Background



The basic NHS prescription charge for patients in England from April 2006 is a flat-rate fee of £6.65 per item.  This is not intended to reflect the economic cost to the NHS of the drugs, many of those that are prescribed being considerably more expensive.



There is also a wide range of exemptions from prescription charges.

These include:

• Children under 16 years of age



• Full time students aged 16, 17 or 18



• Anyone aged 60 or over



• War pensioners with a valid certificate



• Anyone in receipt of Income Support or income-based Jobseekers Allowance



• Anyone with a partner in receipt of Pension Credit Guarantee Credit



• Anyone with one of a range of exemption certificates

Certain medical conditions also entitle a patient to exemption.

These include:

•   Permanent fistulas (caecostomy, colostomy, laryngostomy etc)



•   Diabetes



•   Hypoparathyroidism



•   Myasthenia gravis



•   Myxoedema



•   Epilespy, requiring continuous anticonvulsive therapy



•   Physical disabilities hampering mobility

Discounts are available for patients requiring longer courses of medicines, via "Prepayment Certificates". A patient must demonstrate that he or she falls into an exempt category by means of an entitlement claims procedure.

Issues / Events

The founders of the NHS regarded the concept of charging as contradictory   to the notion of a service "free at the point of use", but today they are widely accepted as necessary.

Nonetheless, the system is not without its critics.

• In 2002, the Wanless Report - commissioned by the Government - condemned the system of exemptions as "illogical". The class exemptions, the report argued, take no account of ability to pay: wealthy pensioners are exempt, but many poor families are not.

The range of exempt conditions has been widely criticised.

• The list has not been updated since 1968, and it excludes a number of chronic conditions that have become highly prominent since then.



• The scheme does not exempt outpatient treatments for conditions such as cancer, multiple sclerosis, arthritis and HIV/AIDS.



• The Government, however, has repeatedly indicated its unwillingness to reconsider the exempt list.
  
  
  
  Prescription charges were introduced, at least in part, to deter unnecessary prescribing and keep NHS costs down.



• However, today, many health groups claim that the high cost of prescriptions is

having a deleterious effect on health, as people on low incomes find themselves unable to pay.

• A 2001 report by the National Association of Citizens Advice Bureaux claimed that as many as 750,000 prescriptions in England and Wales had not been dispensed because of cost that year. It also alleged that many asthma sufferers were rationing their medication to keep their ongoing costs down.
  
  
  
  Many in government and the NHS are concerned about the lack of correspondence between prescription charges, the cost of drugs and patients' ability to pay.

Prescription fraud

This is another topic which has proved highly controversial within the NHS - with fraud estimated to have cost the NHS at least £117 million in 1997-1998.

• A concerted effort by the Government reduced this figure to £47 million by 2002-2003, following the introduction of fines and greater rigour in eligibility checking. However, as with many other counter-fraud regimes it has been suggested that this greater rigour has discouraged genuinely eligible people from getting what they are entitled to, through excessive bureaucracy

Devolved Countries

Situation in Wales

• The Welsh Assembly is committed to the phased abolition of prescription charges by 2007. Wales already provides free prescriptions to 16-25 year olds and as of 1October 2004 the price of a prescription fell to £5 in Wales. A further price drop took place in 2005 and another one is due in spring this year (2006).

Situation in Scotland

• The Health Committee of the Scottish Parliament recently described the system as "inequitable" with "...too many inconsistencies and anomalies...". Furthermore, they unanimously declared that "maintaining the status quo is not an option."



• In mid Jan 2006, The Scottish Assembly debated the concept of abolishing prescription charges.   Holyrood's Heath Committee narrowly decided to back a bill proposed by the Scottish Socialist Party (SSP) to abolish prescription charges in Scotland. This was the Abolition of NHS Prescription Charges (Scotland) Bill – proposed by MSP, Colin Fox. 

NPA Comment

At the NPA we already know from anecdotal evidence from our members that the current system adversely affects more people on low incomes and in chronic ill health - who find themselves unable to afford the medicines they are prescribed.

This feedback from our members has been flagged in our various media comments and position statements.  The key points/issues cover:

• Many people do not take up their prescriptions, or choose the most important, if prescribed many items. This can cause deterioration in their health, leading to more expensive hospital treatment at a later date.



• We know that the number of people not taking up their prescriptions rises with every increase in prescription charges. 



• We know that the cost of prescriptions also has an effect on people with chronic illnesses. Some diseases are exempt from prescription charges, but there are many, life-threatening diseases, including conditions such as chronic heart disease, arthritis, asthma, cancer, including chemotherapy drugs taken in the community, Hepatitis C and HIV/Aids which all have to be paid for.

For well over a decade the NPA has advocated (and lobbied for) the abolition of prescription charges – largely because the system is riddled with inequities. Our argument has been that the current system is anomalous, unclear and difficult to defend. We believe that prescription charges deter many people from getting their prescriptions filled; and that many patients ask their pharmacist for guidance on which medicines they need most when it contains several items.

"Patients on low fixed incomes who do not qualify for exemption suffer the most. We know that prescription charges deter many people from getting medicines which their doctor prescribes. Patients on multiple medications may be forced to make their own, potentially ill-informed decisions about which medicines to forego. This could lead to a second visit to their GP or, if their untreated condition deteriorated, even costly hospital treatment. Sufferers of chronic conditions such as asthma, cystic fibrosis and multiple sclerosis risk their lives because they cannot afford the treatment they need", says NPA Chief Executive, John D'Arcy

A number of MPs and media sources have used our press release information and stats: most notably:

• almost half the population is exempt from paying - children under 16, students from 16 - 18, expectant mothers, over 60s, and those living on social security - and because these groups are the heaviest consumers of health care, this means that some 85% of prescription forms carry no charge. The burden falls on adults of working age in employment.

History of Prescription Charges

• Prescription charges were introduced in 1952, three years after the founding of the NHS, in order to address the new Service's growing drugs bill. The plans were first put forward by the Labour Attlee government in 1951, causing the resignation of a string of ministers, including the "father" of the NHS Aneurin Bevan and the future Prime Minister Harold Wilson. Following Labour's election defeat, in October 1952, the Conservative government set the charge at 1 shilling per prescription form.
  
  
  
  By 1956, the NHS was dispensing 228 million items per year at a cost of £58   million, and the Government raised the charge to 1 shilling per item to    compensate. Three years later, this went up again, to 2 shillings per item.



• In 1965, under Harold Wilson, Labour abolished prescription charges. This caused the NHS drugs bill to soar, as many low-cost items that patients had previously bought for themselves were increasingly prescribed.



• Labour relented in June 1968, and restored prescription charges, at a higher rate of 2 shillings and sixpence per item, but introducing a range of exemptions for old and young people, people on benefits, and people with chronic diseases such as diabetes.



• In 1971, charges stood at 20p per item, where they remained until July 1979, when the new Thatcher government increased them to 45p.



• Charges were increased twice in 1980, to 70p and then to £1 in December.



• They have risen every subsequent year since 1982.



• During the mid-1980s, charges rose at around 20p per year (with the new prices coming into force on April 1), while in the early 1990s this accelerated to 25p per year.



• When Labour came to power in 1997, the annual rate of increase was reduced to 10p - where it remains today.
  
  
  
  In 2001, the Labour-Liberal Democrat Welsh Assembly Government legislated to abolish prescription charges for people aged 16 to 25 in Welsh pharmacies. This generated widespread concerns that English people would flock to Wales to submit their prescriptions, but evidence to date has shown this did not happen.



• In Jan 06 The Scottish Assembly has recently debated the concept of abolishing prescription charges.   Holyrood's Heath Committee narrowly decided to back a bill proposed by the Scottish Socialist Party (SSP) to abolish prescription charges in Scotland. This was the Abolition of NHS Prescription Charges (Scotland) Bill – proposed by MSP, Colin Fox.