I have chronic asthma and need several inhalers, without which I could possibly die. I am a student but I still have to pay for them and it is a lot of money.  It incenses me that they will become free for some but not for others!

Helen L Booth

From the Health Service Journal

The health minister has said a delayed review into the costs of prescriptions will be published in the autumn.

It is expected that the review headed by Professor Ian Gilmore, president of the Royal College of Physicians, will include a revised list of conditions exempt from payment following on from charges for cancer patients that were abolished in England in April.

At a cost of more than £150,000 the review has covered “deliberative research, stakeholder workshops and meetings”, but “further work to ensure that proposals can be implemented smoothly and efficiently” has delayed its publication from the original summer due date.

Despite the existing costs minister Mike O’Brien said more spending was likely as Professor Gilmore completed the review.

The government has faced criticism for increasing the price of prescriptions up to £7.20 in April despite calls from the British Medical Association to follow examples set in Northern Ireland, Scotland and Wales and abolish charges altogether.

In the last year the NHS in England has saved nearly £394 million through GP’s prescribing generic drugs for common conditions such as high blood pressure, high cholesterol and gastric problems. £278 million of that was saved on anti-cholesterol Statin drugs alone.

This saving in one year virtually covers the cost of providing free prescription charges for patients in England, the only country in the UK which is not ending prescription charges. It’s a reminder that abolition of prescription charges is easily affordable, and only the dogmatism of the government stands in the way.

HARDWORKING people are being forced to subsidise the NHS through unfair prescription charges, according to the British Medical Association. And a Swindon GP branded the rules on paying for medicine “unfair”. The organisation is asking for prescription fees to be scrapped, following Wales and now Scotland’s lead, rather than continuing to complicate the exemptions policy.

But yesterday the Government followed their calls with a 10 pence increase on the current price, taking the prescription cost to £7.20. Exemptions apply to prescriptions for some medicines and patients aged under 16 or over 60. Current charges bring in around £430m for the NHS. But doctors claims that the system is penalising people through a lottery on what condition you have and whether it falls under the prescription exemption policy.

According to the BMA, treatments for conditions like diabetes and now cancer are available free, while asthma or chronic migraines are not. The Wiltshire representative of the BMA, Dr Helena McKeown, from Salisbury, who represents the view of many doctors across the county, said:

“The current system isn’t fair because some conditions are exempt and some others aren’t,” she said. “I worry about people choosing between the treatments I give them and that leaves them vulnerable to ill health.”

This view was backed by Dr Richard Carter, of the Whalebridge Practice on Carfax Street. “There seems to be an inequality with the qualifying conditions for medication that’s prescribed free,” he said. “It seems odd that you can have diabetes and get your medication free, but high blood pressure you have to pay for it. “A small number of people who are working and don’t have an exemption subsidise the NHS and people quite rightly think that’s unfair.” He also said that the charges, that he understands are not imposed on 90 per cent of the population, seems to create an unfair situation for the remaining 10 per cent.

Swindon doctor Liz Mearns, who also works for Swindon Primary Care Trust as clinical governance lead, argued that the rise of 10 pence was not too steep considering the economic climate, but accepted that the system was unfair. She said that the exemption policy would be reviewed by Professor Ian Gilmore at the Royal College of Physicians with the results expected in the summer.

From the Swindon Advertiser by Emma Streatfield

Colin Fox has sent me this letter published in the Glasgow Herald letters page this Thursday.

As the MSP who introduced the Bill to abolish NHS prescription charges to the Scottish Parliament in 2005 I am not in the least surprised by the 26% increase in the use of pre payment certificates reported in yesterday’s Herald.[Cut price prescription drugs policy 'a success' - 28th January]. Cutting the cost of certificates by 50% was always likely to highlight the extent to which the price was an inhibitor to treatment.

However the figures also make clear that there are many tens of thousands of patients in Scotland who are still going without the medicines their doctors have repeatedly prescribed for them because they cannot afford to pay. And this is set to continue for the next 2 years.

I certainly hope the SNP administration keeps its promise to abolish the charges completely by 2011 but I would remind readers that patients in Wales no longer suffer this ‘tax on the sick’ as it was abolished there in 2006. Furthermore the Northen Ireland Assembly has also voted to get rid of the charges and will do so before the Scottish Government does.

Finally, I must take issue with the Herald editorial on the matter [No easy prescription] which rather misses the point when it says ‘if people who can afford to pay do so then …many millions of pounds can be re-invested in the NHS’. Surely the point is that it is patients who cannot afford to pay who are being penalised here whereas our utterly illogical and irredeemable exemptions system actually protects those who perhaps could pay more.Notwithstanding that I remain frimly opposed to the charges and have always felt that only abolition safeguards that ‘cherished principle’ referred to in the editorial, namely, treatment free to everyone at the point of need. That puts me firmly in the camp which believes that our NHS should be paid for out of general taxes and not by doubly taxing the sick.

Yours sincerely
Colin Fox
National Spokesman
Scottish Socialist Party

The Wiltshire & Swindon GMB union branch has passed a resolution which will go forward to the GMB’s national conference in June. If passed there it will commit the union to campaigning for abolition of prescription charges throughout the UK.

A similar resolution from the union UNITE’s Western Region on abolition has been passed to the union’s National Executive Committee for its consideration.

You may recall that we were expecting John McDonnell MP to move an Early Day Motion in Parliament in favour of abolition. Unfortunately the economic crisis exploded onto the scene and John has been busy with that as well as the issue of the third runway in Heathrow which sits in his constituency. However, I have spoken to him and have sent him an updated text which takes account of the concessions the government made late last year. It reads:

“Abolish NHS prescription Charges in all of the UK

With the abolition of NHS prescription charges in Wales and their staged abolition in Scotland and Northern Ireland, England remains the only country in the UK where charges will remain in place.

With the exemption of cancer patients from charges in England and the expressed intent to exempt people in England with chronic illnesses (apparently dependent on savings in the drugs budget), there is no logical case against the extension of abolition to all of the UK. It does not make sense to maintain charges for a shrinking number of people in England alone.

So long as they remain in place then those who have to pay them cannot fail to feel a sense of injustice. Moreover, the government’s assertion that the NHS provides treatment free at the point of use and need is not true so long as charges remain in place.

We therefore call on the government to end this anomaly and flagrant injustice and to abolish prescription charges in England, in line with the decisions of the devolved assemblies in the rest of the UK.”

Prescription Charge Review

As reported previously the government has set up a review on the extension of prescription charges to people with chronic or long term conditions. The Department of Health has set up an on-line survey which says that “responses to this survey will help Professor Gilmore formulate his recommendations to Ministers about how to exempt people with long term conditions from prescription charges and how this exemption can be phased in.”

These words underline what we expected; that the anomalies resulting from an exemption list will not be resolved by such an approach. They may be made worse. The questionnaire asks people to chose amongst the following criteria for determining the basis for exemption.

• How severe the condition is and how seriously it affects the persons quality of life;

• How long they have suffered from the condition?

• Whether they suffer from the symptoms all or most of the time;

• The amount of treatment required the keep the condition under control

• The potential to improve the person’s health.

This is a recipe for subjective judgements which will leave some people with a grave sense of injustice. Why should one be exempted and another not. Moreover, how is the extension of exemption to be phased in? On the basis of some table of illnesses ranked in degrees of seriousness? Who is to say one illness goes above another in ranking?

All this underlines the need to abandon such a ludicrous approach which will leave a shrinking number of people paying charges in England alone, of the four countries in the UK. The £400 million a year required is, of course, a pittance in comparison with the fortune the government has thrown at the banks.

If you have not sent in an email to Dr Gilmore’s review, calling for abolition in England in line with the decisions of the devolved authorities in Wales, Scotland, and Northern Ireland, can you please do so.

Either email dhmail@dh.gsi.gov.uk heading it for the attention of Professor Gilmore, Prescription Charges Review or write to him at:

Prof Ian Gilmore, DH Mail, Richmond House, 79 Whitehall, London SW1 2NS

Martin Wicks
31st January 2009

As part of the continuing campaign for the abolition of NHS prescription charges in all of the UK we are asking trades unionists to move a resolution to their national union conferences. Below is a model resolution. Please let us know if you manage to get your union branch to pass the resolution for forwarding to your national conference. We will providea briefing for any delegates who will be moving the resolution at their conference/AGM.

End NHS Prescription Charges in all of the UK

This conference welcomes the campaign of Swindon TUC for abolition of NHS prescription charges in all of the UK (http://abolishprescriptioncharges.wordpress.com ). Despite the concessions made by the government in response to the campaign by a range of organisations, some patients in England face continuation of the charges. Charges have already been abolished in Wales and are being phased out in Scotland and Northern Ireland.

It makes no sense for a shrinking number of people in only one of the four countries comprising the UK to have to continue paying the charges whilst they are abolished for everybody else.

We believe that this injustice must be brought to an end. The (union name) will campaign for an end to charges in all of the UK. So long as they remain in place then it cannot be said that treatment in the NHS is free at the point of use.

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In October the government announced two concessions in relation to NHS prescription charges:

• the exemption of cancer patients from charges from April of 2009 and

• the exemption from charges for people with “long term conditions”, sometime “over the next few years”.

The latter concession was dependent on savings in the NHS drugs budget which the government was hoping to make from negotiations with the big drugs companies.

Swindon TUC asked our local MP’s whether or not all people with chronic conditions would be exempted. Courtesy of Michael Wills we received a letter from Health Minister Dawn Primarola which explained the review in this way:

“This review will seek the views of the public, clinicians and patient representative bodies and will consider how to define the range of long term conditions which should be exempted from prescription charges and how exemption from prescription charges can best be phased in.”

This seemed to imply that some ‘long term conditions’ might not be included in the exemptions. This we tried to clarify with Ian Gilmore. We received this response from the Department of Health Customer Services Department, not from Mr Gilmore.

“Professor Ian Gilmore will undertake a review of prescription charges to report back to Ministers next summer. The review will seek the views of the public, clinicians and patient representative bodies on how exemption for people with long-term conditions should be phased in. The Department expects charges to be phased out progressively as savings in the drugs budget allow.”

This seems a little different to the Minister’s response: how the exemption will be introduced rather than “the range of long term conditions which should be exempted”. Surely Mr Gilmore would have been given a remit, or terms of reference on exactly what he was reviewing. We shall seek further clarification.

Swindon TUC will write to Mr Gilmore’ review on two points.

• All people with long term (or chronic) conditions should be exempted. We do not wanted a revamped exemption list which includes some conditions and excludes others.

• Secondly, we will reassert the need for all patients in England to be exempted in line with the situation in Wales (where charges have been abolished), in Scotland and Northern Ireland (where they are being phased out).

Mr Gilmore may well say the second of these is beyond his remit. Nevertheless we should continue to drive home the case for abolition in all of the UK, for all patients.

If his remit is as described by the Department of Health above, it only underlines the stupidity of the government’s approach. If charges for “long term conditions” are to be phased out, as money becomes available from savings on the drugs budget, how do you determine a hierarchy of conditions which will be phased out? Which disease do you chose above another to exclude first? Moreover, if the further exemptions are dependent on savings then the current crisis may well extend the time scale beyond “the next few years”.

Given the fact that the government receives only £430 million a year from prescription charges it is the worst sort of penny pinching to dogmatically insist that a shrinking number of people in England alone, continue to pay. Money has been no object when it comes to bailing out the banks and financial institutions responsible for the global financial crisis, yet such a minor sum is apparently an obstacle to abolishing prescription charges for everybody.

As we have said before, whilst charges remain in place the government’s assertion that treatment in the NHS is “free at the point of need” cannot be true. Whilst the concessions are a victory of sorts, we should recognise that the government did not concede them out of compassion. They were the result of its political crisis. The abandonment of the privatisation of pensioners payment cards (at the Post Office) was the result of a high level of opposition all over the UK. Likewise we need to persevere with the demand for abolition because it is the only means of ensuring that treatment in the NHS is genuinely “free at the point of need”; that patients are treated equally regardless of their financial circumstances.

Individuals and organisations can write to Ian Gilmore at:

Prof Ian Gilmore, DH Mail, Richmond House, 79 Whitehall, London SW1 2NS

Or email (for his attention): DHmail@dh.gsi.gov.uk

In his speech to Labour’s conference in September, Gordon Brown announced that:

• From next April 1st cancer patients will not have to pay for prescription charges;

• Over “the next few years” savings from the NHS drugs budget will be ploughed back into free prescriptions for people with “long term conditions”.

The first is a welcome step in relation to what has long been a national scandal, though it should not be forgotten that it has taken Brown 11 years to do it, and not without the pressure of a political and economic crisis.

The second of these promises appears conditional on the level of savings. In addition it is not clear that all people with “long term conditions” will be exempted. The government is carrying out a review led by the President of the Royal College of Physicians which will report back “next summer”. According to a letter from Dawn Primarolo, Minister of State in the Department of Health:

“This review will seek the views of the public, clinicians and patient representative bodies and will consider how to define the range of long term conditions which should be exempted from prescription charges and how exemption from prescription charges can best be phased in.”
(Letter to Michael Wills MP in relation to Swindon TUC’s call for the abolition of prescription charges in all of the UK)

This is what Primarolo deems to be “a fairer system of prescription charges”.

The cost of exemption of cancer patients will not break the government’s bank (no pun intended). It will cost around £20 million per year. It should be borne in mind that the government is estimated to receive only £430 million this year from prescription charges. Compared to the amount of money that they have stumped up for banks that are in crisis because of their own reckless lending, such a figure is peanuts.

According to the government’s own figures 88% of patients in England get prescription charges free. We don’t know how many will be left once cancer patients and at least some people with chronic sickness are added to the list, but it will almost certainly be less than 10% and possibly even 5%. It simply does not make sense for the government to insist on imposing financial difficulties, even on a small number of people, when charges are already abolished (as in Wales) or being phased out (as in Scotland, and now Northern Ireland). Why impose a means test on a shrinking number of people who will rightly consider the government’s doctrinaire intransigence to be unjust?

Swindon TUC believes that this injustice needs to be righted by the government. The fact that they have made some concessions under pressure underlines the need for the campaign for complete abolition of charges in all of the UK to be continued. To that end we would ask that you:

• Write to the Department of Health calling for abolition (we will give you the details of who to write to when these are available);

• Write to your MP pressing them to support abolition, underlining the illogical continuation of charges for a shrinking number of people, or ask to meet them to discuss the issue face to face;

• Continue collecting petition signatures;

• Trade Union members should put forward a resolution to next year’s union conference, committing their union to press for abolition (we will be sending out a model resolution which you can use if you wish).

You will probably have heard that the government has decided to abandon taking the Post Office Card Accounts for old age pensioners away from Royal Mail, as a result of the public outcry. This underlines that public pressure and pressure on MP’s, sufficiently mobilised, can achieve results. We should not let the fact that only a small minority of people will have to pay prescription charges stop us from pressing for complete abolition and an end to this injustice.

Martin Wicks
Secretary, Swindon TUC

This is from the BBC website. This will now leave England as the only country in the UK with charges.

Plans to abolish prescription charges in Northern Ireland have been announced by NI Health Minister Michael McGimpsey.

The cost of a prescription in NI will be reduced to £3 per prescription in January 2009 and will be free of charge by April 2010.

The charges were abolished in Wales on 1 April 2007 and are due to be abolished in Scotland.

This leaves England as the only country in the UK to retain the charges.

Mr McGimpsey said prepayment certificates would come down in price, from £35.85 to £9 for four months and from £98.70 to £25 for 12 months until prescriptions are free.

Speaking at the Cancer Centre in Belfast City Hospital on Monday, Mr McGimpsey said free prescriptions would be introduced, subject to the agreement of the Executive.

The UUP minister established a cost and benefits review into the abolition of prescription charging last year.

Impact

He said that in reaching his decision he had to “carefully consider the consequences of any change to the current charging regime in Northern Ireland“.

“A key consideration for me was the loss of around £13m income each year from prescription charges, and while it is only 3.5% of the total drugs bill, it is still a lot of money,” he said.

“After looking closely at the financial position with my officials, I have concluded that the cost of free prescriptions can be found within my existing budget and without impacting on any existing service.”

Iris Robinson, DUP, chair of the Health Committee, welcomed the news.

She said she was disappointed that charges for drugs used in cancer treatment were not being abolished immediately.

Mrs Robinson urged the Executive to consider this, as soon as possible.

Sinn Féin health spokesperson Michelle O’Neill said: “Many people on low

incomes were forced to choose between what medicines they could actually afford to get on prescription.

“This obviously had a very adverse affect on the ability to treat illnesses.”

The SDLP’s Carmel Hanna, also her party’s spokesperson on health, similarly welcomed Mr McGimpsey’s proposal.

“I believe this announcement to abolish prescription charges for all patients, regardless of their illness or background, is a major step in ensuring people receive the necessary care and treatment at their time of need,” she said.

‘Great day’

Alliance health spokesperson Kieran McCarthy said: “This is a great day for our health service.”

Dr Brian Dunn of the British Medical Association (BMA) Northern Ireland described the health minister’s plan to abolish prescription charged as a “very positive step forward”.

“All those patients who have found it very hard over the years to pay for their medication will welcome it – as does the BMA,” he said.

Heather Monteverde of Macmillan Cancer Support said: “Cancer patients in Northern Ireland have been struggling to pay these unfair charges for too long and it is fantastic news.”