We are now just over two years away from the next general election and political parties are starting to develop their manifestos.
In this age of austerity, Deputy Prime Minister Nick Clegg’s team has already identified “alarm clock Britain” as a key demographic in need of help – these are the basic rate taxpayers who get up early, take their children to school and then go to work only to find their living standards squeezed by current economic circumstances. If Liberal Democrats are indeed committed to helping this section of the population, they need look no further than delivering reform on prescription charges for people with long-term conditions.
The phrase ‘long-term condition’ is used to cover a variety of chronic health conditions that usually persist for a period of at least six months and require continuing management which often (but not always) includes management with medication. Many long-term conditions strike indiscriminately, affecting people of working age who would describe themselves as being intrinsically part of the ‘alarm clock Britain’ demographic.
According to the Government’s own figures, over 15% of people aged 20-29 have one or more long-term conditions, rising to 40% in those aged 50-59. This is a significant proportion of the working population who not only have to contend with the daily grind and declining living standards, but also have to deal with a serious health problem on top – and the additional financial penalties that come with this.
The Coalition Government recently announced that from 1st April 2013, it will cost £7.85 per NHS medicine prescription. This may not sound like much, but it soon adds up if you do not qualify for an age-related, medical or income-related exemption. To be clear, these are people who already pay National Insurance contributions and now suddenly and unexpectedly need help from the NHS only to find that popular NHS mantras of ‘free at the point of delivery’, ‘available to all’ and ‘based on clinical need rather than ability to pay’ do not apply to them.
Prescription charges today are 8 times higher, in real terms, than they were 30 years ago. The latest rise is up from £7.65 last year and is in keeping with a tradition that has seen charges rise every year since 1979. We are not just talking about medicines to keep people well, but to prevent an exacerbation of symptoms that could prove fatal, such as a serious asthma attack.
Why are we bothering to flag this to readers of Liberal Democrat Voice? Because the party has a strong track record on trying to tackle these sorts of health inequalities: from the 2010 manifesto commitment to reform payments to GPs to encourage them to accept patients from areas with the worst health and deprivation scores, right through to the recent announcement by Health Minister Norman Lamb over the intention to cap care costs at £75,000.
The Prescription Charges Coalition – a group of over 20 leading charities and organisations is therefore calling on the Liberal Democrats to address this fundamental inequality by committing to delivering free prescriptions for people with long-term conditions, and dumping the unfair list of selective exemptions that was drawn up in 1968, and remains Department of Health policy to this day.
Our new report Paying the Price makes a powerful case for reform. We surveyed almost 4,000 people with long-term conditions that are not exempt from prescription charges, and found of those who paid for their prescriptions but did not have a Prescription Prepayment Certificate (a pre-pay card which provides free prescriptions for an up-front charge of around £100 a year) 35% had been issued a prescription medicine for their condition but not collected it from the pharmacy because of the cost.
Among these respondents, 72% reported their health deteriorated after failing to take medicine as prescribed, with 40% needing to go back to their doctor. Worse still, 10% said that they ended up in hospital as a result of not taking their medication.
Those who are not hospitalised also pay a heavy price for their essential medication. Our research tells a moving story of the impacts that prescription charges have on society and people’s health. Respondents told us they borrow pills from family members, do not go to work in order to save petrol and face the heartbreaking choice between their medicine and paying for food, new clothes and bills.
The Office for National Statistics recently reported that “In 2011, 36.6% of people felt that they would be unable to meet an unexpected but necessary financial expense”. This means that almost a third of the British public could find themselves similarly torn between food and medicine, if they were faced with the “unexpected but necessary” expense of a long-term condition diagnosis.
The Prescription Charges Coalition came close to achieving its aim when the last Labour Government recognised the inequality of this system, and commissioned Professor Ian Gilmore to investigate into how the system could be improved. Unfortunately his recommendations were not taken forward by the Coalition Government.
With manifesto planning now starting, we hope the Lib Dem leadership will listen to our calls and deliver reform that would be truly priceless for those with long-term conditions.
Paying The Price is available to download here.
‘The Independent View‘ is a slot on Lib Dem Voice which allows those from beyond the party to contribute to debates we believe are of interest to LDV’s readers. Please email [email protected] if you are interested in contributing.
* Jamie Hewitt is Government Affairs Manager of the National Rheumatoid Arthritis Society and writes on behalf of the Prescription Charges Coalition
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7 Comments
Good call. You don’t have to earn very much to go from free school meals and free prescriptions to neither, and the principle of making work pay demands that we do something about this cliff edge.
It is also worth noting that some of the drugs prescribed will cost the NHS less than £7.85, so in these cases we really are charging somebody for being ill. In these days of unsafe medicines available on the internet, there’s a strong argument to make the prescription charge a cap rather than a flat fee.
There are any number of perfectly valid, well thought out cases for additional government expenditure like this. In a fair world, we should not be charging prescription fees in England to anyone except perhaps at a minimal level. However, the report, as far as I can see, makes no attempt to estimate the actual cost of this to the UK government, nor does it say where the extra money can be found.
Unless anyone can suggest precisely how the money can actually be obtained at a time when we are struggling to cut the deficit, we won’t be able to proceed with vital expenditure like this. Everyone in the UK wants a Scandinavian, social democratic type of society, but as soon as you propose that they, themselves, actually pay more taxes to achieve it, they run a mile.
We surveyed almost 4,000 people with long-term conditions that are not exempt from prescription charges, and found of those who paid for their prescriptions but did not have a Prescription Prepayment Certificate (a pre-pay card which provides free prescriptions for an up-front charge of around £100 a year) 35% had been issued a prescription medicine for their condition but not collected it from the pharmacy because of the cost.
I am not clear from the article why the Prescription Prepayment Certificate isn’t the answer to the problem. It costs £29.10 for three months. It saves money if more than three prescribed medicines are needed within a three month period.
There are other changes I would much rather see in prescription charges. Currently a small number of people pay quite a lot (i.e. £7.65 currently) for prescriptions. If you are over 60 (even if you are in work, or are retired on a pension of £20,000 or £30,000 a year) you get completely free prescriptions.
Wouldn’t it be fairer if a much lower charge (say £3.00 per item) were payable by most people?
As the cost of a Prescription Prepayment Certificate would reduce proportionately (to around £11.50 or a three month PPC) this alternative would do much to address the concerns of the Prescription Price Coalition.
” of those who paid for their prescriptions but did not have a Prescription Prepayment Certificate (a pre-pay card which provides free prescriptions for an up-front charge of around £100 a year) 35% had been issued a prescription medicine for their condition but not collected it from the pharmacy because of the cost.”
OK, but everyone is entitled to a pre-pay card that wants one, and if you have a long term condition then the charges are predictable. And actually the “up-front charge of £100 a year” isn’t accurate. You can get a three month card for £29.10, or you can pay for the annual card in ten monthly installments, by direct debit.
And, there’s a wide range of exemptions from prescription charges (income < £16,000, receipt of job seekers allowance or universal credit, or income support, and so on).
I myself am in work., and have a pre-payment card, which I regard as extremely good value for money, and it also makes each visit to the pharmacist quicker and easier. I could see an argument for increasing the exemption threshold. I could also see a case for *requiring* GPs, hospital doctors, and pharmacists to tell patients about pre-payment cards when they first issue pre-payment cards. Neither my consultant nor my GP told me about the card, my pharmacist did, but only when my number of prescriptions had risen well above the value threshold (which is roughly at a single 28 day repeating prescription). So, I support the third recommendation.
The report's first recommendation is to exempt people with long term conditions through "a staged reduction in the cost of the Prescription Prepayment Certificate until charges are phased out altogether." But this could not work as proposed. There's no test to obtain a a PPC – anyone can buy one. So the effect would be to eliminate prescription charges altogether, but through a mechanism which would mean that prescriptions were free, but only for people who knew that they could get them free.
Of course, it might be that we are supposed to assume that the free PPC was only available to people with long term conditions – but that would require some soft of test, and would paradoxically make them harder to obtain. And, it would also mean lifting the cap on prescription charges for people who were no longer entitled to obtain them. The recommendation here should be for an extension to the (5 year) medical exemption certificate scheme: perhaps allowing GPs to sign forms for anyone with a long term condition.
So, the first recommendation is nonsense: instead we should either eliminate prescription charges for everyone by bringing both the cost of individual prescriptions and PPCs down, or we should help people with long term conditions by widening the exemption scheme.
I do agree with the idea of longer term prescribing (the second recommendation), and I'm pleased to be able to say that does seem to be available to me. I have six regular repeat prescription medicine, and two irregular (which might need once or twice a year). I place my orders online, and get 56 days of three of the meds, 60 of another, but only 33 days of the others. I organise my tablets into 7-day dispensers, and that makes the 60 day prescription is as tricky as the 33 day ones. I'm plan to ask to get them all on 56 day prescriptions – so that I only have to make one regular visit to the pharmacist. Of course, longer term prescribing would mean that fewer people would benefit from a PPC, because they'd pay fewer charges in a year (a 56 day prescription costs the same as a 28 day prescription).
Their fourth and last recommendation is that people on Universal Credit should retain entitlement. This recommendation does appear to have been implemented: http://www.nhs.uk/NHSEngland/Healthcosts/Pages/Prescriptioncosts.aspx
This article fails to point out that the “medical exemption” it mentions in passing means that many long-term conditions already entitle the person affected to free prescriptions for all drugs, not just the ones which are pertinent to their long-term condition. It also only barely mentions that people on low incomes are exempt from prescription charges. It does at least mention the prescription card which caps prescription charges at £104 per year, though it claims that it has to be paid for “up front” whereas you can purchase one and pay monthly.
It is also categorically untrue that people will “now suddenly and unexpectedly” pay for prescription charges, as these charges have existed for decades as the article contradicts itself by making clear.
There is an argument over whether certain conditions which are not currently exempting should be recategorised, but we’d need a much more even-handed and factual article than this one to debate that.
PS, Joe is right that some drugs cost less *wholesale* than the prescription charge, but I don’t think that’s relevant unless we’re considering recharging a proportion of the real cost. That would make for a much more complex system, which might encourage patients to select less effective treatments because they’re cheaper in the short term, even though that might imply more cost further down the line.
Good article. I can remember when prescriptions, eye-tests and dental care were free at the point of delivery. For that matter, higher education was also free at the point of delivery. We hear a lot of propaganda nowadays about how Britain was some kind of socialist nightmare in the seventies but I think our country was a better one in those days. Each individual was valued by the state and by society. There was an acknowledgement that all people are entitled to good health and good education. Nowadays, we are increasingly having to pay more for our healthcare and our education. I assume that anyone who thinks prescriptions should have to be paid for also thinks that that prescriptions should be chargeable throughout the UK.