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Gluten free foods 'should be stopped on the NHS'
14th February 2013 - Doctors should stop prescribing gluten-free foods to patients with coeliac disease, say experts. They argue that it is a waste of money which would be better spent on other services for people with the condition.
However, one coeliac disease charity says it is concerned that support for people with the disease is being questioned and warns that people on low incomes in particular could be penalised if access to suitable food on prescription is withdrawn.
Damage to the gut
Coeliac disease is not a food allergy or a food intolerance but is an autoimmune disease caused by gluten, a protein found in wheat, rye and barley - triggering an immune reaction in those with coeliac disease Common sources of gluten include bread, pasta, cakes and biscuits, but it is often listed as an ingredient in favourite foods such as fish fingers, sausages and gravies.
Gluten causes damage to the gut in people with the disease.
Coeliac disease affects at least one in 100 people in the UK but many people with the condition are never diagnosed.
Gluten-free staple items such as bread and flour were first made available on prescription in the 1960s when there was limited access to these alternatives other than through the NHS. However, even today patients still obtain gluten-free supplies on prescription through pharmacies and the latest figures from 2011 show that the NHS in England spent £27 million on these items.
Health budget pressures
An editorial in the Drug and Therapeutics Bulletin argues that it is time to end the supply of gluten-free products on prescription. It says that the increasing availability of these items in mainstream shops and supermarkets, together with pressure on health budgets, make it harder to justify making them available through the NHS.
For instance, research has found that gluten-free versions of wheat-based foods are between 80% and 500% more expensive.
They say that while some attempts have been made to improve access to these foods and free-up family doctor time, by introducing direct supply schemes at community pharmacies, that still leaves the process under the control of a healthcare professional.
"Is it time to consider the use of food vouchers that could be redeemed against gluten-free foods at any outlet, or the provision of personalised budgets for people with coeliac disease, so that the supply of food would no longer be a medical issue?" the editorial asks.
It concludes: "We would urge commissioners to consider redesigning services to ensure that there is ongoing support for people with coeliac disease and to remove the bureaucratic process of prescribing food from primary care."
'Essential service' for vulnerable groups
Sarah Sleet, chief executive of Coeliac UK, the national charity for people with coeliac disease, says in an emailed statement: "Following a gluten-free diet enables patients to live a full and healthy life. However, to do so, it is crucial that they are able to access basic gluten-free foods, such as bread, flour and pasta, which are the staples in all our diets.
"If you are elderly, on low incomes or have mobility problems, there is a gap because such foods are likely to be inaccessible. They cost too much or can’t be found in the shops you can get to. Prescriptions are providing an essential service for these vulnerable groups."