Official Report 135KB pdf
National Health Service (Charges for Drugs and Appliances) (Scotland) Regulations 2008 (SSI 2008/27)
I welcome everyone to the seventh meeting of the Health and Sport Committee in 2008. Apologies have been received from the convener, who is temporarily dealing with another matter of some importance. I remind all persons present please to switch off their mobile phones.
I have two questions. The first relates to the annex to the abridged report of the Subordinate Legislation Committee. It raises a point about regulations 8(11), 10(4) and 11(5). The Subordinate Legislation Committee sought an explanation from the Scottish Government and received a response with which it was partially satisfied. I wonder whether you can expand a bit on that? There was only partial satisfaction with the Government's response. Would you like to say a bit more about that?
As the paper states, the Subordinate Legislation Committee
The other issue is whether there could ever be a challenge on those grounds. What is the likelihood of that? Is it your experience that it would be unlikely for there to be a challenge arising from the issue of where the powers are derived from?
These particular powers, or variations of them, have been in previous versions of the regulations, including the consolidated versions of 2007 and 2001, going back to 1989. There has been no challenge to those provisions so I would not expect there to be a challenge, but one can never tell.
That is fine. That answers my first question. My second question relates to—
I notice that you did not pause between your questions, Helen. That was very cute. On you go.
My second question relates to the provisions on page 7 of the regulations regarding appliances, fabric supports and wigs. As people may be aware, I congratulated the cabinet secretary in the chamber two weeks ago on the move to reduce significantly the charge for wigs from something of the order of £250 to £5.
Guidance will shortly be issued in a circular to boards to clarify the number of wigs that can be prescribed per annum. The advice is that the number of such prescriptions per annum to which people will be entitled should be doubled from two to four as from April this year. The people who will benefit include those who suffer from alopecia, from cancer or from burns.
I welcome that.
I have my usual list of questions, but I will ask only two, on wastage and on demand, and trust that fellow committee members will pick up my other questions.
I will answer the second question and then ask Deirdre Watt to respond to the question on wastage.
The number of people who would be more likely to go to the doctor would be between a quarter and a fifth, according to a survey that was carried out for the Scottish Executive in May 2006. That survey is less than two years old.
I recognise that, but at that point we had very little data from and analysis of what was happening in Wales. You are absolutely right that we have some evidence to suggest that demand could increase, but preliminary evidence from Wales suggests that that has not become an issue. In a sense, we will need to wait and see, but we will monitor the situation carefully as we implement the policy.
In response to the question about wastage, we recognise that in a drugs bill of some £900 million, there is always a need to ensure that waste is minimised. A range of measures is in place, and we will be looking further at developing a broader strategic response to target waste. We are not aware of any evidence that phased—or even total—abolition of prescription charges will exacerbate wastage. I would welcome the committee's comments on the measures that are in place. According to the briefing from the Scottish Parliament information centre, the previous Health Committee believed that
So you do not expect anything significant.
No. We are not anticipating anything more.
I am interested in regulation 9, which says that a qualifying patient is someone who is resident in Scotland. The explanatory note says that if someone goes to an English general practitioner but can prove Scottish residence, they can get an entitlement card. Will everyone start living with their Scottish auntie just to get free prescriptions? How will entitlement be restricted?
The Scottish Government is concerned to ensure that the 1,200 or so people—a relatively small number—who are resident in Scotland but are registered with a GP practice in England benefit from the change in policy. Scottish residents registered with a GP based in England would not get the appropriate prescription that they could simply take to their pharmacy—it is a different prescription form. In order to ensure that those Scottish residents benefit from the change in policy, they will be issued with an entitlement card. The practitioner services division of NHS National Services Scotland knows exactly who those patients are and where their GP practices are. The PSD will be the gatekeeper of the process. To minimise fraud, the PSD will contact those patients, who will be sent an application form. They will also be sent a declaration form, on which they will be required to tick to confirm that they are resident at the given address. When they send that back, they will be issued with an entitlement card.
What happens to new people? The people you are talking about live in the Borders and perhaps find it more convenient to go to an English GP. How will you police that in future? People are signed up at the moment, and you can easily identify them. I guess that what you are saying is that a limited number of GPs qualify, because they have to be within travelling distance of the border, but what happens if people on the other side of the border say, "I've got a cousin who lives a couple of miles over the border. I'll give that as my home address"?
The onus is on the person who ticks the box on the form that they are sending back. If it is found in future that they are not resident at that address, it would be a case of fraud and procedures would go ahead. Ticking the box confirms that they are resident at that address.
But there is no proof of residence, other than ticking a box.
It would be a serious matter for a patient to give an invalid address to their GP practice. The main check will be that the address that the patient declares that they are resident at is the same address that their GP has as their place of residence. If someone were to give fraudulent information to their GP, not only would it be fraud but that person would be putting their health at risk. If they had to have a home visit, there could be delays that would impact adversely on them. It would not be an attractive proposition for people to mislead us and their GP in that way.
I find that hard to accept. There is not an awful lot of cross-checking. Someone might think, "How often am I going to get a home visit? If I need a home visit, I'll say that I'm staying with a friend in such-and-such a place." They will give an alternative address. To me, the system appears to be open to fraud.
Perhaps we should ask about Wales. What has been the experience there?
In effect, we are matching the arrangements that are in place in Wales. Our colleagues there are certainly not aware of a significant problem with people trying to put themselves in the wrong place.
We are talking about a small number of people, because the population in the area of the border is relatively small. The number of people who live in England but are registered with a Scottish practice is 1,800 to 2,000, so the pool of people who could be eligible is limited.
As someone who represents an area close to the English border, I note that, if someone is resident in Scotland but has a GP in England, they are entitled to the rates in Scotland. I take it that we have a note of the number of people who are in that position. You told us the figure for the converse.
Yes. The number of people who are resident in Scotland but are registered with a GP who is based in England is 1,200 to 1,300.
There seems to be a clash between two parts of the Executive note on the regulations. On prescription charges, it states:
Not quite. We confess that this is a complex area, and you are right to ask the question.
So the Executive note is wrong.
Not quite. David Smith might want to assist me, but—
The Executive note clearly says:
Yes. The charge is for "out of country prescriptions." In Wales, out-of-country prescriptions are charged at the English rate.
So, people who are out of their country will pay the rate that applies in the country where they are, but that will be the English rate wherever they go, including Wales.
Yes.
Fine. I just thought that there was something wrong in the note. I appreciate that that is not specified in the instrument itself. I might need to get a prescription to clarify that for me, but that is fine.
My question is also about people coming into the country. At the moment, someone from a non-European Union country pays a private prescription charge if the issue is acute. They might get free prescriptions, but, basically, they are charged. What happens with temporary residents? Will they be charged at an English rate, a Welsh rate or a Scottish rate, or will they get a private prescription?
If they are registered with a Scottish GP, they will benefit from the policy of phased abolition. They will pay the Scottish rate and, on total abolition, their prescriptions will be free.
So the temporary resident is charged the Scottish rate.
Yes.
Are we all clear about that now? I see that Mary Scanlon is rallying.
I am just thinking about temporary residents. In the Highlands in the summer, we have many thousands of tourists. Is a tourist classed as a temporary resident?
No, as they would not be registered with a Scottish GP. A temporary resident has to be registered with a Scottish GP.
It is an important point.
Yes, and we will dip further into it.
People can register temporarily with a GP. If a tourist goes to a GP and asks for a medical service, they register with that GP on a temporary resident basis. If they are temporarily resident as a tourist, they sign up for a temporary resident fee and get free prescriptions. Tourists would therefore be entitled to free prescriptions.
I like it when members give evidence. Can you corroborate that, Dr Pryce?
Yes, that is absolutely right. Deirdre Watt said that the test is whether someone is registered. If tourists need to see a GP while they are visiting the country, they register temporarily with a Scottish GP and therefore benefit.
So they will be entitled to free prescriptions. All our tourists will get free prescriptions.
Is it at the discretion of the GP whether to accept someone's application as a temporary resident, so that people do not just come and use the service?
Not if they are an EU citizen.
If someone comes up here from England and works in the Highlands for a month, he or she is therefore a temporary resident. If they went along to the local GP to get a prescription, would it be free?
I ask one of the witnesses to give evidence about that—however tempting the alternative.
I am happy to be corrected by Dr Simpson if I get any of this wrong.
No—please.
He is blushing.
If somebody is living temporarily in Scotland, away from their own GP, and they need to see a GP, there is a duty on the local practice to accept that person and see them. Somebody who is up here working for a month would be able to see a local GP.
So they would be a temporary resident, and they would get free prescriptions.
Yes. If they stay for longer than three months—I think that that is the period—they are required to register formally with a GP.
Let me clarify the point. If someone comes to Scotland on holiday, goes to a GP and says that they happen to have run out of 10 items from their regular prescription, they will get those items free of prescription charges if they sign on as a temporary resident. Is that correct?
It would be for the GP to confirm that there was a genuine medical need for the prescription to be written at that point.
What if someone says, "I've run out of pills," or, "I forgot to bring my pills with me"?
The GP would have no real option other than to respond accordingly.
So if a person lost their wig, for example, they would get a free wig. They would get what they are entitled to through free prescriptions.
There is probably a reasonable test for the GP to follow in determining whether an item is an emergency item and is therefore required or whether the problem could reasonably wait until the person returned to their place of residence.
It is not as if we are talking about an umbrella that has been left in a taxi.
May I ask a short question?
Yes.
What about a person who flies up from London for a day to attend a meeting or for a weekend? Is there a minimum length of time for which a person can sign on as a temporary resident?
I do not believe so. It would depend on whether the problem could wait. A GP would not be impressed if a patient flew up for the day and said that they needed to see them, unless there was a genuine emergency and the person could not wait.
I think that a person must wait 24 hours; otherwise, it is an emergency consultation.
Another of the professionals has spoken.
The final paragraph on page 13 of the SPICe briefing is devoted to that topic. It states that regulations had to be introduced as a consequence of health tourism and that
The regulations seek to put in place the same cross-border arrangements that exist in Wales. Therefore, account has been taken of what has been learned there.
I am sure that we can revisit the matter if we find that there is an explosion of health tourism. Perhaps England could go the same way as Scotland and Wales—that might be the simplest solution. We could then rest easy in our beds and not worry about a flurry of entitlement cards and prescriptions.