Just what the doctor ordered

Great article - quite frankly I'm surprised the SoS printed it as it's well above their usual standard. JOE

by DANI GARAVELLI (from Scotland on Sunday)

IMAGINE you are suffering from asthma. Your GP has recommended you take salbutamol and beclomethasone, but you can't really afford two prescription charges this week, so you toss up and opt for salbutamol. As a result, you have a severe attack and end up at A&E in the early hours of the morning - a visit that costs the NHS much more than the £6.85 you just saved.

Or perhaps you are suffering from depression that has been kept at bay by a mixture of drugs, but it's Christmas and you've presents to buy so you decide to skip your medication for a couple of weeks and find yourself unable to cope. How much does your inability to pay for your prescription cost the country in terms of arranging foster care for your children and loss of productivity? Then there is the anomaly of cancer patients who receive drugs free in hospital, but have to pay once they go home to their families.

Wherever you stand ideologically on prescription charges - and since the NHS is supposed to be free at the point of use it is easy to argue they should never have been introduced in the first place - the way the system is currently administered is a mess. Not only are they an inefficient form of taxation (they are costly to process and 90% of them are free), but the system of exemptions is arbitrary and unfair: the cut-off point for those eligible for free prescriptions on the grounds of low income is so sharp that those who are just above it often end up worse off than those who are just below it, and the list of those exempted on the grounds of chronic conditions has not been updated since the Sixties, before conditions such as HIV existed and before asthma was so widespread.

Those not exempted can benefit from a Prescription Prepayment Certificate (PPC), a three-month, six-month or 12-month pre-payment or "season" ticket which will save them money. But this adds to the bureaucracy and is not widely publicised. A recent survey by the National Association of Citizens' Advice Bureaux (Nacab) found 27% of those who could have benefited from PPCs did not even know of their existence.

Last week, the Scottish Executive tried to address these inequities by pledging to reduce the charges steadily every year until 2011 when they will be scrapped altogether. Instead of being lauded, they found themselves facing criticism, both from those who believe those who can afford to pay should continue to do so, and those who believe the party should have kept to the letter of its manifesto promise -which was to scrap prescription charges for those chronic conditions immediately.
But it seems to me the party has walked a tightrope between ideology and fiscal prudence with considerable agility. Research shows a direct link between prescription charges and the failure to manage drug regimes properly.

A survey carried out in 2001 showed around 50% of those who had received a prescription in the past year (and about two-thirds with long-term health problems) found it difficult to meet the charges, while Nacab estimates about 100,000 of its clients fail to make full use of their prescriptions. For the government of a country with a low life expectancy that supports improving access to health services to allow this situation to continue would have been unthinkable.

Yet almost two years ago, the Labour executive did precisely that, voting against the Scottish Socialist Party Bill with a fraction of the backlash the SNP is now facing. One option the new executive could have considered was to extend the number of exemptions, but instigating a sweeping review of which chronic conditions should be included would have been time-consuming and expensive, and many people felt it would be unfair to keep charging a smaller and smaller proportion of the population.

As for the SNP's decision not to axe prescription charges for those with chronic conditions sooner, it is unfortunate, but it would be particularly wasteful to launch a review expected to take until 2009 to complete when prescription charges will cease to exist in four years' time.

The party has already pledged to reduce the cost of prescriptions - to £5 next year and by a further £1 a year to 2011, and could easily help ease the burden on those who need regular medication by advertising the "season ticket" option more widely.
Those who oppose the scrapping of charges say they are necessary as a barrier to demand; that if they were abolished patients would seek prescriptions for drugs such as paracetemol that they would previously have bought over the counter. Some doctors have recommended the imposition of a token charge of say £1: small enough not to jeopardise people's access to medication, but enough to remind them that drugs are not free and should not be sought frivolously.

Early studies of the situation in Wales - where prescription charges were scrapped in April - however, suggested no perceptible change in GPs' prescribing habits and only a slight rise in the number of patients asking for prescriptions for over-the-counter medicines. There, patients are reaping the benefits of not having to worry about whether or not they can afford to take the drugs they need and administration has been reduced.

You really have to be the kind of person for whom the glass is always half empty to berate the SNP for "reneging" on a tiny part of its manifesto pledge, when what it has actually done is to commit to a socialist policy that Scottish Labour bodyswerved for a decade.