The public is being asked to take part in a consultation on proposals to make the law governing how the Island’s health service works more flexible and adaptable to meet current and future needs.
The National Health and Care Service (General) Scheme 2017 sets out the broad commitments the Department of Health and Social Care makes to the people of the Isle of Man in respect of the provision of care. It includes measures on prevention, diagnosis, treatment, care and after-care; from contracting doctors to run general practices, to providing specialist treatment off-Island.
The new approach of creating schemes, under umbrella legislation provided by the National Health and Care Service Act 2016, means government can more rapidly respond and adapt to changes, quickly amending the law when needed with the approval of Tynwald. This is in contrast to the current method which can be complex, time-consuming and costly.
A key element of the general scheme is to ensure harmonisation, fairness and consistency. Changes are proposed to the contribution individuals make towards the cost of their prescriptions, sight tests and dental treatment. In addition, the criteria that exempt certain individuals – such as children – from these contributions would be harmonised.
The changes being proposed would mean:
• The removal of some types of criteria that exempt certain individuals from paying a contribution towards the cost of their prescriptions, dental treatment and glasses
• An increase in the contribution towards the costs of prescriptions, rising from £3.85 to £5 per item, except for those individuals who are exempt
• An increase in the cost of prescription pre-payment certificates, from £19 to £20 for four months and £54 to £60 for 12 months
• An increase in the contribution towards the costs of dental treatment, from between £18.50 and £219 to between £20.60 and £244.30, except for those who are exempt
• A move from the availability of free annual eye sight tests to one every two years, with the introduction of a £10 contribution towards the cost, except for those who are exempt and entitled to a voucher
Changes to exemptions would see protection for individuals who are, generally, more likely to have a degree of vulnerability or be in need of additional support and include those:
• Aged under 16 years of age or under 19 years of age in full-time education
• Aged 75 and over
• In receipt of income support, jobseeker’s allowance, incapacity benefit, employed person’s allowance, or a war disablement pension
• In prison
Those who would no longer be exempt from making a contribution would include: people aged between state pensionable age and 75; persons who have specific medical conditions; and women who are pregnant or who have given birth in the past 12 months. As with the wider public these groups would be able to cover all of their prescriptions through the purchase of an annual pre-payment certificate for £60 – the equivalent of just £5 per month.
Minister for Health and Social Care, Kate Beecroft MHK, said: “The appropriate amount each of us should contribute towards the costs of some parts of our health care is a complex area of policy and one that, understandably, divides opinion. It is important to remember, however, that the contributions people pay are exactly that – contributions. Many medicines far exceed the cost of £5 per item being proposed; for example some inhalers can cost around £60 each.
“In bringing these proposals forward the Department has sought to balance the need to provide a fair system that does not disadvantage the vulnerable, whilst seeking the means to address the growing costs of prescriptions in particular. The welcome addition of extra revenue would enable the Department to continue to develop vital health services for the public; for example, the pressing need to introduce a 24-hour thrombolysis service for people who suffer a stroke.
“I expect these proposals to generate a lively debate in our community and we saw the start of this in the recent SAVE public consultation. I would encourage as many individuals and organisations as possible to take part and submit their views. The Department will listen to feedback and, in due course, bring forward any finalised proposals to Tynwald.”
The Government’s SAVE scheme, which invited suggestions from the public on how to save £25 million over the next five years, saw numerous contributors suggest a review of the exemption criteria for prescriptions as well as a review of the level of contribution made by the public.
Contributions towards the costs of prescriptions, dental treatment and glasses were introduced in the early 1950s in the UK and the Isle of Man, shortly after the creation of the National Health Service, in order to help fund the rapid growth in costs.
In the Isle of Man the level of contribution towards prescription costs have been, and are proposed to still be, well below those in England, where patients currently pay £8.60 per item. The increase would be the first rise since September 2010. Prescription pre-payment certificates would remain available and would continue to represent excellent value for money, meaning a patient can have all of their medicines for a maximum fee of £60 a year.
The level of contribution patients make towards their dental treatment has not been increased since 2015 and the proposed changes would bring fees into line with those in England.
In relation to sight tests, it may be that providers on-Island would offer discounted or free tests, as is often the case in England, where free sight tests were withdrawn in 1988.
More than £17 million was spent by Government on prescriptions in 2016/17, funding over 1.6 million items. Of these 90% were issued free of charge either because of exemptions or use of a pre-payment certificate. Less than £700,000 was recouped in fees.
The Minister concluded: “We are faced with significant challenges around improving the quality of our services whilst managing the pressures presented by an ageing population and increasing costs. However, our focus will remain on the continued delivery of the priorities set down in the DHSC’s five year strategy, which align with the policy statements within the Programme for Government.
“Our aim is to deliver value for money by paying attention to how we spend our funds, how we can reduce waste and how we can generate income, so that we can put as much money as possible into frontline services.”
The public consultation runs until 12 September and further information is available online at consult.gov.im.