Why removing gluten-free prescriptions is devastating for patients and a false economy

As part of the government’s refusal to fund the NHS properly, the latest attack is on gluten-free prescriptions amongst others i.e. gluten free bread, flour for coeliac patients (not biscuits and cakes as reported in various places).

A friend who is a paediatric specialist in gastric health has kindly shared the following information which may be helpful for anyone who has friends who require gluten free foods via prescriptions (as there aren’t any drugs available). It is a false economy as patients affected are very likely to develop more complex conditions costing the NHS more than the prescriptions.

Julie Wood’s words (“This is not about cutting essential services or restricting access for patients to services they need—it is about allowing local clinical leaders to make the best and most efficient use of the money . .”) wont cut much ice with coeliac patients, but fits nicely with the current philosophy of getting local teams to make the cuts in services while government absolves itself of any responsibility for the chaos caused by NHS underfunding. Distractions such as ‘low value prescriptions’, along with charges to overseas patients also draw attention away from the massive waste associated with running the NHS as a market, profligate use of management consultants, cost of PFI, etc. It is estimated that 1 in100 of the population have coeliac disease, although many are undiagnosed. Not adhering to strict gluten free diet presdisposes to long term complications such as growth failure in children, osteoporosis, anaemia, micronutrient deficiencies, infertility and lymphoma.

A key aspect of management therefore is promoting strict adherence to a gluten free diet. This is not as easy as it sounds, and the withdrawal of gluten free prescriptions will act as a barrier to achieving this goal in some patients (and further costs to the NHS down the line). Following a recent ‘head to head’ in the BMJ (1) a mother of a child with coeliac disease clearly outlined some of the difficulties including the high cost of gluten free food in supermarkets, and the inclusion of gluten as a bulking agent in cheaper brands of some foods such as baked beans (2). The arguments against prescribing related to the bureaucratic process, and the relatively high cost of prescription gluten free products, neither of which should represent insoluble problems to the NHS.

Coeliac UK has pointed out that Simon Stevens has misrepresented the situation with regard to gluten free prescriptions (whether through ignorance or mendacity is unclear). Suggesting that patients could shop for gluten free food in Lidl is disingenuous when this outlet does not routinely stock such products. Furthermore, budget and convenience stores, which are relied upon by the most vulnerable such as the elderly, and those on low incomes, have virtually no provision.

He also misleadingly implied that significant sums are spent by the NHS on biscuits and cakes, while guidance (supported by Coeliac UK) for many years has rejected such spend. His argument that ‘the price of gluten free alternatives has come down substantially’ is not backed up by the evidence. Industry data since 2008 shows that gluten free bread costs about six times as much as its gluten containing equivalents and this has not reduced. Abandoning gluten free bread by switching to rice and potatoes poses the risk of nutritional deficiencies. Hippocrates is credited with the injunction: “Let food be thy medicine and medicine be thy food.” We should continue to treat those with coeliac disease on the NHS, and stop blaming patients for the problems of a cash starved service.

References

1. Kurien M, Sleet S, Sanders D, Cave D. BMJ 2017;356:i6810 doi: 10.1136/bmj.i6810
2. Gleed G. Commentary: we’re under financial strain without prescriptions for gluten free food.

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