The following table provides an estimate of direct and overhead costs for the administration of prescription pre-payment, maternity exemption and medical exemption certificates for the latest eight financial years in England. These costs are the only elements of the prescription charging system that can be separately identified for England. Information prior to 2006-07 is not retained by the NHS Business Services Authority.

There are various sources of data on medicines in hospitals. The Health and Social Care Information Centre publishes annually the document, ‘Hospital Prescribing: England’, the latest copy of which is available at:

www.hscic.gov.uk/catalogue/PUB12651

From incidents reported to the National Reporting and Learning System (NRLS) there is evidence that the prescription of opioid medicines for all conditions, including chronic pain, have led to

fatal overdoses in patients in England and Wales. However, this information cannot be used to provide evidence of abuse.

The report A review of controlled drug incidents reported to the NRLS over seven years (2005 to 2011) published in the Pharmaceutical Journal in 2013 provided details of the number and types of patient safety incidents involving Controlled Drugs (CDs), including opioid medicines, reported to the NRLS. In addition incidents with reported outcomes of death and severe harm were also analysed qualitatively. A copy of the report has been placed in the Library.

There were 72,028 incidents reported to the NRLS over the seven year period. Of 10,678 incidents of reported harm there were 54 deaths, 74 incidents of severe harm and 10,550 incidents of other harm. Incidents involving overdose of CDs accounted for 89 (69.5%) of the 128 incidents reported of serious harm (combining death and severe harm).

Unsafe use of CDs is the number one cause of serious harm from medication incidents reported to the NRLS. NHS England is working with the Care Quality Commission and has established a clinical safety group of the National Accountable Officers for Controlled Drugs Committee. This group is providing further guidance to Accountable Officers for Controlled Drugs and healthcare practitioners on safer use of controlled drugs.

The NHS optical voucher scheme provides financial support by way of a voucher to eligible persons to help them buy goods such as spectacles. The vouchers are simply a means of financial support; the VAT consequences result from the goods and services that the voucher is used to buy. Therefore, VAT exemption will apply to the eye test, fitting services and any medical treatment of an eye condition and VAT will apply to the spectacles, irrespective of how payment is made.

The Department does not intend to abolish prescription charges in England, which raise in the region of £450 million each year. This is valuable income, which helps the national health service to maintain services for patients.

An extensive system of exemption arrangements are in place which mean that around 90% of all prescription items are already dispensed free of charge.

Prescription Prepayment Certificates (PPCs) are also available for those who have to pay NHS prescription charges and need multiple prescriptions. The cost of the annual and three-month certificates have been frozen for the fifth and third years running, at £104 and £29.10 respectively, and will also remain frozen next year. There is no limit to the number of items that can be obtained through a PPC. The annual certificate benefits anyone needing more than 12 items a year, and the three-month certificate anyone needing more than three items in that three-month period.

Departmental officials have had no such discussions. Officials may discuss individual highly specialised technology topics with the National Institute for Health and Care Excellence, including at the topic selection stage.

The National Institute for Health and Care Excellence (NICE) follows a rigorous process in the appraisal of technologies to ensure that judgments regarding the cost-effective use of NHS resources are consistently applied. This includes consideration of the uncertainty generated where available data have serious limitations.

When making judgments on cost effectiveness, the NICE appraisal committee will consider a number of factors including the strength of the clinical-effectiveness evidence, the innovative nature of the technology, the robustness and plausibility of the economic models, the degree of certainty around the incremental cost-effectiveness ratio (ICER), the range and plausibility of the ICERs and the likelihood of decision error and its consequences. Full details of how the Committee takes uncertainty into account is contained within sections 5.8, 6.3 and 6.4 of NICE’s Guide to the Methods of Technology Appraisal 2013, which is available at:

http://publications.nice.org.uk/guide-to-the-methods-of-technology-appraisal-2013-pmg9

NICE advises that it has not carried out an assessment of the average range around the most plausible cost-per Quality Adjusted Life Year (QALY) in its technology appraisals. We understand that although NICE usually specifies the most plausible cost-per-QALY for each technology appraisal, it does not normally specify a range for this assessment.

We have no plans to do so. As an independent body, the National Institute for Health and Care Excellence is responsible for developing its methods and processes and applying them consistently.

National Institute for Health and Care Excellence (NICE) technology appraisal decisions published between 2000 to end of February 2014 have already been placed in the Library.

NICE has advised that it does hold the most plausible cost per quality adjusted life-year for each technology appraisal, the estimated patient population for each appraised indication, details of appraisals where the end-of-life criteria were applied in each final appraisal determination and the dates each appraisal was initiated and concluded. However, this information could be provided only at disproportionate cost.

Data on the proportion of people receiving medicines is not held centrally; the National Drug Treatment Monitoring System (NDTMS) collects data on patients who receive prescribing interventions in a range of settings, but not which drugs they are prescribed.

The Health and Social Care Information Centre publishes data on the number of prescriptions dispensed in the community and in 2012-13 just less than three million prescription items containing either methadone or buprenorphine were dispensed through primary care facilities.

In addition to methadone and buprenorphine, which are recommended by the National Institute for Health and Care Excellence (NICE) for treating drug misuse, drug treatment should always involve evidence based psychosocial interventions. These psychosocial interventions are designed to treat drug misuse and help drug misusers achieve specific treatment goals. They are the mainstay of treatment for the misuse of cocaine and other stimulants, and for cannabis and hallucinogens.

People receive prescribing and psychosocial interventions in different settings, and these are recorded by the National Drug Treatment Monitoring System (NDTMS) as;

— Community;

— Primary Care;

— Inpatient Unit (prescribing in this setting is mostly for detox);

— Residential rehab; and

— Recovery House.

The NDTMS data which shows how many people received psychosocial interventions and prescribing in each of these settings, broken down into the four public health regions is in the following table.

Table 5.2.3: Interventions received by clients in treatment 2012-13, new interventions

* This is the total number of individuals receiving each intervention type and not a summation of the psychosocial and prescribing columns.

Table 5.2.3 provides information on interventions commenced after the changes to the core dataset on 1 November 2012 (see section 1.5 for more detail on this change). It shows the number of clients who received each intervention by setting for interventions starting on or after 1 November 2012 based on the new intervention codes. If a client’s intervention features in Table 5.2.3, the same intervention (for interventions that can be directly mapped between tables) is not featured in Table 5.2.2 to avoid double counting.

In the calendar year 2012, 73.5 million of dispensed prescription items, which accounted for 7.3% of the total of 1,000.5 million prescription items dispensed in 2012, were exempt from a charge as a result of medical exemption.

Information on the number of charge-exempt prescriptions in 2013 will be available in July this year.

No reliable information is held centrally on the number of prescription items which were exempt from charges in 2011 or previous years.

This information was provided by the Health and Social Care Information Centre (HSCIC). It should be noted that HSCIC records only one exemption category per prescription item, so that prescriptions for a patient who is, for example, exempt from prescription charges

on the grounds of age as well as due to a medical condition would be recorded under one or the other, but not both, of these categories. The information does not record if more than one exemption category applies.

The cost to the public purse of extending entitlement to free prescriptions to all claimants of universal credit once universal credit has been fully rolled out will depend on the number of claimants at that time. This number will depend on a range of factors. This is likely to be greater than the number of people that currently qualify for free prescriptions because of their current benefits or tax credits. However the Government intends that broadly the same number of individuals will be passported via universal credit as are currently passported.

National Institute for Health and Care Excellence (NICE) guidance is based on a thorough assessment of the available evidence and is developed through wide consultation with stakeholders. Clinicians are expected to take NICE guidance fully into account in their prescribing decisions but it does not replace the judgement of clinicians to determine the most appropriate treatment for individual patients. NICE guidance is not mandatory for clinicians and the Department does not monitor its implementation.

Health service commissioners are legally required to fund those treatments recommended by NICE in its technology appraisal guidance.

The latest report on the, Use of NICE appraised medicines in the NHS in England was published by the Health and Social Care Information Centre on 21 January 2014. The report looks at the use of medicines recommended by NICE in relation to the estimated number of eligible patients, where possible, and variation in use of medicines over time. The report is available at:

www.hscic.gov.uk/catalogue/PUB13413

The most recent release of NICE Technology Appraisals in the NHS in England, Innovation Scorecard (to September 2013) was published by the Health and Social Care Information Centre on 5 March 2014. The Scorecard uses National Health Service and industry data to provide patients and the public with information on the treatments available within their local hospitals and NHS services. It is available at:

www.hscic.gov.uk/catalogue/PUB13669

The following table shows the number of prescription prepayment certificates (PPCs) purchased in England in each calendar year 2011 to 2013. The publicity campaign to promote the uptake of PPCs commenced in late 2012.

The general trend in PPC uptake has continued to increase steadily over the last three complete calendar years. The increase in 2013 may be due to a number of factors including the publicity campaign, increases in the number of prescription items and a freeze in the price of PPCs.

Annual sales of PPCs in England 1, 2

Year

3 month PPCs

12 month PPCs

All PPCs

2011

676,844

658,314

1,335,158

2012

684,897

742,873

1,427,770

2013

690,515

832,348

1,522,863

Source: NHS Business Services Authority

Note:

1. The data includes new and renewed PPC purchases.

2. The figures provided include PPCs which have been issued and refunded at a later date. A patient can apply for a proportional refund of the amount paid for a PPC if their circumstances change and the patient becomes exempt or are entitled to remission from NHS prescription charges.

The limited number of studies conducted to date indicate that the risk of passive exposure to electronic cigarette vapour is small relative to tobacco cigarettes. Further research was, however, recommended to evaluate the impact of e-cigarettes on indoor air quality and to estimate any possible effects of passive inhalation of e-cigarette vapour. There is no research assessing the risks to health in small confined spaces, such as cars.

No estimate has been made of the cost of prescribing licensed e-cigarettes. Any e-cigarette licensed as a medicine would be treated as a nicotine replacement therapy (NRT) in accordance with the National Institute for Health and Care Excellence public health guidance on smoking harm reduction. The revised European Union Tobacco Products Directive makes provision for e-cigarettes not subject to medicines licensing to be regulated as consumer goods with specific requirements set out in the directive.

The current cost of prescribing NRT on the national health service can be found in the Prescription Cost Analysis section of the NHS Business Services website at:

www.nhsbsa.nhs.uk/PrescriptionServices/3494.aspx

The following table provides an estimate of direct and overhead costs for the administration of prescription pre-payment, maternity exemption and medical exemption certificates for the last complete financial year in England. These costs are the only elements of the prescription charging system that can be separately identified.

Costs for processing prescription charges cannot be provided, because they are processed as part of the reimbursement arrangements for dispensers in England and are not separately identifiable. Costs cannot be provided for the pursuit of prescription charge fraud as it is not possible to separately identify this from the cost of tackling other types of NHS fraud.

There are additional costs associated with the issuing of NHS tax credit certificates and assessment of eligibility for the NHS Low Income Scheme. These are not included in the table because the English costs cannot be isolated from costs for the devolved Administrations. In addition these certificates do not solely relate to prescription charges as NHS tax credit and NHS low income scheme certificates also provide help with the cost of NHS dental treatment, sight tests, vouchers towards the cost of glasses or contact lenses, NHS wigs and fabric supports, the cost of travel to receive NHS treatment on referral, as well as help with NHS prescription charges.