Examination of Witnesses (Questions 214
- 219)
THURSDAY 2 FEBRUARY 2006
MS PAULINE
THOMPSON, MS
LIZ PHELPS
AND MR
MARTIN RATHFELDER
Q214 Chairman: Could I welcome you
all and I wonder if you could just give us your names and the
organisations you represent.
Mr Rathfelder: I am Martin Rathfelder
and I am Director of the Socialist Health Association which is
affiliated to the Labour Party in the same way as the Fabians.
Ms Phelps: I am Liz Phelps, Social
Policy Officer from Citizens Advice.
Ms Thompson: I am Pauline Thompson,
a Policy Adviser at Age Concern England.
Q215 Chairman: I think, Mr Rathfelder,
we should have had you here last week, so I hope you have not
been on the train all week and it was just a delay last Thursday!
Mr Rathfelder: Thank you very
much for letting me have another bite of the cherry.
Q216 Chairman: Can I ask you, starting
with you, Mr Rathfelder, in your written submission you recommend
the abolition of all charges, so why is that?
Mr Rathfelder: We are essentially
concerned with the issue of health inequalities and we see charges
as deterring particularly the lower middle classes actually. We
have a bizarre system where people with lower incomes and of middle
age have to pay and other people get them free and that does not
seem to us to make any sense whatsoever. The Government has made
quite a lot of commitments to the idea of reducing health inequality,
but the Department of Health does not appear to have taken that
on board because clearly, if you make a charge on something, be
it prescriptions or windows, then the consumption of those items
is likely to reduce amongst the population least able to afford
them. If we are serious about encouraging people less able to
pay to use the Health Service, then forcing them to come up with
£6.50 every time they have a prescription seems counterproductive.
I would also like to say a bit perhaps later about the Hospital
Travel Costs Scheme because that is also part of the same—
Q217 Chairman: We will move on to
that.
Mr Rathfelder:—and other
things that the Department of Health seem to have forgotten about,
like wigs and trusses. I came into this because I used to work
as a welfare rights officer in a teaching hospital and I was next
door to the orthopaedic department. People who have to have a
surgical truss have to pay for it, unless they come within the
scope of the Low Income Scheme. Similarly, if they need a wig
for surgical reasons, they have to pay a charge for a rather inferior
item. These are forgotten areas of the National Health Service
and I found myself advising doctors, pharmacists, all sorts of
people, who had no idea about the Byzantine nature of the system
of charging, exemptions and reductions in charges. A system of
rationing which works essentially on ignorance seems to be the
worst possible method of rationing.
Q218 Chairman: Could you expand on
your comments about the question of charges deterring patients
from seeking help? Do you know which groups are particularly unlikely
to seek help? You have said obviously the issue of income which
is something we touched on in the earlier session and indeed we
did last week, but are there other groups beyond this question
of income?
Ms Phelps: I think from our point
of view it is a combination of people's chronic health problems
and low income. It is when those two things butt up against each
other, that is the client group that we find most often has problems
with prescription charges. As was mentioned earlier, the PPC actually
really misses out here on this highly vulnerable group because,
if they cannot afford the individual charge, they cannot afford
the PPC. Particularly, I think, when you come down to people on
Incapacity Benefit, that is where it really hits hardest because
a lot of this client group were on Income Support and they got
free prescriptions, but then they got sick and, for whatever reason,
got moved on to Incapacity Benefit at a slightly higher level
and now, thanks to a slight change in the rules in April 2004,
there is help with the short-term lower rate, but once they get
on to the long-term rate, which is slightly higher, they lose
out. You might think that Incapacity Benefit is paid at a higher
rate, so they can afford it, but the point is the way Housing
Benefit and Council Tax Benefit impact on ICB which is that they
pull back 80% of any income above Income Support. I am not sure
that Department of Health officials and ministers sufficiently
recognise that. What that leaves is a huge poverty trap and, if
you are trying to tackle health inequalities, you are missing
the boat. From our point of view, we were very disappointed that
this is the one area in the whole NHS where money is changing
hands between patients and the Health Service and yet, in the
context of the whole health inequalities agenda, it has not been
looked at.
Ms Thompson: Obviously for older
people prescriptions is not an issue, but, where we do have problems,
if you go to any Age Concern in the country, they would say they
are really concerned about older people with dental charges and
optical charges, and the amount of time they actually have to
spend describing the Low Income Scheme. I think, when we are looking
at costing things, you are not just costing what it costs the
NHS to collect the money, but it is really costing all of those
services that are spending hours and hours trying to help people
and encourage people to go and to see the dentist when they are
really quite scared to because they are so worried about the cost.
We would, therefore, say exactly the same thing, that it really
does impinge and we are very concerned about the way it does put
people off. When you have got a government which has just issued
a White Paper that mentions the word "well-being" 179
times and you are trying to look at the same time at charging
to actually try and achieve that well-being, it just seems very
strange.
Mr Rathfelder: Just to follow
up on what Pauline has said, because there is an age angle to
this, it is not widely known that the Income Support system is
age-biased. People under the age of 25 are given less money to
live on and that is reflected in the way the National Health Service
Low Income Scheme works, so for people under 25, they are expected
to live on £44.50 a week, and that is not really a great
deal and, if that is all they get, they get free prescriptions,
but, if they have Incapacity Benefit or some other benefit or
they work, the marginal amount above £44.50 is expected to
pay part of their rent, their food, their heating, the costs of
all their prescriptions. If they have to have any dental treatment
or an eye test or anything else, they are in severe financial
difficulty. One other point I would like to put to you is that,
if we are going to continue with some sort of means-tested system,
why are we still attached to the Income Support system which was
designed with entirely different considerations in mind? The point
of the lower amount for people under 25 is that it is expected
that those people will live with their parents, so they do not
have as many costs, which may or may not be true, but I do not
see that it is the scope of the Low Income Scheme to encourage
young people to stay with their parents because that is the only
way they can afford their prescriptions, nor does it make much
sense for older people when they get an Income Support amount
of £109 a week now. Why do we do that? If old people need
£109 to live a tolerable standard of life, why should young
people only have half of that? The argument for that is about
incentives for work.
Chairman: That might be for a different
select committee. I have some sympathy with what you are saying,
but not today.
Q219 Dr Taylor: Going back to Ms
Thompson, prescription charges are free, whereas dental and optical
are not. Are there any others that are free for the elderly and
for co-payment?
Ms Thompson: Prescriptions is
the one that is the free one. Older people get free optical checks,
but not free dental checks, so why? Teeth are incredibly important
to older people. Malnutrition, well-being, yet they can have free
optical checks, but not free dental checks.
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