Prescriptions

So, Jeremy Hunt, who will best be remembered as the man who attempted to demolish the NHS (and will probably succeed) has a new idea. He has decreed that the wholesale cost of drugs costing more than £20 should be printed on the prescription label, to tell the person taking those drugs that they are funded by taxpayers.

I used to work in a rural dispensing practice. I absolutely loathed working in the dispensary, and only did during very busy periods, but sometimes I helped unpack the drug order upon which the wholesale cost of drugs is printed. This is the cost your CCG actually pay for the drugs, which you then pay £8.20 per item for, if you pay at all.

Now, in some cases, the price of the drug is less than the prescription cost, so you can bet Jeremy Hunt isn't going to put THAT on your drug box. It would not do for people to know they are paying £8.20 for a drug which has cost less than a quid. They might lose their faith in the prescription charge altogether, and then there would be issues.
However, many drugs cost an absolute fucking fortune. I used to use an asthma drug called Seretide, through an accuhaler (which is a type of inhaler where you don't have to co-ordinate breathing and squeezing). They cost £75 each, wholesale. I often used two a month when my asthma was severe, because I was on double dose. I paid standard prescription cost for it (£6-something back then). My GP recently changed it to the much cheaper Qvar, which is nowhere near as effective, but considering I'm "poorly compliant", it's cheaper for them.
One of my least-favourite jobs when working for the NHS was changing people's drugs, in batches, to something cheaper (usually statins and contraceptives) because the CCG had decided X drug was exactly the same and 5p cheaper, so upsetting hundreds of people's medication routines was worth it. And I could see their point, because that 5p multiplied by a few thousand people per month was a large saving. I hated the impersonality of it.

Now, Jeremy Hunt claims that this new measure will reduce drug wastage. Drug wastage is a HUGE problem for the NHS. If you take your drugs out of the chemist, change your mind and pop back in, those drugs have to be thrown away. They cannot be recycled. They cannot be put back on the shelf. Once they've been signed over to you, they're gone whether you take them or not. Sometimes, an elderly patient would die and their relatives would bring in binbags full of unused medication, hoping we could recycle it. Medication collected month on month, for which they'd paid nothing, never used because they hadn't told the GP they'd stopped taking X four years ago, or they didn't trust the new packaging and weren't sure it was the same drug, or they didn't NEED a fresh bottle of psoriasis shampoo every month, or they weren't sure if they were supposed to take the red tablets with the little white ones. Regular medication reviews may be a pain in the arse if you're on repeat prescriptions, but they're designed to stop this sort of thing happening. I daresay it still does, particularly with older people who live alone and struggle with transport.
But I doubt Jeremy Hunt's measure will make any difference. In fact, if I know elderly, often anxious patients on numerous medications, it's more likely to make them scared to get their medication at all. They don't want to make a fuss. They don't want to cost anyone £80 a month. They don't want any trouble. They'll just leave it. If they only take the pills every other day, that'll help save the NHS money. And that calcium tablet, they only take that once a week anyway, so maybe they don't need it at all?
And you can imagine the damage.

Well, if you can't, increased falls, increased stroke, increased heart attacks, increased extremely expensive operations and intensive care therapies, increased inpatients, increased A+E attendance, increased premature death. None of which will particularly save the NHS money. Except the deaths, I suppose.

There is another issue here. If there is one thing I could not loathe more about this toxic fucking government, it's the buzzwords of taxpayer and hardworking families. As a former taxpayer, married to a current taxpayer, in a hardworking family (I assume we're hardworking, I haven't ACTUALLY sent the kids to work down the mine yet, but it's only a matter of time) with fuck all money, I can honestly say that if I get ill, paying for a prescription vs waiting to see if I get better is often a genuine ethical conundrum. I frequently don't bother ordering asthma medication because it costs me almost £17 a month in prescription fees that I don't feel able to justify. It's not a problem at the moment because I have a maternity exemption certificate, but in another year, that'll be gone and I'll be back to poorly managed asthma and recurrent chest infections. Woop. If I was on multiple therapies, the problem would be multiplied. SOME people with life-threatening conditions get their medication free, but not all. And most people who have to pay for their prescriptions ARE taxpayers. This is the sheer bloody idiocy of it.
Taxpayers aren't IMMUNE from illness. Indeed, in the current economic climate, taxpayers are more likely to need antidepressants, anxiolytics and painkillers than usual. Wealth directly correlates to good health, less disability affected years, and longer life expectancy. The poorer you are, the sicker and more disabled you are likely to be (see The Black Report, The Marmot Review for more info) regardless of whether you work enough to pay tax or not.
Not to mention that the elderly, who probably cost the NHS the most in free prescription charges, have been taxpayers. Just as the government like to put pensions in the 'benefits' bracket of government spending, they also put them in the 'workshy' bracket of usefulness. Bloody old people, living too long and costing us money. Let's have a cull.

The money raised by prescription charges helps pay for everyone's medication cost. You might pay £8.20 for your one pound pack of painkillers, but the old lady behind you in the queue has paid nothing for her monthly bag worth £80 or so. And there is a massive deficit, because people live longer thanks to a regime of drugs aimed to hold chronic illness at bay. One day, you will probably need one of those chronic disease drugs, be it aspirin, insulin, a statin, a betablocker, or inhaled steroids. Maybe you're already on them, but begrudge having to pay for it because you'll die without it. Or you begrudge having to pay when you already pay your tax. But National Insurance doesn't just cover medication.
As a five year old, I cut my arm in half, lengthways. The NHS sent an ambulance, X-rayed my arm, cleaned all the glass out, fetched a plastic surgeon in on call to repair tendons and stitch a ligament back together, sewed it back up, gave me two days of inpatient care and then sent me home to recover, with painkillers. The staff, equipment, anaesthetic drugs, bedspace and care were not cheap. Without it, I was unlikely to have died from my injury, (unless it got infected) but I would have lost the use of my right hand, effectively disabling me for life. The NHS has emergencies like that every single SECOND across the country.

Chronic disease causes heart attacks (for which you need intensive care, heart surgery, specialist care, rehabilitation and sometimes intensive care transport), strokes (see previous, but with brain surgery instead of heart), progressive lung disease (home oxygen therapy, home care), and of course, death. The medications used to tackle chronic disease attempts to reduce the need for these expensive interventions. They are ultimately cheaper than inpatient care.Which is also funded by the taxpayer. Perhaps if this measure is a success, we will have balloons at the end of each inpatient bed telling us how much our stay has cost the taxpayer. I mean, I'm due to have a baby any day now, and that'll cost the NHS between £800 and £1000. Perhaps I should go and thank my husband for his taxpaying contributions that will allow a (hopefully) safe birth.

Personally, I think the prescription charge should be reduced, and means tested. If more people paid it, it would be both more profitable even if it were cheaper for individuals. I don't think it's fair that (lifelong taxpayers or not) some very rich people get their medication for free while people scraping the barrel have to choose between food or drugs.

But I don't actually think Jeremy Hunt's new scheme is anything to do with reducing wastage, and the cost of medication to the NHS. If he was that bothered, he'd aim his ire at pharmaceutical companies, who never shy from making money out of the sick. I think this is an early attempt to frighten us into accepting the eventual demise of the NHS, and the use of health insurance.