Examination of Witnesses (Questions 600
- 619)
THURSDAY 16 FEBRUARY 2006
RT HON
JANE KENNEDY
MP, MS ROSIE
WINTERTON MP, DR
FELICITY HARVEY
AND MR
BEN DYSON
Q600 Mr Burstow: There is one other
specific to consider perhaps in that regard. We have had some
evidence indirectly from the British Association of Day Surgery,
and they tell us that day case patients are being required to
take pay for painkillers which they take once they return home,
and this is as a result of a policy that was promulgated from
the Department. Is this policy of charging for painkillers for
people who have had day surgery consistent with a policy of trying
to encourage an increased emphasis on people opting for a day
surgery rather than becoming inpatients?
Ms Winterton: I think we have
got to be realistic about what is a deterrent. I had day surgery
on my foot and had to buy painkillers, but I think that was preferable
to spending four days in a hospital. If you are looking at saying:
is that going to stop people going for surgery? Are they going
to take an overall view of what they prefer? The usual complaint
is that people say that they are having to go unnecessarily into
a hospital setting or are staying there too long. I think that,
on balance, it is about saying there are some very, very clear
advantages to having the day surgery option and probably, if you
balanced out all the costs of that to the individual themselves,
they might still say they would prefer to take a day surgery approach
than have to go into hospital for a week or so with all the attendant
costs that there may be to them in that. I think it is a balance.
Q601 Mr Burstow: Presumably you would
be concerned if that behaviour was stimulated by this new charge
for painkillers, if people were making part of their decision
about whether they opted for day surgery. Would you actually know?
Would you be in a position to have information that would inform
on such a situation?
Ms Winterton: Patient surveys
very often show how people react, and I think the evidence from
patient surgeries is that people like to have the minimal time
in hospital. I have not seen any evidence. I do not know whether
that has been specifically asked in patient surveys, but I have
not seen any evidence of people saying, "I much prefer to
go into hospital because I can get a free painkiller."
Jane Kennedy: Do not forget, it
is not a new charge. It is a charge that has come about because
of the different way in which the medicine is being prescribed.
There are only 13% of prescriptions that face a charge, and of
those 13% there are ways in which you can ameliorate the cost
of that.
Q602 Mr Burstow: My point is that,
as a result of policy decisions and choices you have made, a new
set of anomalies start to emerge from something that has not been
changed since 1968. Surely that does behove a further examination
of the 1968 exemptions in the light of other policy changes.
Jane Kennedy: And it is something
we want to look at carefully as we take the work on the White
Paper forward.
Q603 Chairman: Can I ask about the
issue of low income families in particular. We heard when we were
in Cardiff last week that one of the reasons why they were moving
in the way that they are is that they believe that prescription
charges may act as a form of poverty trap, that people would be
deterred from going back into work because of the cost of the
prescription when they are in work as opposed to the exemption
that they get because they are on means-tested state benefit.
Have you any evidence of that?
Jane Kennedy: There have been
a number of studies. There was a study conducted in Manchester
some two or three years ago which was a relatively small study
of the impact of charges on those people who had to pay and what
they took as a result of that from their prescription, but we
have been reluctant to extrapolate from that because it has been
a relatively small study. Professor Peter Noyce conducted that,
but it was only 14 pharmacies. What he found was that, yes, people
who were being asked to pay a charge were discussing with the
pharmacist which items on the prescription were necessary and
were there alternatives, over the counter medicines, that might
have provided a cheaper alternative, but he found that a very
low proportion within that small study were at risk of not taking
a medicine that was actually important to them for medical reasons,
but that is the only study we have on that front.
Q604 Chairman: We had some evidence
from the pharmacists last week in relation to that. I am more
concerned about this issue of the threshold where you have to
pay or do not have to pay. If you go into low-paid work from being
unemployed altogether on a different benefit, you then would have
to pay your prescriptions. There is no taper in this. You are
either exempted from paying prescription charges because of your
age or income or condition, in some cases, or you have to pay
the full cost of the prescription. What they were saying to us
in Cardiff is that they believe, and I do not think they have
done any great study into this, that it was potentially a disincentive
for somebody to go back into work, because, even in low-paid work,
they would have to pay the full cost of their prescriptions and
not be exempted from paying in that work situation. What worries
me about that, Minister, is the potential for social exclusion
not to be broken down in society. Of all the areas that this Government
wants to work at to bring people back into society, to get them
back into work, this particular area might be a disincentive for
some people to do that. I do not know if any studies have been
done in England about that.
Jane Kennedy: I would share your
concern. We have not commissioned a study specifically on that,
but we do work very closely with the Department for Work and Pensions
and we are, as you will know, joint partners with them in the
schemes in which we are seeking to help people who are on incapacity
benefit return work, and this sort of issue has very much informed
the policies as we have been developing them in that scheme. It
is one of the reasons why the Low Income Scheme was extended to
12 months rather than six months, so that, even if you have gone
back into work and the particular condition for which you got
the exemption in the first place is ameliorated and goes away,
you can still get relief on prescription charges for the rest
of the year. It is that kind of work that we have been doing to
try and deal with that problem, should it arise.
Q605 Chairman: Do you have any regular
meetings yourself with ministers from the Department for Work
and Pensions?
Jane Kennedy: I have not. That
is not to say other colleagues across the Department have not.
Q606 Dr Taylor: I am coming on to
the age-based exemptions, because they do not really seem to make
sense when there are lots of people who are retired and well off
who do not need those exemptions. Have you any comments on that?
Ms Winterton: There obviously
have been manifesto commitments, discussions with organisations
representing older people and reintroducing free eye-tests for
the over 60s was a very popular measure, widely welcomed and very
good in terms of ensuring that a particular group of people who
probably did need regular eye-tests were able to get them. That
is a debate, in a sense, about how we decide to treat older people,
frankly.
Q607 Dr Taylor: In any possible review
would there be a question of looking at the multi-millionaires
in their 60s and 70s and reckoning that they should pay?
Ms Winterton: I do not see, particularly
on the eye-tests for over 60s, a change in that policy in the
near future.
Q608 Dr Taylor: And prescription
charges?
Jane Kennedy: We have no plans
to do with prescription charges either. You will remember, the
largest number of prescriptions is written for people in that
older age group. Something like 57% of all prescriptions go to
people in that age group. You are more likely as you age to require
medical support, medical treatment and medicines, and we have
taken the view that we should not take away entitlements, and
that is the position that we hold.
Ms Winterton: I suspect that Parliament,
having voted in some of these changes, would be rather loath to
remove them.
Q609 Dr Taylor: But you have said
that one of the principles is that those who can afford should
pay. Are you not now contradicting that?
Jane Kennedy: No, because we have
exempted those who are in retirement and are not working.
Q610 Dr Taylor: But you have also
exempted a lot who could afford to pay?
Jane Kennedy: That is true.
Q611 Dr Taylor: Which goes against
your principle?
Jane Kennedy: If you like, we
have refined the principle.
Q612 Chairman: Do we not have a problem
with extending principles that are in manifestos!
Jane Kennedy: We do not mind refining,
but extending is more difficult.
Q613 Dr Taylor: I want you to refine
another one. War disablement pensioners do not have to pay prescription
charges but only in respect of the medication for their disablement.
Could not the system be refined so that these lucky patients with
an under-active thyroid only get free prescriptions for their
thyroid, diabetics only get free prescriptions for the things
directly related to their diabetes. If you can do it for war disablement
pensioners, could you not do it more across the board?
Jane Kennedy: I am reluctant to
begin that sort of review, which would inevitably lead to
representations from every patient group who believed that they
were a case that should be considered for exemption. We have really
discussed that earlier. It is not a policy discussion that is
enticing us. It is not high on our priority list.
Q614 Dr Taylor: No, we are back to
the very strong argument for the abolition and not the review.
One other final question. Is it true that a directive came from
the Department of Health about out-patient charges that anybody
who had been in hospital for less than 24 hours should pay a prescription
charge for the drugs that they take away with them? As I am sure
you know, one of the rather odd definitions is that if you manage
to get a patient out of hospital at 23 hours, rather than 24,
they count as a day case and therefore they would have to pay
prescription charges, whereas, if they managed to stay 24 and
a half hours, they would count as an inpatient and so they would
be exempt?
Jane Kennedy: I have to apologise.
I am not cited on that. I would want to look into that and see.
Q615 Chairman: I think since 1948
the definition of an "inpatient" is one who was occupying
a bed at midnight.
Jane Kennedy: As far as I know,
there have been no recent changes to the rules, but I would want
to look at what you say.
Q616 Dr Taylor: We were told there
was a directive sent round from the Department of Health about
charging for people who were in for less than 24 hours.
Jane Kennedy: It is not something
of which I am aware.
Q617 Chairman: I hear what you say
about the issue of conditions exemptions, and, indeed, it was
put to us that is not somebody suffering from depression a long-term
condition as well and where do you stop? We heard that in Cardiff
last week. Would it not be easier to say that, given in 1951 there
probably were not as many millionaires living into their retirement,
in fact there were not as many millionaires full stop as well
as people living into their retirement, and given an exemption
on age nowadays when we have got a massive amount of millionaires
who are able to get free prescriptions I think from the age of
60 now, is that not something that could be reviewed and stood
on its own? I know it sounds like we are into class-bashing, and
it is not meant in that respect. NHS charges are another form
of tax, in a sense, and these people could well afford to pay
£6.50, could they not?
Jane Kennedy: The thing is that
you would not introduce a system where you started saying people
who had an income or asset base of a million pounds or more had
to start paying more or had to start paying for their prescriptions.
The vast majority of older people who are on acknowledged good
pensions have planned for their retirement and taken into account
that they will not have to pay prescription charges perhaps to
a certain age, and to remove that would be just as controversial
as some of the issues that you are asking us to consider in a
different context.
Q618 Chairman: What about doing it
for people who pay the top rate in income tax when they retire?
Ms Winterton: Sometimes it can
be quite difficult, when you look at those systems. The cost of
administering something like that can actually remove from the
amount of revenue that you raise.
Q619 Chairman: Have you looked at
the costs of administration?
Jane Kennedy: No, I must admit,
we have not.
Ms Winterton: I remember looking
at the general admin costs and, at the time when I looked at them—this
is all from my own interest, by the way, not some kind of fundamental
review—it was fairly clear that the system was relatively
simple at the time and the balance of administration was quite
low, but I did think from that that, once you started introducing
various different levels, it might become more complicated.
| 
