Health Committee, 25 Apr 2006

Meeting date: Tuesday, April 25, 2006

Official Report 179KB pdf

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Subordinate Legislation

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National Health Service (Charges for Drugs and Appliances) (Scotland) Amendment Regulations 2006 (SSI 2006/149)

We move to item 3, rather later than I anticipated. Members expressed interest in policies that relate to prescribing and other national health service drug charges, so we invited Scottish Executive officials to explain the changes that are being made by the National Health Service (Charges for Drugs and Appliances) (Scotland) Amendment Regulations 2006. Anne MacLeod and Chris Naldrett, who are from the Scottish Executive Health Department, will give a little background to the regulations. The Subordinate Legislation Committee made no comment on the regulations and no motion to annul has been lodged. I invite the officials to make a short opening statement—I emphasise the word "short". After that, members may ask questions.

I will be brief. Members will have heard this before, but it is worth recapping. Prescription charges have been levied since 1952, apart from a three-year period, and have raised about £44 million per year during the past few years. The charges do not relate to the prescribed costs or to the medicines, but are simply a contribution to the service that is provided. That information is set out in the current consultation document on prescription charges.

As members know, charges for drugs and appliances are a devolved matter. The primary legislation that enables ministers to make and recover charges is in section 69 and schedule 11 of the National Health Service (Scotland) Act 1978. The matter is governed by regulations. The principal regulations, which underlie the amendment regulations that the committee is considering, provide for the recovery of charges for drugs and appliances—dental and optical charges are covered by separate regulations—and provide for exemptions on the grounds of age and medical condition. Low income is dealt with by separate regulations.

Charges are reviewed annually as a matter of course. For a number of years and under numerous Administrations, the policy in Scotland has been to keep the rate of increase below the rate of inflation. That remains the approach and the National Health Service (Charges for Drugs and Appliances) (Scotland) Amendment Regulations 2006 provide for an increase of 2.3 per cent, in increasing the prescription charge from £6.50 to £6.65. The same—or slightly lower—rate of increase is applied to the cost of pre-payment certificates and to other items that are listed, such as elastic hosiery, fabric supports and wigs. However, a further change is made in relation to wigs.

In addition to the increase in the prescription charge, after its annual review, I will mention three other amendments. First, there is the amendment of the definition of "prescription form". That was made necessary by changes to the supply of domiciliary oxygen services in England, where the use of a prescription provision system has been withdrawn but is being continued transitionally on the basis of a new arrangement whereby independent suppliers provide oxygen services. It is an ordering system, not a prescription system. We had to change the definition in our regulations to ensure that people who come to Scotland on holiday or whatever, not with a prescription form but with something different, can still get access to the oxygen that they require.

The second amendment will reduce the charge of supply for a modacrylic wig from £53.90 to £6.65. The third amendment is also concerned with the provision of wigs. The regulation exemption provisions have been adjusted so that the exemption conditions now apply for the supply of wigs as well as the supply of drugs and medicines. Hitherto, that was not the case.

As you will appreciate, all the changes were effective from 1 April.

Are there any questions?

When someone has a quarterly pre-payment certificate, why is the prescription always a little bit dearer? You probably cannot do anything about that. Patients who have difficulty in finding even a few pounds more might take a prescription out again and it will cost them more. It is not as if it is a loan or anything like that. I have always wondered why it is slightly dearer.

My knowledge does not go back that far.

The four-monthly pre-payment certificate is beneficial in cost terms if a person has more than five items on prescription over the four-month period. The difference between it and the 12-monthly certificate is that the 12-monthly certificate gives a person a cost benefit if they have more than 14 items on prescription in a 12-month period. That is just the way in which the provision has been made.

The four-monthly certificate costs just over what someone would pay for five prescriptions, so that if someone had six prescriptions over that period they would pay less than they would otherwise pay on a per-item basis. It is not matter of a percentage discount or anything like that; it is a question of multiples of the prescription charge and a cut-off point below what someone would pay for six prescriptions. That is how it works. Obviously, the standard could be reconsidered but it has been applied throughout Great Britain since pre-payment certificates were introduced.

Thank you. In practice, people usually buy quarterly pre-payment certificates because they cannot afford the yearly one. The amount of money is small, but not for people who do not have a lot of money.

The cost benefit depends on how the prescribing periods are worked out. It is feasible to buy a four-monthly certificate, have a dispensing on the same day and then—in the case of someone who has two-monthly prescriptions—have two more lots of prescriptions in the same period. The benefit also depends on the number of prescription items that the person has.

Of course. I understand that.

The benefit varies from patient to patient.

This is probably as much a comment as a question. At a time when a consultation process is going on that could lead to major changes to prescription charges—whether in the rate or in the way in which they are delivered—it seems unhelpful that regulations are being introduced that could be subject to major change within a short period of time. I presume that that is what the second paragraph in the Executive note is getting at when it states:

"It is now proposed to consolidate by July 2006, when further amendments will require to be inserted into the 2001 regulations."

Do you mean that you will make changes in the light of the outcome of the consultation?

No. The principal regulations are amended every year; other amendments also take place regularly. The instrument is purely a consolidation of current amendments. Any changes that result from the consultation exercise, which is due to complete at the end of this week, will not be available in July. As the consultation document says, the changes are likely to be complex and their implementation will therefore be phased in over a period of time. The view is that this is a case of business as usual. The consultation is happening in the background, but it is not impeding the normal review process.

There is not much of a sense of urgency, then.

I could not comment on that.

Are you involved in the consultation?

Yes.

Can you give us some clues on how it is going in terms of responses and so forth?

Yes. There have been 80 responses so far.

Will you remind me of the deadline?

It is the end of this week—30 April. We have issued notifications to one or two people to give them an extension. We have also gone through the list of people who requested applications and identified those from whom it would be beneficial to have a response. We have written to them to remind them of the deadline and to say that their contribution would be valued.

We have appointed an independent company to prepare a summary and analysis of the results. We have also asked it to set up focus groups, where appropriate, if there are gaps in the information that is given in the responses. This afternoon, I will look at tenders for another exercise in which we will undertake user surveys to assess public awareness and attitudes. We will bring together those three streams. At this stage of a consultation, 80 responses is probably about normal.

Right. As there are no other questions, and having held the debate on SSI 2006/149, we must decide whether we wish to make a recommendation to the Parliament on the instrument. No motion to annul has been lodged. Are we agreed not to make any recommendation on SSI 2006/149?

Members indicated agreement.

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Functions of Health Boards (Scotland) Amendment Order 2006 (SSI 2006/132)<br />Sight Testing (Examination and Prescription) Amendment (Scotland) Regulations 2006 (SSI 2006/134)

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National Health Service (Primary Medical Services Performers Lists) (Scotland) Amendment Regulations 2006<br />(SSI 2006/136)<br />National Health Service (Service Committees and Tribunal) Scotland Amendment Regulations 2006<br />(SSI 2006/139)

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National Health Service (Pharmaceutical Services) (Scotland) Amendment Regulations 2006 (SSI 2006/143)<br />Mental Health Tribunal for Scotland (Practice and Procedure) (No 2) Amendment Rules 2006 (SSI 2006/171)

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Mental Health (Relevant Health Board for Patients Detained in Conditions of Excessive Security) (Scotland) Regulations 2006 (SSI 2006/172)<br />National Health Service (Travelling Expenses and Remission of Charges) (Scotland) Amendment (No 2) Regulations 2006 (SSI 2006/183)

We have a further eight instruments to consider under the negative procedure: SSIs 2006/132, 2006/134, 2006/136, 2006/139, 2006/143, 2006/171, 2006/172 and 2006/183. The Subordinate Legislation Committee made no comment on any of the instruments other than to raise one query on SSI 2006/136 and to express a reservation on SSI 2006/139. The committee has resolved both matters in its correspondence with the Executive. No member has commented on the instruments and no motion to annul has been lodged. Are we agreed not to make any recommendation on the instruments?

Members indicated agreement.

Thank you. That ends the meeting in public session.

Meeting continued in private until 15:40.