The Tories need a dose of reality

Once again the news that the number of prescriptions issued in Wales has gone up has been met with the same old response from the Tories: "It's because they're free, and we should start charging for them again."

So once again I have to write a post explaining that the rise has absolutely nothing to do with how much they cost. Year on year, the number of prescriptions issued in both Wales and England goes up by about 5%. The 61.9% rise in Wales over the past decade is actually less than the rise in England, which has seen a 67.9% increase over the same period even though their prescription charge has kept on rising.

In fact the only thing remarkable about last year's 3.3% increase in Wales is that it is so low. As we can see from the link, the rise in England last year was 4.6%.


Yes, the number of prescription items per head is higher than it is in England; but it has been higher for many years, largely as a legacy in the form of chronic industrial diseases. The gap hasn't suddenly appeared as a result of free prescriptions.

The only explanation for this knee-jerk response must be that the Tories are suffering from the same sort of disease: a chronic inability to put statistics into perspective. But sadly it's contagious, because we'd expect a healthy news media to have picked up on this by now and do some analytic reporting, rather than just collating quotes and figures. For if the BBC has got it bad, the Western Mail's version is much worse. For them, the number of prescriptions has not just risen, the figures are now "massive" and "staggering". So perhaps a strong dose of sedatives is required too.

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Siônnyn said...

The Western Mail story is another example of what is looking more and more like a deliberate attempt at casting every story as unfavourable to Wales, regardless of the facts. The rate of increase in England is 40% more than that in Wales - no that would make a good headline!

I think also that the number of retired people moving to Wales from England has a significant effect - reducing the preps over there, and increasing them here. Another good story.

Pads said...

It's as though treating sickness was a bad thing. More operations good, more medicine bad?

Just as worrying is the assumption that the bill must be picked up by the sick.

Pads said...

@Sionnyn also the demographics of Wales are very different to England: age profile, poverty, industrial past... you name it.

The media love a headline - "Unemployment up 23,000", a figure well within the margin of error of the Labour Market Survey. Ben Goldacre in the Guardian writes about this kind thing. It's inspired me the do a maths course with the OU so I can see through the BS.

Hendre said...

I'm rather curious about the activity of the Rarer Cancers Fund in England. They went to the trouble of obtaining information from PCTs in England on prescribing patterns of certain cancer drugs - fair enough, part of their remit - but then went on to compare precribing in England with that in Wales and Scotland. It's very kind of them to be concerned about us but it's hardly within their remit. It seems politically motivated i.e. 'bigging up' Tory policy in England while making unfavourable comparisions with health policy decisons elsewhere.

Ioan said...

Great post MH.

Hendre, follow the money. Rarer Cancers Fund in England is funded by:

Hendre said...

Ioan, thanks for the info! I had confused the Rarer Cancers Foundation with the Coalition's Cancer Drug Fund. So it's big business (in the main) who is making these unfavourable comparisions (and undermining the role of NICE).

MH said...

Aside from the red herring of free prescriptions, the number of items prescribed per person is probably a good measure of the relative ill health of Wales, and that should be of concern. But we would need to look at the reasons for that. Chronic industrial illness is one, though that is probably on the decline as people of that generation pass away. Siônnyn is right to point our demographic profile includes a higher proportion of older people. And another factor is that we are relatively poor; if there was a regional breakdown of figures in England we would probably be on a par with the NE, NW and WMidlands of England.

I hadn't thought about it before, but Pads is right to note that a higher number of operations is counted as a "success" but that some people think the opposite is true of prescriptions. In many cases appropriate medication taken early enough can prevent the need for more drastic intervention later. A middle aged man who doesn't "feel ill" might well think he doesn't need to spend £7.40 a throw on a drug that might or might not prevent a condition from developing, only to find himself in the operating theatre in ten years' time. That's not a success, that's a failure.

I'm totally convinced of the desirability of making medication available for free. If there were evidence of free prescriptions being abused, we might well have to think about how to deal with that abuse. But there isn't, as the figures I linked to show. We hear the same paracetamol story time after time, but nobody in their right mind would go to see their GP just to get a 16p packet of paracetamol for free. Yet if they felt they needed to go to the doctor anyway and paracetamol was then included in a prescription, what's wrong with that? And of course people that earn more should pay more, but they already pay more through the tax system. But isn't it odd to see the Tories saying that the better off should pay more than they currently do ... are they advocating higher taxes for the rich? Free prescriptions primarily help the "working poor", i.e. those that are not on benefits, but working on low wages to provide for themselves and their families.


As for the RCF, what Ioan says repeats a point made by BlogMenai about the funds they receive from pharmaceutical companies. The big picture is that we have to accept that some drugs either have not shown themselves to be effective, or provide only limited benefits and probably cost more than can be justified from those benefits. That's why some drugs are not routinely available on the health services of Wales, Scotland and England.

But there should be exceptions in special cases. Both Wales and Scotland have mechanisms for this ... and the cost, whatever it is, will come out of the respective NHS. All that is different in England is that a specific, separate fund has been set up to pay for this. It is true to say that more people benefit from the English arrangement than the Welsh and Scottish arrangements. The question is whether it's worth it. Obviously any story of someone dying of cancer is heart-rending, but the story of moving to England is full of "mays" and "mights"; and although someone might get a drug that they wouldn't get here, that drug might not do very much to prolong the patient's life or improve their quality of life in the months they have left. If there was any reasonable chance that it would, then I'd have thought it would be available in Wales through the exceptional case mechanism.

MH said...

Adding to what I said, but turning now to politics, the main thrust of Tory policy in Westminster is that even though they have had to make wholesale cuts in public expenditure, they have chosen the health service as their one exception. This is a clever political move, for they can claim that health is "the one most important thing" and point at it whenever anyone makes a point about the cuts that they are making everywhere else.

But the other factor is that politics in Westminster is a two horse race between the Tories and Labour. In order to attack Labour to prevent them forming a government in Westminster in 2015, the Tories are going to attack the only Labour government in the UK ... which just happens to be in Wales. Therefore everything that is worse in Wales than it is in England is going to be held up as the fault of the Labour government in Wales. The two will, so far as the Tory attack plan is concerned, become the same thing.

So I agree with Hendre that this report has a political dimension, but I think that this is only the thin end of the wedge. Comparisons with Wales are going to become more and more frequent over the next few years. It will be interesting to see not only how the Welsh government responds, but how the Labour opposition in Westminster responds. When Labour were in power in Westminster, Welsh Labour were anxious to put "clear red water" between themselves and Labour in Westminster. Will we now see the much less left wing Labour party in Westminster trying to put "clear pink water" between themselves and the Labour government in Cardiff?

Anonymous said...

Finally some sense- when I read the BBC and W.M article on this. The one thing I wanted to know was - what was the increase for England (to compare). Yet they didn't show this- as it would not be a story.

The one thing I would press the W.G on is to try and get 'smaller' sizes of items on prescription. For example when you get bandages, all you need is one or two - you end up with a bagful - all gone to waste. This isn't the fault of GP's or Pharmaceuticals - but the suppliers, and the W.G should press down on them.

Siônnyn said...

I know the number of prescriptions per person in Wales is greater than those in England, but as the rate of increased issuance in England is 40% higher than in Wales, then the gap is closing, and England will eventually overtake us if current trends continue. Isn't that a story?

And as for the esoteric cancer drugs, has anybody got information on how many people in Wales would be treated if we followed the English model? And of those, how much quality time would it gain them? And which other patients would be disadvantaged by diverting these funds? The WM, if it wants to be considered a serious paper, should have covered these questions in it report. Perhaps it has given up the hope of ever be taken seriously again.

MH said...

I suppose it's fair to say that the gap is closing, though very slowly, Siônnyn. But I'm not sure if this is what really matters.

What's happening all too often is that a particular set of figures which measure the "input" is deemed more important than the "output". The Tories and LibDem do the same with education: they cite the £600 per head spending difference between Wales and England as the main reason for the difference in GCSE results in Wales and England. But as any look at the variation between spending figures in different local authorities will show, there is no correlation between the amount spent (the input) and the GCSE results (the output).

The same faulty logic is being applied in the case of unapproved drugs. What matters is not whether you spend money on a particular drug, but whether that drug will actually make a significant difference in either prolonging or improving the quality of a patient's life.

And the same is true of the number of items issued on prescription. In itself, a high number of items is nothing to be defensive about; what matters is whether the medical needs of patients justify the items being prescribed. Any concern should not be about the numbers of items, but about what it shows us about the relative ill health of people in Wales.

As to your question about how many people would be treated if we followed the English model, the figures in the report are that 159 patents would receive these unapproved drugs rather than the 31 who get them through the current exceptional case mechanism. But we shouldn't confuse getting these drugs with how much benefit they provide. There's a very relevant letter by a Dr Gareth Rees on the subject, here.

And as for the Western Mail, they have just seen an 8.9% drop in their circulation to just under 27,000, at the bottom end of the table. So questions need to be asked about its future. I would like to see the Western Mail and Daily Post combine to create a truly national paper. The Daily Post has had only a very minimal fall in its circulation, so it is seems to be doing things better than its southern sister.

Cibwr said...

and of course the Tories claim that by putting a £2 charge on higher earners they will make enough to fun a cancer fund, whilst ignoring that it may well cost more to collect than it generates.

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