I realise that I am coming rather late to the most recent prescription charge furore – set off by the article in the BMJ’s Drugs and Therapeutics Bulletin suggesting that providing gluten-free food for coeliacs on prescription is bureaucratic, inefficient and outdated – see the reports on the BBC, in the Daily Telegraph and in the MailonLine a week ago.
Just over a year ago many of the same arguments were rehearsed when Oxfordshire PCT put out a consultation document on withdrawing prescription gluten-free food. This is what I said then – and I do not think anything has really changed:
Oxfordshire PCT are currently creating serious waves within the coeliac community with a consultation document on withdrawing funding for prescription gluten-free food for coeliacs. Their reasoning runs as follows:
• There is now a wide range of gluten-free foods in supermarkets, eg, gluten-free pasta, pizza bases, cakes and breads
• There is a good choice of various makes of gluten-free food
• The cost of gluten-free foods is not as high as it used to be
• Non-wheat, barley or rye based foods that provide carbohydrates are readily available, eg potatoes and rice.
• The NHS does not provide prescription food for other groups of patients whose diseases are associated with, or affected by, the the type of food they eat.
They also point out that their PCT is under financial strain because the population of Oxford is growing, more people are living to an older age, the cost of medicines are rising etc etc etc. What they do not say, although of course it is also true and certainly adds to the strain on their finances, is that whereas 30 years ago, when the gluten-free food on prescription was introduced, less than one in 300 people were diagnosed as coeliac, the number has now risen to somewhere between in in 70 and 100 – a 200% increase in the number of coeliacs to be fed.
All the points that they make about the availability of gluten-free food also happen to be true. There is a very much wider range of it available in a very much wider range of outlets, its price is dropping (although it remains significantly more expensive the gluten-filled food) and there are plenty of alternative carbohydrates available to coeliacs or anyone else who chooses not to eat gluten. It is also true that the gluten-free food that is on offer in retail outlets can often (though absolutely not always) be better quality and more appealing than what you can get on prescription.
So, if have to pay for your prescription, although shop-bought gluten-free food may still cost you slightly more, the extra cost may not be that significant and the choice and convenience could be a good deal greater.
The rub, and the concern, is for those who do not pay for prescriptions – babies and children, pregnant or lactating women, the elderly, those with specific physical disabilities and those on benefits of various kinds. For them, getting gluten-free foods on prescription may be the only way that they will be able to get them as they may not be able to afford to pay the extra premium for them in the shops. If they are not able to get gluten-free food on prescription, although they could, in theory, achieve a gluten-free diet by using other cheap carbohydrates such as potatoes, and lots of culinary imagination, the chances are that they won’t and that they may therefore damage their health more or less seriously by eating foods which contain gluten. The corollary to that is that, in the long run, they will cost the health service more as their condition will become worse and they will need more care and medication.
So should prescription g-f food be available only to those who are entitled to free prescriptions? In principle, that seems a sensible way to go. But, will the drop in volume mean that it may not longer be commercially viable for those companies currently supplying the NHS to continue to do so and that they therefore will turn purely to the retail market?
Alternatively, should those who currently are entitled to free prescriptions for g-f food just be given extra money instead to cover the cost of buying their g-f food in the retail sector? This would certainly be a cost effective option for the NHS but, what guarantee is there that the money would actually be spent on gluten-free food? When money is short, paying the electricity bill may seem more important that buying gluten-free food.
Maybe a possibility could be some version of Green Shield stamps which could be provided for those coeliacs who would have received gluten-free food on prescription which they could exchange, in major supermarkets and other participating stores, for gluten-free foods, and only for gluten-free foods?
I am not saying that this is the answer, but as the availability of gluten-free food increases and as the price drops providing it as a standard prescription food becomes more and more questionable. While just dropping it may not be the answer, some creating thinking is definitely needed.
Since then…. Coeliac UK has been quoted as worrying about the complexities of implementing a voucher scheme through supermarkets. However, in this digital age when every supermarket already runs a number of complex ‘loyalty’ schemes, I cannot see that it would be beyond fairly basic technical competence to incorporate a discount for registered coeliacs into the mix. The pressure is obviously growing, so maybe everyone concerned need to look at the possibilities somewhat more seriously.