The Business Committee has agreed to allow one and a half hours for the debate. The proposer of the motion will have ten minutes to propose and ten minutes to make the winding-up speech. Other Members will have five minutes each. One amendment has been received and has been published on the Marshalled List. The proposer of the amendment will have ten minutes to propose and five minutes to make his winding-up speech.

I beg to move

That this Assembly calls upon the Minister of Health, Social Services and Public Safety to establish a cost and benefit review for the purpose of abolishing health prescription charges as has been carried out in Wales.

As the Alliance Party’s spokesman on health, social services and public safety, I wish to see the best possible health provision for everyone living in Northern Ireland, and I am sure that all Members agree with me. To that end, I hope that the Assembly will support my call to the new Minister of Health, Social Services and Public Safety, Michael McGimpsey, who I am glad to see in the Chamber, to initiate a cost-and-benefit review for all current prescription charges.

In addition, I am happy to support the amendment.

The Alliance Party’s policy on health provision continues to be that the service should be free to patients at the point of delivery; funded through general taxation; available to all on the basis of need; and universally and equally accessible by everyone.

The National Health Service was introduced throughout the United Kingdom in 1946, and it was to be free from any charges. However, in 1949 a new Act was introduced to permit charges for prescriptions, and it came into force on 1 June 1952. Prescription charges were abolished in 1965, and prescriptions remained free until June 1968 when charges were reintroduced. Those charges remain throughout the UK to this day, with the exception of Wales where all prescription charges have been abolished from 1 April 2007.

I congratulate the National Assembly for Wales on the planned and gradual way it abolished prescription charges. The Welsh Assembly’s main reason for abolishing the charges was that it wanted to ensure that people would not be put off going for their medication due to cost, and that patients would get the medication they required to improve their health and, ultimately, their quality of life. The Welsh Assembly also reckoned that people who were on modest incomes and who had chronic illnesses might not have been eligible for free prescriptions under the previous exemption system, which could be complicated.

Research has shown that costs have prevented patients availing of healing drugs, and that the long-term costs to the NHS could end up being much greater through avoidable hospital treatment having to be carried out.

UK regions have different opinions on prescription charges. Scotland has promised to reform its system and introduce more exceptions for chronic conditions, students and people on low incomes. England retains prescription charges, but its health Minister has pledged that increases will not go above the rate of inflation and that all proceeds from these charges will go straight back into front-line services. At present, we in Northern Ireland have to pay for prescriptions, although it is now estimated that some 90% of people get prescriptions free of charge for one reason or another.

Our challenge today is to ensure equality of treatment for everyone in Northern Ireland. My information is that everyone in the Republic of Ireland is entitled to either free or subsidised approved prescription drugs and medicine and certain medical and surgical aids and appliances.

In asking the Minister to instigate a cost-and-benefit review on prescription charges, there are many factors to be considered. For instance, how much does it cost the Health Service to administer the prescription system? What is the revenue from prescriptions in the context of the wider health budget? How can we reduce prescription fraud, which was estimated in 2005-06 to amount to almost £7.6 million? Should free prescriptions for Northern Ireland be introduced on a single date, or should we gradually reduce the cost of prescriptions as happened in Wales? What has to be done to ensure that patients comply and take their prescribed medication? The review must answer these and many more questions, taking into account the voices of local general practitioners (GPs).

There is also a fear that if all prescriptions were free, patients would simply telephone surgeries and ask for medication that can be bought over the counter, thus giving our already hard-pressed GPs extra and unnecessary work. The review must consider, in addition, the overall benefit to the National Health Service and how to make a real and visible improvement in Health Service provision.

In conclusion, we acknowledge the efforts of one of our leading newspapers the ‘Belfast Telegraph’ to establish a level playing field for all patients by seeking the total abolition of these charges. Indeed, I warmly welcome the Minister’s published views on this important subject and his eagerness to have a review of it. Now he has the opportunity to respond positively to my proposals today.

I ask Members to support the motion and the amendment.

I beg to move the following amendment: After “Wales” insert

 “; and to review the list of conditions that currently entitle patients to free prescriptions in order to reduce anomalies.”

Prescription charges were first introduced in 1952 and, except for a three-year period between 1965 and 1968, they have been levied ever since.

A person can qualify for exemption on three grounds: age, financial status or medical condition. It is estimated that around 50% of the population qualifies for free prescriptions under the current exemption arrangements.

However, because this group includes children, the elderly and people with chronic health conditions, all of whom are high users of medicine, it is estimated that over 90% of items dispensed could be supplied to patients free of charge.

Undoubtedly there are arguments in favour of prescription charging. It places a value on the medicine that patients require, helps reduce the level of less urgent demands on GPs’ time and provides a much needed source of revenue for the National Health Service.

There are indications that between a quarter and a fifth of people would be more likely to go to their doctors for prescriptions if prescriptions were free to all. Dropping prescription charges might lead to an increased demand on doctors’ time and for prescriptions.

As indicated in the amendment, current exemption arrangements contain certain anomalies that need to be addressed. Any changes to the present system should be straightforward and easy for patients to understand. Secondly, the impact of any changes should not increase the administrative burden on GPs and community pharmacists. Some chronic conditions are currently exempt while others are not.

The argument is made that it is one thing for diabetics, for instance, to receive free prescriptions for their condition, but quite another that they should receive free prescriptions for conditions unrelated to diabetes.

However, it may prove difficult to determine whether one medical condition is related to another. In addition, some conditions can cause secondary problems or can affect sufferers’ general health. For example, the symptoms that affect sufferers of multiple sclerosis are wide-ranging. They include fatigue, pain, spasms, depression, incontinence and other problems. Drawing a distinction between drugs that relate to multiple sclerosis may, therefore, be difficult.

Similarly, it has been recognised that treatment of the main condition may cause side effects for which a prescription is also required. Furthermore, a patient may suffer from an illness that is unrelated to the exempt condition, but which may, nonetheless, lead to a deterioration of that condition if left untreated.

Concern has also been expressed that limiting exemption to treatment for the main condition would require significant changes to be made to current administrative systems, which would be costly. From a processing perspective, it would be difficult to have some items on a prescription form that were exempt from charges and others that were not. It has even been suggested that such changes could cost more than the complete abolition of charges for people who have a chronic condition.

Another idea is to base exemptions on a list of drugs rather than on a list of conditions. However, there are several drawbacks to that suggestion. The extra bureaucracy required to maintain the list of drugs may prove costly. There would be a potential time lag between new drugs coming on to the market and their addition to the list of exempt drugs. The feasibility of developing a list of drugs that includes all of those medicines that are required to treat even common chronic conditions is questionable. As many drugs are used to treat more than one condition, drugs-based exemption from charges might be granted not just to those who have chronic conditions, but also to those who have minor ailments or short-term acute illnesses who may be less in need of assistance with charges. For example, antibiotics can be prescribed for anyone who has a cough. For a patient who has cystic fibrosis, however, the consequences of not taking antibiotics are severe. That is not the case for other patients.

Some people have suggested that there be a reduced flat fee for prescriptions. The main argument in favour of that is that all patients would contribute something to the cost of their medicine, which would provide much-needed revenue to the NHS. There is no doubt that some of those people who are already exempt from charges could afford to pay something towards their medication.

For patients who require many prescriptions, a more affordable option is to purchase a prescription prepayment certificate (PPC). Those can be cost-effective when a patient needs several items over many months. The PPC system could be improved by allowing patients to pay in instalments, issuing PPCs retrospectively and publicising the system better. For patients who are not exempt on the grounds of income, but who require many or frequent prescriptions, the prescription prepayment certificate presents a more affordable way of paying for their medication.

However, it is recognised that the PPC system has several shortcomings; in particular, the size of the upfront fee may present difficulties for some patients, particularly those who are on lower incomes. Options include abolition of the system of upfront payment and allowing patients to pay in instalments with the option of paying by direct debit, standing order or by a stamp-scheme system. Some people favour the retrospective issuing of PPCs to patients who incur significant but unanticipated charges during a set period.

There are many varied ideas on prescription charging. Representatives of the Royal College of General Practitioners have suggested replacing the current charging and exemption arrangements with a patient co-payment system, similar to those that exist in other countries, in which charges vary for different categories of drugs. They have also stated that it would be worth examining experiences elsewhere, such as the current French system in which patients receive a higher level of reimbursement for evidence-based treatment than for newer or more expensive medication, which is not necessarily more effective.

In such a model, it is likely that the great majority of prescription medicines — perhaps 90% — would be free to the patient. That would require the categorisation of all medicines. However, as a first step toward addressing this important issue, Members should seek to review the list of exempt conditions.

I call Mrs Michelle O’Neill. She will be making her maiden speech, and it is the convention that it be heard uninterrupted.

Go raibh maith agat, a LeasCheann Comhairle. I am pleased to have the opportunity to make my maiden speech on an issue that has an impact on the lives of so many people.

Sinn Féin is determined to create a society in which inequalities in health provision are eradicated. To that end, we launched a campaign for free prescriptions over a year ago, which we took to most councils in the North. It received universal backing.

Sinn Féin notes that the graduated abolition of prescription charges over one electoral term was in the UUP manifesto, and we will support the Minister of Health, Social Services and Public Safety in achieving that worthy goal.

Prescription charges should be redundant in the Health Service, which is supposed to be free at the point of delivery. The current cost — almost £7 per prescription — has the detrimental effect of excluding many people from receiving the correct medical treatment. People on low incomes cannot access the medications that they need. That cannot be allowed to continue, and Members must end charging now.

Sinn Féin recognises that it may take some time to implement, as it did in Wales. In the interim, we urge the Minister of Health to go the extra mile and to adopt our recommendations from last year concerning the list of chronic conditions that qualify for exemption. As other Members have said, that list was compiled in 1968, is no longer fit for purpose and must be modernised. There have been tremendous advances in pharmacology in the 40 years since the exemption list was compiled. Sinn Féin urges the Minister to immediately widen it to include long-term conditions such as Alzheimer’s disease, arthritis, cancer, multiple sclerosis, HIV and schizophrenia, to name but a few. There must be a more consistent approach for patients who require repeat prescriptions for long-term medical conditions. The disparities associated with the outdated exemption list must be addressed as soon as possible.

In its report, ‘Unhealthy Charges’, the National Association of Citizens Advice Bureaux found that more than two thirds of those with long-term health problems had difficulty meeting prescription charges. That has an adverse impact on their health and raises costs elsewhere in the Health Service due to hospital admissions and appointments.

With that in mind, Sinn Féin calls on Members to support the motion.

Members have heard some lucid arguments in favour of the motion. A look back in time may help Members to take a long-term view.

In 1979, the prescription charge was 20p. Figures for the retail price index, on the 1974 basis, show an increase by a factor of 6·62 between 1979 and 2007. That implies that the prescription charge could reasonably be expected to have increased from 20p to £1·32 — yet in 2007 it had reached £6·85. That is more than five times what might have been expected due to normal inflationary pressures. That simple arithmetical exercise shows how inflated prescription charges have become.

That is not the whole story. If prescription charges played a significant part in recovering the cost of medicines, such an overblown increase might be understandable — even justifiable, if all moral and ethical issues were set aside to deal just in figures and recovery costs. However, the picture painted by the facts shows that prescription charges are negligible in terms of cost recovery.

In 2004, just 4% of the cost of prescription items was recovered through prescription charges. Some 95% of prescription items — 25·73 million prescriptions — were not paid for at the point of dispensing. That figure included the 90% receiving free prescriptions and the further 5% using prescription prepayment certificates.

In 2005-06 the 501 pharmacies in Northern Ireland dispensed 27·1 million prescription items at a cost of £340 million. Four million pounds was received in prescription prepayment certificates, and only £10 million was received in prescription charges. That is £10 million out of £340 million. The general pharmaceutical service cost some £381 million in 2005-06, and that cost was defrayed by only £14 million from prescription charges and prescription prepayment certificates.

The extent of the bureaucracy involved in administering the system simply cannot be justified in terms of the rate of recovery. A new prescription bar- code system, begun in 2006 and based on a £6·8 million contract with Hewlett Packard, will enable whatever data recovery is necessary on patterns of prescribing by drug, patient and doctor. That will render much of the bureaucracy obsolete.

Quite apart from this statistical approach, there is the ethical issue of taxing health. Make no mistake — that is what prescription charges actually are. Strip away all the arguments and you come back to this point. That is why the Welsh Assembly, which has fewer devolved powers than the Northern Ireland Assembly, has abolished prescription charges from 1 April 2007.

The purpose of levying prescription charges is now unclear. The income from them is negligible in overall terms. We must get away from continuing and perpetuating activities simply because we have always done them. Levying prescription charges is one of those survivals from past practice that no longer makes sound business sense for Government.

It may be argued that we need to get back to the founding principles of the National Health Service in this matter. The National Health Service introduced in 1947 was a comprehensive health service that was free of charge at the point of need. If patients are treated free of charge at the point of need, medicines should also be free.

The motion calls for a review of prescription costs and benefits. On that basis, I support the motion.

The existing charging scheme in Northern Ireland is outdated and inconsistent. A review of the system is clearly needed. There are many inequities and anomalies in the system. Although around four out of five prescriptions are exempt, the price of a prescription — set at £6·85 from April — sometimes hits those who cannot afford these charges.

There are many people with chronic conditions who are still not exempt. With the continued rise in prescription charges there is concern that more patients will be discouraged from visiting the doctor when they are ill. Research in the UK and Canada shows that charges result in patients not taking the treatment that they require.

Therefore, prescription charges may constitute a financial barrier to receiving treatment for a portion of the population, which would obviously have a detrimental effect on the health of those individuals. That is probably accurate. There are many other groups of patients who are on long-term, or indeed lifelong, treatment, such as those with cancer, cystic fibrosis, Parkinson’s disease and other conditions. They are certainly disadvantaged.

Unfortunately, some terminally ill patients cannot afford the cost of medicines. It would be fairer, particularly for the most vulnerable, to extend the grounds for exemption from prescription charges to include chronic illness. Cancer charities have recently called for the abolition of charges for the chronically or terminally ill to be implemented as a matter of priority. Of course, a fair legal definition of the word “chronic”, on which to base the exemptions, would have to be established.

The Scottish Parliament is not convinced that an equitable charging scheme can be created by identifying exemption categories and may be in favour of abolishing prescription charges entirely. However, in Northern Ireland the abolition of charges should be costed to determine whether it could be budgeted for. It is estimated that, in Wales, free prescriptions will cost £25·5 million for the first year. I have no doubt that the Minister of Health, Social Services and Public Safety will initiate a cost-and-benefit review to measure the impact of abolishing prescription charges. Indeed, it might be more cost-effective to abolish charges; the vast majority of people already do not pay for prescriptions.

Another important question is whether abolition of prescription charges will impact positively on public health and benefit the people of Northern Ireland. There is an argument that free prescriptions will result in fewer hospital stays. Conversely, there is an argument that free prescriptions will encourage a rise in the number of prescriptions issued, which will put further pressure on the health budget and may not be good for public health.

Doctors should be encouraged to prescribe less expensive generic medicines. Pharmacists should inform patients when there is a cheaper, over-the-counter alternative to that prescribed. Pre-paid prescriptions should be availed of and made more flexible.

Society is very reliant upon medication, and that is not to detract from the benefits of powerful drugs. However, these are often seen as the only solution to health problems. Members interested in health issues will accept that we must create a Health Service that promotes good health and supports early intervention. People must be encouraged to take more responsibility for their health, so that they do not become too reliant upon medication. That is why the costing of free prescriptions is important. It will assist those who cannot afford essential medication. Should prescriptions become free, the prescribers — mainly general practitioners — will have an added responsibility and will have to be extra careful, especially with regard to repeat prescriptions. We are all aware of individuals who are dependent on medication. Last weekend, we heard about an eight-year-old boy who was selling his parent’s medication. That is becoming common. It is important to weigh the options, and remember that medicine is not a panacea.

Go raibh maith agat, a LeasCheann Comhairle.

I support both the motion and the amendment. As the Sinn Féin spokesperson on health, I look forward to working with the Minister and acknowledge that the Committee for Health, Social Services and Public Safety and he will have much work to do together.

The Investing for Health strategy should be at the centre of the Executive’s concerns. Health, like many other policy areas, cuts across the responsibilities of several Departments. Deprivation in north and west Belfast has been well publicised, as have the links between ill health and poverty. In this debate Members have consistently made the connection between those on low wages having restricted access to prescriptions and the fact that they also suffer the long-term effects of lack of access to primary care. Those people will be much more expensive to treat when accessing secondary care, which will put more pressure on an already stretched Health Service. Furthermore, it does not take into account the cost in human terms to the individuals.

At this early stage of the Assembly, it is good that Members are seeking to help those in most need — by trying to give them access to services from which they are deprived due to the financial implications. Sinn Féin supports the motion and the amendment. Go raibh maith agat, a LeasCheann Comhairle.

I call Mr John McCallister to make his maiden speech, and I ask Members not to interrupt.

First, I congratulate the Members who tabled the motion for bringing the extremely important issue of prescription charges before the House. It is encouraging that they have read, and agree with, the Ulster Unionist Party manifesto. It is with personal satisfaction that I make my maiden speech on such a pressing matter.

If the Department of Health, Social Services and Public Safety establishes a cost-and-benefit review, such as the motion calls for, I hope that it would result in firm and sustainable proposals to abolish health prescription charges. I use the phrase “firm and sustainable” because there have been situations in which similar measures have been adopted and subsequently rescinded.

The National Health Service Act 1946 did not allow for health prescription charges — those were introduced in 1952. The founding fathers of the NHS wanted the service to be free at the point of need. It was my party that brought the National Health Service to Northern Ireland.

However, for many hard-working families today, the Health Service is not free at the point of need. Those people have already paid for their healthcare through their taxes; therefore, the present situation results in almost double taxation. Members must agree that it has to stop.

As Rev Coulter stated, prescription charges are a tax on health, or indeed on ill health. A recent citizens advice bureaux survey found that 37% of respondents who suffered from long-term conditions such as arthritis could not pay for all or part of their prescriptions because of cost. If those people cannot afford prescriptions, their health may deteriorate, they may be hospitalised and may cost the NHS and the taxpayer even more money.

There are serious flaws in the current exemption regulations for prescription charges. The exemption system does not necessarily include chronic conditions and terminal illnesses such as cancer, multiple sclerosis, cystic fibrosis, arthritis and asthma, which means that sufferers have to pay for what could be life-saving treatment.

The Ulster Unionist Party wants to introduce free prescriptions, and the cost would be around £14 million to the taxpayer — less than 0·5% of the current health budget. The new Minister of Health, Social Services and Public Safety, my friend and colleague Michael McGimpsey, has reiterated his commitment to free prescriptions. The Welsh Assembly has delivered free prescriptions from 1 April 2007, and the Scottish Parliament may follow soon. Why should Northern Ireland be the only devolved region in the UK to be different?

The proposal to abolish prescription charges serves as an excellent example of how devolution can benefit all of the people of Northern Ireland. It is a prime demonstration of how the Ulster Unionist Party plans to serve the people, and how we will strive to improve the quality of life for everyone.

I welcome the debate and support the call for the Minister of Health, Social Services and Public Safety to examine the cost and benefits of abolishing prescription charges. Ending prescription charges is a step towards restoring a key principle of the National Health Service. The Ulster Unionist Party supported free prescriptions in its manifesto, and I am delighted to see that the measure has attracted support from all parties.

Prescription charges are effectively a tax on illness. It is an unfair system that gives free medication to various groups who can often afford to pay, while charging numerous other groups who may find it difficult to pay — for instance, those who have chronic illnesses or who are on a low, modest income but who do not qualify for income support.

The current exemption system is complicated and unbalanced. There is a range of chronic and terminal illnesses that are not included in the list of conditions that are exempt from prescription charges. These conditions include arthritis, asthma, cancer and multiple sclerosis. Sufferers of those illnesses must continually pay for medication that could effectively save their lives or at least improve their quality of life.

It is grossly unfair that 230,000 people in Northern Ireland who are affected by arthritis, many of whom have to take a wide range of medications over a long period of time, should not be awarded free prescriptions on the basis of their condition. Those costs are in addition to other financial restraints such as loss or limitation of employment and the cost of aids and adaptations that are necessary to easing their everyday lives.

Arthritis is the single largest cause of physical disability and lost working days in Northern Ireland, yet many people suffering from arthritis find it difficult to pay for the necessary medications to reduce their pain. That is unacceptable.

Similarly, all those suffering from cancer would benefit from free prescriptions. Macmillan Cancer Support research has shown that one in seven cancer patients under the age of 55, who must currently pay for prescriptions and whose financial situations have worsened, are unable to afford their cancer treatment. Poverty is a particular problem for people of working age who suffer from cancer. That is deplorable.

Macmillan Cancer Support research has established that, of those people who have been diagnosed with cancer at age 55 or younger, seven out of 10 households have suffered an average loss of income of 50%. Furthermore, increasing numbers of cancer patients receive their treatment as outpatients, which means that more and more people must now pay for medication such as treatment for side effects, long-term preventative medicines and even treatments such as oral chemotherapy when they get home.

Prescribing medicines is often complicated, with some medicines complementing another, and others requiring to be taken with another drug. Two substances can sometimes be combined into one tablet, but others cannot and must therefore be paid for separately. That creates further financial problems for many people who are already suffering a lot of distress.

The National Association of Citizens Advice Bureaux found that 37% of respondents with long-term conditions have failed to purchase all or part of their prescriptions because of cost. It would surely be more cost effective for the National Health Service for patients’ conditions to be adequately treated as prescribed rather than paying for avoidable hospital treatments in the long term. Rather than select only parts of medication that patients are prescribed, free prescriptions would enable them to comply fully with their prescription, bringing longer-term health benefits.

The inequalities of the current system must be eliminated. The British Medical Association calls for a:

“fundamental review of the whole system of prescription charges”,

describing prescription charges system as “outdated”.

The current system awards free prescriptions to 87% of the people, but many of the remaining 13% who pay regularly for prescriptions are suffering because of the outdated system. The National Health Service makes a real difference to our lives, contributing in vital ways to the quality of life of people in Northern Ireland.

The Member’s time is up. We need to keep within the time allotted for the debate.

I thank the two proposers for tabling the motion. The motion is entirely in keeping with the Ulster Unionist Party’s manifesto commitments and my already stated determination on the issue of prescription charges. Therefore, the support of Mr McCarthy and Dr Deeny is wholly welcome.

I also thank all the Members who have spoken on the subject. Many useful points have been made. It is not overstating the case to say that there is strong agreement in the Chamber. I look forward to further cross-party enthusiasm in support of my future requests for additional health funding.

Some Members:

Hear, hear.

It is clear that prescription charges are an issue on which Members want to make progress and that the people of Northern Ireland wish to have addressed. That is why the Ulster Unionist Party is committed to the introduction of free prescriptions for all. Therefore, I welcome the opportunity to bring the issue forward for review. Indeed, I have already told my departmental officials that such a review is a priority.

My Department will also seek to restore the key principle of the National Health Service, which is that healthcare should be free at the point of use. After all, it was a Stormont Government that brought the National Health Service to Northern Ireland. Now, this Stormont Government have the opportunity to renew their commitment to the fundamental principles of the National Health Service.

Some Members:

Hear, hear.

On prescription charges, it is worth considering a number of points. Currently, each prescription item costs £6·85, unless a patient is entitled to free prescriptions. Members will be aware that there are several grounds for exemption from paying for prescriptions. These include age, medical condition and income. However, the implementation of exemptions is complex and highly bureaucratic.

Until now, the direct rule Government’s view has been that if people can afford to pay for their medicines, they should do so. Annually, approximately 28 million prescriptions are dispensed here. The income from charge-paying patients is around £13 million. That must be set in relief against the £360 million that is spent on medicines prescribed by GPs. Of that £360 million, only a small proportion — around 3·5% — is recovered. Additionally, each year, hospital consultants prescribe approximately £100 million worth of drugs, all of which are free to patients. Therefore, only a small proportion of the costs is recovered as income through prescription charges.

People who are not exempt from prescription charges, and who need regular medication, can reduce their costs by using pre-payment certificates. These certificates cost £98·70 for 12 months. If a person buys a pre-payment certificate, it allows him or her access to a year’s worth of medicine for £100.

Approximately 90% of NHS prescription items are dispensed free of charge: not 90% of prescriptions, but 90% of prescription items. Although that appears to be a lot, it disguises the fact that it accounts for approximately 28 million items.

One prescription with, for example, four items on it will cost about £27. Therefore, prescription costs can be an onerous financial burden on families. I know only too well of large numbers of people — people with serious, often chronic conditions — who still have to pay for the very medication that is keeping them alive. That is not the kind of NHS that we envisage because it is not a free service. That principle apart, there are serious inequities and weaknesses in the current system that must be addressed. Irrespective of our views on charging for prescriptions, Members must ask whether the current system reflects the best way to deliver medicines to those people who need them.

We must consider the categories for exemption. Aside from age, pregnancy, a war disability and income, several medical conditions are listed as exemptions, with no apparent justification for their inclusion, while others are excluded. How does that stack up in equality terms? Do we have a rational and robust explanation for why one person is exempt and another is not? Why does one person’s suffering have a greater priority than that of another? Those are the questions that must be answered. The rationale must be defensible on the basis of evidence or health grounds. Why is a prescription issued by a hospital consultant free of charge, while the same prescription, written by a GP, for the same illness and the same patient, attracts a charge?

There is no good answer to that either. Why is a 50-year-old with a serious illness charged for prescriptions, yet a 60-year-old with a different illness, who may be better off, can get free prescriptions? I could go on, but the point is clear. The current system cannot be the best, and it should be changed.

As Minister of Health, Social Services and Public Safety, however, I know that my Department’s budget is neither infinite nor a bottomless pit. I have a responsibility — and I am well aware that Members will hold me to that responsibility — to ensure that the budget is spent in the most prudent, far-seeing and intelligent way for the health, social care and well-being of the people of Northern Ireland. In short, I shall decide how and where the health budget is best used to maximise its impact.

It worries me to hear evidence from patients and their families that prescription charges deter some people from having their prescriptions dispensed, either in part or entirely. The long-term costs for the Health Service of avoidable hospital treatment would improve if patients were able to afford the medication needed to treat their condition.

I am aware that people who might be able to go back to work fear that, in doing so, they will not be able to afford the prescriptions to which they were entitled when unemployed.

There are many anomalies in the system. Not only is it complex and bureaucratic, and breaks the principles of the Health Service as laid down, it is, on several grounds, hard to justify. For example, hard-working families feel that they are being taxed twice; they pay their taxes for the National Health Service and, as patients, they pay prescription charges. Northern Ireland’s hard-working families deserve better. They deserve a National Health Service that is genuinely free at the point of use, and that must include prescriptions.

There are equality implications for the people of Northern Ireland in ensuring fairness and social justice. Scotland, England and Wales have recognised the fundamental flaws in the existing system. Scotland has concluded that the list of exemptions must be substantially extended and seeks a fairer alternative to the present charges. In England, a review of the list of conditions already exempt is being undertaken, and a report will be forthcoming later in the year. England also recognises that the existing system is flawed and not fit for its purpose. As Members know, the National Assembly for Wales abolished prescription charges — not all at once, but over five years.

I welcome the motion, which supports my expressed intention to establish a cost-and-benefit review for the purpose of abolishing prescription charges. The time is right for Northern Ireland to look at arrangements locally. My officials will establish a review that will inform how we move forward on this question. The review group will include representatives of the key stakeholders involved — pharmacists, doctors, and, most importantly, patient representatives through the health and social services councils.

I want the review to take full account of the needs and wishes of patients, as well as of the practical implications for the professionals who have to deal with the consequences. The review will involve wide research and public consultation, and an equality impact assessment will be undertaken. I shall ask the review group to report back to me before the end of the year with options and recommendations. I shall bring my decisions and proposals back to my colleagues in the Executive, the Health Committee and the Assembly for approval.

I am delighted that the hon Member for Strangford Kieran McCarthy supports the inclusion of the amendment proposed by my hon Friend Tom Buchanan. The issue of prescription charges is an important one for the Assembly to debate. Our counterparts in the Scottish Parliament and the National Assembly for Wales have also considered the matter. Wales has abolished prescription charges for everyone; Scotland has been more circumspect.

Although free prescriptions are a fine idea in principle, the prospect raises other significant issues that must be fully considered before a decision can be reached. From where would the extra funding be found? What other services might suffer as a result? Access to expensive but effective new drugs, which is already very limited, could be reduced further.

The current exemption list should be reviewed, as it disadvantages those with certain lifelong or terminal illnesses who depend on regular medication. For example, patients who receive free prescriptions for diabetes may also benefit from free prescriptions for other ailments. Some may ask whether that is necessarily fair. Those patients can avail themselves of an all-round free prescription service while others with life-limiting cystic fibrosis cannot access free prescriptions for anything. A review of the current list of exemptions should be carried out, and I am delighted that the Minister has announced one this afternoon.

Initiatives to control the number of prescriptions being issued should also be investigated, so that the service is not taken advantage of or misused in any way. We do not want to reach a position in which over-the-counter drugs that are already available are sidelined in favour of free prescriptions. The sale of over-the-counter medications must be monitored. GPs will also need to monitor whether patient demand for free prescriptions increases. How will GPs react if that occurs? Those patients and families who are living with terminal or lifelong illnesses should be considered.

Free prescriptions already benefit many groups of people, such as those on low incomes and women during and after pregnancy. There is clearly an argument that those who can afford medicines and are not dependent on prescriptions should not necessarily be exempt. We also need to calculate the likely amount of drugs that would be wasted if all prescriptions were to be free of charge, and, again, how that might be monitored. If people no longer value their medications, compliance will suffer and more money will be wasted.

It seems reasonable that patients who are subject to compulsory treatment orders should not be expected to pay for their medication. That should be a ground for exemption in any new list of conditions.

In considering the shape of a further list of conditions, it is widely felt that all patients who are terminally ill or have lifelong conditions should be exempt from paying prescription charges. It is felt that many other specific conditions should be included on any new list. Among those most commonly mentioned are cystic fibrosis, cancer, asthma and mental illnesses.

I am pleased to support the motion and the amendment.

I congratulate you on your appointment, Mr Deputy Speaker. A lot of people were congratulating you yesterday. I have worked out that if all 108 of us were to congratulate all the new Deputy Speakers, we would be here until Christmas. I sincerely wish you well, as I do the other Deputy Speakers and, in his absence, the Speaker himself.

The issue is very important to me as a GP. I do not have much to say, because it has all been said, and I do not want to be repetitive. I am in my twenty-seventh year as a doctor. Apart from one year in Australia — 1985-86 — I have spent all that time in the NHS. I am delighted to hear the representatives of all parties going right back to the fundamental principles of the NHS, which was set up just after the Second World War.

Like many GPs, I believe in the fundamentals, concepts and ethos of the NHS: equity for all patients; free at point of use; funded through general taxation; and available to all on the basis of need. That final point is important, because as recently as this morning there was a radio discussion about the possibility of people being refused healthcare, and operations, if they are too obese, or if they smoke. That is a dangerous and wrong road to go down. That, however, is an issue for another day.

Healthcare should be universal, and there should be equitable access for all. Most of my GP colleagues would agree that those are the tenets of the NHS. I absolutely support the motion. As I am also wearing my GP hat today, I am delighted to hear Members from all parties expressing concern for “poor” GPs. [Interruption.]

Some Members:

Poor? [Laughter.]

I do not mean poor in the financial sense, but certainly in the administrative sense. That point should be taken on board.

In the 26 years in which I have worked in the NHS, I have seen huge and dramatic changes, and the cost incurred is a big issue. The spiralling costs of operations have gone through the roof, and investigative procedures and drugs are now very expensive. A course of oral drugs for shingles can cost more than £100. That is one example of what drugs can cost in 2007.

Healthcare costs are increasing. I fully support my colleague and namesake’s motion, but constituents will want us to address other equally important, or more important, healthcare issues. The important word is “prioritisation”. Not enough operations are being done — waiting lists must be tackled. There are not enough front-line healthcare workers, or enough doctors or nurses, and the number of available hospital beds is a problem. I worked for five years at a hospital and I have now worked for 21 years as a GP, and I cannot accept trolley waits in modern-day healthcare. To have human beings on trolleys waiting in hospitals is an indictment of any Health Service in the developed world. That would not happen in a veterinary hospital, so resolving that situation should be a priority for us all in the Assembly, in particular for our new Minister of Health. I am delighted to see him in the Chamber, along with several members of the Committee for Health, Social Services and Public Safety.

Mental health has always been the poor sister in healthcare. It is necessary that the Assembly look at that issue, and I think that a will exists to do just that.

We have talked about 90% of prescription items being exempt. One benefit of the introduction of free prescriptions would be that it would do away with prescription-exemption fraud. Another issue that has been mentioned is what GPs call “poly-pharmacy” — where a patient who, although not in an exempted category, is not well off and has six or seven medical conditions, for which they pay six or seven different charges. That is wrong.

The review should look at certain simple medications that are currently free but that perhaps should not be available on prescription. The dangers of having free prescriptions across the board are that patients may not appreciate the medication and that there will be wastage. Regardless of the situation, GPs will always have the problem of poor compliance, which is something that will also be looked at during the review.

Does the Member agree that the primary objective of any Executive or Government should be the promotion of the good health and well-being of all its citizens and that one of the most significant steps forward that the Executive could take would be to reintroduce the Investing for Health strategy at ministerial and Executive level? I did not want to interrupt the Minister during his announcement this afternoon.

Yes, I agree.

I welcome the amendment. I know the good Member from West Tyrone Mr Buchanan very well, and I know that he has a deep interest in health. I agree with his amendment, although I would prefer that the word “criteria” replaced the phrase “list of conditions”.

We must be careful when dealing with this matter. For example, rubs, sprays and lotions that people currently get on script should be taken off prescription. That issue should form part of the review. However, we must ensure that very important medications are kept on script, and those prescriptions should be free.

Mr Buchanan mentioned the fact that it would be difficult to deal with a list of drugs as opposed to a list of conditions. I do not agree with that. Doctors would be much happier to deal with certain drugs. Indeed, doctors would know what drugs should be on script and what ones would be better given over the counter. For example, somebody could ring the doctor’s surgery to say that they have a serious back injury and ask for a spray, but that spray may only be needed for a sports bag. People could say that their child has a serious fever and needs Calpol, but it may well be used just for teething. Different scenarios must be considered.

I agree with my colleagues across all the Benches that it is wrong that less-well-off people who suffer from conditions such as cancer, multiple sclerosis, debilitating rheumatoid arthritis and chronic heart disease have to pay for prescriptions, while a 60-year-old millionaire may well get Calpol free on prescription. That is wrong, and it is an issue that we must consider.

People have asked how free prescriptions will be paid for. I do not know. Again, this is a subject for discussion in the review. However, we have been told that the reforms that will arise from the review of public administration (RPA) will help front-line services and will focus on patients’ needs. If those reforms do what they say on the tin, money should be available for many more front-line health services and for patients. Thus, that is one area in which money could potentially be found. I was delighted to hear the Minister say that we as a group should push for a very substantial and decent healthcare budget. I hope that that will be the case.

We must deal with all the other front-line issues — hospital bed shortages, trolley waits, operations and mental health — and ensure that important medications are kept on prescription while very simple medications that really do not belong there are taken off prescription. If we can deal with all that, I believe that we can realistically look towards the introduction of free prescriptions for all in Northern Ireland.

I support the motion.

Question, That the amendment be made, put and agreed to.

Main Question, as amended, put and agreed to.

Resolved:

That this Assembly calls upon the Minister of Health, Social Services and Public Safety to establish a cost and benefit review for the purpose of abolishing health prescription charges as has been carried out in Wales; and to review the list of conditions that currently entitle patients to free prescriptions in order to reduce anomalies.