Published: 20/03/2003, Volume II3, No. 5847 Page 22 23

So once again, prescription charges are to rise - by 10p from April. The relative modesty of the increase (1.6 per cent) should not be used to hide the fact that prescription charges are already unaffordable for thousands of people in poor health with incomes just above the income support threshold.

Many of those affected are people receive disability benefits who, by definition, are likely to be heavy prescription users. If they are unable to afford£6.30 for a single prescription charge, the pre-payment certificate at£32.90 for four months or£90.40 for a year is completely out of reach.

The Citizens Advice Bureau commissioned MORI research in 2001 which estimated that as many as 750,000 patients go without the medication because they cannot afford to get their prescriptions dispensed. Since then, CABs have continued to report clients whose health is suffering because they are unable to afford the medication they need. Recent cases include a client with severe mental health problems whose condition deteriorates without regular medication, and a client with chronic heart disease who was trying to choose which of five recently prescribed items he would get dispensed.

Clearly the government's stated policy, which is to ensure no-one need be deterred from obtaining any necessary medication on financial grounds, is not working. Yet there has been no action to address this issue, even by taking the modest step of making the pre-payment certificate available on a sliding scale to people on low incomes.

This is all the more surprising given the government's recognition of the links between health and poverty and its commitment to tackling health inequalities.

In contrast, the Welsh National Assembly has announced that it will be building on its current policy of freezing charges at£6 and extending exemptions to under-25s.

It is undertaking a review of prescription charges 'to include identifying options for extending exemptions to those who have most difficulty paying'.

This only serves to highlight the need for urgent action for the rest of the UK.

David Harker Chief executive Citizens Advice Bureau