Another Daily Mail big lie: £13million NHS bill for suncream
On 8th April 2015, the Daily Mail published the following article: £13million NHS bill for suncream: Millions also wasted on prescriptions for toothpaste, Yakult and Calpol http://www.dailymail.co.uk/news/article-3031124/13million-NHS-bill-suncream-Millions-wasted-prescriptions-toothpaste-Yakult-Calpol.html
The claim being made by the Daily Mail is that the NHS has wasted £13 million on prescriptions for suncream, and more millions on toothpaste, multivitamins, treatment for indigestion etc., items described as bathroom cabinet items or household essentials, which the Daily Mail says can all be bought over the counter. The Daily Mail bases its ‘analysis’ on the 2014 Prescription Cost Analysis, a document published annually by the Health and Social Care Information Centre, the national provider of information, data and IT systems for health and social care, and which provides details of the number of items and the net ingredient cost of all prescriptions dispensed in the community in England: http://www.hscic.gov.uk/searchcatalogue?productid=17711&q=title%3a%22prescription+cost+analysis%22&sort=Relevance&size=10&page=1#top .
Let’s first have a look at the language used by the Daily Mail before looking at the validity of the Daily Mail claims:
|‘The NHS is spending millions on prescriptions for suncream and toothpaste, a damning analysis has found’.‘It has prompted concern that patients are abusing the system by demanding prescriptions for household essentials which are cheaply available at their local chemist’.‘Other bathroom cabinet items routinely being prescribed by GPs include Calpol, Vaseline, Strepsils and toothpaste, according to the Health and Social Care Information Centre’.‘Every week we hear of patients being denied another cancer treatment or refused cataracts while others are being prescribed toothpaste’.
‘Doctors admit that some patients abuse the system and arrive at surgeries with shopping lists of toiletries and remedies. But their contract states they must prescribe any medication they think is ‘necessary’, meaning patients can claim that most remedies are needed even if they are cheaply available from a chemist.’
‘Jonathan Isaby, of the TaxPayers’ Alliance, said: ‘The vast majority of hard-pressed families have to pay for their own everyday essentials, and taxpayers will be furious if others are gaming the system’.
One point which is not explicitly made, but which has been picked up in the readers’comments, relates to the groups of people most likely to ask for a prescription for items which can be bought over the counter and which cost less than the prescription charge of £8.20. Although people over 60, under 16, or over 16 and in education etc. are all entitled to get free prescriptions, Daily Mail readers were very quick to pick on benefit claimants, which may all along have been one of or indeed the sole objective of the Daily Mail.
But do the Daily Mail claims stand up to scrutiny?
The information which follows is based on the 2014 Prescription Cost Analysis, and a special explanatory spreadsheet (found at the bottom of this document) has been compiled in order to provide forensic analysis of the Category Suncream. It is quite complicated, but it is this very complexity which allows the Daily Mail to get away with almost anything.
In the Category Suncream, which has incidently been subsituted by the Daily Mail for the term Sunscreen used in the Analysis (and words matter, as suncream obviously evokes for one commentator people taking holidays in sunny countries), there are 43 medicines, and the only thing that the Daily Mail gets right is the number of prescriptions: 404.556 (non rounded figures) and their cost £13,018.160 (approx. £13 million).
4 out of these 43 medicines (Actikerall Cutaneous Solution, Efudix Cream, Picato Gel 150mcg/g and Solaraze Gel 3%) are prescribed for actinic keratoses, which are pre-cancerous patches of thick, scaly, or crusty skin, and they are all Prescription Only Medicines. The total cost for these 4 medicines is £11,648.280 (almost £12 million of the £13 million supposedly wasted on Suncreams or 89% of the £13m). These medicines are highlighted in yellow in the Excel table below.
2 other medicines (Sunsense and Uvistat with different formulas and strengths) are only prescribed within very strict guidelines from the Advisory Committee on Borderline Substances (ACBS). They can only be ‘regarded as drugs when prescribed for skin protection against ultraviolet radiation in abnormal cutaneous photosensitivity resulting from genetic disorders or photodermatoses, including vitiligo and those resulting from radiotherapy; chronic or recurrent herpes simplex labialis. Anything outside of this is not permitable’. http://www.bnssgformulary.nhs.uk/138-Sunscreens-and-camouflagers/. They account for 99,230 prescriptions at a cost of £1,177,580 (approx. £1.2million). There is no indication that these medicines were inappropriately prescribed. These medicines are highlighted in pink in the Excel table below.
Which means that of the ‘404,500 prescriptions for suncream at a cost of £13 million’ quoted by the Daily Mail, only 16,670 prescriptions are not linked to a specific medical condition (which does not mean that there wasn’t one), and their cost is £174,140. Or to put it differently, £12,825,860 of the £13m are financially and medically accounted for, as the vast majority are Prescription Only Medicines.
A similar analysis could be done for the other categories of medicines, but this would be very time consuming. But it is worth noting that the medicines prescribed for ‘indigestion’ as selectively described by the Daily Mail (under Tab Totals_for_BNF_Sub_Paragraphs, Cell A8) and accounting for £29 million are also prescribed for Gastro-oesophageal reflux disease (GORD) http://www.nhs.uk/Conditions/Gastroesophageal-reflux-disease/Pages/Introduction.aspx
A common complication of GORD is oesophagitis, a less common one is oesophageal cancer, and there is no indication that these medicines were inappropriately prescribed, although they can be bought over the counter. Most importantly, they are prescribed to treat chronic/long term conditions in order to prevent the occurrence of more severe illnesses.
Other examples include, in the Category Multivitamins, Dalivit_Dps (Davilit drops) which are given to premature babies: http://www.gosh.nhs.uk/health-professionals/clinical-guidelines/nutrition-enteral-nutrition-for-the-preterm-infant/, Nephro-vite, prescribed for renal patients under dialysis: http://www.nbt.nhs.uk/sites/default/files/filedepot/incoming/Renal%20Haemodialysis.pdf, or in the Daily Mail’s category of toothpaste, most if not all preparations or solutions are medicated.
Even for common items like Strepsils, there were only 5,329 prescriptions at a cost of £16,222 (Tab Individual_Preparations, Cells A11212- A11224), Vaseline 6,718 prescriptions at a cost of £ 18,147 (Same Tab A11388-A11389), Calpol, 13,437 prescriptions at a cost of £ 80,249 (same Tab Cell A3684-A3694), Yakult, 15 prescriptions at a cost of £458 (same Tab, Cell A9672). These are items described by the Daily Mail as routinely prescribed although the only represent 25,499 prescriptions out of 1.1billion prescriptions written in 2014, i.e. 0.0025494% of all prescriptions.
So if there is waste or abuse in the NHS around prescriptions, the amount is negligible. Once again, the Daily Mail has been caught red-handed, lying and distorting facts and statistics, in the same way it abused and manipulated facts and figures in its article: ‘75% of incapacity benefit claimants are fit for work’ in order to smear Incapacity Benefits claimants.
Instructions for using the PCA table which can be found on HSCIC webpage (see the screenprint below to identify the link):
There are 4 tabs, but only 3 are used for the purpose of this analysis.
1: Totals_for_BNF_Sections. This is where Sunscreens may be found, at Cell A99, which also includes Camouflagers. This sheet gives the BNF Chapter and the BNF Section for both medicine categories, and identifies the path leading to specific medicines included in these categories and their costs. In the case of Sunscreens and Camouflagers, this is Chapter 13, and Section 8.
2: On Tab Totals_for-BNF-sub-Paragraphs, Sunscreens and Camouflagers have been split into 2 distinct categories, and Sunscreen (Cell A303) can now be found at Paragraph 1 of Section 8, of Chapter 13.
3: Finally the Tab Individual_Preparations details the medicines and their costs, and Sunscreens can be found in the Chapter 13, Section 8, Paragraph 1, from Cell A11950 to Cell A11991
They are summarised in the Table below.