STUC Response to the Review of NHS Prescription Charges and Exemption Arrangements

Introduction

The Scottish Trades Union Congress is Scotland’s Trade Union Centre. Our purpose is to co-ordinate, develop and articulate the views and policies of the trade union movement in Scotland.

The STUC represents around 630,000 trade union members in Scotland, the members of over 40 affiliated organisations. We speak for trade union members in and out of work, in the workplace and in the community, as workers and as citizens. Our affiliated trade unions have members in every sector of the economy and across a broad range of occupations.

The STUC welcomes the opportunity to respond to the Review of NHS Prescription Charges and Exemption Arrangements in Scotland. The STUC believes in a National Health Service based on the ideals of a public sector for healthcare which is free at the point of delivery and accessible to all. These are principles which have underpinned the NHS for over 50 years and should still be the principle on which the current NHS is based.

The STUC supports the abolition of prescription charges, as we believe them to be intrinsically unfair, inequitable, illogical and inconsistent.

Change Possibilities

The consultation document proposes a number of change possibilities, including a review of exemptions related to medical conditions; ability to pay; and exemptions based on economic need and affordability.

Review of exemptions related to medical conditions

The STUC agrees that a review of exemptions related to medical conditions should be carried out. Extending the list of exempted conditions would be an improvement on the current situation and would reduce some of the widely acknowledged anomalies in the current system. The anomalous situation whereby those with diabetes and hypothyroidism can claim exemption from charges, whilst those with other chronic conditions such as cancer, asthma and Parkinson’s Disease continue to pay for essential medicines is incomprehensible.

We believe however, that even adding a small number of chronic illnesses to the list would reduce the amount of revenue collected to a level where it would not be financially viable to collect and we do not believe this on its own would solve the current problems in the system.

Ability to Pay

With regard to ability to pay, the STUC would agree to the proposal that exemptions should be extended to all persons in full-time education and training, including apprenticeships. However, we believe that charges based on ability to pay would be cumbersome to administrate and would not take account of the number of drugs needed by patients and again, would not solve the problems with the current system.

Exemptions based on economic need and affordability

The STUC believes that other charging methods would assist with the problems. We would agree with the proposal to extend exemption from paying prescription to all persons holding an NHS Low Income Scheme (LIS) HC3 certificate, which extend charge exemption in Scotland to over 21,500 people in Scotland and their dependents.

We also believe that there should be better access to the prescription season ticket scheme, or Pre-Payment Certificate Scheme (PPC). Many patients who would benefit from this scheme are unaware that it exists. There must be more publicity and awareness-raising in relation to the PPC, so that more people benefit from the Scheme.

Furthermore, the one-off payment is not a viable option for many on the lowest incomes in Scotland; although cheaper in the long-term, it is simply not possible for them to afford such an amount at one time. The STUC believe that the minimum period for which the PPC applies should be restructured and that those on the lowest incomes would find the PPC much more accessible if they were allowed to pay for the ticket on a monthly basis, throughout the course of a year. However, administration costs would be complicated and there would still need to be exemption of certain groups of people in addition to the charges.

Conclusion

Whilst the STUC would support the alternatives, as we have advocated above, and believe that they would improve the levels of take-up for many people, we do not believe that any of them by themselves would eradicate the deficiencies of the current system.

The STUC believes that the Scottish Parliament should follow the example of the Welsh Assembly and introduce a programme to abolish all prescription charges in Scotland that is in keeping with the spirit of the NHS being free at the point of use.

STUC April 2006