Prescriptive Remedy

Could we be paying for our pills again?

ONCE upon a time, the only thing the Wales Labour Party wanted to make free was Nelson Mandela. But the last decade has seen a range of public services that once were charged for now delivered for free. School breakfasts, museum entry, bus travel for older people, hospital parking, swimming during the holidays – the elimination of charging is the key unifying factor.

But arguably another no-charge policy has been the most memorable of all. When commentators are asked to point to the most totemic policy brought forward by the Welsh Assembly Government, a common answer is the free prescriptions policy. Many Assembly Members chose this initiative as the most important yet delivered in Wales under devolution when asked last month to reflect on the achievements of the first 10 years of devolution. It is a policy which has been impossible to ignore.

Free prescriptions took a while to deliver. Between 2003 and 2007, the then-Labour minority government reduced in increments the charge levied on around 10% of all dispensed Welsh prescriptions, with the others being covered by category exemptions of various kinds. By election time in May 2007 all prescriptions in Wales were free. The cost of this policy has been estimated at some £30m per annum.

The Labour line on their policy has been consistent both in the last Assembly and the current one. They argue that free prescriptions are a long-term investment in improving health and that if people aren’t put off seeking the appropriate care, due to financial reasons, their health will improve and this will also ultimately help to reduce the long term cost to the health service. Further, they have contended, with the echoed support of many patient groups, that too many people with chronic or long term conditions were not covered by the previous policy and those who were slightly above the borderline of exemptions on cost basis were also left high and dry. Labour has been supported consistently on this policy by Plaid Cymru, from both within government, as they currently are, and from the opposition benches during the last Assembly.

Undoubtedly it has been a distinctive policy. Witness the emulation in Scotland and Northern Ireland, where plans are in place to follow the Welsh policy with a phased approach to abolition. In England, too, there has been an impact. The Department of Health may have ruled the policy out as a complete cost exemption, but it has extended the range of long-term conditions that now qualify for free prescriptions. Charges for cancer patients have been scrapped from this year and charges for those with other conditions are now pledged to follow afterwards. All of which is music to the ears of the patient organizations who have lobbied for change on both sides of Offa’s Dyke.

When the free prescriptions policy was first introduced in Wales, the Conservatives and Liberal Democrats were both opposed to it on the grounds that the money could be better spent in other parts of the health service. The Liberal Democrats now seem to have changed their tune and are not inclined to turn the clock back to the charging era. Clearly, new health spokesperson Peter Black is prepared to change direction on some key issues.

This now leaves the Welsh Conservatives now as the only party in Wales who oppose the free prescriptions policy. Indeed, they have now hardened their line and last week announced that they would reintroduce a charging system, albeit a modified one, to ensure that those who can afford to pay will pay. They stated that: “in order to help deal with Labour’s debt crisis and get maximum value for money in the Welsh NHS, free prescriptions will in future only be available to children, pensioners and the most needy in Wales.”

Without a doubt, the current financial situation for public services is a challenging one that needs a financial response. The Welsh Assembly Government is pledged to resist front-line cuts and to talk instead about reconfiguring spending to maximize a return. Its recipe to balance the books certainly doesn’t include charging either now or in the future for any services that are currently free or have been made free over the past 10 years.

But for the Conservatives this is a big step. Scrapping prescription charges was never, in their view, the best use of NHS funds nor the fairest way of doing things. But actually pledging to reintroduce charges is a different matter to opposing their phased abolition. Such a step is both bold and significant. They have bitten the bullet and produced a policy that is distinctive indeed. The Conservatives should be applauded for at least advocating something different and being prepared to adopt a policy which is making people think about what should be the financial priorities of the government here in Wales.

So striking is this decision on free prescriptions that a number of questions arise from this policy position. The first is perhaps what will the electorate make of it. Essentially, the Welsh Conservatives have done something new and radical this week – asking some people to pay for a service that is currently delivered for free in Wales. OK, it has only been free for two years, but nevertheless free it currently is. The electorate are being asked to support a policy of charging.

The second question must surely be for which other ills will we see charging proposed as a remedy? Looking back to the list from earlier, can we expect the grey vote to be told they will now have to give up their free bus pass? Will museums be asked to reintroduce an admission charge when such a policy has also been exported successfully to England? And what of the free school breakfast scheme which the Conservatives also opposed on its introduction. After all, it’s not just the socially excluded who have benefitted from this policy. Quite what would the working parents make of the notion that the free breakfasts that have enabled them to drop their little ones off early so they can get to work would be scrapped under a future Conservative administration?

And finally, what does this policy position do to the chances of the Conservatives at getting into government in Wales at all? Surely on first look introducing a policy so diametrically opposed to the intentions of their possible coalition colleagues in Plaid and the Liberal Democrats does not increase the chance of such an outcome. For Plaid, free prescriptions are as important as they are to Labour, and they would not accept their abandonment as a price to enter government. Ultimately, therefore, coalition horse-trading is bound to mean this policy stands little chance of being introduced.

But sometimes it is worth saying something to make your mark, even if you will have little chance of putting it into practice.