Select Committee on Health Written Evidence

Memorandum submitted by Breast Cancer Care (CP 16)


  1.1  Breast Cancer Care believes that all cancer patients should be exempt from prescription charges. We feel it is unreasonable that they should have to pay for life saving drugs or for drugs to combat the debilitating side effects of their cancer treatment. This includes hormonal therapies that are prescribed to breast cancer patients for several years after their initial treatment.

  1.2  Breast Cancer Care would like to see hormonal therapies prescribed for longer periods, to cut down the cost and inconvenience of frequent prescriptions for a long term medication. We would also like to see uniformity across the country to ensure all breast cancer patients are receiving prescriptions of the same length.

  1.3  Breast Cancer Care would like to see more being done to ensure all cancer patients are informed of the Prescription Pre-Payment Certificate (PPC). Many breast cancer patients find the PPC invaluable in helping them cover the cost of their prescriptions but a concerning number of those we spoke to do not use the PPC despite the fact that it could benefit them financially.


2.1  Breast Cancer Care

  2.1.1  Breast Cancer Care is the UK's leading provider of information, practical assistance and emotional support for anyone affected by breast cancer. Every year we give direct support to over 22,000 people with breast cancer or breast health concerns through our helpline, peer support and other direct services. In addition, we respond to two million requests for support and information about breast cancer or breast health concerns through our publications, website and outreach work. All our services are free. We are committed to campaigning for better treatment and support for people with breast cancer and their families.

2.2  About this response

  2.2.1  A diagnosis of breast cancer often has many long term financial implications attached to it. A major issue we frequently hear about from people affected by breast cancer is prescription charges. Over the past months we have been gathering views and experiences related to prescription charges from people across England who have been diagnosed with breast cancer. In total, 115 women completed the survey. We have used our findings to develop and illustrate this response which is mainly focused on the issue of prescription charges. Key findings from the survey:

    —  98% of respondents think cancer patients should be exempt from paying prescription charges

    —  38% of respondents think prescription charges should be completely abolished

    —  43% of respondents have experienced financial difficulties as a result of paying prescription charges

    —  39% of respondents use a Prescription Pre-Payment Certificate

    —  15% of respondents have decided not to get their prescription dispensed because of the cost

3.   Are charges equitable and appropriate?

  3.1  Breast cancer is a potentially life threatening condition and it seems inequitable to breast cancer patients that they have to pay for their prescriptions when people diagnosed with other conditions are exempt. Respondents to our survey feel they are being discriminated against, even though they have developed breast cancer through no fault of their own.

    "Most life threatening conditions such as diabetes and thyroid problems are exempt from prescription charges so I think by not exempting breast cancer we are discriminated against. How can the authorities say one condition is more serious than another?" Sarah Clark, Kent

    "We have a life threatening, long term condition. In this respect cancer patients are no different from those with diabetes or thyroid conditions. Why are we discriminated against?" Jackie Igoe, Wirral

    "Psychologically you feel that you are being punished for getting cancer." Tracey Harrison, Cheshire

  3.2  Some breast cancer patients feel the very principle of having to pay for prescriptions for life-saving drugs is unjust. One reason given is that people who develop a life threatening illness such as breast cancer, who have worked and therefore paid their National Insurance contributions for many years, have a right to receive their healthcare for free, including prescriptions. Others state economic reasons, in that they believe it would be cheaper to cover the cost of prescription charges for cancer patients, and thereby ensure all patients are able to take the drugs they need and maximise the chances of recovery, than it is to pay for the care of terminally ill secondary cancer patients.

    "I have always been a firm believer in a National Health Service funded from general taxation and free at the point of need. I see this principle being increasingly eroded, not least by the ever-rising cost of prescriptions." Breast cancer patient, Oxfordshire

    "Reducing the numbers of people who go on to develop secondary cancers reduces the overall cost to the NHS. The longer a person remains healthy the less the cost to the NHS in the longer term." Jacqueline Tipple, Kent

  3.3  Breast cancer patients feel that having to pay prescription charges exacerbates an incredibly stressful situation. They are already having to cope with the inevitable concerns and emotions a diagnosis of breast cancer brings and feel they should not have to add finances to their list of worries. People may have to find money for a whole range of co-payments and other expenses, including hospital parking fees, travel and childcare, at a time when they may be on a reduced income as they are unable to work due to their illness and treatment. We have particular concerns about people affected by secondary breast cancer, as they will often require significantly more drug treatments than others and will therefore be under more of a financial burden from prescription charges.

    "Dealing with a terminal disease is difficult enough without worrying about the cost of life-saving prescriptions." Pat Montgomery, Leicestershire

    "Many like myself are unable to work and are only receiving SSP from their employer and simply cannot afford to pay these charges along with other costs of getting to hospital, car parking etc." Breast cancer patient, Staffordshire

    "The diagnosis brings lots of financial pressures in addition to prescriptions: travel for treatment, car parking, heating, clothing, wigs, food. Why should you have to pay for being ill?" Barbara Thomas, Norfolk

    "There are many additional expenses that you incur once you have been diagnosed with cancer such a vitamins and supplements to improve your immune system. Additional purchases when going through chemotherapy. Extra petrol, car parking due to many attendances at hospital. It's certainly not cheap being ill." Janet Clegg, Lancashire

  3.4  43% of respondents to our survey reported that the cost of prescription charges impacts on other areas of their finances or causes them financial difficulty. This is of great concern, because, as was stated earlier, a diagnosis of breast cancer is extremely stressful without the added difficulty of financial pressures. This also shows that the financial support provided by the current exemptions system does not extend far enough, as in theory, all those who are not eligible for exemptions should be able to afford their charges. This is clearly not the case for the 15% of respondents who have decided not to get their prescriptions dispensed because of the cost.

    "I have a family of five and therefore have to pay for a lot of outgoings. We're not all made of money and extra money spent on prescriptions means less money spent on my children's education or we have to reduce our food budget." Secondary breast cancer patient, Berkshire

    "I had to cut my family's food budget down to afford the prescription charges which made me feel guilty on top of being ill." Patra Aretakis, Cambridgeshire

    "My heating bills went up as did my petrol bill because of travel to hospital. I am still paying off the debt on my credit card for from money I spent on these extras. I feel I should not have paid for my prescriptions." Christine Clover, Lancashire

    "Sometimes when I didn't have much money I spent it on food instead of prescription charges." Breast cancer patient, West Yorkshire

  3.5  Some breast cancer patients feel they should be able to access free dental treatment while they are being treated for breast cancer, as a common side effect of chemotherapy is a sore mouth and gums, infected mouth sores and the exacerbation of any existing dental problems. As these problems are directly related to chemotherapy, they should be free of charge for the duration of the treatment.

  3.6  Paying for wigs is another expense that breast cancer patients feel strongly about. Many breast cancer patients lose their hair as a result of chemotherapy and while inpatients are entitled to a free wig, outpatients have to pay a prescription charge of £53.10 for a basic NHS wig. Breast cancer patients do not think this is equitable. Hair loss can be one of the most distressing side effects of chemotherapy and can deeply affect a patient's self-esteem, body image and sense of dignity, regardless of whether they are an inpatient or an outpatient. Patients who have to pay for their wig feel they are being penalised financially. This could become a more prevalent issue as new methods of treatment, such as oral chemotherapy drugs, allow growing numbers of people to receive treatment as outpatients.

    "I would have had a free wig had I received my chemo as an inpatient. This didn't make much sense to me. If I'd been sick enough to be in hospital a wig would have been the last thing on my mind. However it was an expense I had to make as my confidence had sunk so low I couldn't have gone without a wig." Breast cancer patient, Lincolnshire

  3.7  The main prescription charge encountered by breast cancer patients is for hormonal treatments such as tamoxifen and Arimidex. Breast cancer patients feel it is extremely unfair they should have to pay for a drug that is vital in preventing the recurrence or spread of breast cancer. Hormonal therapy is just as important to a breast cancer patient's recovery as inpatient treatments such as radiotherapy and chemotherapy, yet it has to be paid for simply because it is taken at home rather than in hospital.

    "You are prescribed with a life saving drug by your clinician, as part of your treatment after surgery, chemotherapy and radiotherapy. As this is part of the means by which your cancer is hopefully kept under control, you should not have to pay prescription charges at all for such drugs." Breast cancer patient, Surrey

  3.8  The long term nature of hormonal treatment means breast cancer patients can have to find the money to pay for their prescriptions, both for their hormonal treatment and for drugs to combat any side effects, for up to five years, which can be an ongoing pressure on their finances. In the future this could increase to as much as 10 years, with the introduction of new aromatase inhibitors (one type of hormonal therapy). Another issue that breast cancer patients feel strongly about is how often they receive their prescriptions. There are discrepancies across the country, with some women being prescribed their hormonal therapy for three months at a time, others for two months and others for just one month. Some respondents told us that they had asked to receive more than one month's supply of their treatment on each prescription but were told it was not possible. This variation in prescribing habits is penalising those breast cancer patients who have to pay for a prescription every month. There does not seem to be any uniformity as to how often prescriptions for hormonal therapies are issued and naturally some women feel they are being unfairly treated.

    "If hormone treatments are not to be exempt they should be given once a year so that we only have one prescription charge per year." Sarah Clark, Kent

    "I can't understand why prescriptions cannot be given for a longer time span which would save time and cost all round." Caroline Way, Norfolk

4.   Exemptions

  4.1  Breast cancer patients feel that any condition that is either life threatening or long term, or both, should be exempt from prescription charges and other co-payments. This includes all types of cancer. One of the reasons given by respondents to our survey as to why cancer should be added to the list of conditions that are exempt from prescription charges is the changing nature and length of treatment. Survival rates are increasing and people can now receive long term treatment for their condition, for both primary and secondary cancers. As stated earlier, hormonal treatments for breast cancer are routinely taken for five years, which could rise to ten with the introduction of new aromatase inhibitors, and new developments, such as oral chemotherapy, are reducing the amount of time that patients have to spend in hospital. This also means that patients are liable for more prescription charges than ever before. The current system of charges needs to be updated to take this into account—as it stands it is out dated and full of anomalies.

    "Many years ago a cancer diagnosis was as good as a death sentence so I can imagine that policy makers did not consider it a `lifelong' illness. Now treatment has improved greatly and the diagnosis is not always a death sentence but can be managed by medication. . . . There could be a new drug on the market and I could be prescribed that therefore I could live for decades thanks to medication. Cancer treatment has become more and more long term and I therefore believe long term medications should be free." Helen Eastham, Lancashire

5.   Awareness of eligibility for exemption

  5.1   Despite the fact that most people diagnosed with breast cancer will take a hormonal treatment, along with drugs to combat any side effects, for several years after inpatient treatment and that many are only prescribed one month's supply per prescription, only 39% of respondents to our survey use a Prescription Pre-Payment Certificate (PPC). This is a surprisingly low number and suggests that breast cancer patients are not routinely being made aware of the PPC. This is worrying, as those who do use a PPC are overwhelmingly positive about its financial benefit and it could no doubt assist many others who report financial hardship as a result of co-payments and charges. We believe more should be done to ensure that all cancer patients are informed of the PPC.

    "I found out by chance all too late about pre-payment. I wish the hospital had informed me about this." Patra Aretakis, Cambridgeshire

6.   Should charges be abolished?

  6.1  Breast Cancer Care believes that cancer patients should not have to pay co-payments and charges for anything that relates directly to their cancer treatment, whether as an inpatient or outpatient. The overwhelming majority of people who responded to our survey, 98%, believe that cancer patients should be exempt from paying prescription charges.

  6.2  There were mixed opinions from respondents to our survey over the complete abolition of prescription charges with the majority, 62%, opposed to the idea. Many of the breast cancer patients we spoke to are happy to pay prescription charges for other items, but feel they should be exempt for drugs and treatments that are related to their cancer.

    "I don't mind paying for one off prescriptions but long term medication should be free." Julie Ulvmoen, Middlesex

    "I feel that if you can afford it you should normally pay for prescriptions—after all we all go to the supermarket and stock up with aspirin etc. However after a cancer diagnosis I feel there should be a waiver—it is scary enough as it is and the drugs are a necessity." Hilary Duckett, Wiltshire

Jenny Priest

Breast Cancer Care

December 2005


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