Select Committee on Health Written Evidence

Memorandum submitted by the National Consumer Council (CP18)


  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 patients—particularly 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.[57] 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 £6.50—is 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 altogether.

  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 pay—or 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 NHS—particularly 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 not—and 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:—charges.pdf

Sally Hooker

National Consumer Council

December 2005

57   Citizens Advice: Unhealthy charges CAB evidence on the impact of health charges, 2001 Back

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