Prescription restriction – are the savings real?

Outrage has had a field day over the last ten days – whether it is coeliacs outraged that Simon Stevens wants to deprive them of their prescription foods or non-coeliacs who are outraged that coeliacs should get ‘free’ food – which of course is not free anyhow, unless you get free prescriptions. But maybe a more productive way forward is to jettison the outrage in favour of some hard figures.

The NHS’ desire to save money and avoid waste is understandable – indeed laudable. But could some of the proposed ‘savings’ end up by costing a great deal more than they save?

While it is unlikely that failing to provide a pain killer will have any long term consequences for patients other than discomfort, the same cannot be said of failing to provide gluten-free foods for coeliacs, or, as was recently threatened by Croydon CCG, failing to provide cow’s milk free infant formula for allergic babies.

Not following a gluten free diet, if you are coeliac, can have serious long term health consequences requiring significant and expensive medical interventions. And while there are now many more gluten free foods available in larger supermarkets and main centres, they can be up to four times more expensive and may not be available in local stores or in more outlying districts. For elderly, or housebound  coeliacs or for those on very restricted incomes, these products may be too expensive or simply not available unless they can get them on prescription.

As result they may fail to follow their gluten-free diet, thereby seriously impairing their own health to the point that they require far more expensive medical intervention.

The same argument applied to cow’s milk free formula for severely allergic babies. The cost of the formula is, indeed, very high – approximately 8 times more expensive than normal formula, more than even a middle income family can probably afford.

But if these babies do not get this formula they risk a severe allergic reaction, or a staph infection in severe eczema which will result in an emergency admittance. These often mean a 4-5 day stay, requiring intravenous antibiotics, drips, and more to stabilise the baby/ child, along with further drugs to continue to stabilise once discharged home – with all the damage to the child’s longterm health that this may involve.

A quick calculation of the comparative costs  of providing formula for 20 babies for 1 month (£4,320) as against admitting these same babies for 4-5 days of treatment (£100,000) speaks for itself. (See the FoodsMatter site here for more on this.)

Wisely, Croydon and the other CCGs who had been contemplating this move have now thought again.

While the cost comparison for coeliacs may not be so dramatic, it is still significant, and, taken over even a five year period, could be very much greater than the £21.9  million that scrapping prescriptions might save.

For more on the issue see Sue Cane’s article here, and Alex Gazzola’s blog here.