Prescription Charges: People Aged 60 or Over

Andrew Gwynne Excerpts

Monday 6th March 2023 Westminster Hall

[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.

[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.