Have your say on the future of gluten-free foods on NHS prescription From Monday 9 November 2015 to Friday 11 December 2015 What is this engagement about? We want to hear your views about gluten-free foods and if they should continue to be prescribed by the local NHS for adults and children with a confirmed diagnosis of coeliac disease or dermatitis herpetiformis who require a gluten free diet. Nationally the NHS spends 25milllion on providing gluten-free products on prescription such as bread, flour, pasta and cereal. Across mid-nottinghamshire which covers Mansfield, Ashfield, Newark and Sherwood, the total amount spent each year is 212,000 Food is not provided on prescription for many other patients, such as patients with diabetes, lactose intolerance or those with allergies. Healthy eating principles are important for everyone. We should all eat more fibre, fruit and vegetables and oily fish, and eat less saturated fat, sugar and salt. Potatoes and rice are both gluten free and should be included as part of a healthy balanced diet. Dr Mark Jefford said: Gluten is not essential to people s diets and many basic foods such as meat, vegetables, cheese, potatoes and rice are naturally free from gluten. Many gluten-free alternatives are now widely available in supermarkets and health food shops. Given the ever-growing pressures on NHS services and the NHS budget, we must ensure we get the best value for taxpayers money. We understand the proposals to withdraw or limit gluten-free foods on prescription may have an impact on some patients with coeliac disease and dermatitis herpeformitis. That s why we are keen to hear as many views as possible to help inform our decision. What is coeliac disease? It is a common digestive condition where a person has an adverse reaction to gluten, which is found in wheat, barley and rye. Symptoms range from being mild to severe and can include abdominal pain, diarrhoea, nausea, weight loss, headaches and osteoporosis. There is no cure for coeliac disease, but switching to a gluten-free diet can help and this will help to avoid any long term health problems such as oesteoporosis, anaemia and less commonly infertility, some types of cancer such as bowel cancer. What is dermatitis herpetiformis? Dermatitis herpetiformis (DH) is a skin condition triggered by gluten. It causes an itchy blistering skin rash, usually on elbows, knees and buttocks, but it can affect any part of the body. 1
Why are gluten-free products available on the NHS? Over 30 years ago there was limited availability of gluten-free foods in supermarkets, grocers and even restaurants; therefore the decision to include these products on prescription was made. Since then, the availability of gluten-free foods has increased dramatically. Bread is the most popular item on prescription. Price comparisons of supermarkets compared to NHS costs and cost for items containing gluten for a typical 19-59 year old male are listed below: Product Units prescribed each month Cost to NHS Cost of gluten free food at supermarket Gluten containing equivalent 8 x Bread 400g 8 40.80 20 8.80 3 x Pasta 500g 6 20.97 5.04 4.05 2 x Breakfast cereal 300g 3 7.14 4.76 4.20 2 x Pizza bases ( 110g 180g) 1 6.34 1.90 1.36 Total units and monthly cost 18 75.25 31.70 18.41 Who is leading this engagement? It is being led by NHS Mansfield and Ashfield CCG and NHS Newark and Sherwood CCG who are working in partnership across mid-nottinghamshire. These organisations plan and pay for the healthcare services for our communities, ensuring best value for money for our patients. What are the proposed options? With an ageing population and greater demand for services, the NHS must act now to address the financial challenges that lie ahead. We are considering whether to: 1. Stop all prescribing of gluten-free foods. 2. Limit to 8 units of bread and/or flour each month. 3. Continue as now and prescribe staple gluten free foods (non staple foods are no longer prescribed) and continue to follow the Coeliac Society s recommendations for number of units. For example 18 units per month are recommended for a 19-59 year old male and 14 units per month for a 19-74 year old female. The table below describes the gluten free items that make up a unit. Prescribable food item Number of units 400g bread 1 250g pasta 1 2 x 110-180g pizza bases 1 300g breakfast cereal 1 ½ 2
Have Your Say To complete the survey online: https://www.surveymonkey.com/r/glutenfreemidnotts 1. This survey is anonymous, but please let us know the location of your GP practice: Mansfield Ashfield Newark Sherwood (Ollerton, Edwinstowe, Clipstone, Rainworth, Blidworth, Bilsthorpe, Farnsfield) Other 2. Which of the following applies to you? I have coeliac disease or dermatitis herpetiformis I am the parent/guardian of a child with coeliac disease or dermatitis herpetiformis I am a carer for an adult with coeliac disease or dermatitis herpetiformis I do not have/care for someone with coeliac disease or dermatitis herpetiformis (go to question 5) I am a healthcare professional (go to question 5) 3. Do you (or the person you care for) receive gluten-free foods on NHS prescription? Yes No (got to question 5) 4. Which gluten-free products do you receive on prescription? Flour Bread Pasta Crispbreads or crackers Pizza bases Breakfast cereals 3
5. Locally the NHS spends 212,000 a year on gluten-free foods even though they are now more widely available in supermarkets. Please select which proposal you agree with for the future prescribing of gluten-free products. Stop all prescribing of gluten-free foods Limit to 8 units of bread and/or flour each month Continue as now, ie. prescribe staple gluten free foods (non staple foods are no longer prescribed) and continue to follow the Coeliac Society s recommendations for number of units. 6. Is there anything else we could do to support people with coeliac disease or dermatitis herpetiformis to better manage their condition, eg healthy eating advice? 7. Your additional comments: 4
Equality & Diversity The following questions are optional. They help us to ensure we are talking to a range of people across the area. 1. Gender: Male Female 2. Age: 0-17 18-24 25-49 50-64 65-74 75-84 85+ 3. Do you have a disability: Yes No 4. Which of the following best describes your ethnicity: White - British Irish Other Black or Black British - Caribbean African Asian or Asian British - Indian Pakistani Bangladeshi Chinese Mixed - White & Black Caribbean White & Black African White & Asian Traveller/Gypsy 5
Next Steps The closing date for responses is Friday 11 December 2015. We will consider all responses at our mid Nottinghamshire Clinical and Cost Effectiveness Committee who will receive a report on the views collected before a decision is made. Please return this form either by email to julie.andrews@mansfieldandashfieldccg.nhs.uk or by post to: Freepost RTGE-CRAT-BABH NHS Mansfield & Ashfield CCG Hawthorn House Mansfield NG21 0HJ If you would like to be informed of the outcome, please leave your email address or home address so we can contact you directly: Thank you for taking part in this survey. Please contact the Patient Advice and Liaison Service (PALS) on 0800 028 3693 if you require: any further information support to complete this survey copies of the information and survey in different languages and formats www.mansfieldandashfieldtccg.nhs.uk www.newarkandsherwoodccg.nhs.uk 6