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Rob Darracott: Society would like to see a simple charging system
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Illogical, unfair and “a dog’s dinner” are just some
of the criticisms levelled at the present NHS prescription charges system,
which has remained unchanged for more than 30 years. The comments appear
in written evidence collected as part of the inquiry into NHS charges
being carried out by the House of Commons Health Select Committee. Dissatisfaction
is widespread from patient groups, think tanks and organisations representing
health professionals, all of which agree that it is time for a thorough
review of the system.
This week some of the health professional organisations, including the
Royal Pharmaceutical Society, had the opportunity to put their views
to MPs, highlighting the flaws in the prescription system and suggesting
how it could be reformed when they were due to give evidence to the inquiry
at its resumed hearing on 2 February.
The Society falls short of calling for prescription charges to be dropped
because it is unable to come forward with an alternative, says Rob Darracott,
the Society’s director of corporate and strategic development.
Replacing one inequity with another?
Mr Darracott, who was due to give evidence to MPs on behalf of the
Society, says: “What we have tried to do is review the evidence about
what would happen or might happen when you change a charging system.
What we found is that there is little evidence about what might happen
in the UK but there is evidence from around the world that it isn’t
a very simple thing to do. There is a risk (if we opt for abolition)
that we might replace one form of inequity with another. At the same
time the charging system does bring in a considerable amount of money
for the NHS that might have to be replaced another way.”
When prescription charges were abolished in Italy, the number of prescriptions “went
through the roof”, he says. Other European countries have a system
where all acute prescriptions are free, with an annual cash limit on
free prescriptions for chronic conditions. Mr Darracott says: “If
we were to move to a system which says, for example, nobody should pay
more than ‘X’ for their medicines under the NHS in any given
year, then it would make sense that the system would be managed through
pharmacy because that is where the dispensing takes place and pharmacists
are also aware of government priorities.” A similar system already
works along these lines in Norway, he points out.
Whatever the final decision on the future of prescription charges the
Society is clear about what it wants to prevent in the future. Mr Darracott
says: “What we would like to get away from is the situation where
pharmacists think they are just collecting a tax for the government,
so every time the charges go up patients think it’s the pharmacists’ fault.
I think we would also make a plea for something which is simple.”
The Health Select Committee, in its statement on the reasons for setting
up the inquiry, admits the “rationale” for charges, including
prescriptions, is often unclear with patients unaware of the rules and
the grounds for exemptions. It is an issue taken up by the Society in
its written evidence to MPs. The Society argues the charging system is
unfair because exemption is linked to income and ignores clinical need.
It penalises those patients just above the income limit compared with
those below the threshold — even if they have a greater clinical
need. The system discriminates against people with low incomes who are
expected to pay, while better off pensioners and pregnant women are automatically
exempt from charges, it points out. The list of exemptions linked to
chronic medical conditions “creates an arbitrary division between
those who pay and those who do not, which is not based on any defensible
medical criterion”, it says.
The hit-and-miss nature of the medical exemption lists — which,
for example, entitles somebody with an under-performing thyroid to have
all their medicines paid for while patients with asthma or heart disease
have to meet all their prescription costs — is also tackled by
the British Medical Association, which is also due to give evidence to
the committee on 2 February. It says there is no “logic” to
the list and highlights the omission of diseases like cystic fibrosis,
which were excluded when the list was originally drawn up in 1968 because
patients were then unlikely to survive beyond childhood. It wants to
see a system where exemption reflects both the burden of illness and
the need for medication. It says in its written evidence: “It is
grossly unfair that those who are most in need of medication may fail
to access it for financial reasons.” Radical overhaul
The charity Macmillan Cancer Relief, which was due to speak at the
committee meeting on 2 February, calls for a radical overhaul of the
exemptions
list and wants the abolition of all prescription charges for cancer
patients. The terminally ill who are receiving palliative care at home
should also be exempt, it suggests. The charity’s senior policy
analyst Duleep Allirajah says: “When the list of medical exemptions
was set up in 1968, cancer was a very different disease from what it
is today — patients were treated in hospital, where prescription
charges don’t apply, and their prognosis was very poor.”
Today patients with cancer are treated in the community or via outpatient
departments and have to pay a prescription charge for their medicines.
He says: “A number of patients might have four or five items a
month, which can work out at up to £30 and can go on for months
because the disease is so unpredictable.”
The Society also points out that charging patients for prescriptions,
especially those with long-term conditions, contradicts government policy
to focus are on this group of patients. It argues: “It is this
group which is most likely to be deterred from taking the medicines they
need by the existing charging regimen.”
The conflict with government policy is also picked up by the influential
think tank, the King’s Fund, which was also due to discuss its
views with MPs on 2 February. In its written evidence the King’s
Fund claims that imposing charges is incompatible with government policy
to improve patients’ access to health. It also goes against one
of the foundation stones of the NHS — for care to be free at the
point of use and not based on an individual’s ability to pay. It
concludes that the present system is generally an “inefficient
way of achieving objectives which could be obtained more easily and with
fewer undesirable consequences by other means.” |
The
Pharmaceutical Journal