Benefit Claimants: Free Prescriptions

Lord Allan of Hallam Excerpts

Thursday 30th November 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, the right reverend Prelate the Bishop of London helpfully said in her opening speech that she was in some ways surprised to see that this issue would require legislation. I fear that may actually be the point: that the whole purpose of this is to table something and invite Members on this side of the House to vote against it, so that the Government can somehow claim that we are being weak on the workshy. I must say, whenever the Government find time for something such as this—as noble Lords might expect, I think it is wrong in principle and in practice—in lieu of other legislation we have called for, such as on mental health, we have to question their priorities and whether all we are seeing now is a political agenda from a party playing out its last few months in office.

I turn to the substantive issue and why I think this is wrong in principle and in practice. On the principle, we need to understand the rationale for prescription charges. We are not paying for our drugs when we pay prescription charges; the rationale is that people who can afford to do so should make a contribution to the costs of operating the entire system of dispensing prescriptions. Those people are working-age people, in work. The whole system is based on that rationale. People who are not of working age do not pay prescription charges: 70 year-old millionaires—and, indeed, their 15 year-old children—do not pay them. The whole system is based on this, so taking a segment of people who are, by definition, not in work and magically putting them in the in-work paying bucket is entirely inconsistent with the whole scheme as it has been set up.

No deserving/undeserving judgment is made with prescription charges; otherwise, we would be testing people’s incomes and whether they had made themselves ill before getting a prescription. We do not do that because that is not the rationale. The rationale is that people who are in work and have the means to pay, such as myself, should do so. I do not speak for others, although I would have spoken for the noble Lord, Lord Markham, had he been here, because he is in a similar position, in that we are the kind of people who should be paying prescription charges. In a few years, I will stop because I will be deemed no longer of working age, so, although I will have plenty more time here, my prescription charges will cease. Being in work and being of working age are the criteria for making contributions.

In principle, we are breaking that and I see no rationale for doing so. Saying that you have not complied with a jobcentre request and therefore you lose access to the scheme is so inconsistent with everything else that has been set up. That is particularly the case where an obvious response to the sanction is that someone should seek the healthcare they need. Everything in the prescription contribution system has been carefully designed not to deter people from getting drugs. A whole bunch of exemptions are wrapped around this to do that. To undermine it seems entirely problematic.

I turn to the practical issues. The prescription charges are not a fee for the medicines. They are completely unrelated to the cost of the medicines; they are a contribution to the NHS. They are capped at £111.60 per year and the cap is set, effectively, by the prescription prepayment certificate. Anyone who needs more prescriptions than would add up to that price is entitled, whoever they are, to get a PPC. I assume that this will apply equally to the cohort we are talking about today. If the claimant has a condition that needs several prescriptions per year, we are effectively fining them £111.60 per year. This is probably one for the Minister’s DHSC colleagues but, given that we have set a cap, I am curious why, if TfL can figure out when I have travelled enough during a day to hit its daily transport cap, the prescription pricing system—which is all computerised—cannot figure out when I have hit the £111.60 cap and automatically apply it. The obvious reason is that it is hoped that people will keep paying beyond the cap. If we are to have a cap, let us help people claim within it rather than send them over it. That is particularly true here.

This £111.60 fine is now being levied as a sanction on top of all the other sanctions for this group of claimants. The first option is to pay the fine so that, if you need the medicines, you can go off and get them. The second is to keep ticking the exemption box. All sorts of people do this all the time. You run the risk of getting a £100 fine plus the cost of the prescription penalty charge notice at some point in future. Again, I am not saying that to invite it. It is a very common phenomenon. It happens all the time, so much so that the Public Accounts Committee down the other end has done a report on it, which was very critical of this whole system. It is quite expensive to administer and we spend a lot of time chasing people around for this. A rational response of someone in this category is: “Okay, here’s my choice: £111.60 or take my chances. Maybe I will end up paying about the same amount as and when they come and get me with one of these penalty charge notices”.

The third option is for them to stop taking the drugs that they need. That is the worst option, disastrous for all possible outcomes. I am looking at the noble Viscount the Minister—from the point of view of the benefits system, what possible interest is there in having someone stop taking their drugs if the goal is to get them back to work? I cannot see any circumstance in which someone who needs the medicine for a physical or mental health problem would be more fit for work if they stopped taking the drugs than if they continued taking them. Therefore, I assume the hope is that everyone will pay the fine and treat it as just another financial sanction.

On the point made by the noble Lord, Lord Davies, the reality is that we have seen this lots of times in previous economic cycles. When there is a serious downturn in the economy, significant numbers of people—this will vary geographically according to where the downturn hits hardest—will move first to out-of-work benefits and then to sickness benefits. I was brought up in a posh bit of Sheffield but when my communities in South Yorkshire lost the steel and then the coal in the 1970s and 1980s, you saw entire communities moving from work to sickness benefit. What they had really lost was hope. Hope had gone and the community was devastated. People were sick in the sense that they felt terrible. That expressed itself in all sorts of physical and mental problems and they moved on to sickness benefit.

If you are in one of those communities, the solution is not fining you £111.60. That will not give you back your hope or encourage you to go out and take a job. I really fail to understand why the Government think it will. We have seen this play out before—it is politics. The Government must be seen to be doing something; they are trying to artificially create some kind of conflict where they are tough on the work-shy and people who question this are somehow championing them. I think this is completely the wrong target. I know politics must react to things, but in this case it is reacting incredibly clumsily.

I am very grateful to the right reverend Prelate for the opportunity to debate this issue. I leave the Minister with the following questions. First, have the Government assessed how affected people will split into those three categories? In category one, they pay their £111.60 for a prepayment certificate; in category two, they keep ticking the exemption box and risk a fine; in category three, they stop taking the drugs. For a policy of this significance, we need to understand—I assume the Government have some data as they are proposing this—how those people will split. If the numbers in category three are significant, that is the most important area of concern. Secondly, have the Government made any assessment of this measure versus a financial sanction of the same value? If the intention is to fine people for not going back to work, have they considered a straight cash fine rather than this clumsy prepayment certificate method? Thirdly, what measures will the Government take to make people aware of the prepayment certificate option, particularly if they move ahead with this? I hope they will tell everyone not to keep paying the individual prescriptions and to get a certificate as the cheapest option.