Cystic Fibrosis: Prescription Charge Exemption

(Limited Text - Ministerial Extracts only)

Wednesday 2nd February 2022 Westminster Hall

[The Minister for Health (Edward Argar)]

It is a pleasure as always to serve under your chairmanship, Mr Sharma. I congratulate my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) on securing this important debate and thank all hon. Members who have taken part. Although this issue falls within Lord Kamall’s ministerial portfolio rather than mine, it is privilege to answer in this place and to engage in this debate.

Nobody here today, and nobody viewing our proceedings or reading them when they are written up in Hansard, can fail to have been moved by the experiences and stories that we have heard. Hon. Members on both sides of the House told moving stories about their constituents—in the case of my hon. Friend the Member for Ashfield (Lee Anderson), who spoke of his very personal experience, it was his wife, Sinead. As hon. Members have said, it is always incredibly powerful and moving in this place when an hon. Member is willing to share their own experiences, not just with this House and colleagues but essentially with the public. It was powerful, it was personal and it was poignant, and I thank him for that.

I also thank the hon. Member for Bristol East (Kerry McCarthy) for her contribution, in which she set out—again, very movingly—very personal stories, to make this real. It is very easy in this place for us to slip into talking about policies and grand strategies and to not always relate that to people and individual lives and experiences. I am very grateful to the hon. Lady. I do not always agree with her on everything in a political context, but I certainly agree with her on EDMs. I share the experience. I remember Bob Russell from the time before I was a Member, when I worked for previous Members in this place. I admire his belief in the power of EDMs, although I have to say that I do not share it and, like the hon. Lady, I occasionally have to explain to constituents and others who understand-ably think that an EDM moves the agenda forward, that it rarely does, but that it may, on occasion, put down a marker.

As ever, I am grateful to the hon. Member for Strangford (Jim Shannon) for his comments. He mentioned that he has been in just about every debate on this subject, along with the hon. Member for Bristol East. Given his assiduity in attending debates in this House, that could be said for a vast array of subjects, on which he has given well-informed and eloquent contributions, not only representing his constituents, but putting issues of national concern on the agenda.

[Jim Shannon]

The Minister referred to the former Member, Bob Russell. I recall him standing at the door to be No. 1 on EDMs. I put in at least two EDMs every week. Their purpose is not to change policy, but to raise awareness or congratulate some person or group that has been active in the community. For me, that is what EDMs are about.

[Edward Argar]

I am grateful to the hon. Gentleman for his spirited defence of early-day motions, of which he makes powerful use, as he does with every opportunity he has to speak in this place.

My right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) is no longer able to be here, but he made a valuable contribution, and I am grateful to you, Mr Sharma, for allowing him to speak—even if, as a former Minister, he should have known better the consequences of seeking to tempt me to make policy at the Dispatch Box without cross-Government agreement, which might have led to an early termination of my ministerial career. He made a powerful point, as all hon. and right hon. Members have done, and I will turn to some of those points in a moment.

Before I do so, I want to recognise the fantastic work undertaken by the Cystic Fibrosis Trust, which does a fantastic job on behalf of people living with cystic fibrosis and their families, and in bringing the condition and the needs of people with it to the attention of this House, and more widely. I also acknowledge the work of the Prescription Charges Coalition, of which the Cystic Fibrosis Trust is a member. It has worked tirelessly to raise awareness of the help available to patients with the cost of their prescriptions and campaigns on an issue that its members feel strongly about. In our democracy, whether or not we agree on the policy position, it is right that we recognise those who get out there, campaign and seek to drive change and policy. It is important to recognise those who are active in our democracy in that way.

As we have heard, cystic fibrosis is a life-limiting condition affecting many thousands of people in the UK. It is not only a life-limiting disease but, as we heard from my hon. Friend the Member for Ashfield, a disease that can impact on the quality of life and the life experiences of those affected and their families. While there is no cure for cystic fibrosis, there are treatments available on the NHS to help reduce the effect of symptoms and make it easier to live with.

It is not that long ago that conditions such as cystic fibrosis saw life expectancy so low that many were advised not to expect to live beyond their teens. Thanks to advancements in treatments, better care and the work of organisations such as the Cystic Fibrosis Trust, people with cystic fibrosis are now living for longer, with a better quality of life, with half of those with the condition living past the age of 40. Children born with cystic fibrosis today are likely to live longer than that. That is a positive story and a reflection on our medical and scientific advances.

I turn to the crux of the debate. When the medical exemption list was drawn up in 1968 in agreement with the British Medical Association, it was limited to readily identifiable, permanent medical conditions that automatically called for continuous, lifelong and, in most cases, replacement therapy without which the patient would become seriously ill or even die. As the shadow Minister, the hon. Member for Enfield North (Feryal Clark), alluded to, there has been a review since 1968—only one—which resulted in the addition of cancer in 2009.

When the exemption list was drawn up, decisions on which conditions to include were based on medical knowledge at the time—for instance, children with cystic fibrosis were not expected to live to see adulthood—and it is entirely understandable that, given advances in treatment and increases in life expectancy, those who are now living with cystic fibrosis for a lot longer should wish to pursue exemption from prescription charges to help them maintain their quality of life with the drugs that are essential to their quality of life. The issue of prescription charges was reviewed more broadly in the round in the 2010 Gilmore report, which did not recommend further changes at that stage.

As the hon. Member for Enfield North alluded to, I know that the answers that Ministers have given, stating that the Government have no immediate plans to review the list, will have caused disappointment to right hon. and hon. Members and to those with this condition. We do think it would not be right in this context to look at one condition in isolation, separate from other conditions, because others would rightly argue that their condition was potentially equally deserving of an exemption if it fitted the same criteria. My hon. Friend the Member for Blackpool North and Cleveleys has rightly advanced the case of cystic fibrosis, and I entirely understand why, but I know that he will also recognise that other conditions might qualify for consideration in the same way, or for the same case to be made for them by right hon. and hon. Members.

When the exemption list was first put in place in 1968, 42% of items on prescription were free; now 89% are free. There has been considerable change in that space, but to go to the heart of what right hon. and hon. Members have asked for today, were my right hon. Friend the Member for South Holland and The Deepings in his place, I would disappoint him by saying that, as he will appreciate, I cannot make policy standing at the Dispatch Box. It is important that everything is considered carefully. Although this is not my policy, I will continue to reflect on the points that have been made by right hon. and hon. Members today and by campaigners on this issue. I will also ensure that I will not only speak to my noble Friend, the Minister with portfolio responsibility for this issue, but draw to his attention the transcript of today’s debate.

[Kerry McCarthy]

I have just realised that it is groundhog day—I missed an ideal opportunity to weave that fact into my speech, as I think all of us would have done. Is there anything the Minister could say that does not makes us feel like we have been here many times before? He has said that he will reflect on these points, but is there not something a little bit more concrete that he can give us a commitment on, so that we feel that we are perhaps making some progress?

[Edward Argar]

I am grateful to the hon. Lady. She may or may not always agree with me, but I will always endeavour to be straight with the House, even when the message may not always be the one that Members want to hear. I cannot stand here now and say that there will be a review of that list; it is important for me to be honest with her. What I can say—which she may feel is insufficient, and I entirely respect her if she does—is that I will reflect on the points made today and the issues raised. I will discuss this issue with my noble Friend and ensure that the points that have been made in this debate are conveyed to him, but it would be wrong of me to commit to something that I am not in a position to commit to. The hon. Lady rightly presses her case, but I know that she will appreciate my position, and it is important that I am honest with the House in that respect.

I touched on the help with prescription costs previously, and the number of items. While I know that this is not at the heart of the point made by my hon. Friend the Member for Blackpool North and Cleveleys, it is still important that I put on record the point that I alluded to: when medical exemptions were introduced, only 42% of all NHS prescription items were dispensed free of charge. That figure is now around 89%, and around 60% of the English population do not pay prescription charges at all. Many people with medical conditions not on the exempt list already get free prescriptions on other grounds, as my hon. Friend the Member for Blackpool North and Cleveleys said, with current exemptions providing valuable help for those on the lowest incomes.

[Jim Shannon]

In my contribution, I referred to Scotland, Wales and Northern Ireland, where prescription charges are free. I have knowledge of Northern Ireland, though not of Scotland and Wales, and understand that we follow the rules of the National Institute for Health and Care Excellence in the UK but have some liberty about what we add on. I understand that the Minister is not responsible for this. He is a good man who has been honest with us. What we wish to be conveyed from this debate, to the person who is responsible, is that the same should happen here as in Northern Ireland, Scotland and Wales.

[Edward Argar]

I am grateful to the hon. Gentleman. I will finish the point I was making and then respond to his. We have already heard about the annual certificate, which can be purchased by direct debit in instalments, meaning that a person can have all the prescribed items they need for just over £2 a week. I take the point from the hon. Member for Bristol East that that may still not solve the problem for everyone, but that route provides a significant potential reduction in costs.

I shall now respond to the point raised by the hon. Member for Strangford on the devolved Administrations, and the broader approach to prescription charges. Although we have surprisingly managed to stray away from it for quite a while, any debate on this subject will touch on the different positions of England and the devolved Administrations, given the latter’s abolition of charges for prescriptions. I suspect that many people will ask why there is that difference in approach. Health is a devolved matter and the devolved Administrations have full discretion over how they spend their budgets and the choices they make, presumably choosing to spend a proportionately larger share of those budgets on prescriptions.

We have opted for a different approach in England. We also recognise that prescription charges, more broadly, raise significant revenue, which provides a valuable contribution directly to NHS services in England. In 2019-20, they contributed just over £600 million in revenue to NHS frontline services. There is always a balance to be struck, and I suspect that we shall return to this topic, with Members taking different views.

With regard to the key point made by the hon. Member for Strangford, although I am not directly responsible for this area of policy I will continue to reflect on that. In this House, there are times when individual debates or speeches—I look at my hon. Friend the Member for Ashfield—resonate, and cause Ministers to turn them over in their head and reflect on the points made. All hon. Members will be able to point to speeches they have heard on different topics in the main Chamber that stay with them. They go away from that debate, still reflecting on what that right hon. or hon. Member has said. My hon. Friend the Member for Ashfield has had that effect today. I will reflect carefully on what he said, within the context that I cannot make policy at the Dispatch Box. In response to the point made by the hon. Member for Strangford, I will pick up that issue and convey the sentiments of Members speaking today to my noble Friend Lord Kamall, and ensure that he has a copy of the transcript of the debate.

I conclude by thanking all hon. Members for their contributions. Often, people judge what goes on in this place by the half an hour or 40 minutes that they see at 12 noon on a Wednesday on both sides of the Chamber and what happens there. Many people do not see what happens in Westminster Hall, where, in a measured and sensible way, people can discuss, debate and sometimes disagree on issues that really matter and impact on the lives of individuals or particular groups of people. This debate is one that those that clears a very high bar for the quality of the contributions, for the importance of the subject and for its ability to cause us to leave this Chamber continuing to reflect on what we have heard.

[Paul Maynard]

I thank all those who have participated, particularly my hon. Friend the Member for Ashfield (Lee Anderson). We are all grateful to him for not just speaking on a personal basis, but illuminating a debate far better than I could from my more dry, academic analysis. I thank him for his personal contribution, and I thank all hon. Members for a constructive debate. I recognise the point that the Minister made; making a commitment on the hoof at the Dispatch Box can be career-limiting. I know that myself, as I reflect on what I once said on rail and aviation, which I suspect led to my defenestration. Saving High Speed 2 can be terminal for a career, perhaps. None the less, I hope he will take the issue back to Lord Kamall, and that he might encourage him to meet me and other interested Members to hear what the Gentleman whose brief it is thinks of the matter.

[Edward Argar]

I am happy to reassure my hon. Friend that I will certainly convey his request for a meeting to my noble Friend.

[Paul Maynard]

We have something concrete on which to conclude the debate.

Question put and agreed to.

Resolved,

That this House has considered prescription charge exemption and cystic fibrosis.