NHS prescribing restrictions and tax cuts for the rich

By Savi Hensman

March 28, 2017

NHS prescribing may be further restricted, forcing yet more patients to buy medical products or, if they cannot afford this, to go without. At the same time tax for profitable UK companies is being reduced, as is inheritance tax for some better-off families.

Meanwhile, major loopholes remain, allowing huge amounts of tax revenue to be lost through avoidance and even evasion. However some benefits are being cut in real terms, hitting low and middle-income households.

NHS England has announced that it will consult on preventing doctors from prescribing around ten 'low value' items, for which there are supposedly better alternatives or which can be bought over the counter. Further restrictions are expected to follow.

News reports indicate that these include vaccination for typhoid, hepatitis A and cholera and a combined jab for diptheria, polio and tetanus for overseas travellers. These vaccinations are meant to protect public health.

Without this, some low-medium income families may be prevented from going on holiday or to visit relatives abroad – or take their chances, potentially endangering themselves or others. But if, say, a family is eager for a seemingly low-cost break or someone’s grandmother is critically ill, they may not be as cautious as they should.

Patients with certain skin disorders need suncream from spring to autumn, according to the National Institute for Health and Clinical Excellence. But in future they may have to buy this, if they can. Some such conditions are hereditary, which may mean that more than one family member is affected, increasing the household bill.

Fentanyl to reduce pain in dying patients is another drug which GPs may be prohibited from prescribing. This is more expensive than morphine but may have fewer side-effects.

Reviewing the effectiveness of prescribing practice is important and some restrictions make medical sense. However, the NHS has reached a stage where cost-cutting is often given priority over avoiding suffering.

This also further undermines the principle of care paid for when people are able to pay, through National Insurance and other taxes, then available free of charge at the point of need.

Even NHS England has been prompted to step in recently as local rationing becomes more severe. Officials have warned clinical commissioning groups against arbitrary restrictions on hip and knee surgery, the Health Service Journal reported.

Some sections of the public will no doubt accept the state’s reasoning for stopping doctors from meeting certain patient needs. This may be in part because the seriousness of some conditions is played down in official pronouncements. So it may seem sensible for the NHS to stop prescribing antihistamines, indigestion remedies and gluten-free food.

Many people may need certain medicines only occasionally and be well able to afford them. However for those with certain chronic conditions but low incomes, the costs can mount up and skipping doses may have serious consequences. Likewise gluten-free food is available in supermarkets but is often expensive.

Indeed, it is not even clear whether, in terms of long-term financial – let alone human – costs, such policies will save more than their overall price. Increasing health inequalities can be expensive for society.

At a deeper level, intensifying cuts raise serious questions about society’s priorities. Boosting shareholders’ wealth and ensuring that the well-off need not pay much tax has been given more weight than preventing suffering. This is surely wrong.

For people of all faiths and none, the financial shortfall in health and social care, and the harsh rationing or long waits which often result, are a serious ethical challenge.

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© Savitri Hensman is an Ekklesia associate and respected commentator on welfare and other issues. She is author of the book Sexuality, struggle and saintliness: same-sex love and the church (Ekklesia, 2016): http://www.ekklesia.co.uk/node/22613 and has been involved in seeking greater inclusion.