On 30 November 2023, the House of Lords will debate the following question for short debate:

The Lord Bishop of London to ask His Majesty’s Government what impact the removal of free prescriptions for benefit claimants who fail to look for work will have on their health, and the health of the workforce.

1. What is the current situation?

1.1 Eligibility 

At present, NHS prescriptions are free for those in Scotland, Wales and Northern Ireland. In England, the current prescription charge is £9.65 per item. However, some individuals are entitled to free prescriptions if they meet certain criteria.[1] This includes if they:

  • are aged 60 or over
  • are under 16 years old
  • are aged between 16 and 18 and in full-time education
  • are pregnant or have had a baby in the previous 12 months and have a valid maternity exemption certificate
  • have a specified medical condition and have a valid medical exemption certificate
  • have a continuing physical disability that prevents them from going out without help from another person and have a valid medical exemption certificate
  • hold a valid war pension exemption certificate and the prescription is for their accepted disability
  • are an NHS inpatient

Additionally, individuals are entitled to free prescriptions if they or their partner receive certain benefits, or are under the age of 20 and a dependent of someone receiving:

  • income support
  • income-based jobseeker’s allowance
  • income-related employment and support allowance
  • pension credit guarantee credit
  • universal credit (UC) and meet the following criteria:
    • They either had no earnings or had net earnings of £435 or less in their last UC assessment period, or
    • they receive UC, which includes an element for a child, or they (or their partner) had limited capability for work or limited capability for work and work-related activity, and either had no earnings or net earnings of £935 or less in their last assessment period.[2]

Individuals are also eligible for free prescriptions if they have certain medical conditions, such as cancer or diabetes, and have a valid medical exemption certificate.[3]

In March 2023, the government stated that 60 percent of the population were exempt from prescription charges. However, data providing a breakdown of this figure by exemption type, including how many of those received free prescriptions as a result of their benefit status, was “not held centrally”.[4]

1.2 Costs of prescription exemptions to the NHS

The majority of prescription items dispensed in community pharmacies in England are provided to individuals with prescription exemptions, at a cost to the NHS. The NHS Business Service Authority (NHS BSA) publishes annual prescription cost analyses, providing detailed information on the costs and volumes of all prescriptions dispensed in England’s community pharmacies. In its latest analysis for 2022/23, the NHS BSA found that 95.08 percent of prescription drugs dispensed in the community were exempt from charges (1.12mn out of 1.17mn items). In contrast, charged items accounted for 4.92 percent of prescription medications dispensed (58mn).[5] The analysis revealed that the total cost to the NHS of exempt prescription items in community pharmacies in England in 2022/23 was £9.9bn, while the total cost of charged items was £506mn.

However, some commentators have argued that free prescriptions may benefit rather than cost the NHS financially because it could lead to a reduction in related health problems and subsequent appointments and treatment. A study conducted by researchers at the York Health Economics Consortium in 2018 demonstrated that eliminating prescription charges for individuals with inflammatory bowel disease and Parkinson’s disease could potentially save the NHS around £20mn annually. This reduction in costs would stem from a decrease in health complications associated with these conditions, often arising from patients’ non-adherence to prescribed medications due to financial constraints.[6] This might include reductions in: hospital admissions; visits to accident and emergency departments; general practitioner appointments; and treatments for colorectal cancer.

1.3 Health impacts of prescription charges

Some studies have suggested that prescription charges have impacted health outcomes, leading to reduced medication adherence and increasing health disparities. This, in turn, they argue has led to workforce absenteeism.

In February 2023, the Royal Pharmaceutical Society (RPS) published the results of a survey of 269 pharmacists assessing the impact of rising living costs on access to prescription medication in England. [7] The survey revealed that:

  • over half (51 percent) of pharmacists had experienced an increase in the number of patients not collecting their prescription medications in the six months prior to the survey
  • a similar proportion (52 percent) had reported an increase in the number of patients asking them to prioritise items on their prescriptions due to affordability concerns
  • approximately two-thirds (67 percent) had seen an increase in the number of patients inquiring about cheaper over-the-counter alternatives to their prescription medications

In response to the survey findings, Thorrun Govind, chair of the RPS, expressed “deep concern” about individuals “having to make choices about their health based on their ability to pay”.[8] She further warned that:

Reducing access to medicines leads to poorer health, time off work and can result in admissions to hospital, the cost of which must be set against any income gained from prescription charges.

The following month, the Prescription Charges Coalition, which is comprised of approximately 50 organisations, surveyed over 4,000 individuals with long-term conditions who were not currently exempt from prescription charges. Their findings revealed that prescription charges seemed to pose a barrier to accessing medication, with one in 10 respondents having skipped medication in the year prior to the survey due to cost concerns. This led to respondents developing additional medical conditions and being absent from work.[9] Amongst those who skipped medication:

  • 30 percent developed additional physical health problems beyond their original condition
  • 37 percent developed additional mental health problems beyond their original condition
  • 53 percent had to take time off work due to “worsening health”

Furthermore, 9 percent of respondents reported being unable to collect their prescription due to cost constraints, and 35 percent had the duration of their prescription changed, leading to more frequent prescription refills and increased costs.[10]

2. What changes has the government proposed?

In a speech to the Conservative Party conference in October 2023, the chancellor of the exchequer, Jeremy Hunt, outlined that the government was planning to withhold benefits from those who refused to seek employment.[11] In his speech, Mr Hunt stated that the government was going to look at the way the sanctions regime works, arguing that “it isn’t fair that someone who refuses to look seriously for a job gets the same as someone trying their best”.

In a written statement on 16 November 2023, the secretary of state for work and pensions, Mel Stride, introduced the ‘Back to work’ plan, describing it as a “package of employment-focused support that will help people to stay healthy, to move off benefits and to move into work”.[12] In the statement, Mr Stride said that there were some unemployed people who “resolutely refuse to engage in job seeking activities and continue to receive benefits”, despite “being able to work”. Therefore, he stated the government would be “toughening the application of sanctions” for those who failed to comply with the government’s “expectations on job-searching”. He also noted that as a result of these reforms, “no claimant should reach 18 months of unemployment in receipt of their full benefits if they have not taken every reasonable step to comply with jobcentre support”.

The government argues that the plan will see investment of £2.5bn in health and support initiatives over the next five years which will assist up to 1.1 million people with long-term health conditions, disabilities or in long-term unemployment.[13] The government intends that it will be delivered across three phases:

  • Phase 1: Unemployed claimants across Great Britain will receive regular support from a work coach to “search for and move into work”. To strengthen the government’s understanding of how early interventions can help claimants find work or increase their income, the government stated that it had increased additional jobcentre support in England and Scotland. This initiative will examine how intensive support could help claimants who remain unemployed or on low earnings into work after seven weeks into a claimant’s search for employment.
  • Phase 2: If a claimant in England and Wales has failed to find work after six months, they will be referred to the “expanded and improved” ‘Restart’ scheme. The scheme will provide 12 months of “intensive, tailored support to tackle barriers to employment”, with support comprising of coaching, CV and interview skills, and training sessions. As part of phase 2, work coaches will also track the activity of participants to ensure they complied with the scheme’s requirements.
  • Phase 3: Claimants in England and Wales who are still unemployed after 12 months on the ‘Restart’ scheme will be required to participate in a claimant review point, which is a review process through which a work coach would assess the claimant’s situation and determine the most suitable work search conditions or employment pathways to support their transition into work. Should no suitable local job be available immediately, a claimant will be required to participate in time-limited mandatory work placement or engage in other activities designed to enhance their employability. Should a claimant refuse to accept these conditions “without good reason”, their UC claim will be closed. The government has stated that this model will be rolled out gradually from 2024.

Alongside these measures, the government announced the expansion of several health and employment programmes.[14] These included:

  • NHS talking therapies: This scheme provides psychological therapies for the treatment of mild and moderate mental health conditions. The government has said that the scheme’s expansion will help an additional 384,000 people over the next five years.
  • Individual placement and support for severe mental illness: This is an employment support service within community mental health teams, aiming to help people secure and maintain paid employment. It will be expanded to provide an additional 100,000 places over five years.
  • Universal support: This programme matches long-term sick and disabled participants with suitable vacancies, based on their preferences, strengths and any lessons learnt from previous work experience. It also provides funding of up to £4,000 per participant for support services, such as relevant training or employer adjustments, to ensure they can succeed. The government announced that the programme would expand to 100,000 people in England and Wales, doubling its initial commitment made in the spring budget 2023.
  • WorkWell: This service provides integrated work and health support to individuals at risk of long-term unemployment due to disability or sickness. The government said that integrated care systems across England would be supported to develop a localised work and health strategy. Services will then be provided in 15 pilot areas.

Further to these measures, the government stated that it would “strengthen the UC sanctions regime” to “incentivise compliance” with the plan.[15] The government argued that this would “further enforce the government’s expectation that those who can work must engage with the support available or lose their benefits”. Specifically, the government stated that it intended to:

  • Target claimants who continued to disengage with job centre support: This includes closing the claims of individuals who have been subject to an open-ended sanction for over six months and who are solely entitled to the UC standard allowance. Consequently, these individuals would also end their access to passported benefits, such as free prescriptions and legal aid. At present, there has been no further information published by the government on the sanction or detail on how it would be applied.
  • Root out fraud and error: By using the existing targeted case review process to review the UC claims of disengaged claimants who have been under an open-ended sanction for over eight weeks. This would ensure they received the right entitlement.
  • Track claimants’ attendance at job fairs and interviews organised by job centres: This would enable work coaches to have the information they needed to determine whether claimants were meeting their commitments. The government has stated that it would look to build on these changes in the future to “further integrate employers into jobcentre processes and improve oversight of claimants’ work search activities”.

In an interview with Sky News on 21 November 2023, the chief secretary to the treasury, Laura Trott, defended the government’s plans to end the benefit claims of individuals who refuse to work. She stated that “ultimately, there is a duty on citizens that if they are able to go out to work, that’s what they should do”.[16]

3. What has been the response to the government’s proposals?

Several industry bodies welcomed the government’s plans to assist people with long-term health conditions, disabilities, or long-term unemployment into employment. Alex Veitch, the director of policy at the British Chambers of Commerce, said that “getting this right could help fill hundreds of thousands of jobs and provide a big boost to the economy”.[17] Similarly, Kate Shoesmith, the deputy chief executive of the Recruitment and Employment Confederation, expressed her support for the plan, stating that it would “help the Restart scheme keep making a real difference to people’s work and life chances”. She added that the plan “contributes to efforts to overcome our labour and skills shortages and to further growing our economy”.[18]

However, the government’s proposals, particularly the removal of passported benefits from claimants, have drawn criticism from several former and current Conservative politicians, opposition parties, and health organisations.

Speaking to the Independent in November 2023, Lord Heseltine (Conservative) stated that he was “all for persuading people to go back to work” but cautioned the government against “attack[ing] people on health grounds”. Similarly, Stephen Dorrell, a former secretary of state for health in the John Major government, said that “making a virtue of withdrawing healthcare support from people who by implication need it is deliberately unpleasant”. He also raised concerns about the potential for legal challenges against the government’s sanctions.[19]

Opposition parties also voiced their disapproval. The shadow health secretary, Wes Streeting, stated that there were already UC sanctions in place and that he did not see “how limiting people’s access to healthcare is going to be effective or ethical”.[20] Similarly, the Liberal Democrats’ Treasury spokesperson, Sarah Olney, said that the government “seems more interested in penalising people than helping them get back into work”.[21]

The plan to end access to free prescriptions for benefit claimants who refuse to work was also criticised by some healthcare organisations and charities. Dr Latifa Patel, chair of the representative body at the British Medical Association, argued that the government should not “hold people’s health to ransom especially when their poor health may be the very reason they are unable to work in the first place”. Dr Patel also expressed concerns that the sanction would be “counterintuitive” and could increase the burden on the NHS.[22] Vicky Nash, the associate director for policy and campaigns at Mind, also criticised the government’s approach, suggesting there had been a disconnect between different departments. She also warned that “the increase in the use of sanctions” was “deeply worrying”, with evidence having “repeatedly shown they don’t work and make people’s mental health worse”.[23]

4. Read more

Cover image by aleksandarlittlewolf on Freepik


  1. NHS, ‘Who can get free prescriptions’, accessed 23 November 2023. Return to text
  2. NHS, ‘Help with health costs for people getting universal credit’, accessed 23 November 2023. Return to text
  3. NHS, ‘Who can get free prescriptions’, accessed 23 November 2023. Return to text
  4. House of Lords, ‘Written question: Prescriptions: Fees and charges (HL5756)’, 7 March 2023. Return to text
  5. NHS Business Services Authority, ‘Prescription cost analysis: England 2022/23—additional analysis data tables’, 8 June 2023, table A4. Return to text
  6. University of York, ‘NHS could save millions by scrapping prescription charges for people with long-term conditions’, 22 May 2018. Return to text
  7. Royal Pharmaceutical Society, ‘The cost of living impacts access to prescription medicines says RPS’, 13 February 2023. Return to text
  8. As above. Return to text
  9. Prescription Charges Coalition, ‘Continuing to pay the price: The impact of prescription charges on people living with long term conditions’, March 2023, p 2. Return to text
  10. As above. Return to text
  11. Simon French and Oliver Wright, ‘Jeremy Hunt’s speech: The five key points’, Times (£), 2 October 2023. Return to text
  12. House of Commons, ‘Written statement: Labour market update (HCWS43)’, 16 November 2023. Return to text
  13. HM Treasury, ‘Autumn statement 2023’, 22 November 2023, CP 977, p 47. Return to text
  14. HM Treasury et al, ‘Employment support launched for over a million people’, 16 November 2023. Return to text
  15. HM Treasury, ‘Autumn statement 2023’, 22 November 2023, CP 977, p 47. Return to text
  16. Archie Mitchell, ‘Sunak to cut benefits for long-term sick unless they seek to work from home’, Independent, 21 November 2023. Return to text
  17. British Chambers of Commerce, ‘BCC welcomes new support to get people into work’, 16 November 2023. Return to text
  18. HM Treasury et al, ‘Employment support launched for over a million people’, 16 November 2023. Return to text
  19. Kate Devlin et al, ‘Heseltine accuses Tories of fuelling ‘hate politics’ over plot to strip jobless of free prescriptions’, Independent, 18 November 2023. Return to text
  20. As above. Return to text
  21. Liberal Democrats, ‘Back to work plan: Government failing patients stuck on waiting lists’, 18 November 2023. Return to text
  22. Kate Devlin et al, ‘Heseltine accuses Tories of fuelling ‘hate politics’ over plot to strip jobless of free prescriptions’, Independent, 18 November 2023. Return to text
  23. Mind, ‘Mind responds to announcement of new back to work plan’, 16 November 2023. Return to text