Westminster Hall

Monday 6th March 2023 Westminster Hall

Monday 6 March 2023

[Sir Edward Leigh in the Chair]

Prescription Charges: People Aged 60 or Over

Monday 6th March 2023 Westminster Hall

[Relevant document: Summary of public engagement by the Petitions Committee on prescription charges for people aged 60 or over, reported to the House on 27 February 2023, HC 73.]

16:30

[Tonia Antoniazzi (Gower) (Lab)]

I beg to move,

That this House has considered e-petition 594390, relating to prescription charges for people aged 60 or over.

It is an honour to serve under your chairship, Sir Edward. The petition I am presenting touches on a number of incredibly important issues in healthcare from access to treatment to public health and preventative care, all within the context of how the NHS adapts to an ageing population. Although the petition focuses on prescription charges, it must be considered in the broader economic context of the cost of living crisis, with months of rising prices and inflation where even the most basic necessities are becoming luxury items for many.

The steady rise of pensioner poverty since 2015 shows no sign of stopping, continuing a trajectory that will see millions of us face a retirement dominated by debt and hardship. That context means we are duty-bound to look beyond figures on spreadsheets and examine what the proposed scrapping of free prescriptions for that age group would mean for those who would be impacted by it. It is those impacts that the petition creator Peter had in mind when he set it up.

When I spoke to Peter about why he started the petition, he shared his concern about the impact these changes would have not on him, but on his local community—the men and women who are already struggling with costs and are making difficult choices about what to prioritise. It is people like him who have spent a lifetime working in industry and those who, because of that work, now suffer from a variety of medical conditions, each needing different medications. It is those women, including his wife, who had their lives upended by the callous way the Government implemented the equalising of the state pension age. WASPI—Women Against State Pension Inequality Campaign—women, who were born in the 1950s and live in England, have further issues to deal with compared with those in devolved countries.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

Uprating the age when prescriptions become free in England to be in line with the state pension age, as the Government consulted on, would be harmful given the cost of living crisis, as the hon. Lady said, and the growing economic activity in those over 50 for various reasons, including their health. Does she share my concern about what this could mean for ease of access to medical treatment for the older generation?

[Tonia Antoniazzi]

I thank the hon. Lady for her contribution. It is, indeed, a huge concern that people with multiple health problems are facing extra difficulties in accessing prescriptions and are having to make those difficult choices about how they spend their money.

For Peter, it seems that something has gone incredibly wrong to get us to this point—something broader than this planned introduction of charges, but something encapsulated by it. It is the breaking of a promise—the promise between citizen and state and the promise that a lifetime of contribution, whether financial through tax and national insurance or through the unpaid labour of care that enables our economy to function, means support in retirement. Peter kept his part of the bargain. It was great to have a conversation with him. He could not believe that his petition was being debated in this place, and it is so important that his voice and the voices of others are heard in this place. He kept his part of the bargain, first in the shipyards on the Tyne and then working on aircraft. He paid in and did what was expected, as did hundreds of thousands of others, but the Government have not held up their end of the bargain. They have changed the rules, and it looks like they will do so again. That unfairness is the reason why we are discussing the matter today.

The plan to introduce charges seems particularly unfair when Peter does not even have to look that far from home to see a better way. England is the only nation in the United Kingdom without free prescriptions and, as colleagues may have guessed from my accent, I am Welsh. I have the great pleasure of representing Gower, one of the three Swansea constituencies, which is beautiful. If anyone ever wants to visit, please do.

Swansea and Newcastle have a lot in common: both are port cities with a proud industrial heritage; both are famous for an excellent night out. It seems the height of unfairness to many in Newcastle and across England that they alone in the United Kingdom pay for prescriptions. I am sure that the Government will tell us that several conditions are exempt and that pre-payment certificates cut costs, but, as I said earlier, we must look beyond the briefings to the reality of the system actually. The exemptions list is not only woefully out of date but, apart from the addition of cancer in 2009, it has not been reviewed since 1968. It also does not cover several life-changing conditions, such as Parkinson’s, arthritis, asthma, Crohn’s disease, cystic fibrosis, lupus or motor neurone disease.

That is the tip of the iceberg. People with those conditions, and other complex, lifelong conditions, still pay for their prescriptions. For those with multiple, co-existing conditions, the cost is even higher. Evidence from the Prescription Charges Coalition, a group of 50 organisations calling on the Government to scrap prescription charges for people with long-term conditions in England, shows that people with long-term conditions struggle to pay for their medication. A third of respondents in England with long-term conditions reported that they had not collected a prescription item due to the cost. Nearly a third admitted that they are skipping or reducing medication doses, with cost concerns a key factor for more than four out of 10. As a direct result of reducing or skipping medications, nearly three in five—59%—became more ill, and 34% needed to visit their GP or hospital. In fact, the Government’s own impact assessment on the introduction of charges highlighted that issue and noted the potential effect on people’s health.

In 2018, thousands of over-the-counter medicines were taken off the list of those that GPs are able to prescribe, leaving those with long-term conditions facing additional costs for their conditions and to stay well. Those worrying health outcomes come with a cost to the NHS. Several member organisations of the PCC conducted research last year. They found that, of those surveyed, one in six of those with asthma and lung disease had cut back on using their potentially life-saving inhalers, as they were worried about the cost; 29% of respondents with cystic fibrosis reported that they had skipped their medication due to prescription charges; and one in five people with multiple sclerosis say that they do not have enough money to pay for the medication or treatment they need.

One lady who lives with kidney disease was hospitalised twice because she had to wait until payday to collect a prescription. In hospital, she had to have a lumbar puncture and an MRI scan, which cost the NHS thousands of pounds more than the prescription would have. As colleagues can see, the impact is vast and, when meeting campaigners prior to this debate, I heard far too many stories like that one. The lived reality of those impacted by this proposed change and the issues caused by the current dysfunctional exemptions system are best understood through that lens.

I work closely with Parkinson’s UK, which is one of the many organisations deeply concerned by this proposal. Medication is the only way to control the symptoms of Parkinson’s disease; most have to take a cocktail of medications to stay well. Research shows that Parkinson’s cost households over £19,000 a year in 2021, due to loss of work; and additional health and social care costs. As Parkinson’s progresses, it becomes more complex. Among people eligible to pay for prescriptions who are aged 60, in any year 5.5% will die within five years and 23.8% will need support to live independently—that is within only five years of being diagnosed. However, they would still have to pay for their essential medications for Parkinson’s.

I want to tell the Chamber a little about Denise. She is 59 and was diagnosed with Parkinson’s in April 2019. She has had to reduce her working hours from 37.5 to only 12 per week, due to her symptoms. She uses a prepayment certificate for her prescriptions, because it is cheaper than purchasing them individually. If the exemption age rises to 66, however, she will have to continue paying for them.

Denise told Parkinson’s UK about the impact that that would have on her:

“I always thought I would work until I was 67, because I would be able to. However, as my Parkinson’s advances I worry about whether I physically will be able to. My employer is really understanding, allowing flexibility to start later in the mornings until my medication has kicked in, but I have already had to reduce my hours by 60% and I’m already noticing the impact of this reduced earning capacity on our household.

I have to pay for my prescriptions, and this is eating into the diminishing amount I can contribute towards the household bills. If they were to increase the age at which I become exempt, it would be really tough because we haven’t allowed for more years of these additional charges.

It feels like the Government is once again penalising those living with a long-term condition like Parkinson’s that anyone could get and for which currently there is no cure.”

Denise’s story is not an isolated one. Parkinson’s is not the only condition whose sufferers will be further disadvantaged by the change, but this is not a problem that will be solved by changing the exemption list. An exemption list has winners and losers baked into its design, and the complexities of managing chronic conditions mean that any approach that is not universal is not fit for purpose.

Furthermore, the Government need to answer why the change is being prioritised now. What evidence is there that it will have any kind of positive impact? We cannot see one. Even if the Government make savings in the short term, the long-term impacts could be catastrophic, leading to greater illness and to more GP and hospital visits.

A poll published in Pulse found that 40% of GPs linked prescription charges to adverse patient outcomes, also indicating that those could lead to far greater costs and more adverse outcomes down the line. Initial results of the 2023 survey by the Prescription Charges Coalition showed that nearly 10% of respondents had not collected medicine due to cost. Of that group—I have more data —30.74% said that they now have other physical health problems, in addition to their original health condition; 30.33% said that they had to go to their GP; 17.32% said that they had to go into hospital for treatment; and 8.32% said that they had to go to A&E.

Research published in 2018 by York Health Economics Consortium highlighted how ending prescription charges for long-term conditions could save money and reduce pressure on the NHS. That comes from preventing avoidable health complications that occur when people do not take their medication. The research identified net savings of more than £20 million per year if the NHS scrapped prescription charges for people with Parkinson’s and inflammatory bowel disease alone. Instead, the Government are discussing introducing additional charges. That flies in the face of common sense.

We know that the NHS is under pressure, but that is the case across the United Kingdom, and the devolved nations are not even discussing removing universal free prescriptions. I urge the Government to follow that lead, to look to the future and not to engage in short-termist, quick fixes that will not be a fix for all, and not for the petition creator.

16:44

[Taiwo Owatemi (Coventry North West) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Edward. I thank my hon. Friend the Member for Gower (Tonia Antoniazzi) for securing such an important debate.

As a cancer pharmacist, chair of the all-party parliamentary pharmacy group and somebody who still volunteers at a local hospital—I was there this morning—I have seen at first hand the difference that free access to medication makes to those over the age of 60. For years, I have treated patients whom the prescription proposals will make worse off. I know just how anxious they are at the prospect of having to fork out another monthly expense that they simply cannot afford. When the choice is between heating and eating, which is a day-to-day reality for thousands of people in my city, we cannot sit idly while health is incorporated into the mix. It should not have to be spelt out that, as people age, they will develop long-term healthcare needs, and those needs will need to be treated by prescription drugs.

[Margaret Ferrier]

Prescription charges have been described by pharmacies as attacks on the sick. As we have heard, pharmacies have reported a significant increase in the number of patients not collecting their prescriptions because they simply cannot afford them. Does the hon. Member agree that that is worrying for all age groups, but especially for over-60s, who are more prone to sickness and to requiring that medical aid?

[Taiwo Owatemi]

I agree. Sadly, we look at the pharmacy shelves and see that many patients are not picking up their prescriptions, or patients come to the pharmacy counter, realise how much a prescription costs and that they cannot afford it because they have not financially planned for it. I will speak about that later in my speech.

The Government’s impact assessment concluded that 52% of people between the ages of 60 and 64 will have at least one long-term health condition, so by aligning medical exemptions with the state pension age, the Government are hitting the people in my community who have the greatest need for medication but simply cannot afford it. What do the Government expect to happen when people in their 60s decide that they can no longer afford their prescriptions? If saving money is the Government’s aim, I question whether they have considered the reality—that the proposals will simply shift the costs from primary to urgent care. Health conditions will inevitably worsen, and patients will be forced into overcrowded A&E units—adding to the already overwhelmed health service.

I support some of the points highlighted by my hon. Friend the Member for Gower regarding long-term health conditions, especially unchanging health conditions such as asthma, motor neurone disease and sickle cell anaemia. As she highlighted, the York Health Economics Consortium estimated that £20 million would be saved each year if the NHS scrapped prescription charges for people with Parkinson’s and inflammatory bowel disease. That is because fewer people would be forced into A&E, which would mean fewer hospital admissions and fewer GP visits. If we want to save the NHS money and reduce the burden on the NHS, prevention is key, and medicines play an essential part in preventing patients’ healthcare conditions from worsening and preventing patients from developing other health conditions. It is concerning that the Government can consider the proposals as a way of reducing the burden on the healthcare system. That is a hugely irresponsible decision for the Government even to consider making. It is essential that the Government engage in some form of cumulative impact assessment. People over the age of 60 with long-term conditions will be disproportionately affected.

My older constituents in Coventry North West are anxious and stressed. They tell me that they simply do not know how they will make ends meet at the end of each month, especially when they have to deal with soaring energy bills and food costs. They ask why the Government continue to attack elderly residents during the most severe cost of living crisis for a generation. I hope that the Government will answer that. I especially worry that making our ageing population pay for medication will leave huge numbers of people unable to afford essentials and force them into further hardship. I add my support for the Prescription Charges Coalition, which is calling for a freeze in prescription charges for 2023 and has said that the Government must scrap the alignment plans. I recognise that the Government are planning to support the proposals.

Every year, especially on 1 April, I find myself helping patients to fill out prepayment card applications or to navigate the increase in NHS charges, because many do not even realise that those changes are coming. I therefore first ask the Government to notify patients of the increase way before 1 April so that they are able to financially plan; otherwise, the increase may mean that many do not have access to their medication when they need it. Secondly, will the Government review the long-term exemption list for patients with medical conditions that, due to their nature, we know will not change?

I want to make a final important point. Older people have contributed to our society their whole lives, and they have trusted that if they work hard and pay their taxes, they will be looked after. That is the deal we make with them, and it is what they expect from us when they get older. The Government’s proposal will break that trust. We cannot afford to abandon older people now simply because the Government have decided that this is the best way forward. Doing so will impact trust in the long term.

Lastly, will the Minister, who is responsible for primary care, come to the all-party parliamentary pharmacy group meeting from 1 pm until 3 pm on 29 March in Room S, Portcullis House, and speak to pharmacists? We would like to continue the debate and to talk about the current pressures facing pharmacy as a whole.

It has been a pleasure to contribute to the debate. I look forward to hearing from other colleagues.

16:51

[Marion Fellows (Motherwell and Wishaw) (SNP)]

It is a pleasure to serve under your chairmanship, Sir Edward. I thank all the previous speakers; some of what I say will be a repetition, but in this case I do not think repetition is unwelcome.

Under the SNP Scottish Government, prescription charges were abolished in Scotland in 2011. Scotland gets free prescriptions because the Scottish Government believe that mitigating the costs of illness is in the best interests of the population of Scotland. The SNP has led the way in delivering progressive and forward-thinking public health measures, which people across Scotland continue to benefit from. I speak from experience, as I was honoured to be part of the call for the new generation of cystic fibrosis medications to be released in Scotland, which was first place to get them. I declare an interest, because my granddaughter Saoirse will continue to benefit from those new drugs for the rest of her life, and they will extend her life expectancy quite considerably.

All credit to the Scottish Government: inhalers, antibiotics, life-saving medicines such as insulin for diabetes and many other treatments are provided at no cost at all to the patient at any stage. Scotland receives no extra funding for this decision and does not take money from other areas of the United Kingdom to pay for it. England is out of step with the rest of the UK. For more than a decade, NHS prescriptions have been free in Scotland, Wales and Northern Ireland. Yet the Tories, who have been in power in England for 13 years, have not replicated this approach, instead penalising those wishing to collect medicines; and, as we have already heard, the cost of living crisis has increased the non-collection of prescriptions.

When the NHS was founded in 1948, there were no prescription charges, but fees were introduced in the early ’50s to help with funding. Labour’s position in 2019 was to roll back charges for England—that appears to have been dropped under the present leadership. Unequivocally, the SNP has used the powers we have to ensure that people in Scotland benefit from the most generous social contract in the UK. The cost of NHS prescriptions can be mitigated in England if people use a prescription season ticket—a prepayment card. However, many people in England are still unaware of the system. Is the Minister prepared to advertise it more than is currently the case?

I used the example of cystic fibrosis medication, but the hon. Member for Gower has done really good work in the area of hormone replacement therapy over the years. After the arguments she has forcefully put in this place, it is incredible that women going through the menopause still have to pay for their HRT. The most recent announcement committed the Government to reduce the cost from April this year so that women can receive a year’s supply of HRT for the cost of two single NHS prescriptions in England, but in the rest of the UK they get it free. Although cost reductions are welcome, charging menopausal women less seems inadequate—they should get it free because the amount of work they can then do will increase, and that is a benefit to the whole economy.

People who have asthma are sometimes afraid to collect their prescriptions, as we heard from the hon. Member for Gower (Tonia Antoniazzi). A small survey of pharmacists published by the Royal Pharmaceutical Society last month found that a rising number of patients in England are failing to collect their medicines, because they cannot afford them. Some 51% of the pharmacists surveyed reported an increase in patients not collecting their medication, and 67% saw a rise in patients asking whether there was a cheaper over-the-counter substitute for the medicine they had been prescribed. That is appalling in this day and age, and it leads to more hospital admissions and more expensive care being required in the longer term. It defies common sense to allow that to continue.

The three devolved Governments have taken a preventive approach to mitigate poorer health outcomes by providing free access to medicines for those who need them. In England, the tax on sickness reduces access to medicines and leads to poorer health, time off work and potential hospital admissions, offsetting any costs gained from prescription charges. The UK Government should scrap prescription charges. To introduce them for people who are working until 67 is absurd. As the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) said, we are more likely to need medication as we get older.

The Government’s public consultation document ominously states:

“Anyone aged 60 and older can get free prescriptions for medicine. We are thinking about changing this.”

The change would mean that prescriptions would be free only when people get to pension age. Today’s pensioners have no need to worry, but they will worry—people worry even more during a cost of living crisis.

Is the Minister prepared to heed what is happening in the devolved nations and to equalise access to medicine across the United Kingdom?

16:59

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Edward. I want to start by thanking the Petitions Committee for facilitating this debate, and my hon. Friend the Member for Gower (Tonia Antoniazzi) for the passionate way in which she put forward the arguments of Peter, Denise and many others who find themselves in the predicament of having to pay for prescriptions or who worry that they might have to pay for them as pensioners.

It is a pleasure to respond to the debate on behalf of the shadow Health and Social Care team, but also as the Member of Parliament for Denton and Reddish, and I know that many of my constituents are concerned about this potential policy change. As we have heard, we are in the middle of a cost of living crisis, when many people face unsustainable rises in their energy and household bills. It is little surprise that the Government’s decision to consult on scrapping free NHS prescriptions for the over-60s will be of profound concern to many people already struggling to make ends meet. That anxiety has been compounded by characteristic delay from the Department of Health and Social Care.

The Government first announced the consultation to scrap free NHS prescriptions for the over-60s in July 2021, meaning that there was little or no time for Members of this House to sufficiently scrutinise the proposals before that year’s summer recess. The consultation closed in September 2021 and, two and a half years on, we are still none the wiser about where the Government are on the issue.

A quick glance at written parliamentary questions shows that many Members from across the House have asked the Government for clarity, only to receive a boilerplate response that an announcement would be made “in due course”. In his response, will the Minister set out precisely when that announcement will be made and why there has been such a delay in the Government addressing their own consultation?

That is important, because the Government’s own impact assessment raises several potential problems with the proposals. Notably,

“some people towards the lower end of the income distribution may struggle to afford all their prescriptions”,

which can result in

“future health problems for the individual and a subsequent cost to the NHS.”

That is precisely the point made in their interventions by my hon. Friends the Members for Gower and for Coventry North West (Taiwo Owatemi) and, indeed, the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier), who is not in her place. Therefore, if the Government do decide to opt for this policy, we need to know what steps they will take to support people—especially those over 60 and with long-term conditions—with their prescription fees.

Prescription charges have already increased by 30% since 2010 and, given the financial context we are in, there are really valid concerns about people being priced out of accessing vital medicines. The Royal Pharmaceutical Society recently conducted a survey of 269 pharmacies, with half of respondents saying that patients were asking them which medicines they could do without. Half of pharmacies surveyed also said that they have seen a rise in people not collecting their prescriptions at all. That is incredibly concerning.

Last year, Asthma & Lung UK found that 15% of surveyed people with respiratory conditions were rationing the use of their inhalers to make them last longer. Some 5% of people said they were being forced to borrow medicine from others, which really frightens me, because someone’s prescription is pertinent to them and them alone. I had hoped that we had moved away from a world where we lend medicines to others. Frankly, these statistics should be ringing alarm bells in the Department of Health and Social Care and, for that matter, in the Department for Work and Pensions, but unfortunately we have had radio silence.

I would like to impress on the Minister the simple fact that if people are not taking vital medication, they could be living in extreme pain, and in some cases they will be at risk of serious medical complications as well. Have the Minister and his officials made any assessment of the number of people in England who are currently unable to afford medicine, and of the knock-on impact on NHS services, which are already at breaking point thanks to this Government’s mismanagement of the NHS?

Last year, the Government froze prescription charges in a move that was welcome to many in England. The next review is due to take effect in April, and I am sure I do not need to remind the Minister that that will come at the same time as the implementation of Ofgem’s new energy price cap. Will the Minister provide an update on that review? Does he anticipate another rise in the cost of prescription charges, or will the Government do the right thing and freeze them again, for another year?

While he is at it, perhaps the Minister will also nudge his colleagues in the Treasury to do the decent thing and implement a proper windfall tax on energy and gas giants to extend energy support, so that those on the lowest incomes are protected against astronomical price rises. In the 21st century, here in the United Kingdom, no one should be forced to choose between accessing vital medication, heating their home or feeding their family.

The final point I wish to make is connected to this issue. The Government seem to have no vision or appetite to prioritise preventive public health. In the context of an ageing population, it is important that we build healthier communities. That is important not only morally, but practically, especially if we want to reduce reliance on prescriptions and primary care. What steps is the Minister taking to prioritise preventive health? On that note, will he set out why the public health grant allocation has still not been announced for local authorities in England? Many local authorities that have already set their budgets still do not know what their public health grant allocations will be in three and a half weeks’ time.

The next Labour Government will give the NHS the tools, staff and technology it needs to treat patients on time and to put prevention right at the heart of everything it does. Coming back to the issue before the Chamber, I really hope that the Government understand the concern, worry and anxiety of those over 60 in England, who are concerned that their free prescriptions may come to an end.

I want to mention my right hon. Friend the Member for Wentworth and Dearne (John Healey), who was here at the start of proceedings. As a member of the shadow Cabinet, he cannot take part in these deliberations, but he wanted me to highlight some of the work he has done in his constituency. He and his local team collected signatures against the proposed scrapping of free prescriptions for the over-60s. His story can be told 650 times over to the Minister, because there are elderly people across England who are concerned about this issue and who want answers from Ministers. They want their concerns to be heeded, they want assurances that the Government get the reason why prescriptions are free for the over-60s and they want the Government to understand why it is important that that remains the case. They also want to know that the Government are on their side on this issue, that their free prescriptions are not at risk and that we will not face people who cannot afford their medication with the dilemma of whether to heat their homes, feed their families or get the medication they so desperately need. Britain is better than that, and I hope the Minister has some positive news for us.

17:10

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

I am grateful to the hon. Member for Gower (Tonia Antoniazzi) for opening the debate so effectively on behalf of the Petitions Committee, and I thank all Members for their constructive contributions. I also thank the 46,000 members of the public who signed the petition.

The Government provided their initial response to the petition in January 2022, and I am pleased to be able to respond again today, having listened to hon. Members’ important and interesting contributions. The context, of course, is the Russian invasion of Ukraine and the high energy prices, inflation and cost of living pressures that it has unleashed. It is worth situating the debate in the context of some of the things we are doing to take action on that, some of which hon. Members have already referred to.

This winter, we are spending a total of £55 billion to help households and businesses with their energy bills—one of the largest support packages in Europe. A typical household will save about £900 this winter through the energy price guarantee, in addition to £400 through the energy bills support scheme. We are also spending £9.3 billion over the next five years on energy efficiency and clean heat, making homes cheaper to heat. Some of that is being paid for by the windfall tax; at 75%, it is one of the highest in any of the countries around the North sea, and it is enabling us to do more on the cost of living, such as the £900 cost of living payment for 8 million poorer households, and the largest ever increase to the national living wage, which will help 2 million workers. In total, we are spending £26 billion on cost of living support next year.

Turning specifically to prescription exemptions, I should start by trying to manage expectations about what I can say today, for reasons on which I will elaborate. It is clear that the outcome of the consultation on aligning the upper age exemption for prescription charges with the state pension age is very important to many Members’ constituents. However, I can only say at this point that no decision has been made yet to bring proposals forward.

We received over 170,000 responses to the consultation —a testament to the strength of feeling on the issue. We want to ensure that everyone across the country, especially those affected by the cost of living pressures caused by the Russian invasion, can afford their prescriptions. That is why we have thought long and hard about how best to balance the needs of those in the affected age group, many of whom will find that they have additional health needs compared with when they were younger, with the pressures facing the public finances. I can, however, assure Members that we will respond to the consultation in due course.

Hon. Members will be aware that the petition calls on the Government to protect free NHS prescriptions for all over-60s. We value our older members of society, and we recognise their social care and health needs. On the one hand, we recognise that families up and down the country are facing unprecedented pressures with the cost of living; on the other, we have to recognise that in the light of the covid pandemic, which has tested the NHS like never before, and the challenging economic landscape, we must ensure that public sector spending represents the best value for money for the taxpayer. As we look to the future in a post-pandemic world, there is no shortage of challenges ahead of us: an ageing population, an increasing number of people with multiple health conditions, and deep-rooted inequalities in health outcomes, which we are tackling. That is all in addition to the challenges of the pandemic and the elective backlog.

Charges have been around in the NHS for over 70 years, and prescription charges provide a valuable source of income for the NHS, contributing £652 million in 2021-22. That significant funding helps to maintain vital services for patients, and it is particularly important given the increasing demands on the NHS.

It is for those reasons that we consulted on aligning the upper age exemption for prescription charges with the state pension age. Historically, the initial exemption for prescriptions was for people aged 65 and over. The exemption was then extended to women aged 60 and over in 1974, and to men aged 60 or over in 1995, based on the state pension age for women at that time. The state pension age has subsequently increased to 66 for both men and women, with legislation already in place to increase it to 67, and then 68, in future years.

The Government have abolished the default retirement age, meaning that most people can continue to work for as long as they want and are able to. That means that many people in the 60 to 65 age range can remain in employment and be economically active, and therefore more able to meet the cost of their prescriptions. Indeed, more than half of people aged between 60 and 65 are economically active, with a further 20% receiving a private pension or some other income.

As increasing numbers of people live longer, work longer and so on, there are more people claiming free prescriptions on the basis of their age. It is projected that by 2066 there will be a further 8.6 million UK residents aged 65 and over, and that they will make up about a quarter of the total population.

It is important to know that over 1.1 billion prescription items are dispensed in the community each year, with nine out of 10 currently dispensed free of charge. The exemptions that allow that may be based on the patient’s age, certain medical conditions, or income. We estimate that if we were to make the proposed change, around 85% of 60 to 65-year-olds would be minimally affected by it. As I have just noted, more than half of them are in employment, with about another 20% retired with a private pension, so they have a higher income, while others would continue to qualify for free prescriptions on the basis of their particular conditions.

It is also worth noting that there are extensive arrangements in place to help those who are most in need of support with prescription charges. People who are on a low income but do not qualify on the basis of an automatic exemption, such as being on universal credit, can get help through the NHS low income scheme, which provides either full or partial help with health costs on an income-related basis. Anyone can apply for the scheme if they or their partner, or they jointly as a couple, do not have savings, investments or property totalling more than £16,000, not including the place where they live. A person will qualify for full help with their health costs, including free NHS prescriptions, if their income is less than or equal to their requirements.

To support those who do not qualify for an exemption due to one of the many other reasons, such as their age or their condition, or for the NHS low income scheme, prepayment prescription certificates, which were mentioned earlier in the debate, are available to help those who need frequent prescriptions to reduce the cost. The prescription charge is currently £9.35; a three-month PPC is £30.25; and a 12-month certificate is £180.10, which amounts to just over £2 a week. PPCs can offer significant savings, and an annual PPC can be paid for in 10 direct debit payments, to allow people to spread the cost over the year.

[Andrew Gwynne]

I am a little concerned about the tone of what the Minister is communicating. He seems to be accepting that there will be a change on prescriptions for pensioners, but does he acknowledge the challenge with pension credit, whereby a large number of pensioners who are eligible for it do not apply for it, because they are fearful of the means test? What will he do to ensure that that does not happen when it comes to prescriptions?

[Neil O’Brien]

Perhaps I can set the hon. Member’s mind at ease. I said earlier that no decision had been made, and I reiterate that now. I have talked about the different measures that cause people either to be exempt from charges or to have the cost of their prescriptions cut, and I talked about PPCs as a final step, which can reduce the cost of prescriptions for those who do pay them.

It has been mentioned several times that prescription charges have been abolished entirely in the devolved Administrations. Health is of course a devolved matter, but it is worth noting that spending is £1.25 in Scotland and £1.20 in Wales for every £1 in England, so there is that additional budget. Those devolved Administrations, with the record increases in their spending settlements, have full discretion about how they choose to spend those budgets.

Several hon. Members asked me quite specific questions about the outcome of the consultation. I can only reiterate that we continue to consider, long and hard, the many responses that we received, trying to balance the cost of living pressures with the need for increasing funding for the NHS, and we will respond to the petition in due course. I thank hon. Members for their contributions today.

17:19

[Tonia Antoniazzi]

I thank Members for participating in the debate and the Minister for his response. I am sure that the people I have met will not be reassured by that response, but it is difficult, with no decision having been made about the reduction in prescription charges. That needs to be done, and the Minister needs to confirm it.

I feel for the many unpaid carers—mostly women—who look after children or partners, given of the impact of this situation on them. People see that as unfair, and the system is not perfect, so we hope that change will come.

Question put and agreed to.

Resolved,

That this House has considered e-petition 594390, relating to prescription charges for people aged 60 or over.

17:20

Sitting adjourned.