Public spending review to put up prescription cost: NHS expenditure will rise in real terms every year as promised, Virginia Bottomley told Colin Brown

PRESCRIPTION charges are likely to be raised by more than the inflation rate next April to over pounds 4 per item as part of the toughest review of public expenditure in a decade.

Virginia Bottomley, the Secretary of State for Health, in an interview with the Independent, defended the principle of increases. 'Prescription charges are paid on one item in five. The prescription pays less than half the cost of the drugs. Limited charges are a long-standing part of the health service, supported by political parties of both sides. Each year a judgement has to be made about how we can maximise the benefit to patients. Prescription charges are one of the aspects of that discussion.' Prescriptions would be raised to pounds 4.12 per item if, like this year, they were increased by 10 per cent. Mrs Bottomley said the Government would be able to fulfil its election pledge to increase spending in real terms on the NHS every year, in spite of the public spending cuts. But she said 'tough decisions' would have to be taken.

However, Mrs Bottomley made it clear that new NHS charges were not on her agenda. She had no plans to introduce 'hotel charges' to cover the accommodation, bed and food costs of hospital patients.

Mrs Bottomley, having served as William Waldegrave's deputy at the Department of Health, was given the task by John Major of defusing the NHS as a political minefield for the Tories, and securing peace with the professions over the changes to the health service.

She is keen to avoid the rebellion among dentists spreading to GPs, who are angry at a threat to claw back pounds 3,831 in an overpayment that they earned by meeting targets for treatment but which may have to be paid back under their net remuneration system.

Mrs Bottomley is having to perform a delicate balancing act between calming the professions and meeting the cuts in spending growth demanded by Michael Portillo, the Chief Secretary to the Treasury.

Mr Waldegrave's White Paper, The Health of the Nation, said 'setting priorities is essential' because the NHS would always face finite resources meeting infinite demand. Would Britain follow the United States by telling patients that some treatments would not be available on the NHS - an idea being studied by the British Medical Association?

Mrs Bottomley said the insurance-based US health system and the largely publicly-funded NHS were not comparable. But she acknowledged that some rationing of health is going on.

'I don't see anything new in commissioners of health having to make judgements. What is new is that there is a more explicit commitment to commissioners for health care (the health authorities) assessing the health needs of the local community and then commissioning the services to meet those needs. The process is more explicit.

'The health authorities will always have to assess need and allocate resources accordingly. Inevitably, they will always give priority to more urgent cases. The recent debate with Teresa Gorman (Conservative MP for Billericay) on the removal of tattoos was interesting to the extent of the number of people who said, 'Why is the health service tackling tattoos anyway?' There are guidelines that the removal of the tattoo needs to have some significance in terms of the well- being of the patient.'

The changes to the NHS had introduced a split between purchasers - GPs and health authorities - and providers of health care - hospitals - in the NHS. Mrs Bottomley believes the power of the GPs to deliver improvements for their patients is insufficiently understood. She said: 'The leverage of the purchaser is an area that I want to see developed and understood by the public.' The main objectives she had issued for this year were the Health of the Nation White Paper, which set out targets for reducing disease, community care, the patients' charter, and detailed improvements including the care for the mentally ill. The objectives target finite health resources for maximum health gain, she said.

But the debate about health rationing is over whether the public should know where the cut-off point in treatment on the NHS falls, and whether the NHS should continue to attempt to provide a comprehensive service. Mrs Bottomley is reluctant to allow the expenditure review to force the issue on to her agenda.

She said she was 'quite confident' that she would be able to emerge from the spending round with the election commitment on health spending intact.

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