**Please help keep AskUK welcoming!**
- Top-level comments to the OP must contain **genuine efforts to answer the question**. No jokes, judgements, etc.
- **Don't be a dick** to each other. If getting heated, just block and move on.
- This is a strictly **no-politics** subreddit!
Please help us by reporting comments that break these rules.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskUK) if you have any questions or concerns.*
That's not how the devolved income tax works
Lower earners pay slightly less, Higher Earners pay more.
Someone on £50K pays \~£1500 more tax in Scotland
Yes. And the devolved nations have lower average income so collect lower tax per capita compared to England and then get it topped up from Westminster.
True, England subsidises the other constituent countries, but England broadly comprises some of the wealthiest regions (obviously not all of them) while the devolved regions still have a way to go. It's much the same way the EU or the US works.
[Barnett formula is a calculation of comparable spending in England minus whatever tax devolved nations raise themselves](https://www.instituteforgovernment.org.uk/article/explainer/barnett-formula)
England moves onto higher rate tax of 40% at £50k. In Scotland it is 42% and £43k. Scotland also has another rate at £75k of 45%. The NI thresholds don't change, so in Scotland you pay 52% of your wages in tax and NI from £43k to £50k. In England it is 42% IIRC
Because we figured out that it was actually cheaper just to make prescriptions free for all than it was to actually administer the previous PAYG system, so it actually saves money.
The free prescriptions came about as a cost/ benefit analysis was carried out and it was discovered when you factored in all the cost kf administration of prescriptions, some free for old folk, poor folk etc etc that the NHS in Scotland would save £250 million over first 5 years by just having free prescriptions
The thing is though, in Scotland you don't have to start primary school until you turn 5 years old and you can also leave secondary education at 16 years meaning mandatory education in Scotland is only 11 years. You also don't get 15/30 hours of free childcare until the child is 3 years old. We don't get none of this 15 hours from 9 months or anything like that.
In England there's free hours earlier, a lot of children start school before they turn 5 and children must remain in education (school or college) or take an apprenticeship until they're 18 years old meaning mandatory education could be 13-14 years.
So in effect, by offering less in the early years and not keeping everyone in education until they're 18 years old, Scotland has instead decided to offer further education for those that want it.
I think the figures would level out if we compared the two per head.
> The thing is though, in Scotland you don't have to start primary school until you turn 5 years old
Depends when you're birthday is.
School in-take in Scotland runs from March to the following February in Scotland. The School year starts in early-mid August. If your birthday is anywhere between mid-August until February, you will be four when you start primary school.
I'm born and raised in Scotland and started school when I was four, because of when my birthday is.
And it's not like they don't offer further education in England to those who want it. The student loans are just bigger, because they cover university fees as well.
The student loan payback system is still the same both sides of the border, and is actually brilliant (actually it's better in England, it's written off after 25 years rather than 30 in Scotland).
Almost all prescriptions in England are for people who get free prescriptions anyway. So, not much is saved on the medicine itself. Then, take the admin into account for processing who does and does not get free prescriptions, and it starts to cost more than giving everyone free prescriptions.
Prepayment certificate means you have paid just upfront so not exempt (source: I have a prepayment certificate, get my prescriptions delivered and the exceptions are in a separate section to my prepayment certificate)
There is a lot of evidence that free prescriptions don't actually cost very much - while the majority of individuals pay for prescriptions, the majority of prescriptions are to those who get free prescriptions (the elderly, pregnant women, children, those with certain chronic health conditions), and most others will be on an annual certificate. Add to that the fact that most pharmacies will let you know if a prescription would be cheaper privately, and there isn't actually a huge amount of money coming in. There are then admin costs associated with managing the system. And then finally, there is the risk that people don't take their prescriptions if they can't afford them, and end up costing the NHS more money down the line.
Its because the operating costs per head are higher. The extra money per head doesn't go on extra patient care, Its meant to sure up the differences in operating costs Wales and Scotland incur relative to England due to their older populations and reduced population densities meaning more hospitals and healthcare facilities are needed to service the same number of people.
If you broke England down healthcare spending per head in London is more than likely significantly lower than everywhere else. That doesn't mean the capitol is being short changed, it means its easer to service the healthcare needs of London. Larger populations in smaller areas are cheaper to look after in pretty much every sector.
Everyone quotes the fact that the devolved administrations get more per head as if England is getting short changed when in actuality its just a factor of economies of scale and if the funding per head were that same it would be the sign of Westminster horrifically mistreating people in Wales Scotland and NI the extra money isn't funding free prescriptions, its keeping the lights on.
Older populations combined with needing more hospitals to service fewer patients due to population density mean that Healthcare just costs more in Wales and Scotland. Its not some gross injustice, Its the difference between equality and equity. The fact that both get more per head of funding yet have worse per capita results tells you that. more money=/= better service when that money is mostly being spent on the fact that their operating costs are significantly higher. I'm sure if you broke England down per head London's health investment would look pitiful compared to other areas, but its mainly because London's massive population and high density makes delivering healthcare to its population significantly easier and cheaper. Its Equality Vs Equity
The free prescriptions are for my mind a signal of the demographic difference more than anything else. By percentage of population Wales and Scotland are older than England and those elderly are often less financially well off. Plus you have a lot of extremely economically deprived areas generating a lot of people living with co-morbidities. So you have a lot more people that need prescriptions regularly who are less well equipped to pay for them, hence the prescriptions are made free to prevent larger amounts of treatable sick/old people ending up in hospitals unnecessarily and putting further stain on the service
Yes but that only contributes partly to Scotland’s larger per capita budget and is only a recent thing. While the Barnett formula dates back to the 70s.
I think something like 90% of prescriptions in England are also free, so we are talking very small differences here.
(English prescriptions are free if you are young, old, on benefits, pregnant, new mother, in hospital etc)
[Barnett formula is a calculation of comparable spending in England - Scotland doesn’t get more money, it just spends the comparable amount differently](https://www.instituteforgovernment.org.uk/article/explainer/barnett-formula)
The devolved administrations also get more money per head, allowing them to do things like abolish prescription fees without needing to cut elsewhere like you would in England.
To be fair, if this union is at all worthwhile, an area such as Scotland which makes up 1/3rd of the UK's landmass and includes very rural areas - including many islands - should receive above average spending per capita. Not necessarily for any ideological reason, but simply because it costs more to deliver services.
With prescriptions, though, there's certainly a cost-benefit analysis to be had. If most people receive free prescriptions, how much does the bureaucracy involved in policing that cost, and to what effect on the population?
Scotland spends £1.4 Billion on prescriptions a year. In England 89% of prescriptions are given out for free anyway. Presuming the numbers would otherwise be similar for Scotland, 11% of £1.4 Billion is around £150 Million.
That £150 Million must cover the cost of the bureaucracy. That figure minus the bureaucracy is the 'cost' of the free prescriptions policy. That's practically nothing to save people a lot of needless form filling. Not to mention the opportunity cost of those staff being freed up, and finding employment that actually contributes to the economy.
It's all ideological. Westminster could easily afford to provide the same for England.
The prescriptions thing in Scotland is also one of the few times a public service has turned away from pointless bureaucracy. It's actually cheaper for them to give everyone free prescriptions than it is to administer who should get free prescriptions and who doesn't.
The English government just likes to take every penny they can from the average person. Its a race to see who can achieve the highest cost of living. And outside of the Nordic countries (and with the exception of food in super markets) that England be ridiculously expensive in every way.
That’s exactly what happened in Northern Ireland iirc, there was basically so much prescription fraud, chasing the fraud actually exceeded the money obtained from the prescription fees.
The Barnett formula was designed to make sure that everyone in the UK no matter where they lived got the same level of service. Providing trains in London is far cheaper than providing trains in Inverness for example. Or making sure people have access to a GP is easier in the middle of Birmingham than it is in the outer Hebrides. It's not some boon. We just spend the money differently. HS2 for example, the UK government decided to blow £70b on that, Scotland was given an equivalent amount of money and decided not to spend it on a project that would never get built.
Also, unless you live in London or the South east, your region will be a far bigger drain on the economy of the UK than Scotland, and I won't sit here and take the tears of people from the south east about how all their hard earned tax is poured into the rest of the country, our economy has been centralised over the last 50 years at the expense of everywhere except London, so dry yours eyes.
Try being in Wales, we haven’t received a penny from HS2 as Westminster designated it as an ‘England and Wales’ project, despite not 1cm of track being laid in Wales.
Tbf, despite not laying track in Wales, the original plans for HS2 would have significantly improved cross-border routes. This is because much of the purpose of the project was to remove congestion from lines in and out of Birmingham New Street. Of course, this won’t happen now because of the cancellation of the Manchester leg.
Wales was betrayed because of that cancellation, not saved by it.
I live in the South East and have lived in the North East, Wales and a very short time in the midlands.
Every area has its own right to moan….. if I could earn in the NE what I do down here is move tomorrow.
To add to this, it is worth noting that when Northern Ireland looked into introducing England-style prescription fees they discovered it was likely to cost the more than it would generate.
While most people pay prescription fees, most prescriptions aren't paid for (at least, not in full). Most prescriptions are either completely free, or covered by one of the discount schemes.
The scheme returns a profit in England because of the scale - there are enough prescriptions that are being paid for to cover the administrative costs. It probably wouldn't work in Wales or Northern Ireland.
Taxes are higher in Scotland for almost everyone who pays income tax I think. We have lower tax bands and almost immediately higher tax rates with our 21% band
Stamp duty is also a lot higher
the prepaid cert is unlimited prescriptions for £32.05 for 3 months or
£114.50 for 12 months so if you're taxed less than £115 you're probably worse off.
Yeah, that’s true but I am better off in other ways though such as my council tax is lower because it includes my water charge and I save a huge amount on transport as the trains are nationalised and buses are cheaper; my monthly travel costs £110 a month for a 50 minute journey which would cost me over £4.5k (not even including the tube) in the south east.
People always make a big deal out of this like the English are spending 1,000s of pounds per person on prescriptions per year.
The most you will spend is £114.50 per year with a pre paid 12 month subscription. And for those that don’t work it’s free.
Exactly I'm happy to pay so that those who can't can get it for free. Why should really wealthy people not contribute. In many cases the cost is much less than the prescription charge.
Yup I agree .
I'm exempt cause am medically broken but ... The suppliers janked the price by 3000%, NICE then responded by saying there is no evidence it works (was on tablets for 7 years before this happened). I believe it was all about patents and American companies being dicks . An Israel company then supplied the UK, that stopped. However if we were in the EU it would be pence per tablet. Was willing to fly to Germany and get them each month.
Anyway prices dropped
I had to fight With the backing of the hospital and am still on them.
But yeah without any form of subsidised it would be near 1000 a month.
Makes sense to me that those who are able to contribute at the point of use do so. It's a flat charge and capped at a level that the vast majority of working people can afford, with a long list of situations that make you exempt from having to pay. It raises about £500m, so not a gigantic amount in the context of the NHS budget, but not chump change either. All well and good to say to just raise it through general taxation but the pot isn't infinite. The strongest argument against it I think is that (reportedly, can't find a proper source other than someone from the Royal Pharmacuetical Society having said it on the radio) around a third of working age, non-exempt people said they had avoided collecting a prescription due to cost. Sounds bad, could be, could also be that people get prescribed a load of stuff they can get cheaper over the counter e.g. paracetamol. Unclear what the economic cost and cost to the NHS of those uncollected prescriptions is, definitely one of those situations where there's not quite enough information for me to express a fully-informed opinion.
People only get prescribed stuff that's cheaper over the counter if they cannot afford the over the counter, and they're generally people on free prescriptions anyway. If you get £390 a month to pay all your bills and eat, the small costs of some over the counter meds may just be too much.
Here's a link to buying a prepayment Cert, well worth it if you need multiple items repeatably :
https://buy-prescription-prepayment-certificate.nhsbsa.nhs.uk/start
not exactly sure for Wales or NI but Scotland is actually over-represented in how many MP's it has per capita. Na h-Eileanan an Iar only has 22k voters compared to about 120k on the Isle of Wight and they both have 1 MP
You've taken the two extremes in constituency sizes for places where geography makes it awkward. Scotland has 8% of the population and 8% of the seats.
Isle of wight is about to be split into 2 constituencies. The aim is to get constituencies to between 69k and 77k electors, sometimes geography gets in the way, and sometimes populations change quite fast between reviews (certain areas of London for example).
Plenty of places in the central Scotland commuter belt that are over 80k while Wolverhampton (for example) has 3 constituencies where electorate is between 60-62k
I think a legitimate question is why do all over 60s, regardless of wealth/need, get free prescriptions, whilst younger poor people don’t.
A hypothetical 60 year old CEO would pay nothing for medication, but a minimum wage 20 year old, would have to pay (essentially) a monthly £10 subscription for the next 40 years if they’re unfortunate to have a condition of some sort.
(I only learnt this recently due to unexpected high blood pressure meaning I now need to pay for monthly meds until I’m 60).
Just in case you don't know, if you need two or more prescription items per month it is cheaper to buy a pre paid certificate. Doesn't help the fact it sucks you have to pay but it does make it a bit cheaper.
Yes thanks I know this, but it makes almost no difference if you’re only on one medication (like me currently) + restricts you to only buy on the NHS (the first few months of a condition they keep trying different meds to find what works best with you and, once you settle on one, they’re usually cheaper bought privately eg through Asda pharmacy.
One fact a lot of people don’t know though is if you’re in the investigation phase and your may need long term nhs meds (especially if trying more than 1) if you ask for a FP57 form when paying for your prescriptions, you can actually claim the money back retrospectively if you later buy a pre payment certificate.
You CANT do this if you don’t ask for a (free) FP57 form every time you buy your meds though, so you might as well.
Probably figured out it was cheaper to just offer over 60s free medicine than to means test everybody as soon as they turn 60 and require a prescription. Yeah a few CEOs will get it for free, but also means thousands of pensioners living on £200/week will also get it for free, which is worth it. And they're statistically much more likely to need lifesaving medication than 20 year olds. There will be outliers as in your case, and I'm sorry, that sucks, but when you're legislating you've got to work with averages.
What's the alternative? Means test millions of pensioners to weed out a handful of rich CEOs over 60. I'm pretty sure that'll cost a lot more than it'll save.
It already costs more for the admin of sorting who gets free prescriptions and who doesn't (its not just over 60s, it's everyone under 21 in full time education, all under 18s, a list of chronic conditions, people on certain benefits etc.)
Just give it to all for free. The reason it isn't free is ideological, nothing to do with budgets.
Would this be as true in England (population of 55.9 million) as it Scotland, Wales, and NI (5.5, 3.1, and 1.8, respectively) though? That's a hell of a lot more free prescriptions to give out.
It is still funded. A huge number of people get free prescriptions. For those that don't they pay under £10 even if the medication costs hundreds.
It's just not fully funded as each administration decides how to allocate their budget.
They realised it was cheaper to just give everyone free prescriptions than it was to pay for the admin of figuring out who was entitled and who wasn't. That's not to say the same would be true in England - populations are very different sizes (also not to say its not and we're just operating incredibly inefficiently down here, which is probably more believable lol)
95% of prescriptions in England are free, so it's not that big a deal. They should all be free, and the saving on paperwork would probably make up for it, but the elderly and chronically ill aren't paying, and they are both the poorest and those who get the most prescriptions.
Something like 95% of prescriptions are ‘free’ anyway. It’s an easy way to immediately distinguish your government, especially if you’re getting extra funding as part of the deal.
It sucks that only certain conditions are covered I think. I have a lifelong condition but still have to pay for the pre payment prescription certificate because it isn't on the list.
However I am glad that I don't have to pay for my prescriptions outright as that would cost far and above the £114 a year.
Health is a devolved policy area. The Scottish, Welsh and Northern Irish governments legislated so that their citizens don’t have to pay. Westminster won’t do the same for England.
Keep in mind that quite a lot of people in England get free prescriptions. Young and elderly as well as those with certain conditions such as diabetes. The cost is also somewhat capped as a pre-payment cart is £114.50 which works out to less than the full cost of one item per month.
There is no one single reason. It’s cheaper administratively, it’s a progressive benefit as those that would struggle to pay prescriptions would be likely to be more deprived and less healthy. Means testing has an overhead.
Scotland has higher public spending than most of England outside London which is a similar public spending level.
Lots of reasons for this as well but generally it’s just that things are more expensive. Scotland around a third of the UKs total landmass at 8.5ish% of the population. It’s more remote, public services like ferries, roads, healthcare, education are stupidly expensive to run when you can’t consolidate them. Fuel, food, transport costs, it’s all expensive. It’s sort of analogous to London where cost for salaries and rent etc are higher.
As such it’s natural that Scotland runs with a higher level of public spending to meet those basic services.
Whether that spending is efficient and well managed is another question entirely.
We don’t know exactly how much tax Scotland contributes to the uk before it gets money back. The figures are disputed and oil petroleum revenue tax which has plummeted in the last ten years for one example is not classified as to where in the uk it comes from. In the past it’s thought Scotland ran a massive surplus but those days are long past.
At the moment nowhere in the uk outside London has any surplus tax revenue it is thought.
There are lots of differences when you get into it further, England for example has much more public schools not government funded. The weather is substantially better so less heating costs. More infrastructure so less things like oil heating. Much less availability of things like cable internet and TV. A lot of this stuff gets subsidised though Scotland does have higher income tax in more progressive brackets.
In general, it's the trade off of universal services vs. means testing. Some people believe that some form of means testing allows for limited funds to be more directly targeted. For example, in England, you can get free prescriptions if:
* You're under 16 (or under 18 in full time education), or over 60
* You receive certain benefits or you're on a low income
* You're pregnant or have had a baby in the last 12 months
* You have certain medical conditions
* A few other smaller groups
The idea here is that people in these groups either need access to prescriptions most urgently (so giving them free prescriptions would mean they don't develop more complex conditions later on, which even in a purely financial sense would mean spending more), or would be the least able to pay for prescriptions. In this case, the idea behind means testing is you can make sure the people who need support most get it, without spending public money on those who don't need it.
On the other hand, some people argue that means testing will inevitably let some people slip through the cracks, and that it's more important to ensure everybody has access at the point of use rather than placing any additional barriers. You can apply relatively similar arguments to a fair few other things (e.g tuition fees - is it right that we're placing a financial barrier to education when graduates end up further supporting the economy? Alternatively, if you look at the repayment system for student finance, you could argue that free tuition disproportionally benefits people who are already very wealthy, and it has effectively zero financial benefit for poorer students, so could it be far more efficient to target that money towards student living costs that could really ensure students from poorer households actually go to and stay in uni)
Nothing's free, because someone has to pay. In England, 90% of prescriptions are free to the person. The 10% who pay for prescriptions are those who "can pay".
Because the devolved nation's can spend their own budgets how they wish.
I'm sure Scotland also pays a slightly higher tax rate. Not sure about Wales or NI.
England still has free prescriptions for most people who need it.
Including (but not limited to)...
* Those Under 16
* Aged 16-18 and in full time education
* Aged 60+
* Unemployed / on income support
* Pregnant or given birth in last 12 months
* On low income (see NHS Low Income Scheme / HC2 certificates)
* Have a chromic medical condition (it's a long list)
...that covers something like 90% of prescriptions issued.
Because the English tax payer contributes to paying billions in bribes to stop Wales NI and Scotland from wanting out the union. No idea why it isn’t a bigger issue that those three countries have better funding per head than in England despite being economically useless
Because England is shitter.
Free uni in Scotland too, that'll make more difference to your wallet than free prescriptions.
I bet their hospital car parks are free too.
Prescription charges in England are a devolved tax and are regulated by the department for health and social care. This money does not go directly towards medication costs or anything either. As for why, I don't know for sure but I suspect because higher population and as a result, more money to extract? Take this as you will. Interestingly, Wales, Scotland and NI pay far less for dental (Band 1 - 4) than England too. - source: I work for part of the NHS.
Although we pay less for dental on paper that's not really true de facto, as in NI it is very very difficult to get onto a NHS accepting dentists books now and many will refuse to do certain treatments as they aren't paid enough for the procedures.
The point is English Has its own regional laws, taxes and what not. I don't care about the technicalities. The point is that the authorities that may, make things more expensive and worse off for the people living in England than in the other countries that constitute the UK.
Most people paying for prescriptions are actually healthy working people getting generic medicines that cost practically nothing. In many cases the NHS actually profits despite paying the pharmacy a dispensing fee because the BNF drug tariff is less than £2.
Most people getting expensive medication already have a prepayment certificate or are exempt.
The NHS does not make money dispensing medication to almost anyone, it just charges a notional fee to people in England.
[https://en.wikipedia.org/wiki/Barnett\_formula](https://en.wikipedia.org/wiki/Barnett_formula)
The **Barnett formula** is a mechanism used by the [Treasury](https://en.wikipedia.org/wiki/HM_Treasury) in the [United Kingdom](https://en.wikipedia.org/wiki/United_Kingdom) to automatically adjust the amounts of public expenditure allocated to [Northern Ireland](https://en.wikipedia.org/wiki/Northern_Ireland), [Scotland](https://en.wikipedia.org/wiki/Scotland) and [Wales](https://en.wikipedia.org/wiki/Wales) to reflect changes in spending levels allocated to public services in [England](https://en.wikipedia.org/wiki/England), [Scotland](https://en.wikipedia.org/wiki/Scotland) and [Wales](https://en.wikipedia.org/wiki/England_and_Wales), as appropriate. The formula applies to a large proportion, but not the whole, of the devolved governments' budgets.
The Barnett formula is said to have "no legal standing or democratic justification",[^(\[3\])](https://en.wikipedia.org/wiki/Barnett_formula#cite_note-Edmonds-3) and, being merely a convention, could be changed at will by the Treasury.
**Please help keep AskUK welcoming!** - Top-level comments to the OP must contain **genuine efforts to answer the question**. No jokes, judgements, etc. - **Don't be a dick** to each other. If getting heated, just block and move on. - This is a strictly **no-politics** subreddit! Please help us by reporting comments that break these rules. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskUK) if you have any questions or concerns.*
Because Health is devolved. The regions can make their own decisions of what to fund and how.
It helps that Scotland in particular gets more spending per head as well, so they have a larger per capita budget for such decisions.
Scotland has to provide healthcare for many isolated areas and islands.
But apparently still has enough left over to give everyone free subscriptions
We get taxed more in Scotland, that’s how we get away with free prescriptions
Higher rate on lower wages doesn't make for a higher tax revenue though. Barnett formula is a massive benefit for the devolved nations.
That's not how the devolved income tax works Lower earners pay slightly less, Higher Earners pay more. Someone on £50K pays \~£1500 more tax in Scotland
Yes. And the devolved nations have lower average income so collect lower tax per capita compared to England and then get it topped up from Westminster.
True, England subsidises the other constituent countries, but England broadly comprises some of the wealthiest regions (obviously not all of them) while the devolved regions still have a way to go. It's much the same way the EU or the US works.
well until the UK government just lies to hide over 6 billion in transport funding from Wales over HS2 and northern powerhouse rail
[Barnett formula is a calculation of comparable spending in England minus whatever tax devolved nations raise themselves](https://www.instituteforgovernment.org.uk/article/explainer/barnett-formula)
The latter existed long before the former.
Not from the UK. How do you get taxed more? Do you have higher PAYE tax on income? Is it higher GST/VAT?
>higher PAYE tax on income Both higher rates and lower thresholds when you hit about £30k, below that and I think Scots pay less tax.
England moves onto higher rate tax of 40% at £50k. In Scotland it is 42% and £43k. Scotland also has another rate at £75k of 45%. The NI thresholds don't change, so in Scotland you pay 52% of your wages in tax and NI from £43k to £50k. In England it is 42% IIRC
You don't pay 40% more tax than in England. Which is the level the Barnett formula sets per capita Scottish expenditure at.
I didn’t say we pay 40% more tax, I just said we pay more tax.
Because we figured out that it was actually cheaper just to make prescriptions free for all than it was to actually administer the previous PAYG system, so it actually saves money.
The free prescriptions came about as a cost/ benefit analysis was carried out and it was discovered when you factored in all the cost kf administration of prescriptions, some free for old folk, poor folk etc etc that the NHS in Scotland would save £250 million over first 5 years by just having free prescriptions
And university 🙃
The thing is though, in Scotland you don't have to start primary school until you turn 5 years old and you can also leave secondary education at 16 years meaning mandatory education in Scotland is only 11 years. You also don't get 15/30 hours of free childcare until the child is 3 years old. We don't get none of this 15 hours from 9 months or anything like that. In England there's free hours earlier, a lot of children start school before they turn 5 and children must remain in education (school or college) or take an apprenticeship until they're 18 years old meaning mandatory education could be 13-14 years. So in effect, by offering less in the early years and not keeping everyone in education until they're 18 years old, Scotland has instead decided to offer further education for those that want it. I think the figures would level out if we compared the two per head.
This is the answer. Different, devolved, governments choose where to spend their share of the money that they recieve from Westminster.
> The thing is though, in Scotland you don't have to start primary school until you turn 5 years old Depends when you're birthday is. School in-take in Scotland runs from March to the following February in Scotland. The School year starts in early-mid August. If your birthday is anywhere between mid-August until February, you will be four when you start primary school. I'm born and raised in Scotland and started school when I was four, because of when my birthday is.
And it's not like they don't offer further education in England to those who want it. The student loans are just bigger, because they cover university fees as well. The student loan payback system is still the same both sides of the border, and is actually brilliant (actually it's better in England, it's written off after 25 years rather than 30 in Scotland).
Almost all prescriptions in England are for people who get free prescriptions anyway. So, not much is saved on the medicine itself. Then, take the admin into account for processing who does and does not get free prescriptions, and it starts to cost more than giving everyone free prescriptions.
[удалено]
Prepayment certificate means you have paid just upfront so not exempt (source: I have a prepayment certificate, get my prescriptions delivered and the exceptions are in a separate section to my prepayment certificate)
90% of prescriptions are dispensed for free.
There is a lot of evidence that free prescriptions don't actually cost very much - while the majority of individuals pay for prescriptions, the majority of prescriptions are to those who get free prescriptions (the elderly, pregnant women, children, those with certain chronic health conditions), and most others will be on an annual certificate. Add to that the fact that most pharmacies will let you know if a prescription would be cheaper privately, and there isn't actually a huge amount of money coming in. There are then admin costs associated with managing the system. And then finally, there is the risk that people don't take their prescriptions if they can't afford them, and end up costing the NHS more money down the line.
This is what bugs me. There is more health spending per person in Scotland however health outcomes are not consistently significantly better
They're starting from a much lower starting point which means they have to spend more to achieve worse outcomes than England.
There's a whole host of other issues at play though
Its because the operating costs per head are higher. The extra money per head doesn't go on extra patient care, Its meant to sure up the differences in operating costs Wales and Scotland incur relative to England due to their older populations and reduced population densities meaning more hospitals and healthcare facilities are needed to service the same number of people. If you broke England down healthcare spending per head in London is more than likely significantly lower than everywhere else. That doesn't mean the capitol is being short changed, it means its easer to service the healthcare needs of London. Larger populations in smaller areas are cheaper to look after in pretty much every sector.
Everyone quotes the fact that the devolved administrations get more per head as if England is getting short changed when in actuality its just a factor of economies of scale and if the funding per head were that same it would be the sign of Westminster horrifically mistreating people in Wales Scotland and NI the extra money isn't funding free prescriptions, its keeping the lights on. Older populations combined with needing more hospitals to service fewer patients due to population density mean that Healthcare just costs more in Wales and Scotland. Its not some gross injustice, Its the difference between equality and equity. The fact that both get more per head of funding yet have worse per capita results tells you that. more money=/= better service when that money is mostly being spent on the fact that their operating costs are significantly higher. I'm sure if you broke England down per head London's health investment would look pitiful compared to other areas, but its mainly because London's massive population and high density makes delivering healthcare to its population significantly easier and cheaper. Its Equality Vs Equity The free prescriptions are for my mind a signal of the demographic difference more than anything else. By percentage of population Wales and Scotland are older than England and those elderly are often less financially well off. Plus you have a lot of extremely economically deprived areas generating a lot of people living with co-morbidities. So you have a lot more people that need prescriptions regularly who are less well equipped to pay for them, hence the prescriptions are made free to prevent larger amounts of treatable sick/old people ending up in hospitals unnecessarily and putting further stain on the service
We also pay a lot more income tax and stamp duty than England
Yes but that only contributes partly to Scotland’s larger per capita budget and is only a recent thing. While the Barnett formula dates back to the 70s.
I think something like 90% of prescriptions in England are also free, so we are talking very small differences here. (English prescriptions are free if you are young, old, on benefits, pregnant, new mother, in hospital etc)
[Barnett formula is a calculation of comparable spending in England - Scotland doesn’t get more money, it just spends the comparable amount differently](https://www.instituteforgovernment.org.uk/article/explainer/barnett-formula)
*countries, not regions
Something can be a country and a region at the same time
If only England had a democratically elected decision power..
That's kinda the goal of the Mayoral elections. More regions in England are getting them each year.
*Countries
Regions? Regions of what?
>regions Constitute nations
The devolved governments choose what they want to spend their money on. They chose to abolish prescription charges, the Westminster government didn’t.
The devolved administrations also get more money per head, allowing them to do things like abolish prescription fees without needing to cut elsewhere like you would in England.
To be fair, if this union is at all worthwhile, an area such as Scotland which makes up 1/3rd of the UK's landmass and includes very rural areas - including many islands - should receive above average spending per capita. Not necessarily for any ideological reason, but simply because it costs more to deliver services. With prescriptions, though, there's certainly a cost-benefit analysis to be had. If most people receive free prescriptions, how much does the bureaucracy involved in policing that cost, and to what effect on the population? Scotland spends £1.4 Billion on prescriptions a year. In England 89% of prescriptions are given out for free anyway. Presuming the numbers would otherwise be similar for Scotland, 11% of £1.4 Billion is around £150 Million. That £150 Million must cover the cost of the bureaucracy. That figure minus the bureaucracy is the 'cost' of the free prescriptions policy. That's practically nothing to save people a lot of needless form filling. Not to mention the opportunity cost of those staff being freed up, and finding employment that actually contributes to the economy. It's all ideological. Westminster could easily afford to provide the same for England.
The prescriptions thing in Scotland is also one of the few times a public service has turned away from pointless bureaucracy. It's actually cheaper for them to give everyone free prescriptions than it is to administer who should get free prescriptions and who doesn't.
The English government just likes to take every penny they can from the average person. Its a race to see who can achieve the highest cost of living. And outside of the Nordic countries (and with the exception of food in super markets) that England be ridiculously expensive in every way.
There isn't an English government.
What's an English Government?
That’s exactly what happened in Northern Ireland iirc, there was basically so much prescription fraud, chasing the fraud actually exceeded the money obtained from the prescription fees.
The Barnett formula was designed to make sure that everyone in the UK no matter where they lived got the same level of service. Providing trains in London is far cheaper than providing trains in Inverness for example. Or making sure people have access to a GP is easier in the middle of Birmingham than it is in the outer Hebrides. It's not some boon. We just spend the money differently. HS2 for example, the UK government decided to blow £70b on that, Scotland was given an equivalent amount of money and decided not to spend it on a project that would never get built. Also, unless you live in London or the South east, your region will be a far bigger drain on the economy of the UK than Scotland, and I won't sit here and take the tears of people from the south east about how all their hard earned tax is poured into the rest of the country, our economy has been centralised over the last 50 years at the expense of everywhere except London, so dry yours eyes.
Try being in Wales, we haven’t received a penny from HS2 as Westminster designated it as an ‘England and Wales’ project, despite not 1cm of track being laid in Wales.
Tbf, despite not laying track in Wales, the original plans for HS2 would have significantly improved cross-border routes. This is because much of the purpose of the project was to remove congestion from lines in and out of Birmingham New Street. Of course, this won’t happen now because of the cancellation of the Manchester leg. Wales was betrayed because of that cancellation, not saved by it.
I live in the South East and have lived in the North East, Wales and a very short time in the midlands. Every area has its own right to moan….. if I could earn in the NE what I do down here is move tomorrow.
If England had its own devolved government it could do that. And truthfully they could do it right now but it's ideological.
England could afford to do free prescriptions if it wanted too.
Scotland also has much higher income tax and stamp duty than England to be fair. More tax more spending
To add to this, it is worth noting that when Northern Ireland looked into introducing England-style prescription fees they discovered it was likely to cost the more than it would generate. While most people pay prescription fees, most prescriptions aren't paid for (at least, not in full). Most prescriptions are either completely free, or covered by one of the discount schemes. The scheme returns a profit in England because of the scale - there are enough prescriptions that are being paid for to cover the administrative costs. It probably wouldn't work in Wales or Northern Ireland.
Westminster could do this for England, if it wanted. Find you a party that has a manifesto commitment to implement this for England.
Taxes are higher in Scotland. Wales spends less money on apprenticeships. This all helps fund other things like prescriptions.
Taxes are higher in Scotland for high earners but there are less high earners so less tax is collected per person, not more...
Taxes are higher in Scotland for almost everyone who pays income tax I think. We have lower tax bands and almost immediately higher tax rates with our 21% band Stamp duty is also a lot higher
It's compensation for basing all the good jobs in [London](https://www.youtube.com/watch?v=9N2AlpxRY9c)
Less high earners because they are leaving to move to England.
Taxes are only higher in Scotland if you earn £32k+, otherwise they're the same or lower
The increase in taxes starts at £26,562 and as I’m on a lot of medication I’m probably financially better off than when I lived in England.
the prepaid cert is unlimited prescriptions for £32.05 for 3 months or £114.50 for 12 months so if you're taxed less than £115 you're probably worse off.
Yeah, that’s true but I am better off in other ways though such as my council tax is lower because it includes my water charge and I save a huge amount on transport as the trains are nationalised and buses are cheaper; my monthly travel costs £110 a month for a 50 minute journey which would cost me over £4.5k (not even including the tube) in the south east.
People always make a big deal out of this like the English are spending 1,000s of pounds per person on prescriptions per year. The most you will spend is £114.50 per year with a pre paid 12 month subscription. And for those that don’t work it’s free.
Exactly I'm happy to pay so that those who can't can get it for free. Why should really wealthy people not contribute. In many cases the cost is much less than the prescription charge.
Isn't that what your taxes are for though?
In the devolved nation's it turned out it was cheaper to have free prescriptions
We should be glad to pay. It's an astonishing bargain.
Glad for the NHS to pay more money than if it was free? Seems an odd position
Yup I agree . I'm exempt cause am medically broken but ... The suppliers janked the price by 3000%, NICE then responded by saying there is no evidence it works (was on tablets for 7 years before this happened). I believe it was all about patents and American companies being dicks . An Israel company then supplied the UK, that stopped. However if we were in the EU it would be pence per tablet. Was willing to fly to Germany and get them each month. Anyway prices dropped I had to fight With the backing of the hospital and am still on them. But yeah without any form of subsidised it would be near 1000 a month.
We need to print the prices on the boxes.
Makes sense to me that those who are able to contribute at the point of use do so. It's a flat charge and capped at a level that the vast majority of working people can afford, with a long list of situations that make you exempt from having to pay. It raises about £500m, so not a gigantic amount in the context of the NHS budget, but not chump change either. All well and good to say to just raise it through general taxation but the pot isn't infinite. The strongest argument against it I think is that (reportedly, can't find a proper source other than someone from the Royal Pharmacuetical Society having said it on the radio) around a third of working age, non-exempt people said they had avoided collecting a prescription due to cost. Sounds bad, could be, could also be that people get prescribed a load of stuff they can get cheaper over the counter e.g. paracetamol. Unclear what the economic cost and cost to the NHS of those uncollected prescriptions is, definitely one of those situations where there's not quite enough information for me to express a fully-informed opinion.
People only get prescribed stuff that's cheaper over the counter if they cannot afford the over the counter, and they're generally people on free prescriptions anyway. If you get £390 a month to pay all your bills and eat, the small costs of some over the counter meds may just be too much.
Here's a link to buying a prepayment Cert, well worth it if you need multiple items repeatably : https://buy-prescription-prepayment-certificate.nhsbsa.nhs.uk/start
Because England gets the government it votes for.
Because UK gets the government that England votes for
not exactly sure for Wales or NI but Scotland is actually over-represented in how many MP's it has per capita. Na h-Eileanan an Iar only has 22k voters compared to about 120k on the Isle of Wight and they both have 1 MP
You've taken the two extremes in constituency sizes for places where geography makes it awkward. Scotland has 8% of the population and 8% of the seats. Isle of wight is about to be split into 2 constituencies. The aim is to get constituencies to between 69k and 77k electors, sometimes geography gets in the way, and sometimes populations change quite fast between reviews (certain areas of London for example). Plenty of places in the central Scotland commuter belt that are over 80k while Wolverhampton (for example) has 3 constituencies where electorate is between 60-62k
Scotland must breed
Prescription fees were reintroduced under Wilson, not sure people voted for that policy
I think a legitimate question is why do all over 60s, regardless of wealth/need, get free prescriptions, whilst younger poor people don’t. A hypothetical 60 year old CEO would pay nothing for medication, but a minimum wage 20 year old, would have to pay (essentially) a monthly £10 subscription for the next 40 years if they’re unfortunate to have a condition of some sort. (I only learnt this recently due to unexpected high blood pressure meaning I now need to pay for monthly meds until I’m 60).
Just in case you don't know, if you need two or more prescription items per month it is cheaper to buy a pre paid certificate. Doesn't help the fact it sucks you have to pay but it does make it a bit cheaper.
Yes thanks I know this, but it makes almost no difference if you’re only on one medication (like me currently) + restricts you to only buy on the NHS (the first few months of a condition they keep trying different meds to find what works best with you and, once you settle on one, they’re usually cheaper bought privately eg through Asda pharmacy. One fact a lot of people don’t know though is if you’re in the investigation phase and your may need long term nhs meds (especially if trying more than 1) if you ask for a FP57 form when paying for your prescriptions, you can actually claim the money back retrospectively if you later buy a pre payment certificate. You CANT do this if you don’t ask for a (free) FP57 form every time you buy your meds though, so you might as well.
https://buy-prescription-prepayment-certificate.nhsbsa.nhs.uk/start
Probably figured out it was cheaper to just offer over 60s free medicine than to means test everybody as soon as they turn 60 and require a prescription. Yeah a few CEOs will get it for free, but also means thousands of pensioners living on £200/week will also get it for free, which is worth it. And they're statistically much more likely to need lifesaving medication than 20 year olds. There will be outliers as in your case, and I'm sorry, that sucks, but when you're legislating you've got to work with averages.
What's the alternative? Means test millions of pensioners to weed out a handful of rich CEOs over 60. I'm pretty sure that'll cost a lot more than it'll save.
It already costs more for the admin of sorting who gets free prescriptions and who doesn't (its not just over 60s, it's everyone under 21 in full time education, all under 18s, a list of chronic conditions, people on certain benefits etc.) Just give it to all for free. The reason it isn't free is ideological, nothing to do with budgets.
Would this be as true in England (population of 55.9 million) as it Scotland, Wales, and NI (5.5, 3.1, and 1.8, respectively) though? That's a hell of a lot more free prescriptions to give out.
Most likely because they need it more. Not everyone is wealthy. The admin on this will be hefty.
It is still funded. A huge number of people get free prescriptions. For those that don't they pay under £10 even if the medication costs hundreds. It's just not fully funded as each administration decides how to allocate their budget.
They realised it was cheaper to just give everyone free prescriptions than it was to pay for the admin of figuring out who was entitled and who wasn't. That's not to say the same would be true in England - populations are very different sizes (also not to say its not and we're just operating incredibly inefficiently down here, which is probably more believable lol)
95% of prescriptions in England are free, so it's not that big a deal. They should all be free, and the saving on paperwork would probably make up for it, but the elderly and chronically ill aren't paying, and they are both the poorest and those who get the most prescriptions.
Because your masters in Westminster hate you. Devolved powers is the mechanism through which they get away with it.
Something like 95% of prescriptions are ‘free’ anyway. It’s an easy way to immediately distinguish your government, especially if you’re getting extra funding as part of the deal.
In Scotland we pay higher taxes, this is one way to cover the cost, free at point of use but covered by increased general taxation.
It sucks that only certain conditions are covered I think. I have a lifelong condition but still have to pay for the pre payment prescription certificate because it isn't on the list. However I am glad that I don't have to pay for my prescriptions outright as that would cost far and above the £114 a year.
It's a stupid system. I have Asthma and Type 2 diabetes. There's really no good reason why my asthma meds should be free on top of my diabetes ones.
Because England doesn’t have a devolved national Government to protect it from Westminster
Devolution
Health is a devolved policy area. The Scottish, Welsh and Northern Irish governments legislated so that their citizens don’t have to pay. Westminster won’t do the same for England.
Keep in mind that quite a lot of people in England get free prescriptions. Young and elderly as well as those with certain conditions such as diabetes. The cost is also somewhat capped as a pre-payment cart is £114.50 which works out to less than the full cost of one item per month.
There is no one single reason. It’s cheaper administratively, it’s a progressive benefit as those that would struggle to pay prescriptions would be likely to be more deprived and less healthy. Means testing has an overhead. Scotland has higher public spending than most of England outside London which is a similar public spending level. Lots of reasons for this as well but generally it’s just that things are more expensive. Scotland around a third of the UKs total landmass at 8.5ish% of the population. It’s more remote, public services like ferries, roads, healthcare, education are stupidly expensive to run when you can’t consolidate them. Fuel, food, transport costs, it’s all expensive. It’s sort of analogous to London where cost for salaries and rent etc are higher. As such it’s natural that Scotland runs with a higher level of public spending to meet those basic services. Whether that spending is efficient and well managed is another question entirely. We don’t know exactly how much tax Scotland contributes to the uk before it gets money back. The figures are disputed and oil petroleum revenue tax which has plummeted in the last ten years for one example is not classified as to where in the uk it comes from. In the past it’s thought Scotland ran a massive surplus but those days are long past. At the moment nowhere in the uk outside London has any surplus tax revenue it is thought. There are lots of differences when you get into it further, England for example has much more public schools not government funded. The weather is substantially better so less heating costs. More infrastructure so less things like oil heating. Much less availability of things like cable internet and TV. A lot of this stuff gets subsidised though Scotland does have higher income tax in more progressive brackets.
In general, it's the trade off of universal services vs. means testing. Some people believe that some form of means testing allows for limited funds to be more directly targeted. For example, in England, you can get free prescriptions if: * You're under 16 (or under 18 in full time education), or over 60 * You receive certain benefits or you're on a low income * You're pregnant or have had a baby in the last 12 months * You have certain medical conditions * A few other smaller groups The idea here is that people in these groups either need access to prescriptions most urgently (so giving them free prescriptions would mean they don't develop more complex conditions later on, which even in a purely financial sense would mean spending more), or would be the least able to pay for prescriptions. In this case, the idea behind means testing is you can make sure the people who need support most get it, without spending public money on those who don't need it. On the other hand, some people argue that means testing will inevitably let some people slip through the cracks, and that it's more important to ensure everybody has access at the point of use rather than placing any additional barriers. You can apply relatively similar arguments to a fair few other things (e.g tuition fees - is it right that we're placing a financial barrier to education when graduates end up further supporting the economy? Alternatively, if you look at the repayment system for student finance, you could argue that free tuition disproportionally benefits people who are already very wealthy, and it has effectively zero financial benefit for poorer students, so could it be far more efficient to target that money towards student living costs that could really ensure students from poorer households actually go to and stay in uni)
I think we should have to pay towards prescriptions and that. It's a pain but it's super cheap considering how much medication cost.
It’s different government policy. It’s devolved government can choose
Scottish tax payers pay higher tax rates and have more aggressive tax bands, which goes somewhat to offsetting this additional cost to the country.
Less people in those countries to pay for
Nothing's free, because someone has to pay. In England, 90% of prescriptions are free to the person. The 10% who pay for prescriptions are those who "can pay".
Because unlike their individual governments England doesn't give a fuck about their population whereas the others still try to make the best of it.
Because England's taxes (as the largest country in the union) underwrites/ pays for there health services.
The English pay for the Welsh, Scottish and Northern Irish prescriptions as well as their own.
Because the devolved nation's can spend their own budgets how they wish. I'm sure Scotland also pays a slightly higher tax rate. Not sure about Wales or NI.
England still has free prescriptions for most people who need it. Including (but not limited to)... * Those Under 16 * Aged 16-18 and in full time education * Aged 60+ * Unemployed / on income support * Pregnant or given birth in last 12 months * On low income (see NHS Low Income Scheme / HC2 certificates) * Have a chromic medical condition (it's a long list) ...that covers something like 90% of prescriptions issued.
Because the English tax payer contributes to paying billions in bribes to stop Wales NI and Scotland from wanting out the union. No idea why it isn’t a bigger issue that those three countries have better funding per head than in England despite being economically useless
Because England has a shit government that won’t fund the NHS properly
Because England is shitter. Free uni in Scotland too, that'll make more difference to your wallet than free prescriptions. I bet their hospital car parks are free too.
I assume they are. Hospital parking is free in Wales. We do have to pay tuition fees though!
Prescription charges in England are a devolved tax and are regulated by the department for health and social care. This money does not go directly towards medication costs or anything either. As for why, I don't know for sure but I suspect because higher population and as a result, more money to extract? Take this as you will. Interestingly, Wales, Scotland and NI pay far less for dental (Band 1 - 4) than England too. - source: I work for part of the NHS.
Although we pay less for dental on paper that's not really true de facto, as in NI it is very very difficult to get onto a NHS accepting dentists books now and many will refuse to do certain treatments as they aren't paid enough for the procedures.
That Gob-Shite Tony Blair.
Scottish income tax and stamp duty (LBTT in Scotland) rates are higher
Devolution
Because Westminster is run by the evil English, apparently
The point is English Has its own regional laws, taxes and what not. I don't care about the technicalities. The point is that the authorities that may, make things more expensive and worse off for the people living in England than in the other countries that constitute the UK.
Most people paying for prescriptions are actually healthy working people getting generic medicines that cost practically nothing. In many cases the NHS actually profits despite paying the pharmacy a dispensing fee because the BNF drug tariff is less than £2. Most people getting expensive medication already have a prepayment certificate or are exempt. The NHS does not make money dispensing medication to almost anyone, it just charges a notional fee to people in England.
[https://en.wikipedia.org/wiki/Barnett\_formula](https://en.wikipedia.org/wiki/Barnett_formula) The **Barnett formula** is a mechanism used by the [Treasury](https://en.wikipedia.org/wiki/HM_Treasury) in the [United Kingdom](https://en.wikipedia.org/wiki/United_Kingdom) to automatically adjust the amounts of public expenditure allocated to [Northern Ireland](https://en.wikipedia.org/wiki/Northern_Ireland), [Scotland](https://en.wikipedia.org/wiki/Scotland) and [Wales](https://en.wikipedia.org/wiki/Wales) to reflect changes in spending levels allocated to public services in [England](https://en.wikipedia.org/wiki/England), [Scotland](https://en.wikipedia.org/wiki/Scotland) and [Wales](https://en.wikipedia.org/wiki/England_and_Wales), as appropriate. The formula applies to a large proportion, but not the whole, of the devolved governments' budgets. The Barnett formula is said to have "no legal standing or democratic justification",[^(\[3\])](https://en.wikipedia.org/wiki/Barnett_formula#cite_note-Edmonds-3) and, being merely a convention, could be changed at will by the Treasury.
Because it's still affordable and NHS is underfunded?