Proposal #19: Free prescriptions on the NHS
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By Amanjit Jhund / @amanjit
Since devolution we have seen a great number of disparities emerge in the care for patients in different parts of the UK. One of the most harrowing side effects of this has been the increase in postcode lotteries not bound by local areas or Primary Care Trusts but by national boundaries.
One of the most striking examples of this is prescription fees. Whilst in Wales prescription fees have been abolished altogether, in Scotland and Northern Ireland the devolved parliaments have committed to abolishing prescription charges by 2011 and 2010 respectively.
England now remains the only country in the UK to retain the principle of prescription charges. While the government has extended the exemptions on prescription fees to include cancer patients and has instituted a review on long term conditions, many organisations such as the British Medical Association believe that the government should go further and abolish prescription charges altogether, and I agree wholeheartedly with them.
Up until the recent alterations made to include cancer patients our current system had been unchanged since 1968. This has resulted in gross discrepancies within the system. Under our current system patients suffering from treatable conditions such as hypothyroidism are exempt from charges whilst those suffering from long term, terminal illnesses such as cystic fibrosis (CF) are forced to pay prescription charges from the age of 16 onwards. This is a situation that has arisen due to improved medications and increased life expectancy of CF patients (estimated at 31-36 years), many of whom died in infancy in 1968. There are many other injustices in the system with individuals suffering from debilitating long term degenerative illnesses such as Parkinson’s disease denied exemption.
To counter this the government has set up a review of prescription charges in long term conditions but my concern is that this will simply provide us with a new set of arbitrary dividing lines which over time will become unfit for purpose much like the current exemptions. Even developing a system of exemptions is fraught with difficulties. Simply extending the list of conditions which qualify for exemption does not solve the problem as it fails to consider the highly variable nature of disease from person to person and the impact that it can have on life circumstances. Medicine is often described as an art rather than a science and for this precise reason attempting to restrict exemptions along the lines of aetiology is both unjust and unethical
With the current review another concern is that the patient groups with the best funded and active pressure groups such as the British Heart Foundation will lobby for the inclusion of their patients on the exemptions list much in the same way that cancer charities and patient groups have already successfully done, whilst those with rarer and less publicised but no less debilitating conditions will lose out.
One argument often used for the retention of prescription charges is the estimated £435 million a year raised by prescription charges for the NHS. Whilst this is a substantial amount the Department of Health estimates that the cost of excluding cancer patients alone will cost £15.6 million a year. Combine this with the cost of excluding antidepressants estimated by the BMA at £24 million a year, anti-hypertensive medications at £37 million a year and inhaled corticosteroids at £11 million per year and the financial case for retaining prescription charges looks less and less viable.
If a serious and comprehensive review of long term conditions is carried out then not only these medications but hundreds of others will have to be made exempt for long term conditions. We may even reach a stage where the costs involved in policing, enforcing and administering such exemptions will outweigh the revenue generated by the remaining charges.
While we cannot afford to simply drop prescription charges in the current climate. Like the Fabian Society I would like to see a manifesto pledge to reduce prescription charges in the first instance with the aim of abolishing them altogether once our public finances allow it. Ultimately I believe that this is the only way to avoid these inequalities and resolve our current morally bankrupt and ethically indefensible position.
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