Subordinate Legislation
Community Care (Personal Care and Nursing Care) (Scotland) Amendment Regulations 2011 (Draft)
Good morning and welcome to the 4th meeting in 2011 of the Health and Sport Committee. I remind everyone to switch off all mobile phones and other electronic equipment. No apologies have been received.
Item 1 is an oral evidence-taking session with the Minister for Public Health and Sport and Government officials on an affirmative instrument, the draft Community Care (Personal Care and Nursing Care) (Scotland) Amendment Regulations 2011.
Members have received a cover note that sets out the purpose of the regulations and comments made by the Subordinate Legislation Committee. I welcome Shona Robison, the Minister for Public Health and Sport, and Shaun Eales, policy officer for care at home and free personal and nursing care in the Scottish Government. I invite the minister to make brief opening remarks on the regulations.
The draft regulations reflect the Scottish Government’s commitment to increase free personal and nursing care payments in line with inflation. The regulations, if approved, will benefit vulnerable older people.
Last year, we increased the personal and nursing care payments for residents in care homes in line with inflation. The regulations will further increase—in line with inflation—the weekly payments for personal care by £3, to £159 per week, and the additional nursing care payments by £1, to £72 per week.
In line with our concordat with local government, councils will meet the costs of the inflationary increases, which total about £1.8 million across all councils, from within their agreed settlement allocations.
The free personal and nursing care policy continues to command strong support. I hope that the regulations receive the committee’s support. I am happy to take any questions.
Thank you, minister. As there are no questions, we will move to item 2, which is a debate on the motion to approve the regulations. If no member wishes to speak in the debate, I ask the minister to move motion S3M-7889.
Motion moved,
That the Health and Sport Committee recommends that the Community Care (Personal Care and Nursing Care) (Scotland) Amendment Regulations 2011 be approved.—[Shona Robison.]
Motion agreed to.
Public Services Reform (Scotland) Act 2010 (Consequential Modifications) Order 2011 (Draft)
Item 3 is a debate on the motion to approve an affirmative instrument on which the committee took oral evidence at its previous meeting. The draft order relates to the establishment of healthcare improvement Scotland and social care and social work improvement Scotland.
If no member wishes to speak in the debate, I ask the minister to move motion S3M-7874.
Motion moved,
That the Health and Sport Committee recommends that the Public Services Reform (Scotland) Act 2010 (Consequential Modifications) Order 2011 be approved.—[Shona Robison.]
Motion agreed to.
Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (Draft)
Item 4 is a debate on the motion to approve regulations that also relate to the establishment of healthcare improvement Scotland and social care and social work improvement Scotland, and on which the committee also took oral evidence at its previous meeting.
Does any member wish to speak in the debate? I shall take the silence as a no.
I ask the minister to move motion S3M-7882.
Motion moved,
That the Health and Sport Committee recommends that the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 be approved.—[Shona Robison.]
Motion agreed to.
National Health Service (Free Prescriptions and Charges for Drugs and Appliances) (Scotland) Regulations 2011 (SSI 2011/55)
Item 5 is an oral evidence-taking session with the Minister for Public Health and Sport, and Government officials, on a negative instrument. A motion to annul the regulations has been lodged and will be considered formally at item 6.
Members have a cover note setting out the purpose of the regulations and the comments made on them by the Subordinate Legislation Committee. The minister is joined by Scottish Government officials Tom Wallace, policy manager at health and healthcare improvement; Dr Catriona Hayes, statistician at health analytical services; and Nicholas Duffy, solicitor in the health and community care division. I invite the minister to make some brief opening remarks about the regulations.
I have been in this position on a number of occasions now, both in plenary sessions of the Parliament and before the committee. I again welcome the opportunity to discuss with the committee the abolition of prescription charges.
I do not want to go over too much old ground, but I would like to re-emphasise that the policy will benefit everybody who must pay for their prescriptions. It will be of particular benefit to those with poorer health and to those with long-term conditions. Some people have said that the policy will benefit only rich people, but that is to ignore the thousands of ill people on modest incomes who are already better off as a direct result of the policy.
Patients should not be deterred from following the clinical judgment and guidance of their general practitioners—if that happened, the benefits that people receive from taking all of their medication would be lost. We believe that free prescriptions are a long-term investment in improving health. If, for financial reasons, people are put off seeking appropriate care, their health will not improve. If patients are able to get the treatment that they need, not only will it help their health, it will ultimately help to reduce the longer-term costs to the health service.
The abolition of charges will help people whose long-term conditions currently do not entitle them to exemption. Our approach ensures that all people with any condition will benefit. The approach is widely supported by doctors, patient organisations and other key representative groups. By abolishing prescription charges, we will make a significant contribution to achieving the healthier Scotland that we all want. Cost will no longer put people off consulting their doctors or collecting the medications that their doctors have judged necessary. I strongly believe that the amount of money associated with this policy is a price worth paying to ensure that patients take all their prescription medication.
These are difficult economic times. Removing barriers to good health and putting money back into people’s pockets—especially people who are struggling to make ends meet—have never been more important.
I am happy to take questions.
I invite questions from all committee members, but I will start with Mary Scanlon, as she has lodged the motion to annul, then I will come to Richard Simpson.
Scottish Conservatives acknowledge the huge pressures that will face the national health service over the coming decades. That is why we have pledged to protect health spending in Scotland. However, in these difficult times, it is more important than ever to consider how every pound is spent, and to examine whether that spending represents the best use of limited resources. We have to consider the opportunity costs of allocating money to the abolition of prescription charges.
I point out that we are looking for questions for the minister, not a consideration of the motion to annul.
I thought that you said that you were taking item 6 as well.
No, this is questions. We will then go on to a debate on the motion.
All right. I will leave it at that.
I have one or two questions, the first of which regards the minor ailment service. Until now, the outdated and outmoded prescription charge exemption system has also been the basis for inclusion in, or exclusion from, the minor ailment service. As the minister will know, I have repeatedly asked questions on this matter since the announcement of the Government’s policy initiative. At the moment, the minor ailment service costs £16.2 million per annum. If the massive bureaucracy surrounding the current scheme is maintained and continues to restrict access to services for minor ailments, you will lose part of the benefit of getting rid of prescription charges.
We do not need a massive bureaucratic system asking whether people qualify on this ground, that ground or the next ground. My understanding from the Government’s response—I want to ask whether this is still your position—is that that entire bureaucracy will remain in place for the minor ailment service and the system will not be modified to simplify it.
First, we would never leave anything frozen in time. It is always worth examining whether modifications and changes are required to the minor ailment service, but it is, of course, more of a patient management system, because it targets vulnerable groups and helps to avoid them going to their GP. Those are the people who are most likely to have minor ailments, and the basis of the minor ailment service is to avoid them taking up the time of GPs. There is therefore still very much a role for a system that tries to manage patient flows away from GPs.
If you are asking me whether the system will stay the same for ever, of course it will not—it would be silly to say that it will. It might be worth looking afresh at the service to ensure that its purpose—which is patient management and patient flow—is maintained, and to establish whether the system requires modification in the light of the abolition of prescription charges. We are happy to consider the matter.
We concur with the Government on the fact that the current prescription charge system is outdated and outmoded, but to get totally free prescriptions and to have access to the minor ailment service simply because you have a thyroid condition does not seem to us to be appropriate. We think that the Government has missed an opportunity—which I have been trying to warn it about since its policy to abolish prescription charges was first introduced—to modify the MAS, so I welcome the minister’s relatively conciliatory tone. However, I urge her strongly, given the current period of austerity, to look closely at the MAS to ensure that people who are vulnerable and unable to afford to treat minor ailments can access it, but those who are wealthy and do not need to access it are in some way restrained. I urge a more urgent approach than the Government has hitherto indicated.
I have a second question, convener.
That was pre-emptive. You are, of course, allowed to ask it.
My second question is the one that I asked when the policy was originally introduced. At the time, I was not concerned about getting rid of the scheme—I have said all along that that is an entirely appropriate measure—but I am concerned that the cost of drugs is rising, and I am concerned about whether we have a robust enough system in place for orphan drugs and, in particular, for ultra-orphan drugs. I am not convinced that we currently have an adequate system.
Given the additional financial pressures that the abolition of prescription charges will put on the system, I would like an undertaking from the Government that it will look again at the ultra-orphan system to ensure that patients with the potential for metastatic osteosarcoma in childhood, for example, will get the appropriate treatment, because the current system of quality-adjusted life years, which the Scottish Medicines Consortium uses in determining whether ultra-orphan drugs will be approved, is totally inappropriate for conditions that affect 10 or fewer patients a year. I do not believe that we have got the ultra-orphan system correct.
I think that a question was buried in there.
I think that there were two or three. First, on the system for approving ultra-orphan drugs, improvements were made following strong representations through the petitions system. I think that we all acknowledge that that led to a much-improved system. Is there further to go? These matters must always be kept under review, but we are in a better place than we were previously.
The general cost of drugs is an important issue. We have introduced a number of management systems to try to ensure that prescribing is appropriate and to move on to more generic prescribing. The gross and net ingredient costs have stabilised a bit during the past couple of years. Nevertheless, the drugs budget as a whole is a major element of the health budget. We have to ensure that we constantly look for new ways of containing that cost.
You asked a number of questions, and I hope that I have given you some reassurance.
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Partially. I welcome the exceptional needs programme, which will come in fully in April. However, the problem with an exceptional needs system is that for someone to have an exceptional need, they have to be different from the generality of patients who are seeking the treatment. If there are only four or five patients with the condition in Scotland, the opportunity for defining an exceptional need is limited.
I do not want to decry the Government’s exceptional needs programme. We have made progress, although it has been slower than I would have liked. Things happen in Government and sometime it cannot move as fast as it would like to. However, I urge the Government to re-examine the ultra-orphan system, because it is important.
The minister will be aware that I have submitted two parliamentary questions—which I will not ask her to answer today, but which I want to put on the record—on the current consultation on changing the price of drugs in England, because that will change prescription costs, which is important and relevant to this debate. I hope that she will put into the Scottish Parliament information centre the Government’s submission to that review.
I was waiting for that bit at the end, because I am allowing a rather broader set of questions about the consequences of free prescriptions.
I echo everything that Richard Simpson has said. I also want to make the minister aware that I have submitted a freedom of information request to all the health boards in Scotland. The evidence in the responses that I have received points to the fact that the drug costs in the minor ailment service have quadrupled during the past four years. I also requested any guidance that the health boards had received about the minor ailment service, and they said that they had not received any. The minister should be aware of those two matters when she is conducting her deliberations.
Okay; thank you for that.
That is the end of the evidence session.
Item 6 is a debate on the motion to annul the regulations. I take it that Mary Scanlon wishes to speak in the debate.
Yes.
Under standing orders, the debate can last for a maximum of 90 minutes. I ask Mary Scanlon to open the debate—
That is a challenge.
That was not an invitation to speak for 90 minutes; those are just the rules. I invite Mary Scanlon to move and speak to the motion.
I do not think that I will take 90 minutes. I will just start where I finished off earlier.
The question that we face today, which comes against a background of efficiency savings and cuts in the health service, is: should the Government reduce from £3 to nil the cost of prescriptions for those who can afford to pay?
Every penny spent has an opportunity cost. In a recent debate on early intervention, the Conservatives suggested that the money could be used to fund a universal health visiting service to ensure that every child under the age of five gets the vital health and development checks that this committee recommended in our report on child and adolescent mental health services. The importance of early childhood development and the impact of early intervention in determining future health, social wellbeing and educational achievement is widely recognised, and that is what we want to use the money for.
The independent budget review, which was established by the Scottish Government, stated in July 2011—
Sorry, but it cannot be July 2011, because we have not reached it yet. Maybe you have, Mary. You are faster than the rest of us. [Laughter.]
I am sorry, I meant 2010.
The independent budget review stated:
“The Scottish Government currently plans to abolish prescription charges entirely from April 2011 at an additional net cost of £25 million when compared with the income expected in 2010-11 ... In the current financial climate, the Panel considers that there is a pressing need to reconsider the planned abolition of prescription charges in Scotland.”
The British Medical Association Scotland stated in its submission to the independent budget review:
“There is an urgent need for an honest and open debate on what the NHS can and cannot afford, and a number of difficult questions may need to be asked: is the move to free prescriptions still affordable?”
I trust that the minister will respond to those comments.
Between 2007-08 and 2008-09, the number of items dispensed to patients who were exempt from paying any charge increased by 4 per cent to 74.4 million. In 2008-09, only 6 per cent of prescriptions were subject to the full charge; 88 per cent were exempt and pre-payment certificates, which rightly cap the charges that patients must pay, accounted for a further 6 per cent.
Over the past decade, the cost of prescribed items to the NHS has increased significantly, from £598 million in 1998-99 to £1.074 billion in 2008-09—the cost has more or less doubled—and that was while a prescription charge was in place. It is also worth noting the figures that ISD Scotland released in December 2010 that showed that 10 per cent of the population of Scotland are on antidepressants and that the number of drugs prescribed increased by 7.6 per cent from the previous year, despite the Government commitment to reduce antidepressant prescribing. We need to ask, will those statistics be affected by the abolition of prescription charges?
Returning to early intervention, we are clear in our commitment that the money saved from abolishing prescription charges should be used to develop a national health visiting strategy. That would be a truly worthwhile use of £20 million that would see significant benefits for children and families in generations to come.
The issue of wastage has been raised in the past at this committee. Health boards have recently been set new efficiency targets to free up £300 million for investment in improving health care. In principle, driving down inefficiencies is to be welcomed, as there is no reason to believe that efficiency savings would automatically have a negative impact on front-line services, and the challenge for the NHS is to ensure that savings can be made and that front-line services can be protected. However, the question remains, how can the minister promote measures to tackle waste while at the same time push ahead with the abolition of prescription charges, which has questionable benefits for front-line care and people who are most in need?
We need more clarity around the abolition of prescription charges. Richard Simpson raised points about the minor ailment scheme, so I will not repeat them.
I move,
That the Health and Sport Committee recommends that nothing further be done under the National Health Service (Free Prescriptions and Charges for Drugs and Appliances) (Scotland) Regulations 2011 (SSI/2011/55).
Mary Scanlon has raised a number of points. On the opportunity costs, political judgments and decisions are involved. We believe that there is a strong argument for the abolition of prescription charges. I will not rehearse what I said in my opening remarks, but I remind members that at least two thirds of medicines are dispensed to treat long-term conditions, and the remaining third goes to patients with acute conditions. Some medicines go to the many patients who are on low or modest incomes. We have referred on a number of occasions to the 600,000 adults who are living in families with an income of less than £16,000 who currently must pay for prescriptions.
The fundamental issue is that the previous system was unfair, which was the conclusion that our colleagues in Wales and Northern Ireland came to. We have steadily worked towards the abolition of prescription charges, and this is the last stage. We believe that this is the fairest and most equitable system. Trying to come up with another list of exemptions would just create new inequalities.
I find it interesting that in opposing the abolition of prescription charges, Mary Scanlon has not mentioned the fact that, to cover their commitments on early intervention and, of course, the cancer drugs fund, the Conservatives would actually have to put charges back up to £5. As a result, this debate is not just about abolishing charges; it is also about increasing them. These are political judgments, and we believe that such a move would be wrong. That said, I very much agree with the comments about early intervention. Indeed, in the budget, we put aside new resource to try to implement many of the early intervention measures that we all want. Of course, we recently had a useful debate in the Parliament on some of those issues, on which there is a lot of consensus.
With regard to Mary Scanlon’s remarks about the number of items dispensed, I point out to the committee that in 2009-10 the number of prescribed items dispensed increased by 3.9 per cent or around 3.3 million items. However, the majority—3 million—went to patients who were already exempt, and we would not expect any more of an increase as a result of this policy. The other 300,000 items—or about 0.3 per cent of the total—were dispensed to non-exempt patients, which we should consider alongside indications from the first half of 2010-11 that the increase in the number of items dispensed to non-exempt patients has slowed to less than 2 per cent. We really must put the issue into some context. Also, there is no evidence from Wales, where prescription charges were abolished a while ago, of a huge upsurge in the number of items prescribed to previously non-exempt people.
I acknowledge that antidepressant prescribing is a really tough nut to crack and has been a challenge to successive Governments. We have sought to look at the problem from the other end of the telescope by investing significantly in psychological therapies and ensuring that viable alternatives to prescribing antidepressants are available, particularly to general practitioners, who have to make decisions about the best way forward for the patient who is sitting in front of them.
Finally, I agree that we must remain vigilant in reducing drug wastage either in the system or through patient use, and in that respect we have implemented a number of schemes and systems. I have already referred to the importance of appropriate prescribing and of generic drug prescribing, neither of which will be changed in any way by the abolition of prescription charges. They are and will remain important.
I think that that covers most of the points.
We can come back to you, if necessary, minister.
As I have already made clear, my party agrees that the current system is outmoded and outdated and that any attempt to alter the list of exemptions would have been bound to get into trouble. Putting boundaries between conditions does not seem appropriate in this day and age, particularly when long-term conditions are the major problem. After all, when prescription charges were first introduced in the 1950s—at a time of austerity, I should add—the system related more to acute conditions.
I come at this issue from a more personal point of view, as a general practitioner who experienced the deaths of individuals who failed to take the full medication that was set out in multiple prescriptions. Indeed, I know of one student who died when he failed to take his prescription for steroids. I was not involved in that case, but the doctor in question was devastated to find that, despite his admonition to the patient that he had to take the medication, the student decided that he could not afford it. The student would have been exempt under the system, but the application form, which I draw to the attention of members who have not seen it, is about 35 pages long and for students has to be completed every six months. The bureaucracy involved is massive—the whole operation is massive—so I very much support the Government’s approach of abolishing prescription charges.
10:30
Other savings will be made. Not only will there be fewer deaths—clearly, one death is one death too many—there will be fewer admissions to hospital because of compliance failures. No calculations have been done on that, and I regret the fact that we do not have more research to support the very good political case that the Government has made.
There are concerns. This is not the first time that we have reached this point. On the basis of its values and principles, Labour previously abolished prescription charges. We did not introduce them in 1948 because we did not feel that they were appropriate. We were forced to do so in the 1950s, although Bevan himself resigned over the issue, as did Harold Wilson. They were then abolished by the Labour Government, but there was a substantial rise in the costs and numbers of prescriptions.
Again, to give the Government credit, it has followed the Labour Party in Wales in adopting the salami-slicing tactic of gradually reducing the prescription charge to zero. That has had the benefit of getting people to adjust, and it may prevent the massive rise that we experienced when we abolished the charges in the past. However, I add a note of caution. I do not think that the early figures from Wales are as good as the minister is suggesting. There are some early indications that there have been rises, particularly in minor prescriptions—which, thank goodness, do not cost a large amount—and in people switching to free prescriptions for minor ailments and therefore going to their general practitioner.
Again to be fair, the Welsh do not have a minor ailment system. I spoke to Rhodri Morgan when the Scottish Government first mooted that policy, and I asked him whether he would introduce such a system because, as the minister has said, it brings clear benefits in patient flow and reduced consultation with GPs. He said no, because he had received strong advice that to introduce a minor ailment scheme would be massively expensive on top of the abolition of charges and he felt that the Welsh could not do both things at the same time. The jury is also out in Northern Ireland. I therefore ask the minister to undertake today to maintain robust monitoring of what happens with repeat prescriptions and the costs of prescriptions.
Mary Scanlon raised the matter of waste. In my view, there is enormous scope for reduction in waste, which we have not yet tackled. No Government since devolution has taken on the task in a robust way. Pilot projects in Lothian have demonstrated substantial savings from changing the prescribing system, and we will need to follow that up, whoever is in government after May.
I have two final points—you will be glad to hear that I will not use the full 90 minutes, convener. We are disappointed that, despite our encouraging the Government, patients in Scotland with cancer were not exempted from charges at the same time as patients in England were. Frankly, that was unacceptable. It would have been a simple measure. We know that cancer patients have massive problems with poverty. Macmillan Cancer Support has established that fact, and Labour has committed itself to a partnership with Macmillan to ensure that there is poverty support for cancer patients in future. However, this Government could have introduced that policy without great cost. To me, it took a political decision that was inappropriate and regrettable.
My last point—if I can read my own writing—
You are a doctor, after all.
Yes.
My final point is about bureaucracy. When we have changed the prescription system substantially on previous occasions, all the existing prescription pads and print-off systems have been destroyed and replaced by new ones. In a time of austerity, I strongly encourage the Government to ensure, if it has not already done so, that we simply acknowledge that people no longer have to fill in the back of the form and we therefore do not change the form until existing supplies run out. I know that we are not talking about megabucks, but I want it on the record that I hope that that will be taken into account. I can tell members that it causes massive irritation among doctors. In the old days, the changes meant throwing out literally thousands of prescription pads; now, it would perhaps mean throwing out hundreds, if not thousands, of rolls of pre-printed computer paper.
It seems to me that there are two debates running in parallel here. There is the philosophical debate about whether to abolish prescription charges, for the reasons that have been articulated, whether today or at another time. There is also the debate about the position that the Liberal Democrats and I have taken for over a year now in our budget presentations, which is that, because of the grave change in the economic circumstances, we should pause, reflect and take a different view on a number of measures, including prescription charges and free school meals. We repeated that position throughout our budget presentation this year and it would therefore be wholly inconsistent for us to change our view now, because it would raise questions as to how we would pay for the matters that we talked about.
The minister posited in her remarks that Mary Scanlon’s approach is a move to increase charges. That might be the case in relation to matters on which Conservative Treasury spokesmen have made commitments, but my support for Mary Scanlon’s approach is confined solely to the matters on this meeting’s agenda, which have no relationship to any proposal for there to be an increase in charges.
Richard Simpson raised the issue of cancer drugs. I am bound to say that I was much more supportive of what he said earlier. On this difficult issue of approving, exempting or doing whatever you do with particular drugs, we must have a robust, objective basis for whatever is done. If one thinks that there ought to be different treatment for a cancer drug, one does not simply say, “Oh, well, we’re exempting cancer drugs.” I am not suggesting that Richard Simpson said that, but I am not happy with that position.
If one is concerned about the methodology that is adopted by the SMC or whomsoever, that is the point at which the intellectual argument ought to be mooted and we ought to be clear. It is not satisfactory for political parties and ministers simply to decide on a whim which drug ought to be exempt. Richard Simpson’s view may well be right that there are certain issues that ought to be addressed in that system and that the Public Petitions Committee has not wholly done that. I do not demur from that position; I merely observe that the system ought to make decisions on an accepted, objective basis. There may be different elements to that and it may mean that the current system needs to be expanded. Liberal Democrats would certainly be much more content to go down that road.
For the economic reasons that I articulated last year and which, consistent with our position, I have repeated today, I will support Mary Scanlon’s motion.
I believe strongly in a health service that is free at the point of need, but I do not expect all the Opposition parties to agree with me on that. I want to discuss the issue from a rational perspective.
We have a health service where many things are free and easily accessible. For example, a few months ago I asked for an appointment to see a physiotherapist and I got a 40-minute appointment, not because I am an ex-doctor but because anyone can ask for such an appointment and get it. There is no bar to overcome and no one to ask whether it is a reasonable request—you just do it. Further, if you go into hospital for a week or so, you are fed—you are saving money, because you would have had to eat at home, but no one even dreams of charging you. Yet we are considering putting a charge on a prescription that a doctor has decided is necessary for your health. That seems to me an illogical way of tackling challenges in the health service.
I can see three main reasons for the drug bill going up. First, the pharmaceutical industry is inventing new drugs for conditions that either are not being treated very well or are not being treated at all. Obviously, that leads to extra expense. Secondly, we are all living longer. If we were all good enough to have a heart attack and die at 65, we would save the country a fortune—not only in benefits but in the drug bill. Thirdly, there is inefficient prescribing. The first two reasons are good things but, if there is inefficient prescribing, it is our job to tackle those who are prescribing inefficiently. That is what is being done.
If patients have been recommended a drug by a doctor, I cannot see how it is their responsibility not to take the drug so that they can save the country money. Examples relating to antidepressants quite amaze me. I have been to several meetings of professionals at which good evidence has been presented that we are actually underprescribing antidepressants in this country. That leads to a different argument, but trying to cut down the expense of antidepressants by persuading some people with depression not to take the antidepressants that are prescribed to them is, to my mind, applying the pressure to reduce costs at entirely the wrong point in the system. It is the prescriber who is responsible for the prescriptions, not the person for whom the medication was prescribed.
Richard Simpson’s remarks about cancer patients were a little bit of a fig leaf for things that Labour did not do in England during its many years in power. I agree with Ross Finnie’s remarks about that.
This is the wrong place at which to charge people. I do not think that we should levy charges but, if we are going to do so, there are many other better places. This is one place where there should not be charges. If someone takes a drug that is not recommended for them, that is a bad thing—and it will probably be more expensive to the health service in the long run as well.
People around the table may have seen in the news this morning that many patients cannot afford the dental treatment that they so badly need. If a person does not have good dental health, it can impact on their heart condition and on a variety of other conditions. The Government has taken a welcome step; that is excellent and I am not going to criticise the Government for it. However, there are areas in which all of us in this room could do much better—especially in relation to the point that I have just made.
Everyone here knows that I have worked for many years with Skin Care Campaign Scotland, which has many facets—for example, I have worked with Alopecia Help and Advice (Scotland). I congratulate the minister on the work that she has done, because she ensured that the prescription charges gradually came down from, I think, £350 a year to £6.50. However, a concern was put to me by the special working group that the minister set up. She has not come back to that group to ensure that patients who need real-hair treatments—as opposed to acrylic-hair treatments—receive them. I hope that she will address that issue through regulations. The committee of management certainly feel aggrieved that the minister has not come back to the group. I do not say that in a mean way, and I acknowledge everything that the minister has done.
Mary Scanlon said that people who can afford to pay for prescriptions should do so. That is an easy thing to say, but it is extremely difficult to define what “can afford to pay” means. In the debate in the chamber on prescription charges, I asked the Conservative finance spokesman, Derek Brownlee, what level he would attach to that. I admit that he was speaking off the cuff, but he gave a figure of £21,000. That is not a lot of money in today’s society, and I do not know whether the figure was net or gross. However, the line has to be drawn somewhere, and Derek Brownlee drew it round about there.
As people have already said, there are additional costs associated with being ill—for example, for heating and transport—and a person’s income may fluctuate over the period of being ill, because of days off work. Richard Simpson mentioned the complexity of the forms; how often would they have to be completed during a year as the person’s—and their family’s—income fluctuated? Means testing is complex, costly and very unjust. It can make a huge difference where the line is drawn.
10:45
The minister gave a percentage for the number of people who have long-term conditions and who are paying for prescriptions but, during our debates, we have pretty well agreed that it is almost impossible to draw up a comprehensive and fair list of long-term conditions, which makes the arguments difficult.
Ian McKee raised the moral or ethical position. If a person is in hospital and is prescribed drugs, they get them free but, if the person is at home, having been discharged from hospital or having not been in hospital in the first place—and we are trying to stop people going into hospital unless it is necessary—they will be charged for their drugs, and means tested. I cannot comprehend that.
I hope that many people would agree that access to health care should be free at the point of need. We pay our taxes for people to have free health care. I hope that I will hardly ever have to go to hospital, but I pay my taxes willingly—and I hope that others do, too—so that other people may have those services.
I entirely support the abolition of prescription charges, especially at a time of economic recession. Because of job losses and so on, more and more people may require access to medication. Prescription charges should not be levied on them at a time when they are losing income.
I shall try to answer as many as possible of the questions that members have raised. There were a lot.
I do not want to get into a huge discussion about Wales, but there is no evidence yet of an unusual increase in the number of prescriptions being issued there. The Welsh Assembly Government has said that the policy has had no notable effect on the amount of prescribed medicine that has been dispensed over the counter. I reassure Richard Simpson that we will monitor all these matters robustly. I also reassure him that we are doing what he suggested about bureaucracy. A small change to forms will allow existing stocks to run down, and we have no intention of doing anything more than that.
I agree with Ross Finnie that it would be a retrograde step if ministers were to get involved in any decisions on which drugs should be approved or not approved. We must maintain an objective and independent system.
Ian McKee made a number of very important points, and I will pick up on what he said about the prescribing of antidepressants. I was surprised by the robust reports that showed that the prescribing of antidepressants is appropriate in the vast majority of cases. Some people may have thought that the opposite would be true, but the evidence does not support that. However, the lack of an alternative was affecting the decision-making process, and we felt that making psychological therapies more readily available would offer that alternative.
Helen Eadie raised a number of issues, and I thank her for acknowledging the progress that has been made. On the issue of wigs, I will have another look into the point that she made about real-hair treatment.
I will pick up on an important point that was made by Christine Grahame. Earlier, I mentioned the 600,000 adults with an annual income of less than £16,000 who must pay for prescriptions. If a figure of £20,000 is used, the number of adults who are not exempt reaches 760,000; and if a figure of £25,000 is used, the number of adults concerned reaches 960,000. Many people have incomes that do not allow them to live in what might be considered the lap of luxury, but they do not have an income that is low enough for them to avoid having to pay for prescriptions.
My apologies if I have not picked up on every point that members raised, but I have tried to consider the main ones.
I have not forgotten Mary Scanlon; I was letting her hear the complete picture before asking her to wind up the debate.
I thank colleagues and the minister for their contributions.
Obviously, there is much that we agree on. I refer in particular to the minister’s commitment to reduce drug wastage and the point that Ian McKee made about inefficient prescribing. Richard Simpson was not far away from us when he talked about the scope for reducing waste. We have to be mindful of that as we face the abolition of prescription charges, particularly given the financial constraints that we are under.
My party and I in this committee have always fully supported reducing pre-payment certificates for people with long-term conditions, but it would be naive not to acknowledge the difficulties involved. I remember raising the difficulties with exemption and the fact that people with diabetes and epilepsy got free prescriptions while people with Parkinson’s disease or asthma did not. I used that comparison quite often. Therefore, we acknowledge the difficulties with exemption.
It is important to put on the record that today’s debate is about abolition. For the sake of the Official Report, I point out that my motion states:
“That the Health and Sport Committee recommends that nothing further be done under the National Health Service (Free Prescriptions and Charges for Drugs and Appliances) (Scotland) Regulations 2011 (SSI/2011/55).”
That is nothing to do with introducing any charge. I appreciate that Ross Finnie picked up that point, but it is important to be clear about that. Members will notice that my remarks in the debate have been strictly to do with abolition.
The question is whether what has been proposed is the best use of national health service money and whether this is the best time for it. I heard what other committee members said, although I am not sure that I got an absolutely clear answer from the minister. The efficiency savings and the wastage aside, we need to know what the other savings will be in future, whatever happens in May. I think that Richard Simpson made that point. For example, if there are fewer admissions to hospitals and fewer visits to GPs, it is important to have information about that. It is important for decision makers to have that information so that we understand not just the costs but the savings.
I remind Ian McKee that the health improvement, efficiency, access and treatment target was a Government target to reduce the annual increase in antidepressants. It was not a target that I set; it was a Government target. As the minister knows, I have always supported the option for some people to have alternative therapies, such as psychiatry, psychology and cognitive behavioural therapies and counselling. There has been some movement in that respect, but that does not mean in any way that I do not believe that antidepressants are not appropriate. I understand the difficulty of reducing their use but welcome the fact that people with stress, anxiety or depression will be given more options in future rather than just a prescription for antidepressants.
Finally, Christine Grahame talked about the expression “can afford to pay”. I appreciate that it can be interpreted in many ways, but remind her that ISD figures for 2008-09 showed that 6 per cent of prescriptions were paid for at the full charge.
Thank you very much. That concludes the debate.
The question is, that motion S3M-8011 be agreed to. Are we agreed?
Members: No.
There will be a division.
For
Finnie, Ross (West of Scotland) (LD)
Scanlon, Mary (Highlands and Islands) (Con)
Against
Eadie, Helen (Dunfermline East) (Lab)
Grahame, Christine (South of Scotland) (SNP)
Grant, Rhoda (Highlands and Islands) (Lab)
Matheson, Michael (Falkirk West) (SNP)
McKee, Ian (Lothians) (SNP)
Simpson, Dr Richard (Mid Scotland and Fife) (Lab)
The result of the division is: For 2, Against 6, Abstentions 0.
Motion disagreed to.
National Health Service (Pharmaceutical Services) (Scotland) Amendment Regulations 2011 (SSI/2011/32)
National Health Services (Superannuation Scheme and Pension Scheme) (Scotland) Amendment Regulations 2011 (SSI/2011/53)
Natural Mineral Water, Spring Water and Bottled Drinking Water (Scotland) Amendment Regulations 2011 (SSI/2011/94)
Food (Jelly Mini-Cups) (Emergency Control) (Scotland) Revocation Regulations 2011 (SSI/2011/95)
Food Additives (Scotland) Amendment Regulations 2011 (SSI/2011/99)
Health Professions Council (Registration and Fees) (Amendment) (No 2) Rules 2010 Order of Council 2011 (SI/2011/210)
Item 7 is consideration of six negative instruments, which cover various issues. Members have a note from the clerk that sets out the purpose of each instrument. The Subordinate Legislation Committee had no comments to make on any of them. As no member wishes to debate them, are members content not to make any recommendations to the Parliament on them?
Members indicated agreement.
10:54
Meeting suspended.
11:02
On resuming—