Free prescriptions can’t continue

Darren Millar argues that those who can afford to make a contribution towards the cost of their prescription should do so.

In times of austerity, the way in which public money is allocated to competing resources is more important than ever, and nowhere more so than in the National Health Service, where inflationary pressures runs high and technological advances and an ageing population drive up costs and demands.  Labour’s decision to introduce universal free prescriptions in 2007 raised questions about value for money at the time, but in a decade of public spending restraint, we need to ask whether the policy is affordable and even desirable.

Prior to the introduction of universal free prescriptions, an estimated 93% of prescribed items were already exempted from charges. Prescriptions were just £4 per item dispensed and those who needed regular prescriptions were able to purchase prepayment certificates to cap the costs of their medication at just £80 annually. The income raised annually, after taking into account the costs associated with the regime, was around £30 million annually.

Since charges were abolished in 2007, the volume of prescriptions being dispensed in Wales has increased by over a quarter and Wales is now more dependent on prescriptions than any other part of the UK with an average of 25 items prescribed per head of population per year, more than any other part of the UK. Last year alone, the Welsh NHS spent more than £4 million on paracetamol, which can be purchased for less than 20 pence in many supermarkets, and prescriptions are still being doled out for products such as athletes foot powder and mouth ulcer gel each year.

But the reality is that there is no such thing as a free prescription, the policy is now estimated to be costing taxpayers around £40 million annually and when you take into account that many patients make appointments to see their GP simply to avoid a small charge, we can see just how counterproductive this policy has become.

The context against which this policy is being funded couldn’t be worse. Since 2010 the Welsh Labour Government has imposed record-breaking cuts on the Welsh NHS, making it the UK’s worst funded health system. Ministers have refused a Keogh-style inquiry into high death rates on grounds of cost and argue against a £5million Cancer Treatments Fund to end the postcode lottery in access to innovative new cancer medicines.

Labour in Scotland has argued against free prescriptions, while Ed Miliband has said the policy would be unaffordable in England.  Carwyn Jones and Mark Drakeford continue to protect their freebie policy, while other parts of the NHS are crying out for resources.  The British Medical Association has warned that the Welsh NHS is facing ‘imminent meltdown’, while the Royal College of Physicians has warned that the NHS in Wales is so under-resourced, Labour’s hospital reconfiguration plans not be realised.  Three of Wales’ seven health boards had their accounts qualified in 2013-14 because they overspent, while a further two only stayed within their financial limits because of multi-million pound bailouts.  The financial picture for the Welsh NHS is dire because of Labour’s decision not to follow England and Scotland and protect the health budget.

Labour’s policy has become morally indefensible. It is a scandal that Wales is a nation in which millionaires can access free asprin, but cancer patients are unable to access the drugs their clinicians want to prescribe.  That’s why the Welsh Conservatives want to end the free for all policy on prescriptions.

Under our proposals whilst the vast majority of prescriptions would still be free, we would return to a system of exemptions from charges for the under 25s, the over 65s, students, pregnant women and new mothers, anyone on income support and the disabled, but extend exemptions to those suffering from chronic conditions or cancer. Everyone else would be charged just £5 towards the cost of their prescription. Amongst other things, the money saved could easily pay for an innovative Welsh Cancer Treatments Fund, improvements in stroke care, additional investment in the Welsh hospice movement and the recruitment of an additional 100 staff for the struggling Welsh Ambulance Service.

Politics is about making difficult decisions and I appreciate that some people may not appreciate paying towards something they currently receive for free.  But I believe that if those who can afford to make a small contribution towards the cost of their prescriptions do so, then we will be able to go on protecting the vulnerable, whilst helping Wales to build a stronger and fairer NHS for all.

Darren Millar AM is the Shadow Minister for Health and Welsh Conservative Assembly Member for Clwyd West.

23 thoughts on “Free prescriptions can’t continue

  1. No matter what system you put in place there will always be abuse. A t the present time the interaction of the patient with the GP determines what is on a prescription but once an item is included as a repeat item then mechanisms for removing this item are simply not in place. Neither the Patient, the Pharmacist nor the GP have a direct if any say in the removal of any item. So in essence there are several problems here to be addressed. Not least of which is the stockpiling of items for whatever reasons I knew a 91 yr old who held over 1000 aspirins which she never took — through ticking boxes and she was blind
    The problem is not one of political point scoring as is so often the case but of the real need to address the realities of operating a free prescription service without controls being in place

  2. Mr Millar is right. No doubt he will trigger the usual response about ‘uncaring Tories’ but the opposite is true. Free prescription charges are the classic example of how the old Welsh brand of socialism puts false egalitarianism before targeting public resources where they are needed most.

    After all, where would most of us put our own money given a choice between (a) Wales’ crisis-hit A&E services, (b) GPs who seem far less accessible and helpful than they used to be, (c) cancer care below international standards, and (d) subsidising the shopping of the better-off?

    Few of us would choose (d). The Welsh Assembly did.

  3. I agree with G Horton-Jones. Quite apart from the “moral” arguments, the change suggested would simply be counter-productive. By the time you have taken out all the exemptions, and made the levy as low as £5 per prescription (especially if the prescription includes several items) the savings would be outweighed by the administrative costs. A far more effective approach would be:
    1. stronger guidance to GPs not to prescribe drugs such as paracetamol which are cheap and easily available over the counter;
    2. sorting out the bureaucracy to give better control of repeat prescriptions
    3 a public awareness campaign including printing the actual cost of each item on the prescription
    June Clark

  4. Free prescription services are the result of a commitment to a principle. The fact that money is involved does not justify the application of commercial criteria to the issue of health. G Horton-Jones has hit the nail on the head in saying that issues of proper use of resources (which is not the same as value for money) requires proper monitoring of prescription practice.

  5. The decision to abolish prescription charges in 2007 was a ‘political’ one to produce a clear red line between ‘socialistic’ Wales and ‘new labour’ in England.The reality is that even within England people with a)chronic illnesses,b)over 65’s,c)children have ‘free prescriptions’,so the welsh decision only affected a small part of total,however very likely to vote for the LABOUR party. In the world of further and probably deeper cuts to the funding of public services there will be greater need to ensure that all money spent is a)needed,b)spent in an efficient manner and within WAG’S budget there are probably huge savings that could be made. I have never understood why 65’s,(I’m 70) are so prioritised simply because of their age,whereas all other members of society seem to be getting it in the neck. My son has recently lost his entitlement to child benefit because of his income,and I think ALL benefits should be subject to income limits as many pensioners can afford to pay for prescription charges and also do not need fuel subsidies.

  6. John Winters on Richards – The Welsh Assembly didn’t decide on “d”. The Welsh Government did. Otherwise know as the Labour Party.

    As for Darren Millar he fails to make his case.

    The reason claimed by the Labour Government for free prescriptions was that iit was cheaper than the alternative high beuraucratic costs incurred. I don’t know what the numbers are. Neither, it seems does Mr Millar.

    As for the comparison with the English NHS he also failed to mention the millions taken out of their system for a reorganisation, that the English Government said wasn’t needed, and the fact that Clinicians were only last week condemning the Cancer Fund as ” ineffective ” and “a waste of money”.

  7. Gwyn, the distinction between the Assembly and the Welsh ‘Government’ is artificial. As you say, they are both the Labour Party – even when it does not have an overall majority. That was the whole intention.

    Clinicians have an obvious vested interest in attacking the cancer drugs fund, but anyone who has experience of cancer in the family knows that hope is beyond price.

    You are, however, right to draw attention to Labour’s unnecessary and disastrous reorganisation, and the subsequent necessary re-reorganisation, which seem to have been airbrushed from history by uncritical media.

  8. Seems there is an empirical issue here that would help resolve the debate. What exactly would the administrative costs be of charging for prescriptions? How do they compare with the cost of free prescriptions, which Darren Millar says is £40 million? Since that is, what, 0.6 of 1 per cent of total NHS spending in Wales (?) it’s not going to solve the problems of the NHS either way.

  9. One of the features of this blog is that it allows people to inhabit their own insulated world, but in public.

    Putting aside the assertion that there is no distinction between the Government and the Assembly (pause for laughter), what is the “obvious” vested interest that clinicians have in attacking the cancer drugs fund?

  10. RBJ, clearly it takes little to amuse some people, but happy to oblige. Meanwhile, do tell us what the practical difference between the Assembly and the ‘Government’ might be in your own insulated world. In this world both are run by the Labour Party. RBJ-World sounds a much happier place, so full of laughter – a bit like Disney World in fact.

  11. Over the counter medicines costing pennies should not be available on prescription anyway. Stopping this would free up a lot of GP time and expense. How about introducing a means test for all GP prescriptions? Only those aged under 16 and on income-related benefits should get free prescriptions; everyone else should pay or co-pay for their medication. Perhaps with a cap of £20 per prescription, or for chronic conditions £200 a year?

    Most people have to pay for spectacles and dentistry. It is only reasonable for all except the poorest to pay for their medicines, as well. The Welsh Tory Party is only proposing a slighly less universalist version of socialized health care. Let’s be more radical for once!

  12. Given that 93% of charges were exempted from the previous system and we would estimate the same number if we returned to the old system; given the added admin costs what would the saving actually be?
    Model it properly and then argue which way to go.

  13. Thank you Tegid Roberts. That was the point I was trying to make. No use arguing in a vacuum. What are the facts?

  14. @JWR

    The question was:

    What is the ‘obvious’ vested interest that clinicians have have in attacking the cancer drugs fund?

  15. RBJ, the cancer drugs fund was brought in as a response to evidence that cancer care in the UK, not just Wales, was falling below international standards. So those responsible for existing cancer care might, with reason, see its existence as a reproach. They might also hope, with less reason, that the fund could be diverted to their own work. Thus they have two obvious vested interests in attacking it.

  16. Some might see the fund as a reproach but that does not amount to a vested interest.

    The hope that the fund money might come their way is a potential vested interest but is not a reason for attacking the fund, surely?

  17. RBJ, it is a fair point if you prefer ‘potential vested interest’ to ‘vested interest,’ but, in the highly competitive business of public sector resource allocation, either is sufficient reason to attack the fund.

  18. So if you have the opportunity of receiving money from the cancer drugs fund, the best thing to do is to attack its existence.

  19. In England 90% of prescriptions are free because the patients fall into one or other of the exempt groups. These groups make up 60% of the population, so you can see that people in exempt groups (esp the elderly) are in receipt of most prescriptions.

    If me moved to a means-tested system or to the English system (which gives us figures to start working with) the cost of administering the system would far outway the money brought in by the scheme. This is particularly so with means testing which would be more expensive to administer than the English system.

    This is a politically driven idea which is badly thought out, unworkable, would be more expensive, and would require more public service employees at a time when there are fewer and fewer available.

  20. Another example of a politician trying to use the NHS for political gain. However, I haven’t read too many positive responses to the proposal. Abuse and mis-use of the system needs to be addressed through more robust procedures, this should be reviewed and developed by GP’s, their practice staff and Pharmacists – keep politicians out of the picture!

  21. I heartily agree that free prescriptions in Wales is now unsustainable and would gladly make a valid contribution to the cost of my medication bill each month. At present I am on average having 10 items per month and it concerns me greatly that I am such a drain on resources. Maybe some items could be financed by individual contributions. For example I have a every other month a sharps bin, on prescription. I can purchase 4 of these on Amazon for £8:00 delivered. So the cost would be about £12:00 per year. I am quite certain that it is costing a lot more than that to supply me via the NHS. I would be quite willing to finance some of my prescription.

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