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It’s the start of the week. Let’s throw caution to the wind and think about doing things differently.
Whoopee! Yeh, right…
… maybe you don’t want to do things differently. I get that...
... but you might want to do what we are doing, better. I absolutely get that.
That’s the difference between modernisation and reform. A subtle but important difference that seems beyond the grasp of our great reforming leader.
What do you want to do ‘different’? Perhaps you have a list?
I tell you what, let me go first.
Let’s do inflammatory bowel disease, differently.
I’m sure you don’t need me to spell out the consequences of IBD. When your sewage works play up, it can be a lifelong problem. There are treatments. No cures.
Stem cell therapy, microbiome modulation (fecal transplants), and other innovative approaches hold promise for the future.
Usually, IBD first occurs in teens and early twenties. It could emerge later with people in their fifties, or for an unfortunate some, anytime. Out of the blue. Whatever the timing, it’s with you from then on. Treatment is to manage the symptoms with daily drugs to prevent flare-ups and keep people well.
Maintenance treatments.
The average patient might need two, sometimes three different drugs to keep them well. If there are three items on a prescription, the total cost would be: £9.65 × 3 = £28.95 a month.
If you are a typical patient it’s likely you’ll be a student at Uni, you might be eligible for help with prescription costs through the NHS low income scheme, or if you are in receipt of other qualifying benefits, you might get help.
You can also purchase a Prescription Prepayment Certificate that give you a frequent-flyer discount.
Whatever, one way or another you might have to find £360 a year. Which you might call a chronic cost.
Applications for help are complicated and as people’s circumstances change, their entitlement changes. The upshot is one in ten people with IBD skip their medication and inevitably fall into relapse…
… which can result in needing far more aggressive treatment in hospital to get the symptoms under control or even emergency surgery.
All of which, in management terms is called failure demand… the excess cost and demand placed on a system, created by not getting the thing right in the first place.
The obvious root-cause-analysis-solution would be free prescriptions, such as they are for Addison’s disease.
So much for our great reforming leader's the little epithet doing the rounds; ‘shifting focus to prevention’.
But…
… there is more. Despite the obvious, make IBD one of the conditions that comes with free prescriptions, (more here) there is the clunky application and palaver, to get help and…
… older people are exempt from paying prescriptions, as are people with certain eligible medical conditions and maternity. There are also income related exemptions. Here's the gob-smacker...
... all this adds up to 89% of prescriptions are dispensed free of charge. Only 11% of prescriptions bring in revenues, of around £652m a year, and...
... wait for it…
… the total cost of community prescriptions is over £9.69bn. Prescription charge revenues only cover about 7% of the costs.
There’s more…
… the administrative cost of managing NHS prescription services is part of the broader NHS Business Services Authority budget, which oversees processing charges and exemptions. However, specific figures for this administration are not readily separated in the public data.
Prescription fraud, including exemption abuse, might be around £271.8 million annually.
Many cases are resolved administratively, such as by recovering money owed or issuing penalty charges, rather than through court prosecutions. However, severe cases involving fraudulent or stolen prescriptions may lead to legal action.
During 2020-2021, there were approximately 22 successful criminal prosecutions. Yup, twenty two. The latest NHS counter fraud organisation accounts are here.
In 2022/23, only 1% of the DH+'s budget came from patient charges for prescriptions and other services.
Even taking into account recovery of fraud revenues, it’s hard to see the prescription recovery system as anything other than running at a huge loss, bureaucracy adds to the cost, inequalities and aggro. The counter fraud and administration effort, adds more cost.
The Monday morning question for the great reformer is… why bother?
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