The UNISON Scotland Submission To the Scottish Parliament's Health Committee on their call for Written Evidence on the Abolition of Prescription Charges (Scotland) Bill

June 2005

Scottish Parliament Health Committee

Call for Evidence: Abolition of Prescription Charges (Scotland) Bill

Introduction

UNISON Scotland welcomes the opportunity to respond to the call for written evidence from the Scottish Parliament's Health Committee on the Abolition of Prescription Charges (Scotland) Bill.

UNISON Scotland has over 150,000 members in Scotland and in particular, over 50,000 employees in NHS Scotland, many of whom work in GP surgeries, health boards and agencies, such as Prescription Pricing.

UNISON Scotland supports the abolition of prescription charges, as we believe them to be inherently unfair, inequitable, illogical and inconsistent.

UNISON Scotland believes in a National Health Service based on the ideals of a public service for healthcare which is free at the point of delivery and accessible to all. These are the principles which have underpinned the NHS over 50 years and should still be the principle on which the current NHS is based.

Evidence

Impact on People on Low Incomes

The current system of prescription charges is unfair in that it adversely affects many more people on low incomes and in chronic ill health. These are the people who find themselves unable to afford the medicines they are prescribed.

There are believed to be approximately 75,000 prescriptions in Scotland that are not dispensed each year, due to rises in the costs of prescriptions. According to evidence from the Citizens Advice Bureau this situation increases in line with every rise in the charges. From April 2005 the situation was set to deteriorate further as changes to incapacity benefit meant that many recipients would no longer quality for an income support top-up and as a result would no longer quality for free prescriptions.

Seriously ill people who have mistakenly claimed for free prescriptions they believed they were entitled to, and are currently being caught in an NHS crackdown on cheats will also be affected by the changes to incapacity benefit which will cause greater confusion over their eligibility to exemption from the charges.

Although children are exempt from prescription charging, as are various adults on Income Support, in receipt of Child Tax Credit, etc., the Child Poverty Action Group points out that the current system disadvantages a significant number of working poor families with inevitable effects on their children.

Impact on Health

Over a number of years, five separate studies of the effects of charging for prescription medicines have concluded that increases in prescription charges lead to a decrease in the uptake of prescribed drugs. These and other studies have concluded that when patients do not take their prescribed medicine, this leads to deterioration in their health and can cause extra costs to the health service with admission to hospitals and emergency treatment. These studies are supported by anecdotal evidence from our members working in health centres and community settings.

This is particularly relevant in treating coronary heart disease and strokes, the two biggest killers in Scotland. A greater take-up of medication could play an enormous part in saving Scottish citizens from the worst effects of these two diseases, which have a greater prevalence amongst lower income groups.

Other groups particularly vulnerable are those suffering from mental health problems. Whilst in hospitals, these patients have their medication freely available, but on release, there are no funds available to ensure that they can afford vital medicines, even if subject to a Compulsory Treatment Order.

The current system is seen as illogical as there many life-threatening diseases not given exemption, whilst lesser acute conditions are included. Prescriptions for conditions such as chronic heart disease, arthritis, asthma, cancer, including chemotherapy drugs taken in the community, MS, Chronic Leukaemia, Glaucoma, Hepatitis C, HIV/Aids, etc. all have to be paid for. There is an added problem in that many of these conditions require multiple prescriptions to treat patients and many are life threatening and lifelong. Some of the multiple-drug treatments must be taken in combination with each other and if this relationship is broken, the treatment can be rendered ineffective. The Scottish Executive is planning a review of the current system, which will include an assessment of the exemption and remission lists.

Inefficient Prescribing

The current prescription charge can be seen as inefficient, as the cost of the drug is often lower than the cost of the prescription and the drug is often available over the counter, without prescription. However, GPs are not allowed to recommend that a patient could purchase the item cheaper from their local chemist, even when it would save them money, or issue them with a private prescription, for which they would only pay the cost of the medicine.

Funding

Most people in Scotland do not have to pay for their prescriptions. Statistics for Scotland show that at present, whilst 80% of 18 to 60 year olds pay for their prescriptions, 91% of all prescriptions are provided without payment. If as a result of the Executive's review, the list of conditions exempted from payment were expanded, this figure would rise. The current income from prescription charges in Scotland was £46m last year, only 6% of the total drugs bill. UNISON Scotland believes this is not a hugely significant sum and that the Executive should consider it well worth spending to increase the health of the nation.

The gap in funding could be bridged by a radical approach to tackle the ever-rising drug bill. Drug companies make a lucrative income from NHS Scotland and much of the additional government cash for the Health Service is being swallowed up by rising drug costs. Pressure sales techniques on doctors have been well documented and UNISON Scotland particularly supports the "No Free Lunch Organisation" that campaigns for greater openness in the contacts between the medical profession and the drug companies. Nursing staff are now being subjected to these pressures, since the introduction of nurse prescribing in 2002. There is also a current project being carried out by the Scottish Executive which looking at a streamlined procurement strategy and if this is applied to the procurement of drugs across Scotland, there would be considerable savings which would cover the cost of the free prescriptions.

Alternative Proposals

During the original consultation on the Bill, several alternative approaches were suggested, including: extension of exemptions on grounds of chronic illness; exemption based solely on the ability to pay; different charging methods, such as part payment, based on value of the item, paying for first two items a month, with the rest exempt, reduce the current level of charges, and the payment of a standing amount per month for prescription exemption.

UNISON Scotland agrees that extending the list of exempted conditions would be an improvement on the current situation and would reduce some of the anomalies in the current system. However, it believes that even adding a small number of chronic illnesses to the list would reduce the amount of revenue collected to a level where it would not be financially viable to collect and we do not believe this on its own would solve the problems outlined above.

Likewise, we believe that charges based on the ability to pay would be cumbersome to administrate and would not take account of the number of drugs needed by patients and again, would not solve other problems outlined above.

Other charging methods would also assist with some of the problems outlined. As an example, a weekly or monthly standing charge for pre-payment would mean that the annual or quarterly charge was more easily afforded by those on low incomes. Administration costs would, however, be complicated and there would still need to be exemption of certain groups of people in addition to these charges.

Whilst UNISON Scotland would support most of these alternatives and believe they would improve the levels of take-up for many people, we do not believe that any of them by themselves would eradicate the deficiencies of the current system.

Conclusion

UNISON Scotland believes that the Scottish Parliament should follow the example of the Welsh Assembly and bring forward a programme to abolish all prescription charges in Scotland.

In the event of a successful passage of this Bill into law, we would wish to seek assurances that staff employed in Prescription Pricing would be consulted over any changes to their jobs and be given adequate retraining over changes to their work practices.