Hansard

Today, I have great pleasure in introducing this stage 1 debate on the Abolition of NHS Prescription Charges (Scotland) Bill. It is a proud moment for me and for the Scottish Socialist Party. I thank those MSPs, particularly in the Green party and the independent group, who were the original sponsors of the bill. I am grateful for the support of all my colleagues in the SSP and the SSP team in Parliament. I am also grateful for the support outside Parliament of the Scottish campaign to remove all prescription charges, whose members are in the public gallery today. I particularly thank David Cullum and Claire Menzies Smith from the non-Executive bills unit, whose efforts have been immense. I express my gratitude for the work of the clerking teams on the Health Committee and the Finance Committee in bringing those committees' reports on the bill before the Parliament. I am particularly pleased that my bill comes before members on the anniversary of Robert Burns's death. It is a significant day.

I am disappointed however that the speech that I prepared yesterday has had to be substantially rewritten in the light of this morning's announcement that the Scottish Executive has conceded many of the arguments that it previously used in the debate about the bill and has announced a raft of new proposals to go out to consultation. It appears to me that, with its new propositions, the Executive has conceded entirely two lines of argument. The first is that only the rich currently pay prescription charges; the second is that the £44.4 million income from prescription charges is vital for the funding of the national health service in Scotland.

In trying to pull a rabbit out of a hat this morning, the Executive has presented us with another rabbit—one that is half-cooked and inedible. In my view, the Executive has shown in its announcement disdain for the Parliament. The bill has been before the Parliament for nearly two and a half years and before the Health Committee for a year, but the Executive waited until just three hours before this debate to come forward with its proposals. I think that that shows disdain for the Parliament and the Health Committee. In addition, as the sponsor of the bill, I did not get to see the Executive's report until two hours ago.

So what is in the report? I must say that it appears to me to be a proposal/consultation document that has been put together very quickly. It tries to replace one dog's dinner with another, with the ability-to-pay approach contradicted throughout. The Executive puts in question the continuing exemption of the over-60s, which it says is anomalous with its proposals. In effect, the Executive proposes to consult exactly the same people who were consulted on my bill and exactly the same people who were consulted on the Health Committee's proposals. The Executive gives with one hand and takes away with the other.

I will focus my remarks on the case for the abolition of prescription charges in principle. Martin Luther King was fond of borrowing a saying of the Scottish author, Thomas Carlyle:

"No lie can last forever."

King used that in the context of the civil rights struggle in America to highlight the way in which millions of African-Americans were being denied equality under the law.

For me, prescription charges are a lie that will not last forever. They show that medical justice and equal access to health care are denied to people in Scotland today, irrespective of their class, background or income. The founding principle of the national health service was universal free health care, paid for out of people's taxes. The NHS's high ideals have been compromised by prescription charges.

The Deputy Minister for Health and Community Care told us at the Health Committee that prescription charges represent a co-payment contract between patients and the NHS. I have to say that there is no concept of co-payment in the founding principles of the NHS—that should be made clear. The Parliament has the opportunity today to make a profound and very welcome difference to the lives of the 2.5 million Scots who currently do not qualify for free prescriptions. That statistic alone should lay to rest any claims that members would like to make in this debate that the rich alone pay for prescriptions.

The bill concerns the kind of improvement that the people of Scotland wanted from the Parliament when they set it up. In the most recent test of public opinion, 82 per cent of Scots supported the abolition of prescription charges because they see that the charges deny poor people the medicines that they need. That conclusion is based not on sentiment but on hard facts and sound reason. The Wanless report, which was commissioned by Her Majesty's Treasury to consider all the available international evidence, concluded that every 10 per cent increase in health charges leads to a 3 per cent fall in the numbers taking up that care.

It is telling that, as the first part of its consultation, the Scottish Executive's review examined all the available international research literature. That review was completed seven months ago, yet the Executive still refuses to publish it. Why could that be? Could it be because all the studies conclude that prescription charges act as a disincentive to accessing health care and the Scottish Executive wants to avoid the conclusion that the Health Committee and others have drawn? The evidence from the National Consumer Council, Citizens Advice Scotland, the Social Market Foundation and the King's Fund is that the current system of prescription charges is a complete dog's dinner and lacks any basis in fairness or logic.

The bill that is before the Parliament today has the backing of the Health Committee. That committee heard not one piece of evidence backing the status quo. However, the Executive has rejected the committee's working conclusions. I have to say that the Executive gave a slap in the face to the committee system of this Parliament when it delivered its verdict. For the first time, it has rejected the positive recommendation of a lead committee.

The Health Committee recommended the bill because it accepts that the current system is an indefensible dog's dinner. Everyone over 60 is exempt, irrespective of income. Every pregnant woman, new mother and patient with diabetes, epilepsy or an underactive thyroid gets free prescriptions, regardless of income. At the same time, however, only some people on state benefits qualify for free prescriptions.

The reality is that the Queen gets free prescriptions while people on disability living allowance do not. Some 30 members of this Parliament get free prescriptions but people on incapacity benefit do not. J K Rowling, as a new mum, gets free prescriptions, but a low-paid woman worker in the Scottish Parliament must pay in full. That is the reality of the dog's dinner of a system that currently exists.

The Scottish Executive argues that, since 92 per cent of prescriptions go to people who are exempt, only the well-off pay. Unfortunately, however, that picture is simply not supported by the facts. Some 75 per cent of all prescriptions are repeat prescriptions, mostly for people over 60. The reality is that half the population of this country are not entitled to free prescriptions at the moment. That means that the exemption could be extended to 2.5 million people for a small sum of money. We might expect the Executive to say, "Never look a gift horse in the mouth," yet it looks the other way and decides that it does not want 100 per cent exemption, saying that it prefers to target the benefit. The Deputy Minister for Health and Community Care is nodding. He is quite right to nod. However, all the evidence shows that the system is about as effective at targeting as poor old Charlie Kennedy was when he tried to bowl those balls in that old people's home. It is precisely the abject failure of targeting that means that those who need the benefit the most—such as 300,000 people on disability living allowance, 219,000 people on incapacity benefit and 850,000 low-paid people—are left behind. That is the reality of targeting and it is why the current system of targeting was not attractive to any of the witnesses who came before the Health Committee.

However, the Executive goes further and says, "We want to bring forward proposals to increase the number of sufferers of chronic conditions who will be exempt," and that it intends to introduce exemptions for as yet unspecified chronic conditions, pointing out that the list of chronic conditions has not been changed since 1968 and is, therefore, worthy of review. The fact of the matter is that the list of chronic conditions has been looked at 13 times since 1968. Every review concluded that we should leave well alone, because it is a Pandora's box. The National Assembly for Wales decided that it was

"not practically possible to rank chronic conditions in terms of clinical need for medication."

In other words, all chronic conditions should be covered, or none. That is the reality of the sheer folly of the Executive's suggestion of ranking the suffering of cancer patients against that of asthmatics, or the suffering of people with Parkinson's disease against that of people with cystic fibrosis or Crohn's disease. What an unattractive proposition.

The second, and perhaps weakest, argument from the Scottish Executive is that abolition of prescription charges would lose the national health service £45 million of vital income and lead to cuts elsewhere. That raises two questions. Who pays the £45 million and where does it come from? As I have already illustrated, it comes from people who can ill afford to pay those charges. It comes from the 300,000 people who are on disability living allowance, from people on incapacity benefit and from the 850,000 people who are on low pay. They are the people who run the risk of not getting the treatment that they need.

The Executive says that the £45 million could not be absorbed into the budget and would lead to cuts elsewhere. Let us look at the evidence: £45 million represents 0.5 per cent of the national health service budget in Scotland. In Scotland, 99.5 per cent of the NHS's income comes from taxes, but it is the 0.5 per cent that comes from prescription charges that we cannot do without. The NHS's income is £9,000 million a year, but £45 million cannot be absorbed. I remind the minister of the background: the United Kingdom Department of Health at Westminster pledged a 7 per cent increase in health expenditure year by year until 2009. That gives the real context of the £45 million.

Two years ago, the former Secretary of State for Health, John Reid, renegotiated—to his credit, and I applaud him for it—the contract between the drugs companies and the national health service to the advantage of the service of £1.8 billion over the next five years. The financial claims of the Scottish Executive in the matter are just not credible.

The evidence in front of us today makes it absolutely clear that there would be savings for the national health service from the abolition of prescription charges: the £2 million that it costs to run the system. I see that the minister is now nodding in agreement after shaking his head; it always pays to listen to the end of a sentence. It is also clear that other parts of the national health service must pick up the tab for those who are denied their prescriptions. If they present themselves at hospital, the cost is £1,800 a week for a stay in a general hospital or £7,000 a week for a stay in a high-dependency or intensive care unit. That is the reality of people going without prescriptions. Considerable savings are to be made from the £45 million.

Finally, I want to touch on the party politicking that is going on in the chamber on the question of prescription charges. Scottish Socialist Party policy is to support the abolition of prescription charges and to support the bill, and that is the position of the Greens and the Scottish National Party. The Liberal Democrats will go into the 2007 Holyrood election calling for the abolition of prescription charges, but they will not vote for it today. The Labour Party policy in Wales was to abolish prescription charges, which, much to its credit, it did in 2003. However, the Labour Party in Scotland refuses to abolish charges—it hasnae got the bottle.

Some cynics have suggested that Labour would back the bill if it had come from a Labour member, but I could not possibly comment. Labour MSPs intend to vote against the bill, while the Labour Party in Wales championed the abolition of prescription charges. The Scottish Executive offers vague propositions in a consultation that begins today, yet there is a bill before the Parliament that would abolish prescription charges and introduce fairness and equality in the national health service. That is the choice for Labour back benchers. Members should support the bill, which I have pleasure in commending to the Parliament.

I move,

That the Parliament agrees to the general principles of the Abolition of NHS Prescription Charges (Scotland) Bill.