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AntiCoagulation Europe campaigns >
by Dr. Richard Moore Introduction Some time ago we started to ask Government to review the existing Prescriptions Exemptions list with the aim to include anticoagulation therapy in the list. Although there are many conditions requiring permanent medication only the following qualify for exemption:
The list of medical conditions conferring prescription charge exemption was introduced in 1968 after discussion with the medical profession and has not been amended since. In the Wanless Report of 2002 it was recommended that prescription charge exemptions should be rethought as current arrangements were neither logical nor rooted in the principles of the NHS. Some of this lack of logic can be seen in the arbitrary manner in which the above-mentioned long-term conditions enjoy immunity from charges whilst others do not. For example, individuals with insulin dependent diabetes or severe epilepsy are exempt while those requiring continuous medication for other conditions, such as HIV, cystic fibrosis or, indeed, anticoagulation therapy, have to pay. The exemption list is irrational in that if a patient has one of the conditions on the exemptions list then they will receive free prescriptions for any condition! Rosie Winterton MP, the Minister of State at the Department of Health, has categorically stated to Anticoagulation Europe that the Government has no plans to change the current forty year old exemption arrangements. What is happening elsewhere within the United Kingdom? Wales In 2001 the ruling Labour/Liberal Democrat coalition of the Welsh Assembly responded to public concerns about prescription charging by introducing exemption from charging for all people aged between 16 to 25 years of age. The proportion of Welsh people receiving prescriptions which were exempt from charging went up from 89% to 93%. 20 Labour Welsh Assembly members voted with Plaid Cymru and the Liberal Democrats to extend exemptions to those suffering from chronic medical conditions. However, before legislation was introduced Labour pledged in their manifesto for the Welsh Assembly elections that they would abolish prescription charges entirely. Prescription charges will be abolished in Wales from 2007. Scotland The Abolition of Prescription Charges (Scotland) Bill was introduced to the Scottish Parliament in January 2005. The Scottish Parliament's Health Committee agreed on January 11, 2006, by five votes to four, to support the Bill. The devolved assemblies are in the process of abolishing prescription charges completely which will leave England alone in paying the charges. England Prescription charges were, in fact, increased for England from April 1, 2006 and will be increased again on April 1st 2007. Some 80% of people in England aged 18-60 have to pay the full cost of their prescriptions. The House of Commons Health Select Committee agreed to review NHS charges in England, including prescription charges, on October 13, 2005. Written evidence was requested by December, 2005 with evidence sessions being held during February 2006. Many organisations submitted written evidence that questioned the rationale for prescription charges. For example, The Parkinson's Disease Society stated that 'the current system is illogical, unfair and discriminatory as regulations only provide an exemption for a small number of health conditions.' MIND believed that prescription charges should be abolished completely. The National Consumer Council stated that 'the absence of a rationale for charging has led the system for charging for prescriptions to develop in a manner which has disadvantaged some patients'. Conclusion It does seem wrong that in the United Kingdom we have two devolved assemblies which have, in the case of Wales, agreed to the abolition of prescription charges in 2007, and in Scotland a Bill to abolish prescription charges making its way through the Scottish Parliament. Meanwhile, in England, we have had an increase in prescription charges and a Government whose official position is to retain prescription charges and leave the existing Prescription Charges Exemptions list as it is. We have to wait for the House of Commons Select Committee to draw its conclusions from its current review of NHS charges. We must hope that they opt to go the same way as both Wales and Scotland.
Update 1: prescription charges campaign Previously I have outlined the findings of the House of Commons Select Committee on Health's report into NHS Charges. This report was published in July, 2006 and the Government responded to the report at the end of October 2006. I thought readers would be interested in the Government response to the issue of prescription charges and the prescription charges exemption list. I reported that the Health Committee finally made 22 conclusions and recommendations. Readers might recall that the one which concerned us most was number 18 which stated: "We recommend that the Government establish a review to examine the costs and benefits of the following:
We are pleased to note that the Government, in its response, has concluded that the time is now right for a wider review of the current arrangements for prescription charges." The Government's response was as follows: "Abolish Prescription Charges - Health charges from prescription and dental charges currently generate income for the NHS of some £1 billion per annum. A new dental charges system was introduced from April 2006 and the Government accepts that it would now be appropriate to review prescription charges to consider options for possible change to those charges that would be cost-neutral to the NHS. However, the Government does not agree that it would be appropriate to abolish health charges as this would reduce by some £1 billion the money available to deliver other health priorities." However Ministers have asked officials in the Department of Health to undertake a review of prescription charges. The Government stated in its response that it will report the outcome of this review to Parliament before the 2007 Summer Recess. This review will include options to:
These options will be considered on the basis that any changes to prescription charge exemptions, if implemented, would be cost-neutral to the NHS. Clearly this response is somewhat disappointing to ACE as we thought the abolition of prescription charges would resolve the anomalies of the current prescription charge exemption list. The Select Committee agreed that 'the criteria that distinguish between patients exempt from health charges and those who pay are inconsistent and anomalous. In particular witnesses thought it absurd that the list had not been updated since 1968'. The commitment by the Government to review prescription charges, including the possibility of revising the list of medical exemptions, introducing a flat-rate prescription charge with no exemptions, or basing exemptions to prescription charges solely on income is, of course, to be welcomed. The caveat to this, however, is that the options will only be considered on the basis that any changes to prescription charge exemptions must not increase costs to the NHS. Our concern is that this could lead to recommendations that are in some way compromised. Whatever recommendations are made that result in an on-cost to the NHS must have a corresponding saving elsewhere in the NHS. AntiCoagulation Europe has asked to participate in the review that Department of Health officials will be undertaking.
UPdate 2: PRESCRIPTION CHARGES - NEXT STEPS Readers may recall that in the February, 2007 issue of INReview I outlined the Government response to the House of Commons Select Committee on Health's report into NHS Charges. This report was published in July, 2006 and the Government responded to the report at the end of October, 2006. It was confirmed in that response that Ministers had asked officials in the Department of Health to undertake a review of prescription charges. The Government stated in its response that it would report the outcome of this review to Parliament before the 2007 Summer Recess. It was planned that this review would include options to:
These options would be considered on the basis that any changes to prescription charge exemptions would be cost-neutral to the NHS. In a written Ministerial statement made to the House of Commons on July 23, 2007, Dawn Primarolo, the Minister of State for Public Health at the Department of Health, stated: "As part of the response to the Health Select Committee Report on NHS Charges the Government committed to carrying out an internal review of prescription charges and to making a further statement to the House prior to the summer recess this year. Following this internal review, the Government have decided to hold a consultation in the autumn so that the public can contribute their views on any proposals prior to a final decision on future prescription charges. The Government have made it clear that any changes to the system would need to be cost neutral for the NHS. A further statement will be made after the summer recess giving details of the consultation." Anticoagulation Europe will participate in the public consultation when details are announced by the Government. | |||||||||||||||||||||||||||||||
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