OPINION: Can we really afford free prescriptions?
TO widespread applause, a measure was introduced in April that will cost our department of health more than a £1 million a month.
Free prescriptions had the support of all the major parties in Northern Ireland, despite coming just as the full scale of Britain's indebtedness was becoming apparent.
Prescriptions had cost 6.85 until 2009, when they dropped to 3, before this year's abolition.
This contrasts with England, where prescriptions now cost 7.20.
It means that areas such as the southeast of England, which are net contributors to the Treasury (ie, their citizens pay more in tax than they get back in public money), have to pay for their drugs.
But people in Northern Ireland, which is a net beneficiary (ie we get an awful lot more out of the public purse than we pay in), don't.
And it means something else: prescriptions were never paid by the poorest people in society, such as the unemployed or pensioners or those with a specified medical condition such as diabetes.
Script charges were only paid by those who were deemed to be able to pay.
To put it another way, Stormont has just introduced a measure that benefits people who — by their very classification — are not among society's most needy.
As an example, I was recently diagnosed asthmatic, which was not one of the specified medical conditions. I had to pay for my inhalers but from April no longer do, despite being otherwise healthy, being in employment, having no dependents, and thus being someone who — if there was any form of means testing — would be judged easily able to pay.
Naturally anyone is going to be happy to get for free something that previously cost, and I can’t claim to be an exception, but it does prompt an obvious question: is this a sensible priority for government at a time when huge cutbacks are imminent?
The global ratings agency Fitch this week said that the UK will have to cut spending by around 20 billion a year, about three times the 6 billion announced recently by the chancellor George Osborne.
Northern Ireland’s share would be 400 million, far above the 128 million that caused so much concern last month, if not higher — a detailed analysis of the figures in the Political Review last month suggested up to 1 billion a year cuts for the province.
Abolition of prescription charges moves in the other direction, by adding to costs rather than reducing them.
Last month the health minister Michael McGimpsey said that any further cuts to health in Northern Ireland would have “dire” consequences.
Mr McGimpsey is the man who will have to implement any cuts, and who in a conventional government would be bound through the system of collective responsibility to defend any agreed government cuts, even if he privately disagreed with them.
But leaving aside the apparent absence of such collective responsibility at Stormont, his statement begs an obvious question:
If he reinstated prescription charges, that would be a “cut” that would save the health service 13 million a year.
So is he saying that such a move would put us in dire situation?
In other words, was the position dire just a few weeks ago, merely because those able to pay prescription charges were made to do exactly that?
He seems to say that it was, telling the News Letter in a statement: “It is simply not acceptable that some people may have found themselves in a position where they could not afford all their medications.”
Mr McGimpsey described abolition as a cost effective investment, saying that the impact of people not receiving medication could result in hospitalisation, a much greater financial cost to the health service.
Clearly, he was able to persuade all 108 of Stormont’s MLAs, because none of them has argued the other side of the coin — against free prescriptions.
There are certainly arguments that prescription charges had become complicated and inconsistent and need to be abolished, across the UK.
The point is there are also strong arguments against, and what sort of assembly do we have if our elected politicians are too afraid to make such arguments, and indeed initiate debate on them?
Wages make up the bulk of health spending, and some employees such as doctors and nurses have enjoyed far above inflation pay rises over the last decade.
But don’t expect any Stormont MLA to point out that a mere 1 per cent pay cut across the NHS would save more money per year than abolishing prescription charges.
I asked the five main parties if any of them had wondered if we should rethink the abolition of prescription charges in light of economic hardship, and none has replied to say that they did.
Some politicians, such as the DUP, have cited free prescription charges as an example of devolution working in Northern Ireland.
Even Alliance, which has opposed populism around freezing of the regional rate and is ahead of everyone on the reality of water charges (another case of where Northern Ireland furiously assumes it mustn’t pay what Great Britain does), supported abolition.
On Tuesday, a unionist first minister Peter Robinson denounced cuts alongside a republican deputy first minister Martin McGuinness, while the latter said: “The British government ... are going to inflict huge pain.”
For all the harshness of the Brits, they have proved strangely tolerant of Ulster folk getting for free what English people have to pay for.
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Tuesday 29 May 2012
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