NHS prescription fines system causing distress to elderly and vulnerable

The current system for fining people who wrongly claim free prescriptions is not fit for purpose, MPs have said.

In a damning report, the Commons Public Accounts Committee said a huge number of penalty charge notices (PCNs) are handed out mistakenly, causing distress to patients, particularly the elderly and vulnerable.

MPs said the “presumption of guilt” means penalty charge notices are issued too readily to too many people.

Their report said: “Since 2014, around 1.7 million PCNs (30% of all PCNs issued) have been subsequently withdrawn because a valid exemption was confirmed to be in place following a challenge.”

PCNs are supposed to discourage people from claiming free prescriptions or dental treatment when they are not entitled to do so, with fines of up to £100.

But MPs argued patients are finding it extremely difficult to understand whether they are entitled to free prescriptions, and the current system of fines is “a heavy-handed rush to judgement”.

They said the Department for Health and Social Care (DHSC) and NHS England “have been shockingly complacent about the fundamental problems with the PCN process, justifying their approach because most exemptions are claimed correctly and the system generates additional revenue for the NHS”.

They said the NHS Business Services Authority (NHSBSA) has not attempted to identify those who are entitled to an exemption but pay for treatment, and the DHSC admits some patients are put off seeking treatment because they worry about fines.

Furthermore, a new system for checking whether people have a valid exemption at the point they pick up their prescription in pharmacies is also a long way off, MPs said.

A middle step alerting people to the possibility they are mistakenly claiming a free prescription and giving them a chance to rectify the situation has also not been put in place.

The report said that even when there is clear evidence that people are persistently committing fraud by making false claims, NHSBSA has failed to take effective action.

Almost 115,000 people have received five or more PCNs for prescriptions and more than 1,600 have received 20 or more – yet only five cases have been referred to the Crown Prosecution Service.

Committee chairwoman and Labour MP Meg Hillier said the “convoluted” system needs an overhaul.

She added: “The Committee fully support efforts to deter fraud and pursue those who claim exemptions to which they are not entitled to but the current penalty notice system is cumbersome, inefficient and not fit for purpose.

“The Department should substantially overhaul the system, so that those who are rightfully entitled to free prescriptions and dental treatment get the exemption they deserve.”

The British Dental Association (BDA) said the current system sees vulnerable patients, including those with learning disabilities, receive £100 fines for simply ticking the wrong box on a form.

Charlotte Waite, chairwoman of the BDA’s England Community Dental Services Committee, said: “A system that’s hurt our most vulnerable patients and treated millions who’ve made honest mistakes like fraudsters requires more than tweaks.

“Ministers shouldn’t be profiting from patient confusion. Families across England will keep paying the price until we get a fair and focused way to protect NHS finances.

“Dentists call on the Government to do right by our patients, and follow these recommendations in full.”

Dan Scorer, from learning disability charity Mencap, said: “People with a learning disability are being unfairly hit with fines for making honest mistakes when filling out complex eligibility forms to access the free NHS dental care and prescriptions they are entitled to.

“This is a huge source of unnecessary stress and worry for them, their families and carers, in some cases it stops people with a learning disability from accessing the treatment they need for fear of being fined. This is simply unacceptable.”

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