It found:

• Nearly 1 in 10 people have skipped medication in the past year due to the cost of prescriptions. Of this group:
• Almost a third (30%) of those who have missed medication now have other physical health problems in addition to their original health condition.
• 37% now have other mental health problems in addition to their original health condition.
• And over half (53%) have had to take time off work as a result of worsening health.
• 12% of people who pay for their NHS prescription have cut medication in half to make it last longer.
• Over a third (35%) of survey respondents reported they had the duration of their prescription changed, meaning they’re paying more frequently for their medicines.
• Almost 2 in 5 (38%) people with long-term health conditions only learned about the prepayment certificate more than a year after their diagnosis.

The survey shows that people with long-term health conditions that cannot afford their medication are seeing an increase in GP visits, trips to accident and emergency (A&E), and hospital stays. Some survey respondents reported they had to stay in hospital for up to 6 weeks. Not being able to afford medicine has also led to mental health is sues and increased time off work. 

• Nearly 1 in 10 people have skipped medication in the past year due to the cost of prescriptions. Of this group, 30% now have other physical health problems in addition to their original health condition, 37% now have other mental health problems in addition to their original health condition, and over half (53%) have had to take time off work as a result of worsening health.
• 1 in 10 (9%) report being unable to collect their prescription due to the cost in the last 12 months.
• 38% of respondents became aware of the Prescription Prepayment Certificate more than a year after their diagnosis with a long term condition.
• Around a third (35%) have had the duration of their prescription changed, meaning they’re paying more frequently for their medicines.

Recommendations

The report makes the following recommendations:

• The UK Government should commit to freezing the charge for 2024.
• Recommend that prescribers stop reducing the duration of prescriptions - as this prices people out of affording their vital medicines.
• Conducts an independent review of the prescription charge exemption list urgently. The review should examine the benefits to the health of the citizens in Northern Ireland, Scotland and Wales of scrapping the charge, and also take into account health inequalities.
• Scrap their plans to align prescription charges with the state pension age.
• Ensure information about prescription charge entitlements (including the low income scheme and PPCs) are provided to all those with long term conditions when they are diagnosed with their condition. This information should also be given out when medicines are dispensed and reviewed. Materials covering these topics should also be displayed at all GP surgeries and pharmacies.

Related reading

Patient Safety Spotlight interview with Marie Lyon, chair of the Association for Children Damaged by Hormone Pregnancy Tests

There is a 30 minute Adjournment Debate at the end of each day's sitting of the House of Commons. They provide an opportunity for an individual backbench MP to raise an issue and receive a response from the relevant Minister. Unlike many other debates, these take place without a question which the House of Commons must then make a decision on.

Foetal valproate spectrum disorder: Fatalities

Caroline Nokes, MP for Romsey and Southampton North, opened this debate by talking about the case of Jake Alcroft, a 21-year-old who died in April this year after an infection triggered by problems with his kidneys. The coroner listed foetal valproate syndrome as a contributing factor to his death because of the physical damage done to Jake as an exposed baby, which meant that his bowel and bladder did not work properly and he relied on urostomy and colostomy bags.

Some key points highlighted in this debate included:

• Warnings about sodium valproate and the risks during pregnancy are still not being consistently displayed on pharmacy prescriptions.
• Some of the recommendations made in relation to this by the Independent Medicines and Medical Devices Safety (IMMDS) Review have still not been implemented effectively.
• There are concerns that the illness can continue down the generations, and that is not yet well understood but it is causing real fear for the families who have been affected so far.

Towards the end of this debate, Caroline Nokes made three requests for the Minister:

1. To acknowledge that sodium valproate has contributed to a death.
2. Asking if she was satisfied that the pregnancy prevention programme is adequately effective and that the information is properly communicated to women of child-bearing age.
3. Calling for redress for patients and families affected by this, as recommended by the IMMDS Review.

Maria Caulfield MP, Minister for Mental Health and the Women's Health Strategy, provided the Government response at the end of this debate.

1. NHS England, in collaboration with NICE, should urgently commission a national assessment of the clinical and cost-effectiveness of using rapid diagnostic tools. As part of this assessment, differences in the effectiveness of using diagnostics to support prescribing in primary and secondary care should be considered.
2. NHS England should centrally purchase diagnostic tools, to more rapidly increase the percentage of prescriptions that are supported by a diagnostic test, drawing on evidence collected from the national assessment and Wales’ use of a central budget for diagnosing respiratory tract infections.
3. Public health departments should work with charities and patient organisations to develop AMR awareness campaigns in the vein of those delivered during the COVID-19 pandemic, which highlight the experience of individuals living with drug-resistant infection and their families. As far as possible, these campaigns should be led by local Directors of Public Health, to increase the trust that local communities have in AMR messaging.
4. A high-level AMR committee should be formed of permanent secretaries from the Department of Health and Social Care, the Department of Food, Environment and Rural Affairs, the Head of AMR at NHS England, and Chief Executives of the UK Health Security Agency and the Veterinary Medicines Directorate. This group should meet at an appropriate frequency to track progress against the Government’s twenty-year vision for AMR, promote cross-government coordination, and assess present and future social and economic impacts posed by AMR.
5. To drive AMR preparedness and health security coordination at Cabinet Level, the Government should create a subcommittee of the National Security Council dedicated to assessing progress against the five-year action plan and twenty-year vision for AMR, and discuss future risks to health security. A named minister for health security should convene the subcommittee.

1. Population Health Management. Using data (NHS BSA Polypharmacy Comparators) to understand Primary Care Network risks and identify patients for prioritisation for a Structured Medication Review.
2. Education & Training. Investing in clinical leaders – AHSN Polypharmacy Clinical Leads and expert Polypharmacy Trainers and delivery of local Polypharmacy Action Learning Sets (ALSs) to upskill the primary care workforce to be more confident about stopping unnecessary medicines. The ALS model was originally developed and piloted by Wessex AHSN and supported by Health Education England (HEE).
3. Public Behaviour Change. Regional testing and evaluation of public-facing initiatives to change public perceptions of prescribing and encourage patients to open up about medicine concerns and expectations.

Watch a recording of the AHSN Network's Polypharmacy: understanding the data webinar

Here are a couple of the cartoons. Download all of the cartoons here.

• As many as one in ten hospitalisations in OECD countries may be caused by medication related harm.
• One in five inpatients experience medication-related harms during hospitalisation.
• Over $54 billion (US Dollars) is spent on medication-related harm in OECD countries (cost from avoidable admissions due to medication related harms plus added length of stay due to preventable hospital-acquired medication-related harms).

This report is divided into four main sections:

1.      Medication-related harms and errors are not rare events and have significant economic impact

This section considers the human impact and economic costs of medication safety events and includes the following points:

There has been limited progress in improving medication safety due to a number of converging factors.

•  The occurrence of medication errors can lead to an erroneous feedback loop - compounding harms.
• Non-pharmacological treatment alternatives are underused despite their demonstrated effectiveness to treat several chronic conditions.
• Increasing use of pharmacological treatment for chronic conditions is a contributing factor to potentially dangerous polypharmacy.
•  Some patient groups are particularly at risk of medication-related harm, particularly older patients, patients taking anti-psychotic medications and people living with dementia.
•  The prevalence of inappropriate prescribing is substantial, and possibly increasing.
• In the OECD they estimate that there are over six million hospital admissions annually are the result of medication-related harm.
• Each year, more than one million hospitalised patients in OECD countries experience a preventable medication-related harm in hospital.

2.      Reducing inappropriate prescribing and improving the rational use of medicines

This section considers the importance of the rational use of medicines - ensuring the right medicine at the right dose and duration for the right patient. It includes the following points:

• The most common form of irrational use of medicines is overuse, such as inappropriate polypharmacy.
• The inappropriate use of antibiotics has led to growing crisis of antimicrobial resistance.
• Underuse of medications does not receive much attention, however it also contributes significantly to global morbidity and mortality.
• Regulatory and economic interventions can improve medication utilisation and reduce costs but require robust evaluation alongside implementation.

3.      Improving medication safety throughout the care pathway

• This section considers different national strategies to improve medication safety and includes:
• An overview of selected national medication safety regulations or strategies.
• Discussion of the role of pharmacovigilance and drug utilisation reviews.
• Consideration of the status and adoption of digitalisation and medication patient safety initiatives in different OECD countries.

4.      Building medication safety into the Covid-19 recovery

This section considering the opportunities as countries look to adapt their health systems to build medication safety into their Covid-19 response and recovery activities. It includes the following points:

• The dynamics created by Covid-19 can be used to accelerate change.
• Importance of improving the functionality of data for monitoring medication safety in real-time.
• Need to use good patient safety governance and transparency to build public trust.
• Leadership commitment is required to establishing and maintaining a safe, people-centred environment that enables reporting to medication safety surveillance systems.
• Investments should continue to build systems that capture patient experience of medication-related harms and medication side-effects.
• There should be greater support for people-centred care systems and shared-decision making.

Other OECD patient safety reports available on the hub

• Developing international benchmarks of patient safety culture in hospital (19 January 2022)
• The economics of patient safety: Strengthening a value-based approach to reducing patient harm at national level (June 2017)
• The economics of patient safety in primary and ambulatory care: Flying blind (November 2018)
• Culture as a cure: Assessments of patient safety culture in OECD countries (2 June 2020)
• The economics of patient safety part III: Long-term care (17 September 2020)
• The economics of patient safety: From analysis to action (21 October 2020)
• The economics of patient safety part IV: Safety in the workplace (10 September 2021)