Consultation on Proposal to abolish NHS Prescription Charges

5 Exemptions

“The system of free prescriptions in the United Kingdom is illogical, irrational and works against the principles of the National Health Service” – Derek Wanless, author of the Treasury report on the funding of the health service : “Securing our future health: taking a long-term view”.


5.1 According to the Scottish Executive 91% of prescriptions in Scotland were for those exempt from the £6.30 charge. Over the years a number of groups have been exempted from paying prescription charges. The three main grounds for exemption have been –


  1. Age,
  2. Low Income and
  3. Chronic medical condition.

5.2 The following groups qualify for free prescriptions mainly on grounds other than chronic medical condition:



5.3 As Derek Wanless concluded the reasons why certain groups are exempt are not necessarily or obviously logical. For example all those aged over 60 are exempt regardless of whether they are millionaires or not. But adults in households which have an income which is below the Government’s income poverty line (i.e. those on Working Tax Credits with larger families) are not necessarily exempt.


5.4 Those suffering from certain chronic medical conditions are also exempt from paying prescription charges on medical grounds.


Reasons for medial exemption from prescription charges:



5.5 Similarly there is no real logic to the medical conditions which are exempt. Firstly there has been no addition to the exempt conditions since the 1968 meaning that new illnesses which were unknown then have not been added to the exempt list. For example AIDS, HIV and Hepatitis C do not figure on the list even though they are all chronic life threatening conditions that often require multiple prescription items to treat.


Examples of chronic medical conditions which are not exempt from prescription charges:



5.6 Secondly some chronic conditions which were known, though often little understood, in the 1960s have become much more prevalent since then.


5.7 For example Crohn’s Disease (a chronic condition involving ulceration of the bowel, chronic diarrhoea, persistent abdominal pain and weight loss) which was relatively rare in the 1960s now has an estimated 80,000 sufferers in the UK, with between 4000 and 8000 new cases every year. Because there is no known cure, and Crohn’s requires multiple drug regimes to control the disease’s severity, it would seem an ideal contender for exemption but the Scottish Executive have ruled this out.


“Prescription charges are an unfair tax on people with asthma” – Deborah Jack, Chief Executive, National Asthma Campaign


5.8 Asthma is another condition which has seen a huge increase in the number of sufferers since the 1960s with 5.1 million people in the UK now having the condition. Again, although asthma is a chronic, sometimes life-threatening, condition, requiring treatment via multiple drugs and inhalers, it does not automatically qualify for exemption from prescription charges.


5.9 Cancer sufferers who are on chemo-therapy are usually required to take several drugs to stop the treatment itself making them ill. If they are treated in hospital these drugs are free but if they are released from hospital into the care of their family and the community (saving the NHS hundreds of pounds a week) they are required to pay for all the drugs they need to stop them becoming ill.


5.10 Thus the otherwise welcome trend of cancer sufferers living for years with the condition and increasingly being treated in the community has unfortunately also led to patients being faced with paying multiple prescription charges.


5.11 Another group placed in a particularly bad position because of prescription charges are those with mental health difficulties. Mental illness can affect anyone at any time in their lives. It could strike as a brief episode of depression or as a chronic condition like schizophrenia. However, depending on the severity of symptoms, it can sometimes require multiple drug regimes to control. As no mental illness is exempt from charges sufferers often have to pay for every item, imposing high financial burdens and subsequent stress at a time when people are least equipped to deal with it.


5.12 However those with mental illnesses face even greater difficulties in the future. At present people who cannot afford all the drugs on their prescription sometimes select those they think most necessary for their treatment, but under the Mental Health (Scotland) Act 2003 that choice will be removed. Under the Act’s powers Compulsory Treatment Orders will require some mental health patients to take their prescribed medications.


5.13 Thus mental health patients will have no choice about what they can and cannot afford and will be forced to pay under pain of incarceration in hospital. It is manifestly unfair that mental health sufferers can be compelled to pay for their treatment when everyone else can choose.


5.14 Even the current list of exemptions contains obvious anomalies. For example those with under-active thyroids are exempt whilst those with over-active thyroids are not. Similarly those receiving the mobility component of Disability Living Allowance (DLA) because of a physical condition are given automatic exemption whilst those on the mobility component of DLA because of mental health problems are not.


5.16 The current system is illogical because there seems to be no rhyme or reason why certain chronic conditions are exempt whilst others of equal or even greater severity are not. It is unfair because it discriminates in favour of some people on the grounds of their condition or age irrespective of their means while denying help to others with less money and with conditions requiring treatment via multiple drug regimes (and therefore greater expenditure).


5.17 To sum up the present system of prescription charge exemptions:


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