Memorandum submitted by the National Consumer
The National Consumer Council is an independent
consumer expert, championing the consumer interest to make a practical
difference to the lives of consumers around the UK.
We conduct rigorous research and policy analysis
to investigate key consumer issues, and use this to influence
organisations and people that can make change happen. We have
linked organisations in England, Scotland and Wales, and a close
relationship with colleagues in Northern Ireland.
We are a non-departmental body, limited by guarantee,
and funded mostly by the Department of Trade and Industry.
In July 2003, the NCC published Creeping
Charges, which identified an urgent need to review charging
in the NHS. It is striking how little clarity there is on the
purpose of NHS charges. Very little government research or evidence
has been collected on the efficacy of charging to the NHS or the
public purse. There is no publicly stated rationale for this system
of charges, discussion of what it is meant to achieve or what
it would be "fair" to expect people in different circumstances
to pay. We welcome this enquiry as an opportunity to discuss some
of these issues in a public forum.
The absence of a rationale for charging has
led the system for charging for prescriptions to develop in a
manner which has disadvantaged some patientsparticularly
those on low incomes who are already more likely to suffer ill-health.
Charges can be a deterrent to seeking treatment. A MORI survey
has suggested 750,000 people in England and Wales fail to get
their prescriptions dispensed because of cost.
Because charging can compound the effects of disadvantage, it
raises the question: "are charges an effective way of raising
or saving money for the NHS?"
Prescriptions were originally free with charges
bought in shortly after the creation of the NHS to raise money.
They were briefly abolished in the 1960s but reintroduced in 1968.
Since 1979, there has been a substantial increase in the cost
of prescriptions. Although this increase has slowed recently in
percentage terms, the current cost of £6.50is high
enough to discourage some people from getting the medicines they
need. This has led the NHS away from its guiding principle of
providing clinical services to those in need of them regardless
of the ability to pay.
In recent years, some significant gaps have
opened up between England, and Wales and Scotland. Charges in
Wales have dropped to £4 and are expected to disappear entirely
by 2007. The Scottish Executive has also said it will review payment
and there has been a strong campaign in Scotland to abolish charges
Despite a complex series of exemptions and reduced
payments, we remain convinced that many of those who genuinely
find prescription, optical and dental charges a burden are still
having to payor go without. We agree with criticisms made
in the Wanless Review, which said "the present structure
of exemptions for prescription charges is not logical, nor rooted
in the principle of the NHS."
We believe that the current system of charging
is at odds with core values of the NHSparticularly the
principle of services based on clinical need rather than the ability
to pay. The current system throughout the NHS does not contribute
towards the goals of access, equity, affordability and cost-effectiveness.
Instead, it entrenches health inequalities. We recognise that
the most straightforward ways to address current anomalies and
inequalities in charging are ones that are likely to cost the
taxpayer more. An alternative approach is a root and branch reform
of charging, so that the most effective ways are found to promote
health and allow for an appropriate level of cost recovery.
Either way, we believe that there is a prior
question that needs to be addressed, which is where the boundary
of collective provisions ends and individual responsibility, including
financial contribution, begins. The NHS has never been open about
what is covered by the health service and what is notand
yet, if the core services are not defined, it is impossible to
state where individual rights stop and where responsibility begins.
This ambiguity also stifles the potential for top-up services,
for which charges can be made. For this reason, the NCC recommends
the model of a "core services commission", to fundamentally
review the case for charges in the NHS by examining what constitutes
core services, and should, therefore, be universally available
and properly funded.
The Department of Health should take responsibility
for giving consumers more information about the rationale for
charges and the system of exemptions. This would both raise public
awareness of the reasons for charges and increase uptake among
those entitled to exemption.
For your information, I enclose the link to
the report Creeping Charges: http://www.ncc.org.uk/access/creepingcharges.pdf
National Consumer Council
57 Citizens Advice: Unhealthy charges CAB evidence
on the impact of health charges, 2001 Back