Ministers have marked the 73rd anniversary of their party voting against establishing the NHS to launch a surreptitious consultation on the imposition of prescription charges on people aged 60 to 66, to raise an estimated £226m per year.
The 8-week consultation was launched on July 1, just before the NHS birthday, to run through the summer holiday months when Parliament is in recess and the news media are stuffed with trivia, hidden away behind the hysteria over the football, and while many campaigners have been fixated on the recent White Paper and Health and Care Bill.
It argues that the upper age limit for prescription charges was initially linked with the pension age for women. Now, having repeatedly pushed this age further upwards to deny people pensions until 66 and soon 67, they want to follow up by saddling those who have already lost out with prescription charges – which have just risen again to £9.35 per item.
Two options for change would either impose the charges in one go on all aged over 60, or (the preferred lower profile method) phase them in. Neither option is acceptable.
England is the only country in Britain still subjected to prescription charges, which have been abolished by devolved governments in Wales (2007) Northern Ireland (2010) and Scotland (2011).
In each case the limited extra cost of scrapping charges on the 10% of NHS prescriptions that were not covered by exemptions has been seen as good value in exchange for ensuring that no patient is prevented from accessing all the medication they need by cost barriers.
This indeed was the principle underpinning the provision of medical, dental and ophthalmic services free of charge when the NHS was set up in the war-torn economy of Britain back in 1948. Experience disproved Tory claims that this would simply create a “moral hazard” in which freely available drugs, spectacles and fillings would be dispensed and consumed “frivolously” at an ever-increasing rate.
However there is clear evidence that imposition or increases in charges deter the poorest people from accessing medication or preventive treatment (while of course the poorest are also the most likely to have complex medical needs and chronic ill-health).
After the Johnson government’s ideological precursors in the Thatcher government had controversially hiked up prescription charges three-fold from 1979-1984, an IFS report found that the result was a 40% reduction in the number of chargeable prescriptions dispensed. When the Tories went on to impose charges for eye tests, the rate of testing plummeted from 25 per 1,000 people to just 8.
Now, even though prescription charges raise a vanishingly small proportion (less than £5 in every £1000, 0.4%) of the £137 billion annual cost of the NHS in England, and the financial plight of many of the poorest families has been worsened and health inequalities widened by the Covid pandemic, ministers have decided to demonstrate their contempt for evidence and the values of the NHS.
The cynical ‘Impact Assessment’ published as a justification for the new charges fails to mention the positive impact of scrapping charges, and shies away from evidence around the world of the deterrent impact of charges on those with lowest income seeking health care.
It deals only in percentages, not numbers, and notes that 61% of the current 60-66 age group (equating to 1.5m people) are ‘high users’ of prescription drugs, averaging 34 items per year, compared with just 28% of 55-59 year-olds. 27% of high users in other age groups do not, for whatever reason, buy prepayment certificates (costing £108 per year or £120 if paid quarterly or monthly): but the Assessment does not look at the numbers of people aged 60+ who might struggle to find up-front payments or pay singly for prescriptions.
It admits that among asthma patients 57% of whom reduced medication or had skipped medication as a result of prescription costs, resulting in 24% of those surveyed suffering asthma attacks, more than half of them serious enough to require hospital treatment. But it does not explore the consequent costs to the NHS and consequences for the patients and their families.
The £226m they are seeking to screw from just 2.4m people in this age group would increase the total prescription charge income by more than a third, but it’s still a drop in the bucket.
It would bring total prescription charges up to just £840m – out of a current NHS drugs bill of £10.5bn. After Rishi Sunak’s recent budget, which denied the NHS any extra funding to recover after Covid, the Assessment’s claim that this small amount of extra money would be “invested” in the NHS – and yield an astounding £8.4bn worth of improved health, despite brutal cuts in public health spending – defies belief.
If ministers want extra money for the NHS they should start to tax the billionaires and corporations who have coined in profits while millions have struggled during the pandemic. Rather than slapping on new charges that will undermine the NHS and its principles they should be scrapping the charges on the 10% of prescriptions that are paid for.
That’s what pensioners’ groups, trade unions, opposition parties and campaigners need to be saying loud and clear in the next few weeks.
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