A prescription for change

In his speech to the Labour Party conference in 2008, Gordon Brown promised to abolish prescription charges for people with long-term conditions. To determine which long-term conditions should be included, there followed the Prescription Charges Review, led by Professor Ian Gilmore, whose report was due to be published in summer. This was then delayed until the autumn. And then…..well, where’s that report?! The Government has said nothing further and the report has yet to come out.

One good thing that has happened is that, from April, all patients receiving cancer treatment were exempted from prescription charges. The rest of us wait in vain and, as the general election gets ever nearer, the chance of anything happening diminishes. Yet it is vitally important that pressure is put on the government to act. You only have to look at the research to see how much evidence there is to back up the argument that people with mental distress should be exempted from prescription charges.  

The Disability Rights Commission, in their formal investigation, Closing the Gap, in 2006, showed that people with severe mental distress are more likely than the general population to get a whole host of physical problems, including having a stroke, respiratory disease, diabetes and coronary heart disease.

People with a diagnosis of schizophrenia are 90 per cent more likely to get bowel cancer and women with a diagnosis of schizophrenia are 42 per cent more likely to get breast cancer. The report also reveals that survival rates are lower for people with mental health problems in all key conditions. This is shocking stuff, and is backed up by a number of studies that support the finding that psychiatric patients have high rates of physical illness and a significantly higher mortality rate.

The result of so many people with mental distress also experiencing other major health problems is that a substantial number will require at least several prescriptions a month and yet, at £7.20 per item, how can they afford them? If we look at the figures from the Office for National Statistics, they show that over 75 per cent of people with experience of mental distress are reliant on welfare benefits and as many as 76 per cent are unemployed.

According to a Department of Work and Pensions report in 2001, fewer than four in ten employers say they are willing to even consider taking on people with a history of mental health problems. Of the one in four who are lucky enough to have a job, many are in lower paid jobs, and often face stigma and discrimination in the workplace.

Of the three quarters who are reliant on welfare benefits, most are on what used to be Incapacity Benefit, now called the Employment and Support Allowance. Bizarrely, those on ESA are not eligible for free prescriptions even though they are much more likely to be unwell, live on a very low income and would surely benefit more than any other section of society.

A review of the research on prescription charges was conducted by researchers at the London School of Economics in 2008 and found that they affect poorer households most and that there were greater reductions in essential prescription drug use among welfare recipients than any other group. It also found that higher prescription charges had a negative affect on people’s health, increasing hospitalisation rates, nursing home admissions, mortality rates, adherence to treatment, and increasing the likelihood of needing more intensive care. A study by Rethink in 2008 found that 38 per cent of people with severe mental health problems have to choose between paying household bills and paying prescription charges.

All of these points, of course, are interconnected and show the fallacy of keeping things as they are. People with mental distress are more likely to live on very low incomes. They are also more likely to suffer a number of different health problems.

People on low incomes, especially those on welfare benefits, are those most likely to have their health affected through not being able to afford prescription charges and the knock-on effect is that they are more likely to end up in hospital, develop even more physical health problems, need additional care and be a significantly larger drain on NHS resources than it would cost to exempt them from prescription charges in the first place. It is a false economy that is damaging the health of some of the most vulnerable members of society.

The tired old argument, trotted out on a regular basis by ministers, that 88.6% of people are already exempt only works if prescription charges are based on ability to pay. Which they’re not. As the Government-commissioned Wanless Report pointed out in 2002, the system of exemptions is “illogical,” with wealthy pensioners exempt and many poor families not. Instead, shouldn’t the fact that only 11.4 per cent of people are paying prescription charges make it a lot easier and cheaper to abolish them?

One of the weird ironies is that if a Labour Government went the whole way, abolishing prescription charges altogether, it would be an incredibly astute political move that would wrong-foot its opponents and increase its popularity. The cost wouldn’t be great, less than it costs to supply the over 75s with free TV licences, a drop in the ocean in economic terms and one that would more than pay for itself both economically and politically. 

It is debatable now though whether this would be seen as simply a cynical attempt to buy the electorate a short time before a general election. But even if one of the major political parties promised to introduce free prescriptions as part of their election manifesto, that would at least move it up the political agenda and at least offer some hope.

Of course, exemption from prescription charges on its own isn’t going to solve the health inequalities and poverty of large numbers of people with mental distress. But it can surely only ever be a good thing if we can move away from a situation where people are having to make a choice between paying the bills and paying for prescriptions.

Shaun Johnson

Shaun is a Trustee of Mind and has been involved in the service user / survivor movement for many years. He was a member of the NICE Guideline Development Group on Medicines Concordance and has a varied background in writing, publishing, art, music and journalism.

It is debatable now though whether this would be seen as simply a cynical attempt to buy the electorate a short time before a general election. But even if one of the major political parties promised to introduce free prescriptions as part of their election manifesto, that would at least move it up the political agenda and at least offer some hope.