Benefit Claimants: Free Prescriptions

Lord Bishop of London Excerpts

Thursday 30th November 2023 Lords Chamber

Asked by

[The Lord Bishop of London]

To ask His Majesty’s Government what impact the removal of free prescriptions for benefit claimants who fail to look for work will have on their health, and the health of the workforce.

[The Lord Bishop of London]

My Lords, I start by thanking your Lordships’ House for giving time for this important debate. I also thank the House of Lords Library for its very helpful briefing and the Minister for his engagement with me and for our helpful meeting earlier this week about this debate.

The measures we are discussing today relate to the announcement that the Government made in the Back to Work Plan and the Autumn Statement that people on universal credit who do not engage in activities designed to increase their skills and improve their employability after 18 months of support will have their claim terminated. With that termination, their accompanying passported benefits, including free prescriptions, will also be stopped.

Benefit claimants may disengage from Jobcentre Plus for many reasons, some of which I suspect we do not completely understand, and not solely because they have failed to look for work. I have brought this debate forward from a health perspective, and the central frame of my remarks today is around health inequalities, because the Back to Work Plan as it stands could serve to exacerbate these inequalities. There are many complexities within universal credit, and many exemptions and allowances that are made for vulnerabilities and medical conditions that are to be commended. I was grateful to hear about some of them at the meeting I had earlier in the week with the Minister and officials from DWP and DHSC. I understand that the number of people who will be affected by this is small: they are those without a vulnerability that would exempt them from having their claim ended, and who do not have an additional factor attached to their claim.

However, I also understand that those who will face this measure will have already been zero-rated for six months, for which time their prescription fee exemption will have already been removed. I believe the mitigation there is that if they have a health condition, they can access low-level prescriptions, such as an asthma pump, until the time their claim is stopped. I know that these mitigations and allowances are designed to reassure those of us scrutinising these plans and, more importantly, those who are fearful of losing the prescriptions they need. I appreciate that this measure will impact only a small number of people, whose prescriptions are likely to be of a low level, but I have some significant concerns.

First, as this House is acutely aware, we are in a cost of living crisis. The Royal Pharmaceutical Society published the results of a survey of pharmacists earlier this year. Some 51% had experienced an increase in the number of patients not collecting their prescriptions in the six months before the survey, and 52% reported an increase in patients asking for different items to be prioritised due to affordability concerns. Some 67% had seen more patients asking about cheaper, over the counter alternatives to their prescriptions. If prescriptions that were once free are no longer so, a person whose universal credit has just been stopped may not be able to afford their prescriptions. This is a serious concern, especially when in so many other ways the cost of living crisis has been an incubator of the gaping inequalities that remain.

Secondly, it is those who are unable to engage with Jobcentre Plus who are most likely to be subject to poor conditions that determine their health, or ill health. It is these people who are most likely to make up the “plus” of the Core20PLUS5. It is important that all engagement with them is not lost when their claim ends. If they struggle to engage with public services, any poor health they experience may worsen if they do not take the medication prescribed. Even if the prescription is of a low level, these prescriptions are fundamental to keeping us in good health, and our being in good health will in turn relieve pressure on the NHS. An acute asthma attack in A&E costs far more to the public purse than someone’s routine inhaler and has a far more profound impact on the person concerned.

I would be very interested to hear from the Minister how the department is working to understand the reasons for people’s disengagement from the support it offers, and what resource there might be for the department to offer the steadier relational support that I know Jobcentre Plus hopes to offer. Have they considered a way to identify those who are extremely vulnerable, and work with the health services to ensure that they do not fall off the radar, perhaps by informing the GP that their claim has ended?

Thirdly, I appreciate that this measure is a deterrent from disengagement and is designed to act as an encouragement into work. I was unaware, until meeting the Minister this week, that parliamentary legislation will be required to bring forward these changes. I have no objection to that in principle, but I am concerned that, with a limited amount of parliamentary time, there is a risk that this legislation will never appear. I am concerned that this proposed measure and the press coverage, which I acknowledge was not completely accurate or helpful, seems designed solely to deter, causing anxiety and fear. This is concerning, even given the small number of people it will impact, and when we are dealing with changes to a highly complex system, it often increases anxiety. To use, or to threaten to use, health measures in any way as a punitive consequence for disengagement is, I believe, a misuse of power and could have a significant impact on the lives of people who need to be helped, not punished. Can the Minister confirm exactly what is needed to be brought in by primary legislation—whether it is the whole Back to Work plan—and share whether he has any expectation of when it might progress?

The expansion of the health programmes within the Back to Work plan are welcome and I know that they have been commended as part of the Autumn Statement debate. Health and work are linked, and prioritising the health of the workforce is required for a thriving economy. Part of that is to ensure that people have the option to take time off if they need it, which under the current sick pay system may not always be possible. This is especially true for those in insecure work. A report by WPI Economics, Making Statutory Sick Pay Work, highlights stories of workers coming back to work while still sick or injured because they cannot afford to take time off. Can the Minister say whether the Government have any plans to examine statutory sick pay and ensure that those who are working have the option to take time off while they are ill?

On a slightly different note, I was very surprised to read in the Lords Library briefing that the total cost to the NHS of exempt prescription charges from community pharmacies in England was £9.9 billion, while paid-for prescriptions made up only £500 million. It makes me wonder whether installing universal free prescriptions would be less costly than is sometimes assumed and whether the savings to the public purse from better public health may well be worth it.

I again thank the Minister and look forward to hearing the speeches of noble Lords participating. Worsening health inequalities is one of the worst health outcomes of recent times and it requires a multifaceted approach. It is important to consider how people’s health may be impacted by measures that are not directly health based, and I feel encouraged that the Chamber has decided to debate this.