Professor John Robertson OBA

Before we get into the often unreported benefits, let’s get rid of the myth that we cannot afford them.

From Dispenser payments and prescription cost analysis Financial year 2024 to 2025 published yesterday:

The total (net) cost, which is the final cost to the Scottish Government once item costs, service remuneration, advance payments and patient charges are taken into account, for dispensing items and providing services in 2024/25 was £1.66 billion. This increased by 2.5% from £1.62 billion in 2023/24 and continues a period of largely rising cost, increasing by 29.8% over the last 10 years.

The total number of items reimbursed between 2023/24 and 2024/25 increased by 2.3%, from 114.4 million to 117.0 million items. Over the last 10 years the total number of items reimbursed has increased by 14.5% from 102.2 million items in 2015/16.

https://www.publichealthscotland.scot/publications/dispenser-payments-and-prescription-cost-analysis/dispenser-payments-and-prescription-cost-analysis-financial-year-2024-to-2025/

You can see how the opposition parties and their media would spin this as the unaffordability of the SNP’s free prescriptions but, there’s something important to add – inflation.

From Hargreaves Lansdown, we can see that, in the same period – The cost of goods and services increased by 60.2% over this period.

Figures based on the Retail Price Index (RPI) as at August 2025. Source: Office for National Statistics. https://www.hl.co.uk/tools/calculators/inflation-calculator?msockid=040f0c0f8f6f69bb36d418948ed46872

So, the cost of the SNP’s free prescriptions has increased at less than half that of general inflation. How has this happened? Some kind of efficiency in purchasing? Better advice from docs?

Second, Scotland’s free prescriptions saving lives of thousands of asthma sufferers and reducing GP visits as they surge in rUK

Headlining in the Guardian today, the above and:

The number of patients being treated by GPs for asthma attacks has increased by 45% in a year, prompting calls for urgent action to tackle toxic levels of air pollution.

There were 45,458 presentations to family doctors in England between January and June this year, according to data from the Royal College of General Practitioners research and surveillance centre. Across the same period in 2024, there were 31,376 cases.

The figures come a week after a damning report by the Royal College of Physicians revealed that 99% of the UK population was now breathing in “toxic air”. Air pollution was killing 500 people a week and costing £27bn a year in ill health, NHS care and productivity losses, the research showed. https://www.theguardian.com/society/2025/jun/29/england-air-pollution-gp-visits-for-asthma-attacks-rise-45-per-cent

I don’t have equivalent figures for recent GP visits related to breathing problems but I do have this compelling evidence of a significant difference between asthma rates in Scotland and England:

From 11 November 2024: BBC Breakfast had:

Failure to diagnose and treat lung disease including asthma is ‘silently suffocating’ the NHS.

Not reported, of course, these two starkly contrasting accounts:

In Scotland, from 2008 to 2021, deaths due to asthma have fallen from 103 to 96, a 6.7% fall. https://www.scotpho.org.uk/health-wellbeing-and-disease/asthma/data/mortality-data

Deaths from asthma in England and Wales have increased by a third in the past decade, a new analysis has shown. The analysis of official figures from the Office for National Statistics, released by the charity Asthma UK on 9 August, shows that more than 1400 adults and children died from asthma attacks in 2018, an 8% increase since 2017. Overall, more than 12 700 people have died from asthma in England and Wales in the past decade. Deaths increased by 33% during 2008-18. https://www.bmj.com/content/366/bmj.l5108#:~:text=Overall%2C%20more%20than%2012%20700,a%20GP%20or%20asthma%20nurse

And the rate of deaths?

‘More than 1400’ in England & Wales in 2018.

There were 114 in Scotland in the same year.

England & Wales, with 11 times the population might be expected to have 1254 but has more than 1400, 12% higher.

Why?

Free prescriptions?

In December 2022, we saw evidence of a dramatic effect of free prescriptions:

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.