that increases in prescription charges lead to a decrease in the
uptake of prescribed drugs. These and other studies have concluded
that when patients do not take their prescribed medicine, this
leads to deterioration in their health and can cause extra costs
to the health service with admission to hospitals and emergency
treatment. These studies are supported by anecdotal evidence from
our members working in health centres and community settings.
This is particularly relevant in treating coronary
heart disease and strokes, the two biggest killers in Scotland.
A greater take-up of medication could play an enormous part in
saving Scottish citizens from the worst effects of these two diseases,
which have a greater prevalence amongst lower income groups.
Other groups particularly vulnerable are those suffering
from mental health problems. Whilst in hospitals, these patients
have their medication freely available, but on release, there
are no funds available to ensure that they can afford vital medicines,
even if subject to a Compulsory Treatment Order.
The current system is seen as illogical as there
many life-threatening diseases not given exemption, whilst lesser
acute conditions are included. Prescriptions for conditions such
as chronic heart disease, arthritis, asthma, cancer, including
chemotherapy drugs taken in the community, MS, Chronic Leukaemia,
Glaucoma, Hepatitis C, HIV/Aids, etc. all have to be paid for.
There is an added problem in that many of these conditions require
multiple prescriptions to treat patients and many are life threatening
and lifelong. Some of the multiple-drug treatments must be taken
in combination with each other and if this relationship is broken,
the treatment can be rendered ineffective. The Scottish Executive
is planning a review of the current system, which will include
an assessment of the exemption and remission lists.
The current prescription charge can be seen as inefficient,
as the cost of the drug is often lower than the cost of the prescription
and the drug is often available over the counter, without prescription.
However, GPs are not allowed to recommend that a patient could
purchase the item cheaper from their local chemist, even when
it would save them money, or issue them with a private prescription,
for which they would only pay the cost of the medicine.
Most people in Scotland do not have to pay for their
prescriptions. Statistics for Scotland show that at present, whilst
80% of 18 to 60 year olds pay for their prescriptions, 91% of
all prescriptions are provided without payment. If as a result
of the Executive's review, the list of conditions exempted from
payment were expanded, this figure would rise. The current income
from prescription charges in Scotland was £46m last year, only
6% of the total drugs bill. UNISON Scotland believes this is not
a hugely significant sum and that the Executive should consider
it well worth spending to increase the health of the nation.
The gap in funding could be bridged by a radical
approach to tackle the ever-rising drug bill. Drug companies make
a lucrative income from NHS Scotland and much of the additional
government cash for the Health Service is being swallowed up by
rising drug costs. Pressure sales techniques on doctors have been
well documented and UNISON Scotland particularly supports the
"No Free Lunch Organisation" that campaigns for greater
openness in the contacts between the medical profession and the
drug companies. Nursing staff are now being subjected to these
pressures, since the introduction of nurse prescribing in 2002.
There is also a current project being carried out by the Scottish
Executive which looking at a streamlined procurement strategy
and if this is applied to the procurement of drugs across Scotland,
there would be considerable savings which would cover the cost
of the free prescriptions.
During the original consultation on the Bill, several
alternative approaches were suggested, including: extension of
exemptions on grounds of chronic illness; exemption based solely
on the ability to pay; different charging methods, such as part
payment, based on value of the item, paying for first two items
a month, with the rest exempt, reduce the current level of charges,
and the payment of a standing amount per month for prescription
UNISON Scotland agrees that extending the list of
exempted conditions would be an improvement on the current situation
and would reduce some of the anomalies in the current system.
However, it believes that even adding a small number of chronic
illnesses to the list would reduce the amount of revenue collected
to a level where it would not be financially viable to collect
and we do not believe this on its own would solve the problems
Likewise, we believe that charges based on the ability
to pay would be cumbersome to administrate and would not take
account of the number of drugs needed by patients and again, would
not solve other problems outlined above.
Other charging methods would also assist with some
of the problems outlined. As an example, a weekly or monthly standing
charge for pre-payment would mean that the annual or quarterly
charge was more easily afforded by those on low incomes. Administration
costs would, however, be complicated and there would still need
to be exemption of certain groups of people in addition to these
Whilst UNISON Scotland would support most of these
alternatives and believe they would improve the levels of take-up
for many people, we do not believe that any of them by themselves
would eradicate the deficiencies of the current system.
UNISON Scotland believes that the Scottish Parliament
should follow the example of the Welsh Assembly and bring forward
a programme to abolish all prescription charges in Scotland.
In the event of a successful passage of this Bill
into law, we would wish to seek assurances that staff employed
in Prescription Pricing would be consulted over any changes to
their jobs and be given adequate retraining over changes to their