Neil O’Brien – 2023 Speech on Prescription Charges for People Aged 60 or Over

The speech made by Neil O’Brien, the Parliamentary Under-Secretary of State for Health and Social Care, in Westminster Hall, the House of Commons on 6 March 2023.

I am grateful to the hon. Member for Gower (Tonia Antoniazzi) for opening the debate so effectively on behalf of the Petitions Committee, and I thank all Members for their constructive contributions. I also thank the 46,000 members of the public who signed the petition.

The Government provided their initial response to the petition in January 2022, and I am pleased to be able to respond again today, having listened to hon. Members’ important and interesting contributions. The context, of course, is the Russian invasion of Ukraine and the high energy prices, inflation and cost of living pressures that it has unleashed. It is worth situating the debate in the context of some of the things we are doing to take action on that, some of which hon. Members have already referred to.

This winter, we are spending a total of £55 billion to help households and businesses with their energy bills—one of the largest support packages in Europe. A typical household will save about £900 this winter through the energy price guarantee, in addition to £400 through the energy bills support scheme. We are also spending £9.3 billion over the next five years on energy efficiency and clean heat, making homes cheaper to heat. Some of that is being paid for by the windfall tax; at 75%, it is one of the highest in any of the countries around the North sea, and it is enabling us to do more on the cost of living, such as the £900 cost of living payment for 8 million poorer households, and the largest ever increase to the national living wage, which will help 2 million workers. In total, we are spending £26 billion on cost of living support next year.

Turning specifically to prescription exemptions, I should start by trying to manage expectations about what I can say today, for reasons on which I will elaborate. It is clear that the outcome of the consultation on aligning the upper age exemption for prescription charges with the state pension age is very important to many Members’ constituents. However, I can only say at this point that no decision has been made yet to bring proposals forward.

We received over 170,000 responses to the consultation —a testament to the strength of feeling on the issue. We want to ensure that everyone across the country, especially those affected by the cost of living pressures caused by the Russian invasion, can afford their prescriptions. That is why we have thought long and hard about how best to balance the needs of those in the affected age group, many of whom will find that they have additional health needs compared with when they were younger, with the pressures facing the public finances. I can, however, assure Members that we will respond to the consultation in due course.

Hon. Members will be aware that the petition calls on the Government to protect free NHS prescriptions for all over-60s. We value our older members of society, and we recognise their social care and health needs. On the one hand, we recognise that families up and down the country are facing unprecedented pressures with the cost of living; on the other, we have to recognise that in the light of the covid pandemic, which has tested the NHS like never before, and the challenging economic landscape, we must ensure that public sector spending represents the best value for money for the taxpayer. As we look to the future in a post-pandemic world, there is no shortage of challenges ahead of us: an ageing population, an increasing number of people with multiple health conditions, and deep-rooted inequalities in health outcomes, which we are tackling. That is all in addition to the challenges of the pandemic and the elective backlog.

Charges have been around in the NHS for over 70 years, and prescription charges provide a valuable source of income for the NHS, contributing £652 million in 2021-22. That significant funding helps to maintain vital services for patients, and it is particularly important given the increasing demands on the NHS.

It is for those reasons that we consulted on aligning the upper age exemption for prescription charges with the state pension age. Historically, the initial exemption for prescriptions was for people aged 65 and over. The exemption was then extended to women aged 60 and over in 1974, and to men aged 60 or over in 1995, based on the state pension age for women at that time. The state pension age has subsequently increased to 66 for both men and women, with legislation already in place to increase it to 67, and then 68, in future years.

The Government have abolished the default retirement age, meaning that most people can continue to work for as long as they want and are able to. That means that many people in the 60 to 65 age range can remain in employment and be economically active, and therefore more able to meet the cost of their prescriptions. Indeed, more than half of people aged between 60 and 65 are economically active, with a further 20% receiving a private pension or some other income.

As increasing numbers of people live longer, work longer and so on, there are more people claiming free prescriptions on the basis of their age. It is projected that by 2066 there will be a further 8.6 million UK residents aged 65 and over, and that they will make up about a quarter of the total population.

It is important to know that over 1.1 billion prescription items are dispensed in the community each year, with nine out of 10 currently dispensed free of charge. The exemptions that allow that may be based on the patient’s age, certain medical conditions, or income. We estimate that if we were to make the proposed change, around 85% of 60 to 65-year-olds would be minimally affected by it. As I have just noted, more than half of them are in employment, with about another 20% retired with a private pension, so they have a higher income, while others would continue to qualify for free prescriptions on the basis of their particular conditions.

It is also worth noting that there are extensive arrangements in place to help those who are most in need of support with prescription charges. People who are on a low income but do not qualify on the basis of an automatic exemption, such as being on universal credit, can get help through the NHS low income scheme, which provides either full or partial help with health costs on an income-related basis. Anyone can apply for the scheme if they or their partner, or they jointly as a couple, do not have savings, investments or property totalling more than £16,000, not including the place where they live. A person will qualify for full help with their health costs, including free NHS prescriptions, if their income is less than or equal to their requirements.

To support those who do not qualify for an exemption due to one of the many other reasons, such as their age or their condition, or for the NHS low income scheme, prepayment prescription certificates, which were mentioned earlier in the debate, are available to help those who need frequent prescriptions to reduce the cost. The prescription charge is currently £9.35; a three-month PPC is £30.25; and a 12-month certificate is £180.10, which amounts to just over £2 a week. PPCs can offer significant savings, and an annual PPC can be paid for in 10 direct debit payments, to allow people to spread the cost over the year.

Andrew Gwynne

I am a little concerned about the tone of what the Minister is communicating. He seems to be accepting that there will be a change on prescriptions for pensioners, but does he acknowledge the challenge with pension credit, whereby a large number of pensioners who are eligible for it do not apply for it, because they are fearful of the means test? What will he do to ensure that that does not happen when it comes to prescriptions?

Neil O’Brien

Perhaps I can set the hon. Member’s mind at ease. I said earlier that no decision had been made, and I reiterate that now. I have talked about the different measures that cause people either to be exempt from charges or to have the cost of their prescriptions cut, and I talked about PPCs as a final step, which can reduce the cost of prescriptions for those who do pay them.

It has been mentioned several times that prescription charges have been abolished entirely in the devolved Administrations. Health is of course a devolved matter, but it is worth noting that spending is £1.25 in Scotland and £1.20 in Wales for every £1 in England, so there is that additional budget. Those devolved Administrations, with the record increases in their spending settlements, have full discretion about how they choose to spend those budgets.

Several hon. Members asked me quite specific questions about the outcome of the consultation. I can only reiterate that we continue to consider, long and hard, the many responses that we received, trying to balance the cost of living pressures with the need for increasing funding for the NHS, and we will respond to the petition in due course. I thank hon. Members for their contributions today.

Tonia Antoniazzi

I thank Members for participating in the debate and the Minister for his response. I am sure that the people I have met will not be reassured by that response, but it is difficult, with no decision having been made about the reduction in prescription charges. That needs to be done, and the Minister needs to confirm it.

I feel for the many unpaid carers—mostly women—who look after children or partners, given of the impact of this situation on them. People see that as unfair, and the system is not perfect, so we hope that change will come.