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SP Paper 482 HC/S2/06/R01

1st Report, 2006 (Session 2)

CONTENTS

Remit and Membership

Summary of Conclusions and Recommendations

Committee Report

ANNEX A: REPORT FROM SECONDARY COMMITTEE

Report from Finance Committee

ANNEX B: EXTRACT FROM MINUTES

7 December 2004 (29th Meeting, Session 2 (2004))
1 February 2005 (4th Meeting, Session 2 (2005))
21 June 2005 (19th Meeting, Session 2 (2005))
20 September 2005 (22nd Meeting, Session 2 (2005))
1 November 2005 (26th Meeting, Session 2 (2005))
29 November 2005 (29th Meeting, Session 2 (2005))
13 December 2005 (31st Meeting, Session 2 (2005))
20 December 2005 (32nd Meeting, Session 2 (2005))

ANNEX C: REPORT BACK FROM FACT-FINDING VISIT TO WALES

ANNEX D: ORAL EVIDENCE AND ASSOCIATED WRITTEN EVIDENCE

1 November 2005 (26th Meeting, Session 2 (2005))

Written Evidence

NHS National Services Scotland
Philip Rutledge, Consultant in Medicines Management
Greater Glasgow NHS Board
Royal College of General Practitioners Scotland
Royal College of Nursing Scotland
Scottish Pharmaceutical Federation
Royal Pharmaceutical Society of Great Britain Scottish Department
Highland Area Pharmaceutical Committee and Scottish Palliative Care Pharmacists Association
Citizens Advice Scotland
Patient Partnership in Practice (P³)
Macmillan Cancer Relief
Scottish Association for Mental Health
Dundee Anti-Poverty Forum and Scottish Campaign to Remove All Prescription Charges (SCRAP)
UNISON Scotland

Oral Evidence : Official Report 1 November 2005

Stuart Bain, NHS National Services Scotland
Dr Philip Rutledge, Consultant in Medicines Management
Scott Bryson, Greater Glasgow NHS Board
Dr Jenny Bennison, Royal College of General Practitioners Scotland
May McCreaddie, Royal College of Nursing Scotland
James Semple, Scottish Pharmaceutical Federation
Angela Timoney, Scottish Executive, Royal Pharmaceutical Society of Great Britain Scottish Department
Alison Macrobbie, Highland Area Pharmaceutical Committee and Scottish Palliative Care Pharmacists Association
Lindsay Isaacs, Citizens Advice Scotland
Suzanne Clark, Patient Partnership in Practice (P³)
Elspeth Atkinson, Macmillan Cancer Relief
Chris White, Scottish Association for Mental Health
Jim Milne, Dundee Anti-Poverty Forum and Scottish Campaign to Remove All Prescription Charges (SCRAP)
Glyn Hawker, UNISON Scotland

Supplementary Evidence

NHS National Services Scotland
Greater Glasgow NHS Board
Scottish Pharmaceutical Federation
Royal Pharmaceutical Society of Great Britain Scottish Department
Citizens Advice Scotland
Scottish Campaign to Remove All Prescription Charges (SCRAP)

29 November 2005 (29th Meeting, Session 2 (2005))

Written Evidence

Scottish Executive Health Department

Oral Evidence : Official Report 29 November 2005

Lewis Macdonald, Deputy Minister for Health and Community Care
Dr Nadine Harrison, Scottish Executive Health Department
Colin Fox MSP

Supplementary Evidence

Letter dated 7 December from Lewis Macdonald, Deputy Minister for Health and Community Care

ANNEX E: OTHER WRITTEN EVIDENCE

Organisations

Asthma UK Scotland
Cystic Fibrosis Trust
Fibromyalgia Association Scotland
Guild of Healthcare Pharmacists
Lanarkshire NHS Board
NHS Ayrshire and Arran
NHS Grampian
NHS Highland Area Drugs and Therapeutics Committee
NHS Tayside
Parkinson’s Disease Society
Psoriasis Scotland Arthritis Link
Royal College of Physicians and Surgeons Glasgow
Scottish Consumer Council
Scottish NHS Confederation
Tayside Angus and Perthshire Fibromyalgia Support Group
Tayside Scottish Campaign to Remove All Prescription Charges (SCRAP)

Individuals

Fiona Allen
Ronald Cain

Remit and membership

Remit:

To consider and report on matters relating to health policy and the National Health Service in Scotland and such other matters as fall within the responsibility of the Minister for Health and Community Care.

Membership:

Roseanna Cunningham (Convener)
Helen Eadie
Janis Hughes (Deputy Convener)
Kate Maclean
Mr Duncan McNeil
Nanette Milne
Shona Robison
Mike Rumbles
Dr Jean Turner

Committee Clerking Team:

Clerks to the Committee
Lynn Tullis
Simon Watkins

Senior Assistant Clerk
Tracey White

Assistant Clerk
Roz Wheeler

Committee Assistant
Lynn Devine

1st Report, 2006 (Session 2) 

Abolition of NHS Prescription Charges (Scotland) Bill

The Committee reports to the Parliament as follows—

summary of conclusions and recommendations

Existing prescription charging scheme

  • The Committee believes that the status quo is not an option.
  • Whilst the Committee welcomes the Deputy Minister’s suggestion that the Executive may extend the remit of the review of the prescription charging scheme, it is concerned that the Executive appears to be making very slow progress with this important work since its instigation in May 2003. The Committee also regrets that, when giving evidence to the Health Committee, the Deputy Minister was unable to provide any indication of the specifics of the proposed changes that the Executive intends to consult upon. The Committee acknowledges that the commitment made subsequent to this evidence session to publish a draft consultation by 23 January 2006 moves the work of the Executive further forward. However, the Committee would have found a constructive alternative approach to addressing problems with the existing scheme valuable whilst assessing the merits of the bill’s proposed approach of abolishing charges altogether.
  • The Committee acknowledges that there is scope to improve the effectiveness of the existing system. However, it is clear to the Committee that the current prescription charging regime is inequitable. It exempts individuals suffering from some chronic illnesses, but not others, and it exempts some people on low incomes, but not others.
  • The Committee is concerned that the Executive does not appear, as part of its work, to be seeking to produce an accurate definition of ‘chronic’ on which to base an equitable and inclusive list of exemptions.
  • From the evidence received, at this stage the majority of the members of the Committee are not convinced that an equitable charging scheme can be created by identifying exemption categories. Therefore, it appears to the majority of the Committee that the most effective means by which prescriptions can be issued on an equitable basis is to abolish prescription charges entirely1.

Impact of the abolition of prescription charges

Impact of abolition on public health - Evidence that prescription charges are a barrier to the consumption of prescription medicine

  • The Committee acknowledges that the abolition of charges would provide financial benefits to those on higher incomes who currently can afford to pay for prescriptions and therefore the removal of charges is unlikely to have a significant impact on the health of this proportion of the population.
  • Some evidence received by the Committee suggests that prescription charges may constitute a financial barrier to receiving treatment for a proportion of the population and that this has a detrimental effect on the health of these individuals. The Committee is concerned that some of those most affected by the charge are those in the greatest need, namely those on low income suffering from chronic illnesses.

Impact of abolition on public health – Impact of loss of revenue on NHS services

  • The Health Committee supports the conclusion of the Finance Committee relating to indirect savings which concluded that—

    The Committee remains unconvinced that the member’s claim that an increased number of people receiving free prescriptions would correlate with fewer hospital stays resulting in achieving savings which could entirely offset the costs of this Bill

Economic impact of abolition - Estimated cost in the financial memorandum

  • As the bill seeks to ensure that those who currently cannot afford to pay prescription charges receive the necessary prescriptions, it is clear to the Committee that making prescriptions free of charge to these individuals would lead to an increase in the number of prescriptions issued. The Member should, therefore, have undertaken to provide an estimated costing for this increase in demand within the Financial Memorandum.

Economic impact of abolition - Cost of increased demand for the prescription of medicines currently available over the counter

  • The Committee shares the concerns raised by the Finance Committee within its report on the Financial Memorandum, which concludes that ‘the costs of implementing this bill could be significantly higher than estimated’2.
  • The Committee is concerned that there could be a significant additional cost of abolition, resulting from an increased demand for prescriptions, which the Member in Charge of the Bill has not estimated. As an accurate estimate of the cost of this increase in demand has not been produced, the Committee is unable to fully assess the potential economic impact of the bill, including the impact on the funding of frontline services within the NHS in Scotland.
  • The Committee recommends that, should prescription charges be abolished, the Scottish Executive should ensure that the financial impact of this policy is closely monitored to ascertain the real cost of abolition to the NHS in Scotland.

CONCLUSION

On the basis of the evidence received, and taking into account some of the reservations expressed, the majority of the members of the Committee recommend that the Parliament approves the general principles of the bill3.

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Footnotes:

1 Helen Eadie, Janis Hughes, Duncan McNeil and Nanette Milne dissented from this recommendation

2 Finance Committee report, published 13 November 2005 – Annex A

3 Helen Eadie, Janis Hughes, Duncan McNeil and Nanette Milne dissented from this recommendation.