Not many people are aware that throughout the UK, all prescriptions are free, except for 10% of the English ones. Is it now time to for Boris Johnson to end this inequality, especially when so many people cannot afford them? In the middle of the COVID-19 crisis, it was announced that prescription charges in England would rise to £9.15 per item on 1st April.
Some could be forgiven for thinking it was an April Fool’s story, that the government would not do this at a time of national crisis, but it was sadly true. This was on top of the increase that has occurred annually for some years. In contrast with the other three Home nations, which all have free prescriptions, the increase in charges was almost like a slap in the face to those in England who would have to continue to pay for them.
In 1948 the NHS was established, and the free medical service actually included free prescriptions. Prescription charges were only were introduced in 1952 by the new Conservative government and have risen consistently since then, under both Labour and Conservative governments. With the introduction of devolved government for three of the Home countries, they were given powers to deal with health matters.
In 2007 the devolved Wales government abolished prescription charges. It was argued at the time that doing so would save the Wales NHS a considerable amount of money over ten years. (This is a significant point as many who could not afford the prescription charges suffered worsening health conditions which ended up being more costly to the NHS).
In 2010, the Northern Ireland devolved government also abolished prescription charges, and this was followed by the devolved Scottish government in 2011. This left England on its own as the only Home country where prescription charges still applied, but since then, they have continued to rise.
At the last General Election, the Labour party recognised this inequality and included the abolition of prescription charges in their election manifesto. This was seen as a popular policy by the Conservatives who at the General Election countered by giving the impression that they would seriously address all concerns about the future of the NHS.
The arrival of the coronavirus- COVID-19 crisis has put back any major plans the government may have had for the NHS and including for the long term care of the elderly. This has meant that if there were going to be any re-visiting of the issue of having free prescriptions, it would all have to wait until after the coronavirus has been satisfactorily dealt with.
Delaying this would be a mistake for a number of reasons.
Firstly, the government has clearly said to the nation that “we are all in it together,” This cannot be the case if there are major inequalities in aspects of the health service in the United Kingdom. It is simply not treating everyone the same if people in England have to pay for prescriptions, and their fellow British citizens in Northern Ireland, Scotland and Wales are not. If we truly are “all in it together,” then it is imperative that all together are treated the same.
The second reason is that the government has made it clear that cost is no bar to them spending “whatever it takes” to see the nation through this COVID-19 crisis. That has to include making prescriptions as assessable as possible so that the public can take whatever medications their doctors prescribe for them. It is a fact that The Prescription Charges Coalition said in a report in 2017, that a third of all working-age patients did not collect their prescriptions because they could not afford the cost. An earlier Ipsos Mori poll in 2007 found that 800,000 people in England did not collect prescriptions due to cost too.
The third reason is that there is no logic left in the way the government decides who should pay prescription charges. There are so many exemptions from prescription charges that approximately 90% of the English patients do not pay for them anyway. Often these are people who could afford to pay for them, and often those who cannot afford to pay for them have to.
The system is in a mess, and it would save a lot of time and effort, staff costs, and mindless bureaucracy, just to let the final 10% not have to pay the prescription charges too. In September 2019, it was estimated that the English NHS would lose about £575 million if all prescription charges were made free. This sum is minuscule in comparison with what was then the NHS budget of £135 billion.
So in today’s terms, if the government made all English prescription charges free, it would be an additional investment in the NHS of between £600-£700 million per annum, not an horrendous sum for the benefits it would provide. This pales to insignificance compared with the huge amounts spent on countering the COVID-19 virus. Or even the £320 million recently committed by the government annually for five years to world vaccine-related work. Surely it is important to ensure assessable and affordable healthcare for all in the UK first before dishing out money on questionable overseas aid projects. Should not free prescriptions for all be part of the COVID-19 strategy?
The fourth reason is that the three other Home countries are still effectively subsidised by the UK government. So the free prescription charges they enjoy are indirectly paid for by the central UK government. This is absurd, but there is nothing that can be done about it without causing a lot of unnecessary friction. The best way to resolve this inequality is for the UK government to give a subsidy to the English too, so they do not need to pay for prescription charges either.
In summary, the prescription charges in England have become cumbersome and unfair, and are overdue to be made redundant. One of the best actions the government could do now would be to announce an immediate abolition of prescription charges in England.
It is also worth bearing in mind that the Health Secretary, Matt Hancock, said only recently that now was not the right time to consider a pay increase for the nation’s nurses. Surely now is the “right time” and the “right thing” to do both.
After all, the government has spent billions on fighting the COVID-19 virus, and this has also involved some mistakes in procurement and other areas, which have cost millions of pounds. In the scale of things, free prescription charges and pay rises for nurses would be costs that would be worth it and would reap the benefits of such investments.
Most importantly, it would demonstrate that we “are all in it together”.
Now is the time for the Prime Minister to ensure that action is taken to bring about these well overdue proposals.
Very good article Anthony. Clear, and of course you are right.
At its best the NHS is brilliant, at its worst it is terrible: mostly it is not at either extreme. Variability and reluctance to improve is characteristic of many a large, bureaucratic organisation, such is the NHS.
Every time I have been a patient the NHS has done OK, very good in some respects. But every time it has fallen short in one way or another, and the cause has been poor systems and administration rather than failings of individuals. It is easy to see how things could be done more efficiently.
The administration of prescriptions is a good example. I would like to know how GP and pharmacies are paid for the administration of routine prescriptions, for I wonder if therein lies at least part of the problem.
When I heard that the Covid-19 track and trace App was going to be run by the NHS I could not stop a laugh as I knew it would be a recipe for disaster. For are not the NHS the organisation that ran its computer systems so badly that not so long ago if fell victim to the wanna cry virus? And, if I remember correctly, the grand project to integrate GP computers so patient information can be shared, such as when moving and registering with a new GP, that it was abandoned in failure.
I reckon income lost from free prescriptions would be more than made up by improved efficiencies.
Thanks for the detailed data on this Anthony. – I had no idea that only 10% were still obliged to pay for prescriptions ! – This lack of common sense has been clearly blown to hell by your article, hence my sincere Thanks !