What are NHS prescription charges?

NHS prescription charges are paid by patients for drugs or other treatments prescribed for them by a National Health Service medical practitioner.

As from 1st April 2008 the basic NHS prescription charge in England is £7.10p. However, many people are exempt from paying this fee; indeed according to the Government, 88% of prescription items are dispensed free of charge.

Those exempt include:

Children under 16, pregnant women, people over 60, young people in full-time education, people in receipt of certain benefits such as Income Support or Jobseekers' Allowance and people suffering from specific conditions, such as certain types of physical disability, diabetes, or epilepsy, for which they hold a valid exemption certificate.

Prescription Prepayment Certificates (PPC) offer considerable savings to people who are in need of regular prescriptions. A 3 months PPC costs £27.85 and a 12 months PPC £102.50p. In addition, the NHS Low Income Scheme provides income related help to those not already exempt from NHS charges.

These rules apply only to England. In the rest of the UK prescription charges are a matter for their devolved governments. In Wales prescriptions have been free for everyone since 1st April 2007; the Scottish Assembly plans to abolish all prescription charges by 2011 and the issue is currently under review in Northern Ireland.

Background

Although the NHS, which was founded in 1948, was meant to provide a completely free health service for everyone, a growing drugs bill prompted the introduction of prescription charges in 1952.

The plans were first put forward by the Attlee government in 1951, causing the resignation of a string of ministers, including the "father" of the NHS Aneurin Bevan and the future Prime Minister Harold Wilson. Following Labour's election defeat, in October 1952, the Conservative government set the charge at one shilling per prescription form.

By 1956, the NHS was dispensing 228 million items per year at a cost of £58 million, and the Government raised the charge to one shilling per item to compensate. Three years later, this went up again, to two shillings per item.

In 1965, under Harold Wilson, Labour abolished prescription charges. This caused the NHS drugs bill to soar, as many low-cost items that patients had previously bought for themselves were increasingly prescribed. Labour relented in June 1968, and restored prescription charges, at a higher rate of two shillings and sixpence per item, but introducing a range of exemptions for old and young people, people on benefits, and people with chronic diseases such as diabetes.

On "decimalisation" in 1971, charges stood at 20p per item, where they remained until July 1979, when the new Thatcher government increased them to 45p. Charges were increased twice in 1980, to 70p and then to £1 in December. They have risen every subsequent year since 1982. During the mid-1980s, charges rose at around 20p per year (with the new prices coming into force on April 1), while in the early 1990s this accelerated to 25p per year. When Labour came to power in 1997, the annual rate of increase was reduced to 10p.

In 2001, the Labour-Liberal Democrat Welsh Assembly Government legislated to abolish prescription charges for people aged 16 to 25 in Welsh pharmacies. This generated widespread concerns that English people would flock to Wales to submit their prescriptions, but evidence to date has shown this did not happen.

For many years, local health authorities were responsible for administering the prescription charging regime. In October 2002, however, this role passed to the Prescriptions Pricing Authority (PPA). The PPA's role is to calculate drug and appliance prices, and make appropriate payments to pharmacists and contractors; produce guidance on prescribing for medical practitioners; manage the system of exemptions; and produce and maintain the Drug Tariff, containing the reimbursement prices of a range of prescribable items and remuneration rules.

Controversies

The founders of the NHS regarded the concept of charging as antithetical to the notion of a service "free at the point of use" and controversy continues to surround the issue of prescription charges.

The range of exempt conditions has been widely criticised. The list has not been updated since 1968, and it excludes a number of chronic conditions that have become highly prominent since then. In particular, the scheme does not exempt outpatient treatments for conditions such as cancer, multiple sclerosis, arthritis and HIV/AIDS. The Government, however, has repeatedly indicated its unwillingness to reconsider the exempt list.

In 2002, the Wanless Report - commissioned by the Government - condemned the system of exemptions as "illogical". The class exemptions, the report argued, take no account of ability to pay; wealthy pensioners are exempt, but many poor families are not.

Prescription charges were introduced, at least in part, to deter unnecessary prescribing and keep NHS costs down. However, today many health groups claim that the high cost of prescriptions is having a deleterious effect on health, as people on low incomes find themselves unable to pay.

The Macmillian Cancer Support charity is one organisation currently campaigning for the abolition of prescription charges in England "so that no one is in the position where they can't afford the treatment prescribed by their doctor or health professional."

And Swindon TUC set up a website in August 2008 to support the campaign for abolition, calling on union members and NHS supporters to "take up the campaign in their areas and through their own organisations".

But the Department of Health insists that entitlement to help with health costs "is based on the principle that those who can afford to contribute should do so; while those who are likely to have difficulty in paying should be protected."

However, the British Medical Association has long called for a "fundamental review" of the whole system of prescription charges and exemption categories, claiming there are "many unacceptable inequities and anomalies in the present system".

Nevertheless the BMA states that it does not wish to see the specific clinical categories increased, but warns that there are many other groups of patients who require lifelong treatment, such as those with cystic fibrosis and Parkinson’s Disease, "who are more disadvantaged than some of those presently exempt."

Statistics

Prescription charges are expected to raise £435 million in the next financial year.

Prescription charge increases will stay below the rate of inflation representing the tenth consecutive year that the increase has been held below or around that level.

The increase will mean 25p on prescription charges in England, taking the charge for a single prescription item to £7.10 from 1 April 2008.

In England, 88 per cent of prescription items are free of charge.

Source: Department of Health - March 2008

The NHSBSA Prescription Pricing Division processes over two million prescription items per working day, determining reimbursement and remuneration levels through to payment.

Annual payments to contractors made on behalf of the NHS now total around £7 billion.

Source: NHS Business Services Authority – August 2008

Quotes

"A consultation to review prescription charges in England is due to be published soon by the Government, but they have already stated that they are not prepared to spend one extra penny on prescriptions.

"This means that any reform will inevitably involve some patients losing out. In effect, they will be robbing Peter to pay Paul. We are extremely concerned that this consultation may lead to nothing more than tinkering with an inherently unfair system. "

Macmillan Cancer Support – August 2008

"The level of charge is now such that often it exceeds the actual cost of the drug."

BMA – 2008

“Let us test David Cameron's passion for the NHS. Why not take his slogan of 'sharing the proceeds of growth' and show that need not mean putting tax cuts ahead of investment in public services. Labour could share the proceeds of growth via a more popular route: a manifesto pledge to reduce prescription charges year on year in the next Parliament, seeking to abolish them entirely as resources allow.”

Fabian Society general secretary, Sunder Katwala – speaking after Labour's poor showing in the May 2008 local elections.

http://www.politics.co.uk/briefings-guides/issue-briefs/health/nhs-prescription-charges-$366605.htm

Labour and the Conservatives were today locked in the first big squabble of this year's general election campaign as the Tories described claims by the chancellor, Alistair Darling, that they had a £34bn black hole in their spending plans as "a dodgy dossier full of lies".

In one of the morning's press conferences that laid out some of the battlegrounds of the long campaign – to culminate in an expected polling day on 6 May – Darling said the Conservatives were trying to fight the election "on a nod and a wink".

He issued a 148-page document laying out what he said were Tory weaknesses on spending, with £45bn in spending commitments backed up by only £11bn to pay for them.

But Tory sources hit back, describing it as "a dodgy dossier full of lies". David Cameron said the document was "complete junk" and said he had spotted at least £11bn worth of mistakes in about 11 seconds.

With the parties likely to attack and counterattack through the day, both sides will be eager to come out on top of the media battle. They hope these early skirmishes will give their party authority and bolster morale in the campaign HQs – as well as making an early connection with the electorate.

At a press conference to launch the Conservatives' draft manifesto on the NHS – one of a series on policy areas to be published ahead of the official general election campaign – Cameron insisted that the Tories were the first opposition in 30 or 40 years to go into an election promising to cut spending, and said his party had already spelled out some of where the cuts would have to fall.

"Public spending is going to have to be cut ... We are going to have to take some difficult decisions," Cameron said. Gordon Brown was "trying to give everyone the impression ... that public spending is going remorselessly upwards," he added.

Labour's dossier claims the Tories are pledged to £21bn a year in tax cuts, £13.3bn in reversing tax increases already pledged and £11.1bn in spending commitments.

"These are not long-forgotten promises from another time. All have been confirmed in the last two years. Most have been repeated in the last few months," Darling told a press conference at Labour's HQ in central London.

"You can't fight an election on a nod and a wink, sometimes claiming you are committed to these promises, and when challenged claiming you are not. It's now for them to say when and how they'll be paid for, or come clean and withdraw them."

Liam Byrne, the chief secretary to the Treasury, said Labour had been "generous" to the Tories in counting their spending pledges. But the count included £4.9bn to allow married couples to transfer their tax allowances, which Cameron has said is not his policy. The Tory leader said he had only ever committed himself to "recognising marriage in the tax system".

However, earlier today Cameron appeared to downgrade this from a commitment to an aspiration. He told the BBC he "wanted" to recognise marriage in the tax system and "definitely hoped" that this might be possible during the course of the next parliament, but, due to the "vast" size of the deficit, "today I am not able to make that promise".

Later he released a statement rowing back from this: "Recognising marriage in the tax system is something I feel very strongly about and something we will definitely do in the next parliament," Cameron said. "We will set out exactly how in due course."

Darling acknowledged that even if Labour was elected every department would be affected by spending controls.

The chancellor said: "The Conservatives have so far only set out how to raise a fraction of the money needed to pay for their plans to introduce new tax cuts, reverse current tax changes and fulfil their spending commitments," he said.

"Just to meet those promises, let alone to cut the deficit faster, they would need new tax rises and deeper cuts to public spending elsewhere."

Ed Balls, the schools secretary and one of the prime minister's closest confidants, gave another hint that the election is likely to be later rather than sooner. The favourite date is still 6 May, on the day of the local elections in England. It has to be called by 3 June.

"We are going to have months of this before the actual election comes along," Balls said.

Asked on BBC Breakfast if the election would be held before or after a budget – which cannot be held before March – Balls said: "I think probably it is going to come later but I don't know the answer to that ... I have not been told when the election is going to come."

Brown and Balls said today that from September 2011 all key stage 1 pupils in England – aged six and seven – will be guaranteed extra help if they fall behind in literacy and numeracy.

"We are saying in law we will set out a guarantee to parents: if your child falls behind, our investment will ensure your child gets that extra help," Balls said.

Cameron told a press conference in London: "We cannot go on, we cannot afford, another five years of Gordon Brown," he said. "We are the only party committed to protecting NHS spending. It's there in black and white behind me. I'll cut the deficit, not the NHS. And don't for one minute buy the Labour claim that they'll do the same. They won't – and their own figures show they won't."

He added: "Unlike us, they have not committed to protecting areas of the health budget such as public health and capital investment."

He promised that the Tories would introduce a health premium, so that more money went to poor areas, which would mark a "significant shift" in NHS spending and consign health inequality "to the history books". And the Tories would set up maternity networks, bringing all maternity services together.

Later Cameron and other shadow cabinet members held events across the country to promote the draft manifesto. Cameron was in Gloucester, Michael Gove in Nottingham, Chris Grayling in Reading, William Hague in Yorkshire, Nick Herbert in Southampton, Oliver Letwin in Plymouth, Theresa May in Bristol, Eric Pickles in Luton, and Lady Warsi in Bury.

http://www.guardian.co.uk/politics/2010/jan/04/alistair-darling-tory-bla...