CONCLUSIONS AND RECOMMENDATIONS
1. The
dermatology clinic in Harrogate and the Jentle Midwifery scheme
in London differ significantly. The former involves charging for
purely cosmetic procedures while the latter charges a fee for
services that should be available, according to the National Service
Framework on maternity services, as standard. The Jentle Midwifery
scheme provides cut-rate private care within an NHS hospital.
This is unacceptable. Essential care of this type should be given
to all or paid for privately at full cost. (Paragraph 53)
2. The Government
claims that its exemptions policy is based on income: those who
can afford to pay, those who cannot do not. However, this is not
the case: many wealthy people are exempt, but many poor working
people are not. The exempt medical conditions have not been revised
for almost 30 years, creating many anomalies. It is evident that
Government policy is to maintain the status quo and not to upset
any existing beneficiaries. (Paragraph 74)
3. We recommend that
evidence is gathered on:
- public attitudes to health
charges,
- the extent to which charges affect the use of
health services and, in the long term, health,
- the extent to which charges reduce 'frivolous'
demand. (Paragraph 163)
4. We
recommend the immediate introduction of a monthly Prescription
Pre-payment Certificate (PPC). We also recommend that the annual
certificate be pegged at the cost of 12 times the price of a single
prescription. The monthly certificate should be pegged at the
cost of one prescription. (Paragraph 164)
5. We recommend that
a reduced price PPC be introduced for those receiving limited
help through the NHS Low Income Scheme. (Paragraph 164)
6. Once the NHS IT
system is in place, we recommend that the Government consider
introducing a yearly cap on payment for medicines, as is in place
in Sweden. (Paragraph 165)
7. We recommend that
the Department of Health after one year institutes a review to
report on the effects of the new (dental) contract:
- on patient access and care,
including prevention; and
- on NHS dentist numbers and recruitment, their
salaries, workload and how many signed the new contract 'in dispute'
and how these disputes were resolved. (Paragraph 166)
8. We
recommend that, as part of the General Ophthalmic Services contract
negotiations, the Department of Health require all opticians practices
to carry a range of spectacles within the maximum NHS voucher
value. (Paragraph 167)
9. We recommend that
the Department increase efforts to target people at risk of eye
disease. All young children should be fully screened for visual
impairment. The Department should look at eye examination schemes
in place elsewhere in the UK with a view to implementing them
in England. (Paragraph 168)
10. We recommend that
that all pharmacies, hospitals, and GP and dental surgeries make
available to patients information on charges to which they might
be liable, eligibility for exemption, and possible assistance
with costs associated with attending for treatment. (Paragraph
169)
11. We recommend the
HC1 form should immediately be re-written in clear English. (Paragraph
170)
12. We recommend that
the Department of Health and the Department of Work and Pensions
work together to find ways of automatically extending health charge
exemption from means-tested benefits so that the HC1 form can
be abolished. (Paragraph 170)
13. We recommend that
the Hospital Travel Costs Scheme be extended to cover patients
attending for treatment at primary care facilities, in accordance
with Our health, our care, our say. Consideration should
be given to including dental surgeries under the scheme where
patients have to travel considerable distances to access care.
Information provision on the HTCS and the Patient Transport Service
should be improved to increase uptake of the schemes. (Paragraph
172)
14. We recommend that
the Government consider extending the Hospital Travel Costs Scheme
to some hospital visitors on low incomes (for example, to those
visiting long-stay mentally ill patients for whom it may be particularly
important to maintain links with family and friends). (Paragraph
173)
15. We recommend that
the guidance on car parking arrangements be reissued by the Department
of Health. It should recommend that trusts:
- issue all regular patients,
or their visitors, with a 'season ticket' that allows them reduced
price, or free, parking;
- introduce a weekly cap on parking charges for
patients;
- provide free parking for patients who have to
attend on a daily basis for treatment; and
- inform patients before their treatment begins
of the parking charges, exemptions and reduced rates that will
apply. (Paragraph 174)
16. We
recommend that urgent consideration be given to short-term measures
that could be taken to reduce the costs of calls to bedside telephones,
such as shortening the recorded message and making it avoidable.
In the longer term, we recommend that hospitals should make greater
use of the bedside units as soon as possible, since this would
reduce the costs of incoming calls. It is an utter waste for these
units, which could contribute significantly to the transfer of
information within hospitals, to be used as little more than glorified
telephones and televisions. If the NHS cannot make use of the
additional services in the near future, the Department should
pay the difference in cost between the standard rate and the amount
charged by the companies. Patients' relatives and friends should
not be penalised for the Department's failings. (Paragraph 175)
17. We recommend that,
provided they do so sensitively, patients and their visitors should
be able to use mobile telephones within certain areas of hospitals.
(Paragraph 176)
18. We recommend that
the Government establish a review to examine the costs and benefits
of the following:
- abolishing all the existing
health charges;
- abolishing only the prescription charge;
- abolishing only charges for initial consultation
and diagnosis, such as dental check-ups and eye tests;
- establishing a system of reference pricing for
medicines;
- completely revising the list of medical exemptions
to the prescription charge;
- introducing a flat-rate prescription charge with
no exemptions; and
- basing exemption to charges solely on income
so that those who can afford to pay for their prescriptions, dental
care and sight tests do so. (Paragraph 177)
19. The
terms of reference and results of the review should be published.
(Paragraph 177)
20. The use of a limited
NHS formulary of medicines, possibly linked to reference pricing,
could reduce the drugs bill and improve prescribing practice.
We recommend that the Government look at this and respond to us
specifically on this matter. (Paragraph 178)
21. We need to avoid
the risk of new charges being introduced in an ad hoc way, as
they have in the past. The Government should review the costs
and benefits of an alternative system of health charges. The key
principles that should be considered in this review are:
- services that are clinically necessary should
be free;
- fees should not deter patients visiting their
doctor or accessing healthcare; and
- any system chosen should be adaptable (to changing
medical practice, treatments etc) and consistent. (Paragraph 179)
22. The
review should include:
- the possibility of establishing
a package of core services which would be free (these might include
prescriptions and dental care);
- a set of treatments for which the NHS could charge;
Treatments/interventions that are not cost-effective,
such as branded drugs where an effective generic exists, could
be subject to a charge. The use of charges to promote more responsible
use of services could also be considered, including:
- the introduction of a small
charge for non-emergency patients presenting to A&E. This
would encourage people to register with a GP, and make better
use of out-of-hours services; and
- a fee for patients who do not attend or fail
to cancel GP or hospital appointments. (Paragraph 179)
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