Devolution is doubtless a good thing, but it would be an even better thing if the devolved governments would stop introducing dotty policies. The Northern Ireland devolved government recently announced that prescriptions in the province would be free. They thus joined the Welsh (who already get their medicines free) and the Scots (who are going to soon).
In Scotland this will be a heavy burden for the taxpayer to bear. Already, the Scots have introduced a policy called ‘free long-term personal care for the elderly’. It is not actually any such thing, just an allowance towards the cost, but it is already exerting huge pressure on the Scottish exchequer. In 2008, spending on it exceeded what it was planned to be in 2025. Add to that the cost of the free drugs policy, as well as Alex Salmond’s half-baked plan to get rid of council tax, and you see a country heading for a fiscal crisis.
Free prescription charges are expensive – for England, they raised £433.5m for the health service in 2007-08. But that is a serious underestimate of the cost of removing them. For once prescriptions are free, two utterly predictable consequences follow.
The first is that people want more drugs. I don’t of course mean the lifesaving kind – hardheaded public financier though I am, I cannot really object to Gordon Brown’s decision to make drugs for cancer patients free. I mean the lesser kind, the kind that was campaigned against under the slogan ‘don’t take a pill for every ill’. Seven pounds a throw is at least some sort of deterrent against all but the most determined pill-swallower. But at £0, why not?
More insidiously, the zero charge gives people an incentive to go to the doctor. Bit of a headache? Well, pop in and see the doc and you can have it for nothing. Upset stomach? Better see him and he can check you haven’t got ulcerative colitis while you are there. At a time when government is supposed to be helping you get to see your GP quickly, the surgery is going to be packed with pill-seekers. Human beings respond to incentives, and the incentive to get your drugs from your doctor is not insubstantial.
I should at this stage confess that I benefit from the Welsh assembly government’s generosity. I live half in London and half in Hay-on-Wye, fortunately the Welsh side of the border. My GP in Wales is excellent and I would go to him anyway. But I have to take lots of pills, and getting them free is a bonus. If I had a London GP I should have to buy a certificate to get my drugs free for a year at a cost of £102.50 – which is enough to pay for a good meal out with my wife.
No one objects to free drugs for ill people who cannot afford to pay for them. That is part of what a health service free for all at the point of need is supposed to deliver. But I do not fall into that category. I can easily afford to pay. And – this is the worst bit – if I don’t pay that means less money is available for the health service. In particular, less money is available for the service for the less well off, who under current arrangements live less long with worse care than the better off like me.
Nye Bevan famously resigned from the cabinet over Hugh Gaitskell’s imposition of prescription charges. That made him a Labour hero. But Gaitskell was right. Free drugs for all may sound socialist – but in fact it transfers resources from poor to rich. Let us hope the infection does not spread across the borders.