It's that time of year again. Listening out for first cuckoo of spring has been replaced by listening out for the first Tory to complain about free prescriptions in Wales. My reaction to last week's story was fairly similar to that of John Dixon in this post, where he wondered whether repeating the same old thing time and time again was actually more of a campaign than a simple act of reporting news.
I was, however, very impressed by some of the comments that followed the Western Mail's story, for they showed that people were no longer being taken in by unbalanced sensationalism being passed off as journalism. I didn't bother writing anything because I'd said almost the same thing in previous posts like this one, but today we have a follow up story in which the Western Mail concentrates on paracetamol. It is so bad that it deserves to be torn to pieces.
Paracetamol prescriptions costing Welsh NHS up to £50m a year
In the first instance, the story is portrayed as an "investigation" and talks of "figures obtained by the Western Mail". Talk about an inflated sense of self-importance. No investigation was required, the information on the cost of all prescription items is routinely released every year. The Welsh figures were published on 28 March, and are available from this page:
Prescriptions Dispensed in the Community, 2011
Paracetamol is in the "Chemicals P-Z" spreadsheet. The figures quoted by the Western Mail are correct, although one figure that they didn't publish would have been helpful. The total number of paracetamol tablets prescribed was 121 million, meaning that each prescription was for an average of 105 tablets. At a cost per prescription of £2.62, this works out at 2.5p per tablet or 40p for a packet of 16. Hardly an inflated price. This is what they cost at Boots.
But the idea that this can be inflated to "up to £50m a year" when the cost of consultation and dispensing time is taken into account is bogus maths of the highest order. People go to doctors because they are ill, want to know what's wrong with them, and want treatment for it. What you think might be just a persistent headache could be a brain tumour, and the real cost of a doctor's time will be taken up trying to determine whether it is just something minor or something more serious. Costs cannot be inflated in this way. The cost is what it is: just over £3m a year.
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Next we get the Tory spin. Darren Millar hints that if prescriptions weren't free for everyone the Welsh NHS would be able to spend this £3m on something else:
"It is scandalous that millionaires and other top earners can get paracetamol at the taxpayer’s expense.
"£3m a year would practically fully fund a Cancer Drugs Fund to enable cancer patients to access life-extending treatments currently denied on cost grounds. Labour’s universal free prescriptions policy is simply not sustainable."
This of course is the sort of misinformation we've come to expect from Tories (and on the specific subject of drugs for cancer treatment, see this comment). They imply that if it wasn't for free prescriptions, the Welsh NHS would not be spending anything at all on prescriptions for minor items like paracetamol and would therefore have £3m more to spend on other things. The truth is of course very different, as we can see by looking at the figures for a certain neighbouring country that still charges many of its people for their prescriptions.
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The English figures for 2011 were released on 4 April and are available from this page:
Prescription Cost Analysis, 2011
The equivalent (though slightly less detailed) figures for England are that 20,879,114 prescriptions for paracetamol were issued at a cost of £2.93 per prescription. Although we don't know how many tablets were included in each prescription the cost per prescription is roughly the same, which indicates that things are essentially similar in both Wales and England. About 18 times as many prescriptions for paracetamol are issued in England, but England has a population which is 17 times larger than Wales. The conclusion is obvious, the prescribing pattern for paracetamol in Wales is almost exactly the same as the pattern in England.
However in cost terms, England spends £61,270,062 compared with Wales' £3,024,300 ... so England spends more than 20 times as much on prescriptions for paracetamol tablets, even though its population is only 17 times as large as ours.
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The Welsh NHS seems to have got it right. Which is just as well, for it means that there will be enough money available for the Accident and Emergency department at Ysbyty Glan Clwyd to treat an unfortunate Tory who happens to need treatment for a self-inflicted gunshot wound to his foot.
Update - 01:45 11 April 2012
Just in case anyone thought Darren hadn't really shot himself in the foot, someone has been kind enough to provide the photographic evidence:
The police apparently couldn't persuade him to hand over the gun, so he'll probably end up doing it again. But at least he can smile about it ;-)
14 comments:
A brilliant post MH.
I'm on the fence when it comes to free prescriptions in the grand scheme of health spending, but still think it's positive. I'm disappointed that the Western Mail would stoop to this, and suspect as John Dixon has said, that there's an agenda here.
Free prescriptions are probably seen as an "easy target" in the climate of NHS cuts. Some people, whether within Media Wales or elsewhere, might sense an "easy victory" or "campaign" that could provide headlines for a few months. The cynic in me wouldn't be half surprised for "the cost" of free prescriptions to eventually be tied-in to reorganisations in Hywel Dda LHB. "Paracetemol costs shut maternity ward" - that sort of thing.
Harking back to the comment on the Cancer Fund, the "exceptional case procedures" should be formalised and publicised. Maybe there's a case to ring-fence funding in the area - for proven treatments only.
The cancer fund is a big red herring - all drugs approved by NICE are paid for, it is fringe treatments, of marginal benefit, which are very expensive which, in England, they pay for from the Cancer fund.
the reason why this policy ....which to be fair to welsh labour was initially introduced by them...is very popular among ordinary people in wales is because it means that for the first time in decades the working poor...of which there are sadly tens of thousands in wales......can get the medicines they need should they fall ill
these are people who tho in employment and relatively low paid still did not qualify for any help whatsoever under the old system that existed prior to all prescriptions being made free in wales...and so would be in the invidious position of deciding which medication they could or could not afford....a frankly scandalous state of affairs in a society in which there is supposed to be a free health service....doubly so when you consider that these people tho low paid still paid taxes that would go to vital services such as the nhs.....
so when anyone trots out the tired reactionary old line about 'free prescriptions' they need to be challenged on the vitally important issue of how the working poor in wales are supposed to manage if this excellent egalitarian policy of which we in wales should be proud were to be abolished.
Leigh Richards
swansea
Thanks for this post and especially the links, MH. I've heard my brother-in-law in Cardiff get cross about the (alleged) wasting of money on free prescriptions in Wales, and been puzzled about the idea that people would (a) would go through the minor hassle of arranging an appointment with a GP, (b) waste time travelling to and from a GP's surgery, and waiting in the waiting room, and (c) piss off their GP with a frivolous request for free paracetamol when they weren't actually concerned about their health.
It's not as if charging for prescriptions (a) raises much money, (b) prevents frivolous requests for medicines, or (c) reduces pharmaceutical waste. And in any case, the motivation for taking a medication should be that you need it and understand that need, not that you'll feel bad about "wasting money" if you don't get all those pills down.
In any case, prescription charges are an absolute flat tax. Given the positive correlation between wealth and health, it's even worse than that: they're a tax on the ill. Sadly here in England the simplistic but all-too-persuasive line often seems to be "they can only afford free prescriptions in Wales because our taxes pay for it."
Not paying for prescriptions is completely normal as part of the rights we're entitled to as citizens. Policy in England is the aberration. There really aren't many millionaires running around Wales cashing in on free medicine. The attacks on this policy are cheap and also a waste of time seeing as its quite popular and will probably never be abandoned.
Isn't the western mail an english paper?
The tories should be made to explain why they think the people who pay the most into the system 'millionaires' should get the least out of it.
And of course the cost of collecting the charges - especially if the tories introduced a nominal charge (which they have suggested around £2.50 a shot) and widened the exemptions - would probably cost more than the money raised!
I hope Darren Millar's treatment for his self inflicted injury was paid for by his Bupa subscription. Normally they don't pay out for that sort of thing, so his hated NHS will have to have paid for the treatment.
That foot looks sore. I wonder if his doctor prescribed anything to help with the pain.
MH have you seen this?-
Welsh-only education will damage economy, say 'business leaders'
http://www.walesonline.co.uk/news/wales-news/2012/04/10/lack-of-english-school-will-damage-economy-say-business-leaders-91466-30732362/
I did think of writing something about it, Anon. But I thought that the comment by the local Chamber of Commerce was too ridiculous to need a response.
Although it wasn't mentioned in the report, there are currently only two children in last years' intake of thirty children whose parents wanted them to be in the English stream. See here. That is unsustainable, and it is bad for those children in educational terms because there simply aren't enough other children in class to interact with even if two or three year groups are taught together.
Only a few weeks ago, a final decision was made to close the English stream of Ysgol Pencae in Penmaenmawr, which was in a similar position to Aberteifi with only 6 pupils in the Year 1 English stream compared with 25 in the Welsh stream. The reasons for that decision are here, and I fully expect Leighton Andrews to do the same in this case when it is referred to him.
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