A universal prescription

The gross total payments to Scottish dispensing contractors rose to £1.136bn last year, prompting the Scottish Conservatives to call for the reintroduction of the prescription charge, while Health Secretary Alex Neil insists the Scottish health service provides ‘value for money’.

Although the prescription charge was abolished by the SNP during their first term in government, the idea started as a member’s bill by Scottish Socialist MSP Colin Fox in 2006.
The Scottish Socialist spokesman tells Holyrood: “From the SSP’s point of view, we’re immensely proud of it. I remember Nicola Sturgeon dropping me a letter after 2007 and we’d all lost our seats and she said we’re intending to take this bill up as Government, and we’ll pay credit to the role the SSP and yourself played in pursuing it. I wrote back to her saying it’s kind of you to remember me but it’s more important it’s done than who does it. Clearly that was very generous of me, since the SNP went to town on it, got the benefits of it.”
Wales had already removed the prescription charge, and Fox was inspired to gather cross-party support for the idea. He visited the Welsh Assembly for inspiration, and found a Labour administration which had won an overall majority in an institution designed to prevent that. He remembers speaking to the Plaid Cymru left-winger Leanne Wood, who now leads the party. “She was saying it was down to prescriptions. You’re going up the Welsh valleys as a Plaid supporter with your socialism and the rest of it, and folk are going, ‘I’m voting Labour, they’re getting rid of our prescription charges. They promised and they did it.’”
Fox started the Scottish Campaign to Remove All Prescription Charges (SCRAP) with his fellow SSP MSPs, Greens, Senior Citizens’ MSP John Swinburne and the late Margo MacDonald. The Health Committee, led by Roseanna Cunningham, also backed the Bill, but it got voted down in the chamber by the Labour administration. The then Health Minister Andy Kerr said: “It wouldn’t be good value for money. Every penny is a prisoner in the NHS and every penny needs to be spent wisely. This is a question of priorities.”
Now Scottish Labour’s report by Arthur Midwinter has been dubbed a “cuts commission” by critics, and although the party has yet to publish its findings, it is thought it will recommend the reintroduction of prescription charges. Fox believes Labour will drop it.
“Johann Lamont’s backside has been kicked up and down every scheme in Scotland by the SSP and the SNP and everybody else, throwing back in her face that universal benefits is a something for nothing culture. I mean, that’s an affront, not just to the socialism she wouldn’t know how to spell, it’s an affront to social democracy. The whole point of universalism is nobody is left behind. You already see Labour’s spin doctors trying to put it into context, which is to say, it’s the first step toward dumping the whole episode completely, isn’t it? Labour’s been haunted by that, it’s done untold damage, and they’ll drop it under a stone and walk away from it.”
The arguments against free prescriptions haven’t moved on, argues Fox, and don’t take into account hidden costs. Pharmacists and health professionals had told him “this is bonkers, you’re having so much resources spent on investigating whether this person is actually in this category or not, you had a fraud unit that used to check pharmacies weren’t scooping the money, and people weren’t making false claims and all the rest of it. That’s inevitable; you have a regime to protect it.”
People with multiple prescriptions were only getting one because of the cost, according to Fox, “and instead of you being off work for a week, you were off for three, the hidden costs were huge.”
Labour, he argues, “has been on the wrong side of history for the last 15 or 16 years now. This was their policy. They should have been proud of what Aneurin Bevan argued for. They said at the very beginning, when prescription charges were introduced in 1951 to pay for the Korean war, it was supposed to be a temporary measure, because of a budget crisis in 1951 they had been free for five years. They were introduced as a one-off charge on the entire script. So regardless, if there was one or 11 items on the script, you just paid for one prescription. A shilling.”
Prophecies about the policy failing haven’t come true, says Fox, including one about how people would be going to the doctor for basic drugs like Lemsip or Night Nurse. “It never happened because it was ridiculous. You’re going to not go to work, go up to the medical centre, make an appointment, sit there for an hour waiting to see a GP to get a packet of Lemsip when you can go to bloody Morrisons on the way to your work? You’re not going to do that, are you? Absolutely crazy nonsense. It was contemptuous of working people and the sick,” he says.
Renewed attacks on universalism are bogus, argues Fox, including the Conservatives’ plans to reintroduce the charge. “The Tories are punting this drivel that rich people are getting free medicines. I’m sure they don’t need reminding, but let’s take the opportunity to remind them rich people tend not to get ill. By and large, the people who are ill are the poorest in communities, you know. Chest infections in the winter. I’ll bet the rate of chest infections in Wester Hailes is twenty, thirty times what it is in Juniper Green. So they’re not going to the doctors in the first place.”
When his member’s bill was debated in parliament, Harry Potter author JK Rowling was brought up. “JK Rowling, with £500 million in the bank, would get a free prescription from the Scottish Socialist Party? You call that wealth redistribution? It was the same argument when we put up the free school meals bill. We just turned round to go, ‘Yep. She’ll get a free prescription and a free school meal but do you know what? We’re going to increase the top rate of tax so it’ll be the dearest free school meal she ever got in her life, and the dearest prescription she ever paid for.’ That’s the balance here. Of course it’s got to be paid for, fine, and it should be paid for by a progressive tax system. Universalism is not fully understood by people because universalism is a form of redistribution. We’re basically saying the state will provide this for everybody free of charge, and clearly where it’s paid for comes from those who can afford to pay, and the provision of the service is guaranteed for everybody.”
If universalism means more redistributive taxes, the Government has avoided the issue, suggesting a corporation tax cut in an independent Scotland. “The SNP are vulnerable to the left. They’re not vulnerable to the right. Labour’s coming at the SNP from the right. The SNP has got Labour the Liberals and the Tories on their right, they’ve got nobody on their left,” says Fox. A living wage for staff in social care would be a start, he says. When working with an employment agency in the care sector, he was outraged by the state of nursing homes. “The treatment of elderly people in there is not much better than prison. I used to go round them all and the highlight of their day was what they were going to get for their dinner. Whether they were going to get macaroni cheese or chips or whatever, that’s a pitiful human condition to be in,” he says.
Although Labour’s Neil Findlay has raised this in the Parliament, Fox questions how Labour can reconcile it with comments from the leadership about matching the Conservative public sector cuts. Fox subscribes to the late Tony Benn’s idea: “Labour started out as a party that was for changing the world, and a hundred years later, they became a party about changing people to accept the world. That’s the Labour Party right there. Vent what’s wrong, the rhetoric makes people feel good. It’s like sugar in your coffee, it’s not a diet for the prolonged, just an immediate hit. So you vent the frustration, vent the rhetoric then don’t do anything about it. They’re not prepared to challenge the fundamental problem that confronts them there.”
What did Fox make of Findlay’s ‘Beveridge 21’ proposal to review the NHS for modern challenges?
“That’s a cappuccino, isn’t it?” he laughs, “Or a skinny latte –a skinny Lamonté? The Labour Party of today would not introduce the reforms of Beveridge. We’re on a different planet. I watched the debate with Jim Sillars and George Galloway on Newsnight Scotland on independence. I remember thinking these are two old men who have been sleeping for 25 years. They’ve been hibernating. A left-wing socialist Labour government? Hello! What have yous been drinking? Have you been on stuff in the green room before it started? That ship sank, I’m afraid. The Labour Party of today would not introduce the National Health Service. If you consider its fundamental principles, they are alien to Labour. It’s the same with Beveridge – cradle to the grave care? What’s it now? The deserving poor and the undeserving poor, the ill and the undeserving ill?”