Sue Cane takes issue with NHS proposals to take gluten -free food off prescription.

Prescriptions for gluten-free staples improve the outcome for people who suffer from the autoimmune condition coeliac disease, and the proposal by NHS CEO Simon Stevens to simply stop their supply is not an effective solution to the funding crisis the NHS is experiencing.

Grossly distorted press-reports ignore the fact that gluten-free items on prescription for those that need them are an essential and cost-effective treatment in the management of a life-long disease. But it is the case that the current method of distribution via GPs needs reviewing.

There is no point in banning items if there is clinical need

Lifetime adherence to a restrictive gluten-free diet is challenging, but prescriptions for items like bread, flour and pasta help make it practical. Better patient-outcomes are achieved with access to staples on prescription and the support of registered dieticians within the NHS.

NICE’s standards for the treatment of coeliac disease highlight the role prescriptions play in ensuring the diet is accessible and affordable for all patients.

The evidence base for the NHSCC’s consultation at CCG level was flawed, and the commissioners were eager to mislead the public in their desire to cut NHS spending. The true cost of gluten-free staples was misrepresented and their lack of availability in many parts of the country glossed over. (Contrary to the NHSSS claim, they are not found in Lidl.)

An article in the BMJ highlights the dangers of following advice on diet given by CCGs keen to save money. The writer states when CCGs suggest ‘patients can simply switch to eating rice and potato alternatives, they fail to tackle the nutritional deficiencies of such alternatives. An isocalorific portion of rice contains 90% less iron and 82% less calcium than bread.’

Gluten-free staples are an essential provision for those on low incomes

One in four low-income households already do not eat regularly or healthily because of a lack of money. A third of the unemployed reduce the quality of their diet or miss meals completely because they have insufficient cash to buy food.

Wildly inaccurate reporting ignores the fact that basic gluten-free staples are much more expensive than standard equivalent-products. On a gram-for-gram basis a loaf of bread can cost up to 8 times more.

It is true that the fashion for avoiding gluten has lead to the increased availability of gluten-free items in supermarkets in major cities, but there has been little change in small towns and in rural areas. Contrary to reports, most budget and convenience stores, where the least well-off shop, do not stock gluten-free staples at all.

In 2014 NHS expenditure on prescribed gluten-free-products for each diagnosed coeliac was just £180

In terms of patient outcome it is one of the most cost-effective treatments for a long-term condition within the health service.

Grotesquely exaggerated reports that the NHS subsidises gluten-free junk food are simply untrue

National guidance on prescribing clearly sets out the range of staples allowed within the scheme. It limited to basics such as bread, flour and pasta. It will disappoint some - who like to believe that coeliacs feast on free biscuits and cakes - that these are not included. Coeliacs pay for their prescriptions too, like everyone else.

The proposed cuts will affect the poor, the elderly and those with limited mobility

The Royal Pharmaceutical Society chair Sandra Gidley says these proposals can be ‘interpreted as an attack’ on the NHS principle of providing treatment free at the point of use.

She continues, ‘We are concerned (about) how a blanket ban of products to treat life-long conditions such as coeliac disease and chronic pain could have unintended consequences.’

Gluten-free items via prescription are an effective treatment but their method of delivery has long needed review

The current prescription scheme is cumbersome and takes unnecessary GP/surgery time to administer, but to scrap it without the existence of alternative provision would be catastrophic and merely lead to increased cost in terms of patient outcomes.

CUK has tried to collaborate with NHSCC on the implementation of a pharmacy-lead dispensing scheme and has already conducted successful trials in several parts of the country.

It is clearly wrong if, with its vast procurement-power, the NHS is currently paying a higher price for identical gluten-free products that can be purchased more cheaply elsewhere.

By all means let’s overhaul the current method way by which coeliacs who need gluten-free prescriptions obtain them - not because the provision itself is unnecessary - but because they can be dispensed in a more efficient way.

We are in an execrable position where patients are pitted against each other in competition for treatment from a strategically underfunded NHS

Government policy over many years has lead to the crisis in the NHS. Tax cuts for the super wealthy mean that those who can afford to pay the most actually pay the least. In a society that cares about the most vulnerable we should be proud to fund a health-care system that can treat people equitably and effectively.

The government has failed in its duty to maintain the NHS

Instead it has chosen not to tackle over-charging at source by Big Pharma. It has cut the top rates of tax and helped big business evade paying its due. It has dressed up the fundamental depletion of the health service as ‘improvements’ and like mugs we are fighting each other for the pieces. The gap between rich and poor has never been wider. Cutting access to prescriptions and other treatment where there is need is merely an extra tax on those who can least afford to pay.

The cuts to infant formula, paracetamol and gluten-free food will never be enough to make up for the wrecking of one of the UK’s most noble institutions

I use the word noble advisedly. One day, before it’s too late, we need end our squabbling over what remains and set to work proudly and strategically reinvesting in what, by rights, should be one of the best things about our country.

April 2017

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