Monday, January 28, 2013

Poverty in Scotland

The Joseph Rowntree Foundation has published ‘Monitoring poverty and social exclusion in Scotland 2013’, produced by the New Policy Institute. This is JRF’s sixth assessment of poverty in Scotland.
The report is an excellent overview of poverty in Scotland using the latest data. It covers child poverty and the impact of welfare cuts on those in work and those who are unemployed. Overall, they highlight that the number of working-age adults in poverty remained unchanged over the decade to 2010/11, but there were changes from workless families to working families and from those with dependent children to those without.
The health section highlights three main points:
§  Health inequalities in Scotland are not only stark but growing. A boy born in the poorest tenth of areas can expect to live 14 years less than one born in the least deprived tenth. For girls, the difference is eight years.
§  Rates of mortality for heart disease (100 per 100,000 people aged under 75) are twice as high in deprived areas as the Scottish average.
§  Cancer mortality rates in the poorest areas (200 per 100,000) are 50% higher than average, and have not fallen in the last decade, while the average has fallen by one-sixth.
The report may not be a surprise, but it does add to a growing body of work in recent months on health inequalities in Scotland.

Thursday, January 24, 2013

Drug costs and free prescriptions

Audit Scotland has today published Prescribing in general practice in Scotland, its third report on the subject. It shows that NHS Scotland has improved how it manages prescribing in general practice during a period when it has faced considerable pressures.
GP prescribing accounts for 70% of all NHS spending on drugs in Scotland. This amounts to almost £1 billion a year. Spending fell by 11% in real terms between 2004 and 2011, despite the volume of prescriptions rising by a third during that time. The report says there is scope for further improvements and potential to save up to £26 million a year without affecting patient care. This could mostly be done through reducing waste and cutting the use of less suitable medicines.
While this is the headline from the study, I suspect many people will be interested in what the report has to say about the impact of free prescriptions. We already have ill informed comment from politicians who don't appear to have even read the report. Prescription charges in Scotland started to be phased out from April 2008 and were abolished in April 2011. The Scottish Government estimated that the total cost would be £73 million for the three years up to 2011/12, and £57 million in 2011/12 and in subsequent years. Critics argued that there is a risk that the abolition of prescription charges could lead to an increase in the overall quantity of prescribing beyond that anticipated.
The study says it is difficult to measure the impact of the abolition of prescription charges at present because:
·         the changes were brought in over a three-year period, making it difficult to identify a break point when trends changed;
·         the change took place against a background of increases in prescribing for many drugs;
·         over 90per cent of prescriptions were for people who were exempt from charges, making it difficult to distinguish any impact of the abolition of charges from overall trends;
·         changes to the community pharmacy contract make it difficult to assess the impact of drugs prescribed by community pharmacists under the Minor Ailment Scheme;
·         the total abolition of prescription charges took place in April 2011, too recently for our audit to identify emerging trends.
They did look at prescribing trends for three common drugs available to buy that are also available on prescription: paracetamol, ibuprofen (both painkillers), and antihistamines. They compared changes in prescribing trends for three years before and after April 2008 when prescription charges started to be phased out. They found that paracetamol went down by almost a half, Ibuprofen went up slightly and antihistamines almost trebled. The study argues that no trends can be observed, but an obvious conclusion is that paracetamol is very cheap and antihistamines expensive, so more worthwhile to get a prescription.

SHA Scotland long argued for free prescriptions, not least because some of those just outside the exempt category had to prioritise which drugs to take.  There is no evidence in this study that indicates that the policy is not viable.

Sunday, January 13, 2013

Healthier Scotland - Jan 2013

The January 2013 edition of our Bulletin, Healthier Scotland is now published.

The feature this quarter is on health inequalities, given the range of material published in recent months. But we also cover developments in mental health, NHS Scotland and public health.

NHS Scotland is rarely out of the news at present, so we hope this overview is helpful.

We hope to see members at the SHA Scotland AGM, this Thursday, 17 January at Glasgow City Chambers.