By Professor John Robertson

Parroting New Labour and revealing a complete ignorance of matters that the public should hear of – in the Sunday Post, surely not.

I’ll deal with how the cost is not climbing, how universal benefits save money and how they saved lives in the pandemic.

Scotland’s free prescription costs are static in line with inflation despite a 29% increase in those over 75, over 10 years

From Public Health Scotland, yesterday:

The total (net) cost for dispensing items and providing services in 2023/24 was £1.62 billion, increasing by 6.5% from £1.52 billion in 2022/23. This follows a period of largely rising cost, increasing by 35.3% over the last 10 years.¹

UK general inflation in the same period was 34%.²

The inflation rate specifically for pharmaceuticals from 2015, was 33.5%.³ For 2014 it was 1.45%⁴, giving a total of 34.9%, almost exactly the same as the 35.3% for the cost of prescriptions.

In the same period:

The number of people aged 75 and over is projected to increase by around 29 per cent from 0.43 million in 2014 to 0.56 million in 2024.⁵

Sources:

1. https://www.publichealthscotland.scot/publications/dispenser-payments-and-prescription-cost-analysis/dispenser-payments-and-prescription-cost-analysis-financial-year-2023-to-2024/
2. https://www.bankofengland.co.uk/monetary-policy/inflation/inflation-calculator
3. https://www.statista.com/statistics/621969/health-inflation-rate-uk/#:~:text=The%20inflation%20rate%20in%20the,two%20percent%20until%20May%202024.
4. https://www.statista.com/statistics/306648/inflation-rate-consumer-price-index-cpi-united-kingdom-uk/#:~:text=The%20UK%20inflation%20rate%20was,11.1%20percent%20in%20October%202022.
5. https://www.nrscotland.gov.uk/files/statistics/population-projections/2014-based/pp14-corrected.pdf

Why Scotland’s free prescriptions are saving money for the taxpayer

‘ Universalism is progressive, redistributive taxation and seamless provision of social welfare for all in a linked social system. It is a social system based on the dual principles of ‘from each according to ability to each according to need’ and ‘from the cradle to the grave’. It has produced the most effective society civilisation has yet achieved. We undermine that system at our peril.’ (JRF, 2012)

While some, mainly to the South, like to bemoan our free prescriptions as another example of how we are subsidised by them, I’ve long known that universal benefits are often cheaper than the administrative costs of means-testing (Jimmie Reid Foundation, below). This report, yesterday, on the problems with penalty charges for those falsely claiming, offers another wider justification for universal free prescriptions.

From:

House of Commons Committee of Public Accounts Penalty charge notices in healthcare One Hundred and Fifteenth Report of Session 2017–19

These points are revealing:

The Department argues that its approach is justifiable because it spends 31 pence per £1 collected managing the process. However, it has not calculated costs to the wider health system, where patients—for fear of being fined—do not seek the treatment they need and end up in hospital. Last year the PCN process generated a net yield of £25 million for the NHS, a pitiful sum compared to the annual cost of prescriptions which is around £9 billion.

We believe that this kind of threatening approach is unhelpful, and we are concerned that it could have a negative impact on people who are legitimately entitled to exemption. The British Dental Association tells us that last year it saw a 23% fall in the number of people on low incomes seeking treatment and is concerned that the threat of fines may have discouraged people from going to the dentist. Failure to seek treatment when needed is only likely to push up longer-term costs to the NHS.

Click to access 2038.pdf

Click to access The-Case-for-Universalism.pdf

Evidence that free asthma prescriptions in Scotland may have saved thousands from a Covid death

On 23 December 2022, I posted:

On 21 December 2022, there were only 8 patients in ICU in Scotland but 174 in England, nearly twice as many per head of population. Even in Wales with a smaller population, there were more, 10.

Throughout November and December as Covid hospitalisations began to climb again, there have been 2 to 3 times as many, pro rata, in English Hospitals than in Scotland.

I wondered why this might be and Lorna Murray [https://twitter.com/LornaRetiree] tweeted:

People in England are unable to pay for drugs such as ventolin for asthma therefore are hospitalised as a result

I was intrigued and did a quick search for evidence either way. No research group seems to have done this and I offer my hypothesis below ready to be contradicted with better evidence but:

People with moderate-to-severe or uncontrolled asthma are more likely to be hospitalized from COVID-19.https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/asthma.html

People with mild and/or well-controlled asthma are neither at significantly increased risk of hospitalisation with nor more likely to die from COVID-19 than adults without asthma.https://thorax.bmj.com/content/early/2022/03/29/thoraxjnl-2021-218629

I think its reasonable to interpret ‘well-controlled‘ as involving medication.

Can everyone afford to be medicated adequately?

Essential medicines for treating asthma and COPD were largely unavailable and unaffordable in LMICs [low-income and middle-income countries]. This was particularly true for inhalers containing corticosteroids.https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00330-8/fulltext

The Covid death rate in Scotland is 226.8 per 100 000. In England, it is 310.9, 37% higher in a country with a generally higher life expectancy.

There have been 12 389 Covid deaths in Scotland and 175 007 in England, around 45 890 more per head of population.

Around 5.4 million in the UK have asthma.

So:

1. Have free asthma prescriptions in Scotland played a major part in saving 4 589 (37%) from Covid deaths?
2. Has a lack of free asthma prescriptions for the poor in England, played a major part in tens of thousands of avoidable Covid deaths?

Other sources:

https://ig.ft.com/coronavirus-chart/?areas=e92000001&areas=s92000003&areas=nor&areas=irl&areas=n92000002&areasRegional=usny&areasRegional=usnm&areasRegional=uspr&areasRegional=ushi&areasRegional=usfl&areasRegional=usco&cumulative=1&logScale=0&per100K=1&startDate=2021-06-01&values=deaths

https://www.asthmaandlung.org.uk/media-centre/#:~:text=28%2DSept%2D2022%3A%20Leading,costs%20soar%20and%20winter%20bites.&text=01%2DSept%2D2022%3A%20Asthma,poverty%20on%20children%27s%20lung%20development.