NHS Prescription Charges
Review of NHS Prescription Charges and Exemption Arrangements
- The UNISON Scotland Response
April 2006
Executive Summary
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UNISON Scotland supported the Abolition of
Prescription Charges (Scotland) Bill as we believe prescription
charges are inherently unfair, inequitable, illogical and
inconsistent. We outlined our reasons in both written and
oral evidence to the Scottish Executive Health Committee.
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UNISON Scotland does not believe that the
issues we raised then have been taken into account in this
Consultation document.
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UNISON believes that the current system of
prescription charges is unfair in that it adversely affects
many people on low incomes and in chronic ill health. These
are the people who find themselves unable to afford the medicines
they are prescribed.
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Most people in Scotland do not have to pay
for their prescriptions. If as a result of the current review,
the list of conditions exempted from payment was expanded,
even less people would have to pay, and the amount raised
from paid prescriptions would be negligible.
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UNISON Scotland believes the age thresholds
should be extended to cover all persons up to the age of 24,
but certainly, students of any age, in full time education
or training should not have to pay prescription charges.
Introduction
UNISON Scotland welcomes the opportunity to respond
to the Scottish Executive Consultation on the Review of NHS Prescription
charges and Exemption Arrangements.
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 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.
UNISON Scotland supported the Abolition of Prescription
Charges (Scotland) Bill as we believe prescription charges are
inherently unfair, inequitable, illogical and inconsistent.
We set out below the some of the evidence that we
gave in the Call for Written Evidence to the Scottish Parliament
Health Committee, which was reiterated by Glyn Hawker, Scottish
Organiser (Health) of UNISON when she gave evidence to the Health
Committee.
UNISON Scotland does not believe that the issues
we raised then have been fully taken into account in this Consultation.
Written Evidence to Previous Bill
Impact on People on Low Incomes
UNISON believes that the current system of prescription
charges is unfair in that it adversely affects many 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 qualify 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
have been 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 the charges.
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.
Inefficient Prescribing
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.
Funding
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 current review, the list of conditions exempted from payment
was 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 spent to increase the health of the nation.
We accept that the cost of abolition would be higher
than this figure, due to the increased take-up of prescriptions.
However, we do not accept the inference in the consultation document
that there would be a huge increase in people seeking additional
consultations and prescriptions from their GPs that they would
not normally have bothered about. The figures set out in item
8 of Annex C are complete supposition, and are not evidence-based.
We still believe that 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 project being carried out by the Scottish
Executive which is looking at a streamlined procurement strategy
and if this was applied to the procurement of drugs across Scotland,
there would be considerable savings which would cover the cost
of the free prescriptions.
Consultation questions
UNISON Scotland believes that the Scottish Executive
should agree to the abolition of all Prescription Charges. We
are not in favour of differentiating between the "deserving"
and "undeserving" sick.
We firmly believe that the current system cannot
remain as it is. We agree that there are ways in which the current
system could be improved and that in the absence of abolition,
some of the changes outlined in the consultation document should
be introduced.
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Review of Exemptions related to Medical
Conditions
There is definitely a case for a review of the
list of conditions to be undertaken. There are many anomalies
in the current list which do not cover the main chronic diseases
experienced by many Scottish people. These would include cancers,
heart and stroke problems, arthritic conditions, mental health
problems, in addition to many more. We believe that to change
the current regulation on exemptions which covers all of the
drugs needed by an exempted person, whether or not they relate
to the original condition would be overly bureaucratic to implement
and at a time when the current public opinion is for prescriptions
charges to be abolished, could be seen as mean spirited. As
other conditions for which medication is required, can be caused
by the prior, chronic illness, it would be very difficult to
know when to draw the line and could lead to different anomalies
which would equally disadvantage patients.
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Economic Need - Affordability
UNISON Scotland supports any measures which would
extend charge exemption to more people, especially those on low
incomes.
UNISON Scotland supports a wider choice of payment
for Pre-payment Certificates. The proposals set out are all viable
options, but should be introduced alongside the current scheme,
not to replace it. There are some people who are happy with the
current scheme, and measures to widen the range of payment options
would increase the range of choices which would suit other users.
UNISON Scotland believes that the measures in the
Sections CP7 - CP9 have some merit, but are overly complicated
and require increased staffing to oversee these additional procedures.
3. Ability to Pay
UNISON Scotland believes the age thresholds should
be extended to cover all persons up to the age of 24, but certainly,
students of any age, in full time education or training should
not have to pay prescription charges.
