Select Committee on Health Third Report


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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