The income foregone from the charge would be around £575 million, and there might well be an increase in the uptake of prescriptions once they were free for all. Labour acknowledges that might take the cost closer to £750m – all the more honest given that the limited evidence on changes to take-up is far from clear following the introduction of free prescriptions in Scotland and Wales (and indeed in the UK in the 1960s when they were briefly abolished and then re-introduced). In Wales there was little impact. In Scotland quite a lot.
So for the sake of argument, let’s take the cost to be around £600m. Is it a good idea?
Well, it has to be acknowledged that the existing exemptions from charges, which currently see almost 90 per cent of items dispensed free, are problematic. Aside from children, the elderly and those on low income there’s a host of medical exemptions that make little or no sense. It equally makes no sense that all those aged 60 or over are exempt when the state pension age for both men and women will rise to 66 next year.
The charge – currently £9 – is per item, not per prescription. So someone only just well enough off not to pass the low income test can face a £27 charge for three items. Those who are not exempt and have more than one long-term condition can easily incur that and more. There is evidence, which Labour cites, showing that some do indeed put off filling prescriptions as a result – rationing which drugs they take, or how often. Against that, there are pre-payment certificates – ‘season tickets’ – that cost £104 a year for those who are not exempt and know they will need multiple repeat prescriptions. That is not an insignificant sum for those on lower incomes. But it is not a king’s ransom, and how well known these ‘season tickets’ are is far from clear. GPs and pharmacists should, of course, explain to patients that they do exist – along with a shorter three-month season ticket which costs under £30, and thus involves a smaller initial layout.
But all that said, should this £600 million a year or so be the first priority, or even an early priority, for any extra health expenditure? Surely not.
The sum sounds trivial against the health department’s £135 billion expenditure. But it is not peanuts. In revenue terms it would be far better to spend it over time on mental health services which remain a poor relation and need cash. It could restore a large part of the cuts made to social care since 2010, or to public health expenditure, and given the workforce crisis it could boost training. In capital terms, it could buy a significant new hospital every year – more than sorting out, for example, the Epsom and St Helier problem, where a new build to replace the two is proposed. A London and Surrey example, but there are plenty of others around the country. While not solving the backlog of maintenance problems in one year, it could solve the worst of it over five years. Or it could, quite rapidly, provide badly needed new bits of capital kit, including IT, up-to-date scanners and radiotherapy machines, which would improve treatment for an enormous range of patients, including those who pay the charge.
If as part of its programme for government Labour were to inject many, many more billions into the NHS, then abolishing the charge, which does undoubtedly have its problems, as part of that might be reasonable. But not as a top priority. And there are other ways to reform it, without getting rid of it.
One of its myriad problems is that by international standards the £9 charge per item for those who have to do pay is rather high. Back in 2014 The Barker Commission on the Future of Health and Social Care in England suggested reducing the charge significantly – by at least two-thirds – while also heavily reducing the exemptions but leaving a cap in place (the ‘season ticket’). That could raise more money than the current charge: reducing the burden on the less well off who do pay, while – obviously – seeing many of those who currently pay nothing, pay something.
The politics of that would, undoubtedly, be difficult. Removing the blanket exemption for older people, for example, would be nobody’s vote winner. Scrapping it is obviously far more popular – far easier – than keeping it or reforming it. But to govern is to choose. And choosing to spend £600 million on abolishing it should not be a top, or even an early, priority.