Prescription Charges (Hormone Replacement Therapy) (Hansard, 31 March 1999)

§ Dr. Howard Stoate (Dartford)

I beg to move, That leave be given to bring in a Bill to provide for women requiring hormone replacement therapy to pay a single prescription charge for both single and cyclical hormones, regardless of the preparation they are taking. Hormone replacement therapy has three major benefits. It effectively treats the symptoms of the menopause. There is a likely, but not yet proven, link with reducing the risk of heart disease. The most important benefit to women's long-term health is that it effectively reduces the incidence of osteoporosis in women after the menopause.

After the menopause, all women lose calcium from their bones. For many, the loss is much more severe, resulting in osteoporosis, which is often known as brittle bone disease. The condition reduces bone density and increases the likelihood of fractures, back pain and curvature of the spine. It causes not only much pain and suffering but huge physical, psychological and social cost to sufferers and their families.

The effects on the national health service are also considerable. There are 60,000 hip fractures in the United Kingdom every year, or one every 10 minutes. Sadly, by the time that I have sat down, someone else will have fallen down and broken a hip. Eighty per cent. of hip fractures are in women over 50. Treating a fractured hip costs £4,800. That is £4,800 every 10 minutes. One in five of those who suffer a hip fracture will go on to require long-term residential nursing home care costing, on average, £19,000 a year. That is one extra nursing home place taken every hour as a result of osteoporotic hip fractures alone.

At the menopause, HRT is a logical and appropriate intervention for the prevention of osteoporosis. It is proven to reduce bone loss in women, and it can delay or even prevent the onset of osteoporosis, thus significantly reducing the risk of fragility fractures.

The Department of Health local health action sheet advises GPs to counsel women on the risks and benefits of HRT at the menopause, and lists HRT as an effective drug therapy for the prevention and treatment of osteoporosis. The effectiveness of HRT in preventing reductions in bone density and reducing fractures is beyond doubt.

If we are to meet our targets set out in the Department of Health Green Paper "Our Healthier Nation" for reducing the huge burden of accidents, we need to encourage more women who would benefit from HRT to use it. Current opinion holds that giving HRT for periods of up to 10 years yields significant benefits, with minimised risk. The suggestion that HRT causes women to wear lurid outfits and to act strangely in the national media are purely anecdotal.

There are different types of HRT, and different types suit different women. Women who have undergone a hysterectomy can be prescribed the single hormone oestrogen. This attracts a single prescription charge. Women who are completely past the menopause can use combined therapy with little or no side effects. This also attracts a single prescription charge. Then there is the perimenopausal group—those women who are either still, 1105 or have just finished, menstruating. The other two therapies are usually not suitable for such women, and cyclical treatment is required. If unopposed oestrogen is given to such women, there is a significant risk of endometrial cancer. Thus, they must take two different hormones—oestrogen and a progestogen—separately at different times in their cycle. Although that treatment is usually contained in one treatment pack, it attracts two prescription charges.

Many of my constituents in Dartford, and several hon. Members of the House, have approached me about that anomaly. Why, they ask, should some women, for purely medical reasons, face the double charge? My experience as a GP tells me that some people find the double charge not only inexplicable but a significant cost burden which can put them off taking the treatment altogether. Professor David Purdie, of the British Menopause Society, estimates that 50 per cent. of post-menopausal women would benefit from HRT, but that only 10 per cent. of the group are using the therapy. That means that 40 per cent. of post-menopausal women are not benefiting from a therapy which could bring them relief from their current symptoms and reduce the risk of osteoporosis in later life. Our task should be to reduce the figure of 40 per cent. as much as possible by encouraging women who decide, after discussion with their GP, that HRT is right for them to use it.

Women in the group most likely to require cyclical therapy are aged 50 to 60. Although 86 per cent. of prescriptions are issued free, women in that age group are very likely to pay for their own prescriptions. Nor is this a small problem. Figures that I have obtained from the House of Commons Library show that, of the 5.8 million prescriptions for HRT in 1997, 62 per cent. were charged as one item. That means that 38 per cent., or 2.2 million prescriptions, attracted a double charge. That is a clear disincentive, preventing a wider take-up of HRT.

"Our Healthier Nation" contained welcome initiatives for reducing fractures among the elderly. Osteoporosis is a major cause of fractures, and an important plank of any strategy to tackle it has to be a greater take-up of HRT. I welcome the Green Paper and the strategies contained in it, and I congratulate the Government, and especially the Minister for Public Health, on a document that details how we can put into practice the old adage, "Prevention is better than cure."

When more women are aware of the benefits of HRT and can decide whether it is right for them, and when the double prescription charge disincentive is removed, the incidence of osteoporosis can be reduced. That will reduce the cost to the NHS of treating osteoporosis and, more important, reduce the pain and suffering that it causes.

The Bill tackles a clear anomaly in the system, and it will go a long way towards increasing the use of HRT by those women who could benefit from it. I ask hon. Members to endorse the Bill, which will directly benefit the lives of many of their constituents.