The Sunday Telegraph
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2007.04.03 - The Sunday Telegraph
It's a perfectly healthy system, minister, that you plan to make worse By James Le Fanu, Sunday Telegraph
Last Updated: 2:25am BST 03/04/2007
Regrettably nowadays, whenever a minister threatens a "radical overhaul" of some long-established policy, it is inevitably for the worse. And so it will be with prescription charges: not perhaps the most thrilling of subjects, but important and difficult to balance – not penalising the sick while discouraging excess prescribing.
The present system has worked pretty well for 50 years, with generous exemptions for the young and old and those on low incomes, and a ceiling of £100 per year (the cost of a pre-payment certificate that covers all prescription charges for 12 months) for those who do pay. And, importantly, it is easy to administer. Not so the various "options" recently outlined by the minister of state, Lord Warner. These include a lower flat rate but no exemptions, or basing exemptions solely on income (that will require all to be means-tested). The logistics of both are daunting.
Meanwhile, these options fail to address the outstanding problem that looms larger every year: the staggering cost of new drugs, usually for the treatment of cancer, that threaten to bankrupt the health systems of the western world. The issues are well illustrated by Sutent, a drug for the treatment of kidney cancer that will become available in Britain this week. There's no doubt that Sutent works, though its effect is modest, doubling the time patients survive free from the disease, from five to 11 months. This is an average, so in some it has no effect, while others might keep going for an extra couple of years, at a cost (and here is the crunch) of £3,000 a month.
The same costs-benefit equation applies to a dozen or more drugs introduced in recent years which, if approved for prescription on the NHS, could add hundreds of millions of pounds to the nation's drugs bill. Hence the prevarication of the drugs watchdog, N.I.C.E., in granting that approval, and the inevitable outcry when they refuse to do so.
It's a most invidious situation, compounded by the fact that those who might opt to pay for these drugs out of their own pocket (that may involve re-mortgaging the house), can't do so within the NHS, but must finance their entire treatment privately. There is no ready solution, but it would be good to think the Government was addressing it, rather than meddling with the current system.
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