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NHS Prescription Charge Penalty

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My brother has been off sick with a disablity (both physical and Mental Health) for more than a year. He is not receiving any income from his employer as his sick pay and SSP run out long time ago.

 

He and his wife are in receipt of Universal Credit and my brother is also in receipt of Personal Independence Payment and more importantly due to his mental health not in a state of mind to take rational decisions. Their combined earning for the period was more than £935 however my brother's income was £0. Secondly when I last checked around last year December this net earning requirements used to be individual earnings (thats been changed without me realising). However, at the pharmacy I always show his proof that he is in receipt of Universal Credit as there is no boxes for Universal Credit as yet, nor is there any detailed information about Universal credit earning limits etc and pharmacists asks me to tick the box .

 

He has received this penalty notice from NHS asking him to pay £17.20 for prescriptions and £86 penalty. It says "Your representative (me) incorrectly claim that you (my brother) was included in an award for Income Support or Income Related Employment and Support Allowance.

 

I just checked NHS Business Services Authority website and found following:

 

Prescriptions collected on or after 1 December 2016

 

To be entitled to claim free NHS prescriptions you must be receiving Universal Credit, either as a single person or as a member of a couple, and:

  1. for the last complete assessment period* you and your partner (if you have one) had either no earnings or net earnings** of £435.00 or less. Or;
  2. for the last complete assessment period* you and your partner (if you have one) had either no earnings or net earnings** of £935.00 or less, and had a child element included in your award or had limited capability for work

You would also be entitled if you are a dependent child or qualifying young person of someone who meets the above criteria in paragraph (b).

 

My Question is:

 

1) Is he/is he not entitled to free prescription? Specially when it states in section (b) "OR HAD LIMITED CAPABILITY TO WORK"

 

2) Is he liable to be fined knowing someone (me) has ticked the box on his behalf?

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Hi This link may help its the information that's given to pharmacies http://psnc.org.uk/our-news/universal-credit-update/

looking at it it seems they are saying applicants should have a letter from UC stating entitlement - do you have one of these, it does seem they are supposed to ask if you are still entitled and to warn you that you could face a fine if not, but that wont negate the fine if they didn't, as it seems from other info I have read pharmacists have been subject to violence and abuse if they do ask so would seem they would rather rely on the NHSBSA investigating (and I cant say I blame them)

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I have since looked into the issue including the link you have provided and found the actual problem.

 

 

There was a change in rules in December 2016 in terms of UC and NHS free prescriptions.

 

 

Prior to the rule change to be eligible, a person needed to be in receipt of UC and should've had an income of less than £935 (my brother's income is £0).

 

However After December 2016 the new rule changed the £935 income from being Individual earnings to Household earnings.

 

 

Taking his wife's income in consideration his household income is slightly over £1000 mark therefore he due to the rule changes got affected.

 

 

The biggest problem I have with all this issue is that there is so much lack of information and ambiguity about Universal Credits. Even pharmacists (even though I don't blame them for not knowing) have no idea about Universal Credit.

There is not even a box behind prescriptions for Universal Credit.

 

 

He was under assumption if circumstances around his UC haven't changed then he assumed related benefits such as UC haven't changed either, specially given lack of knowledge and communication where no one has sent him a letter or anything to inform about these changes in rules.

 

Secondly he has been suffering from his own illnesses and last thing is him just keep on checking about changes in various rules. Any normal person would be under assumption that if none of circumstances around UC changed then why would be associated benefits would change?

 

I have contacted NHSBSA appealing on same grounds and have asked them to help us pay for any other prescriptions since this one as they are likely to be affected due to same reasons and last thing is we receive an individual fine for every single prescription.

 

Any thoughts from other people are welcome

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I have since looked into the issue including the link you have provided and found the actual problem.

 

 

There was a change in rules in December 2016 in terms of UC and NHS free prescriptions.

 

 

Prior to the rule change to be eligible, a person needed to be in receipt of UC and should've had an income of less than £935 (my brother's income is £0).

 

However After December 2016 the new rule changed the £935 income from being Individual earnings to Household earnings.

 

 

Taking his wife's income in consideration his household income is slightly over £1000 mark therefore he due to the rule changes got affected.

 

 

The biggest problem I have with all this issue is that there is so much lack of information and ambiguity about Universal Credits. Even pharmacists (even though I don't blame them for not knowing) have no idea about Universal Credit.

There is not even a box behind prescriptions for Universal Credit.

 

 

He was under assumption if circumstances around his UC haven't changed then he assumed related benefits such as UC haven't changed either, specially given lack of knowledge and communication where no one has sent him a letter or anything to inform about these changes in rules.

 

Secondly he has been suffering from his own illnesses and last thing is him just keep on checking about changes in various rules. Any normal person would be under assumption that if none of circumstances around UC changed then why would be associated benefits would change?

 

I have contacted NHSBSA appealing on same grounds and have asked them to help us pay for any other prescriptions since this one as they are likely to be affected due to same reasons and last thing is we receive an individual fine for every single prescription.

 

Any thoughts from other people are welcome

 

 

They won't do that on an individual basis there was to be a valid reason for exemption that everyone has to follow, if the household income is £1000 per month then your brother and his wife may get free prescriptions under the low income scheme http://www.nhs.uk/NHSEngland/Healthcosts/Pages/nhs-low-income-scheme.aspx but that's a means tested scheme based on household income it has to be applied for and all income savings etc have to be taken into account failing that there are other ways of getting costs down like a prepayment certificate this link shows all the ways a person can claim exemption https://www.nhsbsa.nhs.uk/nhs-help-health-costs

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I meant I've appealed telling them how this happened due to being unaware of rule changes and I've offered them to pay for any other prescriptions since as we were not aware. I've done that because I would rather pay than to attract more penalties which may happen due to same reason

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I have little update on situation and I need assistance.

 

 

I had various replies from the NHS during the appeal most of them were simply template type replies where person responding had no idea or intention to reply to my question. This process carried on for nearly a month after which I told them I need to raise this to a manager as I am fed up of receiving standard answers.

 

 

I was told my appeal is been transferred to costumer relations department where a manager would review this appeal and reply back in 10 working days time. I waited but nothing happened during these 10 working days (discounting any weekends or any bank holiday). At the end of 10 working days I assumed since no replies were received this matter was over. However, on the 11th working day I received reply that my appeal is being turned down and in case I need to challenge it I need to send further evidence.

 

 

Million dollar question is, Can this appeal not be struck down based on I was told I will receive reply in 10 working days but reply arrived outside 10 working days? Is there any rules/laws or case studies that can support my case based on 10 working days breach?

 

 

Thanksfully

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How did you receive your response?


My views are my own and are not representative of any organisation. if you've found my post helpful please click on the star below.

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How did you receive your response?

 

All communication happened through email so there is no questions about any delays due to postal issues

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They would have sent you a template letter because that's their procedure not because no-one had any idea or intention to reply, they deal with 1000s of cases every day and I doubt they have the time and manpower to write a personal letter, also all correspondence would have to be written in a certain way for legal means, you didn't want the standard reply so they escalated to a decision maker who upheld the decision, they did their job, you then made an assumption that because they didn't reply within the 10 days stated that the matter was closed, but that's all it was an assumption on your part, unless their correspondence actually stated that if you didn't hear from them within that time your complaint has been upheld, you don't have any recourse, of course you can complain that they didn't respond to you within the 10 days but I suspect the answer would be an apology for the delay, as you rightly say there was a BH within the time frame, that could possibly mean that they were running a day late which is not ideal but not grounds for them to agree to waive the fine.

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They would have sent you a template letter because that's their procedure not because no-one had any idea or intention to reply, they deal with 1000s of cases every day and I doubt they have the time and manpower to write a personal letter, also all correspondence would have to be written in a certain way for legal means, you didn't want the standard reply so they escalated to a decision maker who upheld the decision, they did their job, you then made an assumption that because they didn't reply within the 10 days stated that the matter was closed, but that's all it was an assumption on your part, unless their correspondence actually stated that if you didn't hear from them within that time your complaint has been upheld, you don't have any recourse, of course you can complain that they didn't respond to you within the 10 days but I suspect the answer would be an apology for the delay, as you rightly say there was a BH within the time frame, that could possibly mean that they were running a day late which is not ideal but not grounds for them to agree to waive the fine.

 

When I counted 10 working days I accounted for Bank Holidays. I asked just in case if them not replying back in 10 working days, after they said they would gives me a chance to appeal due to breaching of timeframe.

Hence, I asked if anyone is aware of any case studies/previous cases where such claims be won by fine issuing authority not replying back in agreed timeframes?

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Hi there.

 

http://www.legislation.gov.uk/uksi/1999/2794/regulation/2/made#f00004

 

(g)that a person is not liable by virtue of a penalty notice—

(...)

(ii)to a penalty charge, or a surcharge, if he shows that he did not act wrongfully, or with any lack of care, in respect of the amount recoverable as mentioned in section 122B(1)(a) or (b) of the Act(3).

 

As far as I am concerned, that's your defence, right there. I'm in the same boat and as far as I am concerned, they're going to have to take me to court if they want the penalty.

 

As for the time frames, I wouldn't rely on that, they're indicative, not mandatory.

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