Workmen's Compensation (Accidents) Convention, 1925 (No. 17) - United Kingdom of Great Britain and Northern Ireland (Ratification: 1949)

Observation (CEACR) - adopted 2019, published 109th ILC session (2021)

Article 9 of the Convention. Cost-sharing for pharmaceutical products. In its previous comments, the Committee requested the Government to indicate the measures taken to reduce cost sharing for pharmaceutical products outside the hospital for victims of occupational accidents. The Committee notes, as stated by the Government in its report, that prescription charges and the costs of dental treatment outside the hospital continue to be borne by recipients of industrial injuries benefits on the same basis as they are borne by people receiving other state benefits. The Committee further notes the Government’s indication that assistance may be available, for example, in case of receipt of qualifying income-related benefits or in case of specified conditions related to age or health. As far as Northern Ireland is concerned, the Committee takes due note that all Health Service prescriptions dispensed outside the hospital are free of charge for everyone. Recalling that, in accordance with Article 9 of the Convention, the cost of medical aid, surgical and pharmaceutical aid shall be provided free of charge, the Committee requests the Government to take the necessary measures to ensure the full application of Article 9 of the Convention with respect to the provision of pharmaceutical products outside the hospital to all persons protected in case of occupational injury.

The Committee has been informed that, based on the recommendations of the Standards Review Mechanism Tripartite Working Group (SRM tripartite working group), the Governing Body has decided that member States for which Workmen’s Compensation (Accidents) Convention, 1925 (No. 17) is in force should be encouraged to ratify the more recent Employment Injury Benefits Convention, 1964 [Schedule I amended in 1980] (No. 121), or to accept Part VI of Social Security (Minimum Standards) Convention, 1952 (No. 102) (see GB.328/LILS/2/1). The Committee therefore encourages the Government to follow up the Governing Body’s decision at its 328th Session (October–November 2016) approving the recommendations of the SRM tripartite working group and to consider ratifying Convention No 121 or accepting Part VI of Convention No. 102 as the most up-to-date instruments in this subject area.

Observation (CEACR) - adopted 2011, published 101st ILC session (2012)

Article 9. Cost-sharing for pharmaceutical products. The Committee regrets to note that no reply was received to its previous observations on the measures taken to include all victims of occupational accidents within the category of insured persons exempt from cost-sharing so that pharmaceutical assistance dispensed outside the hospital is provided free of charge to all victims of occupational accidents. The Committee requests the Government to indicate in its next report the measures taken to further reduce cost-sharing for pharmaceutical products outside the hospital for victims of occupational accidents and provide the corresponding statistical information.

Observation (CEACR) - adopted 2006, published 96th ILC session (2007)

Article 9 of the Convention. Cost sharing. In reply to earlier comments by the Committee concerning the cost-sharing by victims of industrial accidents to the cost of pharmaceutical products prescribed outside hospitalization, the Government once again indicates that the provisions of the National Health Service Act regarding reimbursement of pharmaceutical expenses are fair to the extent that they target assistance towards those persons in the greatest financial difficulties. The Government remains convinced that the victims of occupational accidents in this category will be adequately protected by the above legislation. It further undertakes to ensure that over the course of the next three years increases in cost sharing will not exceed the inflation rate.

While it once again takes due note of this information, the Committee reminds the Government that any provision providing for cost-sharing by the victim of an occupational accident in the cost of prescribed pharmaceutical products is not in conformity with Article 9 of the Convention, as the aim of this provision is to prevent the financial consequences derived from the occupational injury being borne by the worker. In this connection, information previously communicated by the Government shows that, firstly, victims of occupational injuries are not required to share in the costs of prescribed pharmaceutical products when they are in a hospital or when their income is beneath a certain limit and, secondly, many categories of insured persons are exempt from cost sharing in respect of pharmaceutical products, irrespective of their level of income. Also, under the existing prescription prepayment arrangements (PPC), persons with paid annual or four-monthly certificates are exempted from the payment of prescription charges for the corresponding period. As a result of these arrangements, only 8.4 per cent of items are paid for at the point of dispensing. Taking these exemptions into account, the Committee still considers that the Government should be able to include all victims of occupational accidents, irrespective of their income level, within the category of insured persons exempt from cost sharing so that pharmaceutical assistance dispensed outside hospital is provided free of charge to all victims of industrial accidents. The Committee trusts that the Government will re-examine this question and take the measures necessary to ensure the full implementation of the Convention on this point.

Observation (CEACR) - adopted 2000, published 89th ILC session (2001)

Article 9 of the Convention.  In reply to earlier comments by the Committee concerning contribution by victims of industrial accidents towards the costs of pharmaceutical products prescribed outside hospitalization, the Government once again indicates that the provisions of the legislation (National Health Service Act) regarding reimbursement of pharmaceutical expenses are fair to the extent that they target assistance towards those persons in the greatest financial difficulties. The Government remains convinced that the victims of occupational accidents in this category will be adequately protected by the abovementioned legislation. It further undertakes to ensure that over the course of the next three years increases in cost sharing will not exceed the inflation rate.

The Committee notes this information. It reminds the Government that any provision providing for a contribution by the victim of an occupational accident in the cost of prescribed pharmaceutical products is counter to Article 9 of the Convention. The aim of this provision is to prevent the financial consequences derived from the occupational injury being borne by the worker. In this connection information previously communicated by the Government shows that, firstly, victims of occupational injuries are not required to share in the costs of prescribed pharmaceutical products when they are in a hospital or when their revenues are beneath a certain limit and, secondly, many categories of insured persons are exempt from cost sharing in respect of pharmaceutical products, irrespective of their level of income. Taking these exemptions into account, the Committee still considers that the Government should be able to include all victims of occupational accidents, irrespective of their income level, within the category of insured persons exempt from cost sharing such that pharmaceutical assistance dispensed outside hospital is provided free of charge to all victims of industrial accidents. The Committee trusts that the Government will re-examine this question and take the measures necessary to ensure full implementation of the Convention on this point.

Observation (CEACR) - adopted 1995, published 82nd ILC session (1995)

1. Article 9 of the Convention (free pharmaceutical aid). In reply to the Committee's previous comments concerning the participation by victims of industrial accidents in the cost of pharmaceutical products prescribed for out-patients, the Government reiterates that it has no plans to extend automatic exemption from prescription charges in cases of industrial accidents because of the risk of adversely affecting the relationship that exists between patient and doctor, the latter having to decide not only which medicines should, or should not, be dispensed free of charge, but also whether or not a particular ailment was a consequence of the accident. Moreover, the Government states it would be unfair to single out one particular group for such exemption when there may be others in similar circumstances, such as the innocent victims of road accidents or assaults, who might equally feel that they too should be exempt. Furthermore, extending automatic exemption to victims of industrial accidents would not necessarily direct help towards those most in need, since only those people whose income is above the qualifying threshold for charge remission would benefit from such a change. In this respect, the Government continues to believe that the manner in which the National Health Service defrays the costs of medical aid in cases of industrial accidents is best targeted on those who are likely to have the greatest difficulty in paying, with a view to ensuring that adequate protection is provided to those that need it.

Notwithstanding these explanations, the Committee notes that the prescription charge has been increased from 2.80 on 1 April 1989 to 4.25 from 1 April 1993. It recalls, however, that no charge is made for pharmaceutical aid whilst a patient is resident in hospital as well as for those out-patients whose income is below a certain threshold. It also notes that, as stated by the Government, about 80 per cent of prescribed items (89 per cent in Northern Ireland) are now dispensed free of charge due to extensive arrangements for prescription charge exemption and remission which protect vulnerable groups in the community, including old and young people of a certain age, pregnant women and mothers who have had a baby in the previous 12 months, war or Ministry of Defence disablement pensioners, and people who suffer from certain medical conditions. In the light of these extensive exemptions, the Committee considers that it should not be difficult for the Government to include victims of industrial accidents, irrespective of their income, among the categories exempted from the prescription charge so that, if treated at home or after leaving hospital, they may benefit or continue to benefit from the free pharmaceutical aid as is recognized to be necessary in consequence of accidents. In this respect, the Committee wishes once again to draw the Government's attention to the fact that any provision laying down participation by victims of industrial accidents in the cost of pharmaceutical benefits is contrary to the Convention. It therefore once again hopes that the Government will reconsider its position so as to ensure full application of the Convention on this point.

2. The Committee notes the comments made by the Trades Union Congress, supplied by the Government with its report, according to which, since 1979 most of the previous benefits of the Industrial Injuries Scheme have been steadily abolished by the Government and in 1986 entitlement to the most significant of benefits, Disablement Benefit, was drastically restricted. In the light of these comments, the Committee hopes that the Government's next report will contain full information in reply to the TUC comment, specifying the legislative changes that have taken place with reference to the application of the Convention. The Committee also asks the Government to provide the detailed statistical information requested in point V of the report form adopted by the Governing Body.

[The Government is asked to report in detail by 1 September 1995 at the latest.]

Observation (CEACR) - adopted 1995, published 83rd ILC session (1996)

The Committee notes the information and statistics supplied by the Government in its report.

1. Article 9 of the Convention. In reply to the previous comments of the Committee, the Government states that, in light of the numerous exemptions from payment which already exist, the current prescription charge is a reasonable contribution from those who can afford to pay, and it would not be fair to extend automatic exemption from prescription charges to all victims of industrial accidents. Furthermore, extending exemption from prescription charges to items solely for the treatment of conditions arising as a result of an industrial accident would involve doctors in deciding whether or not a particular ailment was a consequence of the accident. The Committee notes this information. It recalls that the purpose of requiring the provision of prescriptions free of charge to the injured worker is to avoid placing the financial consequences of the injury on the individual worker. Therefore, in light of the existing exemptions from payment of prescription charges for other classes of beneficiaries regardless of ability to pay (such as persons above or below a prescribed age, pregnant women, and war or Ministry of Defence disablement pensioners), the Committee trusts that the Government will have no difficulty ensuring in the near future that pharmaceutical aid dispensed outside hospital, in particular, is provided free of charge to all victims of industrial accidents.

2. The Committee notes the Government's reply to the comments submitted by the Trades Union Congress concerning changes in the Industrial Injuries Scheme. The Committee also notes the adoption of the Social Security (Incapacity for Work) Act of 5 July 1994, mentioned by the Government in its report, and requests further information on the effect of this Act on the application of Articles 5,6, and 7 of the Convention.

Observation (CEACR) - adopted 1991, published 78th ILC session (1991)

Article 9 of the Convention (Free medical, surgical and pharmaceutical aid). In reply to the Committee's previous comments concerning the participation by victims of industrial accidents in the cost of pharmaceutical products prescribed for out-patients, the Government states once again that whilst it has no plans to alter the existing arrangements for exemption from charges which are set out in the regulations, it has been particularly concerned that no one should be deterred, on financial grounds, from seeking the treatment they need. It adds that under the existing arrangements over 75 per cent of prescribed items are dispensed free of charge and nearly 5 per cent are dispensed under season ticket arrangements. While noting this statement, the Committee can only regret the reasons that, in the Government's view, make it necessary to maintain participation in the cost of these benefits. It is bound to point out that any provision laying down participation by injured workmen in the course of their employment in the cost of pharmaceutical benefits, is contrary to the Convention. It reiterates therefore its hope that the Government will make every effort to ensure the full application of the Convention by abolishing any participation in, among other things, the cost of pharmaceutical products.