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introduction
summary of the report
the government response
the need to find out more about the effect of charges
prescription pre-payment
certificates (ppc)
hc1 forms
the new dental contract
nhs sight tests and optical charges
hospital travel costs
hospital car parking
hospital phone calls
recommendations for long term
change
consideration of a new system of charges
more information
The "House of Commons Health Select Committee Report on NHS Charges" criticises the system of health charges in England, and makes a number of recommendations for change.
“International research has shown that health charges have a negative effect on health, and that patients with long-term illnesses suffer particularly when charges are in place. There is also some survey-based and anecdotal evidence which suggests that patients are less likely to visit their dentist or have prescriptions dispensed in full because of the costs.”
The summary below highlights key findings of the Select Committee. You are advised to look at the full report (there is a link in the more information section below.
The Government response to the Health Committee's Report on NHS chargeshas now been published. Where appropriate selections from this have been added to this summary.
The report recommends that evidence is gathered on:
"The Government accepts that there is little evidence available for the UK other than some generally small scale studies that have been undertaken over the last 10 years. It also agrees that such evidence would be useful in informing future policy. As a result, the Department of Health will include both qualitative and quantitative studies in its future research programme. The timing of this work will be determined by overall research priorities within the resources available." - the government response.
(Paragraph 163 - select committee report)
The report recommends:
"Significant additional administrative costs would be incurred in issuing 12 certificates a year for a patient rather than one or three per year under the current system. At the same time the Government recognises that there will be occasions when patients find it difficult to meet the cost of the 4-monthly or 12-monthly PPC in one payment. To address this, systems at the NHSBSA are being amended so that PPCs can be purchased by monthly direct debit from 1st July 2007. As a result, 12-month PPCs will be available for a monthly payment of £7.95 based on the current cost of a twelve monthly PPC of £95.30. A three monthly certificate will replace the four monthly certificate.
Over 97% of PPCs are purchased through the banking system. We will consider ways in which monthly payments can be made by those who do not have a bank account." - the government response.
"We have considered the operational implications of this recommendation and have concluded that access to PPCs by monthly instalments as outlined in our response to Recommendation 4 would be more straightforward. Reduced price PPCs for those receiving help through the NHS Low Income Scheme could not be available until after a patient had made a claim and entitlement had been calculated. In addition, we believe that it may generate a significant number of additional claims with no certainty that those would result in provision of the help sought with consequent disappointment for those involved." - the government response
"With the introduction of the facility to pay for PPCs monthly, the Government does not agree that the annual cost of a PPC should be pegged at the cost of 12 times the price of a single prescription. We estimate that this, with the introduction of a monthly PPC, could cost up to £100 million in lost revenue from prescription charges income. The Government does not consider that this can be justified in the light of other pressures on NHS resources." - the government response
(Paragraphs 164-165 - select committee report)
The HC1 form should be immediately be re-written in clear English.
"The design and production of the form is now managed on behalf of the Department of Health by the PPD of the NHSBSA. The PPD is looking at ways in which the content may be simplified but with regard to the information that needs to be collected. The PPD is working with the Plain English Campaign with a view to submitting the form to the Crystal Mark Scheme." - the government response
(Paragraph 170 - select committee report)
In addition the Department of Health and the Department of Work and Pensions should work together to find ways of automatically extending health charge exemption from means-tested benefits so that the HC1 form can be abolished.
"We will explore possibilities as part of the review described in our response to recommendation 2. However, it is likely that there will always be some people on a low income who will not be entitled to means-tested benefits and as such will need to seek help through the LIS." - the government response
(Paragraph 170 - select committee report)
There should be a review to report the effects of the new contract on patient access and care, including prevention, and on NHS dentist numbers, recruitment, salaries and workload.
"The Government is fully committed to reviewing the impact of the recent dental reforms to ensure that they are delivering their intended benefits for patients and for the profession. In March 2006 Ministers announced the establishment of an Implementation Review Group consisting of senior dental stakeholders (representing the interests of patients, dentists and the NHS) to monitor the impact of the reforms and make recommendations on any changes that may be needed. The group has already agreed the main success criteria against which progress will be monitored, including patient access and quality of care.
We intend to produce a report on the first twelve months of the dental reforms based on the work of the Implementation Review Group. - the government response"
(Paragraph 166 - select committee report)
All opticians should hold stocks of glasses that are priced within the value of free vouchers for glasses and contact lenses.
"The Government supports the aim of ensuring that patients have access to a wide range of spectacles. We consider that the current arrangements support this objective by giving patients maximum choice in deciding where they purchase spectacles using NHS optical vouchers.
The General Ophthalmic Services (GOS) contract covers the provision of NHS sight tests. The range of spectacles carried by an optician’s practice is not a matter that is within the scope of the GOS contract.
We would be concerned that restrictions which prevented patients from using optical vouchers at certain opticians (on the basis that they did not stock a range of glasses within the voucher value) would reduce patient choice. - the government response"
(Paragraph 167 - select committee report)
Sight tests for all children should also be reintroduced.
"As part of the Department of Health’s current review of eye care services, we are looking at how best to support the NHS in commissioning a wider range of eye care services in primary care. The review is looking at the available evidence from eye examination schemes elsewhere in the UK. The review will make recommendations to Ministers on the scope to improve eye care services in England, within the context of wider NHS reform policy, and is expected to report to Ministers in late 2006." - the government response
(Paragraph 168 - select committee report)
The Hospital Travel Costs Scheme be extended to cover patients attending for treatment at primary care facilities, in accordance with Our health, our care, our say. Consideration should be given to including dental surgeries under the scheme where patients have to travel considerable distances to access care.
"We will extend the HTCS next year, as described in ‘Our Health, Our Care, Our Say’ that is to include people referred to health care professionals in a primary care setting." - the government response
(Paragraph 172 - select committee report)
The Government should also consider extending the Hospital Travel Costs Scheme to some hospital visitors on low incomes (for example, to those visiting long-stay mentally ill patients for whom it may be particularly important to maintain links with family and friends).
“We do not consider that it would be appropriate to extend the HTCS to include hospital visitors on low incomes visiting patients with particular conditions. It is for local PCTs, as commissioners of services with an overview of the needs of their patient populations, to commission services based on clinical need and cost effectiveness. This may include attendance of visitors as part of a care package for long stay mental health patients where it is proven to be effective to do so.” - the government response
(Paragraph 173 - select committee report)
Hospital trusts should introduce reduced car parking charges for patients and their visitors who attend hospital regularly and free parking for those who must attend on a daily basis.
“The Government welcomes the Committee’s comments and agrees that this is an issue of considerable importance for patients and the public and one that is sometimes not given the attention it deserves. As this is a matter for local Trusts, we suggest that they look carefully at the Committee’s recommendations. The Government believes that to enable choice, it is important that Trusts give a clear, accessible statement of car parking policy including the availability of permits/season tickets and will take the Committee’s recommendations into account when re-issuing guidance on car parking arrangements.” - the government response
(Paragraph 174 - select committee report)
Urgent consideration be given to measures that could be taken to reduce the costs of calls to bedside telephones.
“The Department of Health has set up a Review Group to explore the issue of costs to users of the bedside television and telephone systems in National Health Service hospitals as a result of an Ofcom investigation into the cost of telephone calls to hospital patients. It continues to have significant concerns about the level of charges for incoming calls to hospital patients. The Review Group report will be published by December 2006.” - the government response
(Paragraph 175 - select committee report)
Patients and their visitors should be able to use mobile telephones within certain areas of hospitals.
“The use of mobile phones and other digital & wireless technology, in suitable locations, perhaps designated areas, and with respect for others, can be managed. However, this requires a clear policy, understood by staff and backed up with appropriate advisory signs and notices throughout the organisation.” - the government response
(Paragraph 176 - select committee report)
The Government should undertake a major review to assess the costs and benefits of the following:
"A new dental charges system was introduced from April 2006 and the Government accepts that it would now be appropriate to review prescription charges to consider options for possible change to those charges that would be cost-neutral to the NHS. However, the Government does not agree that it would be appropriate to abolish health charges as this would reduce by some £1 billion, the money available to deliver other health priorities." - the government response
"..the Government will undertake a review of prescription charges and report the outcome of this review by the Summer Recess 2007. " - the government response
"The Government and NHS have only recently introduced major reforms to the system of NHS dental charges. ... Whilst the new system is bedding down, we consider that it would be premature to consider significant further changes. The Government is not in any case persuaded that abolishing charges for dental examinations would constitute an appropriate priority for the use of NHS funds....
NHS sight tests are already provided free of charge for children, those on low incomes, certain groups with a predisposition to eye disease, and (since 1999) those over the age of 60. We are not persuaded that the benefits of extending eligibility to other groups of adults (who currently have to pay for a private sight test) would justify the costs involved – likely to be some £100 million.
We will, however look at whether any of the options considered for prescription charges as part of the review described above have knock-on implications for dental or optical services." - the government response
"The Government is not persuaded that it would be appropriate to consider introducing reference pricing for England at this time because:
- a variable co-payment that is related to the difference between the price of a medicine and the reimbursement price that the NHS was prepared to pay would not be consistent with the Government’s values for the health services;
-reference pricing could only be introduced if the current mechanisms for controlling medicine prices (PPRS and Category M) were abandoned." - the government response
The Government review "..will include options to
- revise the list of medical exemptions to prescription charges;
- introducing a flat-rate prescription charge with no exemptions;
- basing exemption to prescription charges solely on income.
These options will be considered on the basis that any changes to prescription charge exemptions, if implemented, are cost-neutral for the NHS." - the government response
The terms of reference and results of the review should be published.
(Paragraph 177 - select committee report)
The review should include:
"...the Government has concluded that the time is now right for a wider review of the current arrangements for prescription charges. Accordingly, Ministers have asked officials in the Department of Health to undertake a review of the current exemptions for prescription charges and to put forward options to them that would be expenditure neutral for the NHS. The Government will report the outcome of this review to Parliament before the 2007 Summer Recess." - the government response.
"The Government does not agree that the system of charges is a mess. The core philosophy of the NHS is that care is available free of charge according to need; charges for clinical treatment are only levied with statutory authority where there is a legitimate case for using charges to reduce unnecessary demand. A wide-ranging system of exemptions is designed to ensure that people in need do not go without treatment on the grounds of cost. Any change to the existing system would need to be justified according to the same core principle, namely that it did not undermine the provision of a comprehensive health service according to need, and would be subject to public consultation and the consent of Parliament. In any case, the Government has no plans to introduce further charges.
The Government agrees with the spirit of the recommendation, namely that the resources of the NHS should be focused on what works and is already taking steps to ensure that the public receives best value from the record level of investment in NHS services. For example, NICE is reviewing ineffective as well as effective treatments and will encourage the NHS to disinvest in the former. The Pharmaceutical Pricing Regulation Scheme (PPRS) already promotes the use of generic medicines. With regard to charges to promote responsible use of services, the Government is very sympathetic to the intention behind this proposal but would note that implementing such charges would be extremely complex. With regard to charges in A&E, issues include who would decide what was, or was not, a non-emergency use of A&E; what to do if a patient refused to pay; and the possible knock-on impact on the four-hour standard for dealing with patients in A&E. As for charges for non-attendance, setting up appropriate administrative systems would have cost implications and it is not immediately clear that these would be cost-effective. The Government believes that a better way of encouraging attendance is to put in place efficient and patient-friendly appointments systems, for example, the new Choose and Book system for hospital appointments. There is also evidence from the Primary Care Collaborative that general practices which offer responsive booking and appointments system see significant reductions in the number of patients who fail to keep or cancel their GP appointments." - the government response
(Paragraph 179 - select committee report)
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