In a briefing document published on December 18th the Department of Finance outlined three proposed approaches to “balancing the budget” over the next two years. For me, it was unsurprising that as part of the proposals to “raise additional revenue” for 2018-20, the department suggested reintroducing a charge for “each health service prescription item dispensed”.

Prescriptions have been free here since 2010. Reintroducing prescription charges could generate “up to £20 million” annually, the department estimated which I feel is a gross underestimate if done properly and it might also have the benefit of improving our overall health. In 2016 our population of 1.8 million received over 41 million prescription items costing over £400m; by international standards that’s pretty impressive medicine consumption.

I use to be the strongest advocate for the abolition of prescription charges. For many years my April Fool’s Day ritual was to speak on TV and radio on behalf of the pharmacy profession about the iniquity of a recently announced prescription charge hike. I used the stock phrases; “tax on the sick”, “unfair”, et cetera. The charge reached £7.20 when Health Minister Michael McGimpsey, sticking to an election pledge, cut it first to £3.00 and then to zero.

McGimipsey reasoned that since only 10% of prescriptions dispensed were paid for due to the complexity of the system, this raised some £10 million but cost £2 million to regulate and catch those who were not work-shy but happy to take advantage. 90% of prescriptions dispensed in the old system were exempt from charge whereas only 60% of the population were exempt.

The big fear about the abolition of charges back in 2010 was a potential surge in prescription numbers. Surprisingly it didn’t happen. Why this was surprising I’m not sure. The 10% of prescriptions that were paid for were paid for by those less who were unlikely to overuse HS services.

Since abolition we have of course had the expected 5% annual increase in prescription items but a welcomed reduction in medical costs. This is mainly due to more generic prescribing and changes in branded medicine pricing. Of the £400 million handed down to the HSC Board for drugs in 2016-17, we are seeing year on year savings that can be reinvested into other services including more prevention services.

There is scope for more savings. NI spends 40% more on drugs per head of population compared to England and 20% more than Scotland which is a region of comparable social deprivation. Do we get 20% to 40% more value from our drug spend in terms of improvements in health and well being? I don’t think so.

Proposed annual savings by the department of finance from this initiative are therefore only a small part of the possible £50-£100 million that could be recovered if we achieved prescribing costs comparable to other UK regions. That is unlikely to happen unless we have a big new idea and for me, this big new idea is paradoxically the reintroduction of prescription charges.

So that makes me sound a flip-flopper. No, I would not support the complex system we gave up 8 years ago which had more faults than a 1970s Skoda and which I campaigned against. We need one prescription fee for all medicines dispensed, I support the proposal for a £1.00 per item fee. There can be no exceptions; the 92-year-old who needs palliative care or the diabetic with 27 items a month cannot be exempt since policing the system would add a huge cost. The money collected would be £40 million immediately and more importantly, it would reduce prescription costs as fewer will consider getting unnecessary prescriptions; it currently costs the Health Service £12.00 to supply a 32 pack of paracetamol when that comes via a GP.

Of course, this approach is a complete anathema to some political parties and for that reason will not happen.