I
do recognise that the medical exemption list has not been reviewed for many
years, apart from the addition of cancer recently, however I believe there are
many other exemptions in place to provide support for those with long-term
conditions. The prescription charging system is designed to support the most
vulnerable of patients, for example children, the elderly and those on low
incomes, from the financial impact of accessing potentially life-saving
medication. This is not an exhaustive list, however I believe it targets
support for those who need it most. It is important to note that nearly 90% of
prescriptions are dispensed free of charge and there are also no charges to any
patients who are dispended medicines when they are discharged from hospital.
There
are a number of issues around extending medical exemptions, particularly with
regard to how to define a long-term condition and a clear divide in opinion in
terms of who should be responsible for deciding who is eligible. The majority
of patients would want this to be decided by their GP, however GPs are rightly
concerned that this would create additional pressure and workload and
potentially cause a breakdown in the relationship between patient and doctor in
cases where a dispute over eligibility arises. There are a huge number of
hidden costs associated with the administration of such a system and concerns
about whether an appeals process for disputes would have to be put in place,
adding further costs.
When
exploring options for how to assess eligibility there are no simple answers and
many of the options explored are simply too complex and costly to administer
and there are concerns about the ways it could influence patient behaviour. For
example, if eligibility was based on diagnosis this would unfairly discriminate
against patients with symptom-based conditions who have no definitive
diagnosis. There is also the practical issues of creating and maintaining a
list of all long-term conditions and diseases considering the European
Medicines Agency report that 5 new diseases are described every week. If
eligibility were based upon the volume of prescriptions required over a period
of time, medical professionals feel this could create an incentive for
over-medicalisation of a condition and treatment-seeking behaviour to retain
this eligibility. There is also evidence to suggest providing free
prescriptions, even if this eligibility is not based on the volume of
prescriptions, acts as an incentive for patients to seek more medication which
may not provide any clinical benefit.
On
top of this, the additional costs that would be incurred due to extending free
prescriptions would add further pressure onto the NHS and potentially take
resources away from other areas, such as better A&E care, new cancer treatments
and better mental health services. As I have detailed above, there is also no
way to measure the hidden costs of implementing and administering such a
system.
There
is also the factor that prescription numbers are significantly rising every
year and the drug cost (not including dispensing costs) to the NHS dispensed in
the community was a staggering £9.17 billion in 2017 compared to £500 million
raised in prescription charges. Whilst the amount raised is a fraction of the
amount spent, this is not an insignificant amount and this funding would need
to be replaced. The recent review of NHS prescriptions highlighted the high
cost of providing prescriptions, and how often free prescriptions are provided
for conditions that either require no treatment or could be treated with
cheaper over-the-counter remedies. For example the NHS spends £23 million a
year on constipation remedies, which could pay for 900 more community nurses
and £3 million on athlete’s foot, which would fund 810 hip replacements. There
is also an estimated £150 million of unused prescription items returned to
pharmacies which cannot be reused due to health and safety, for example because
the medications have expired, not been stored correctly or it is impossible to
know if they have been tampered with in any way. It is paramount that we are
supporting patients with genuine need for medication who would otherwise be
unable to fund their treatment, however, we must also address the high levels
of waste and ensure good value for money.
There
is also already other avenues of support available. For example, benefits such
as Personal Independence Payments (PIP) is not means tested and is designed to
provide additional financial support, for example medical aids, adaptations and
medications for people with long term health conditions and disabilities.
Additionally, Employment and Support Allowance (ESA) is a benefit for people
whom are unable to work due to their health condition and/or disability and any
claimant receiving the income-related component will automatically be eligible
for free prescriptions.
There
is also a pre-payment certificate which provides a significant reduction in
cost per month for patients with more than 1 regular prescription per month and
there are a number of payment options to help patients budget accordingly. In
addition to this, if someone’s circumstances change and they become eligible
for free prescriptions before the end of their pre-payment certificate I am led
to believe you can claim for a refund.
Whilst
I do understand the case for the reduction in cost to other frontline NHS
services by extending free prescriptions to patients with long-term conditions,
the majority of the evidence this report is based on appears to be anecdotal
evidence. More importantly, it does not fully consider the additional and
hidden costs, which are likely to be far in excess of the savings the report
suggest, or the many practical issues of implementing such a system and
therefore I do not feel I can support this campaign at this time.
