Coeliac Disease and Prescriptions

Adrian Bailey Excerpts

Tuesday 1st November 2016 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate the hon. Member for North Durham (Mr Jones) on leading the charge on this subject. There is clearly consensus in the Chamber on the direction the Government should take. I will make a few points about where we are and what I think we need to do, and leave time for him to sum up.

[Mr Adrian Bailey (in the Chair)]

Order. In a half-hour debate, the mover does not have the opportunity to sum up at the end, so you have a little more time than you thought, Minister.

[David Mowat]

Thank you, Mr Bailey.

As the hon. Gentleman said, one in 100 people in the UK suffer from coeliac disease. Interestingly, I was not aware of it until a year ago, when I was tested for the disease—fortunately I was negative. It is a significant disease that benefits from early diagnosis, and the points made about diagnosis were valid. Coeliac disease is an autoimmune condition: gluten damages the small bowel and the immune system feeds on it, resulting in a range of symptoms including diarrhoea, iron deficiency, tiredness and weight loss. It can exacerbate, if not cause, osteoporosis and mental health issues.

As we have heard, the only treatment is a gluten-free diet, which has two components. Meat, fish, fruit and vegetables do not contain gluten and generally do not need to be prescribed, but staple foods such as bread, pasta and flour and non-staple food such as biscuits do contain gluten. Since the 1960s, when the medical community was becoming more aware of the disease, those staple and non-staple foods have been prescribed pretty much, it is fair to say, without limit until recently. We spend something like £28 million a year on these prescriptions and in the great scheme of NHS costs that is not huge when considering the cost of cancer drugs and so on. It is true that we are now seeing a postcode lottery emerge, and I will say a little about why.

The other thing that has happened since the 1960s—I think the hon. Gentleman will concede this—is that the supermarkets and the retail trade have begun to get their act together in selling these products, although of course they are not available to everyone. Many supermarkets now have areas with gluten-free products, including bread and pasta. The products are more expensive than the equivalent non-gluten-free products, but they are certainly more available than in the past and a real alternative. Added to that, the fish and meat part of the diet, which is the same for sufferers and non-sufferers, is available to both.

--- Later in debate ---

[Liz McInnes]

Is the Minister aware that the annual cost per diagnosed patient of prescribing gluten-free food is £180 per year? Weigh that up against the cost of avoiding infertility, bowel cancer and osteoporosis. What is the obvious conclusion for any NHS professional?

[Mr Adrian Bailey (in the Chair)]

Order. Before the Minister responds, can I point out that he has been very generous in taking interventions, but the debate has to finish at 4.45 pm?

[David Mowat]

I made the point earlier that one in 100 people suffer from coeliac disease, and that £28 million is not a huge amount of money in the context of the entire NHS. I am sure the hon. Lady’s arithmetic stands up to that, and those are fair points.

If I may, I will set out the postcode lottery that has emerged. So far, 11 out of around 200 CCGs have ended all gluten-free prescriptions; 27 offer only bread and flour; 20 offer only bread, flour and pizza; 92, which is still by far the majority, broadly follow the Coeliac UK guidelines and offer a full range based a little on age, gender and other restrictions; and only four CCGs now have no restrictions whatsoever. The arguments about this are clear. Many poorer people, in particular—low-income people—are affected by the need to source their gluten-free products in different areas. CCGs are under pressure—the whole of the NHS is under pressure—and choices have to be made. It is true that £28 million is not a huge amount of money, but with £28 million here and £28 million there, we are soon talking about real money. It is true that choices have to be made, but it is not clear to me that this is an area in which the right choice is always being made.

In the couple of minutes available, I want to set out the actions that I think we should take. First, the hon. Member for North Durham correctly said that the community pharmacy sector has a role in this and is not so far being utilised as much as it could be. I think that he was wrong to say that it has stopped doing this in the transition from PCTs to CCGs. Something like 200 community pharmacies—15% of the total—do stock and sell gluten-free products. We are doing a review into the community pharmacy sector, trying to get it more focused on services. This is a very clear example of the sort of thing that we should be paying it to do, and when the Murray review is complete, I will—I am sure the hon. Gentleman will hold me to account on this—endeavour to make sure that that happens.

The hon. Gentleman mentioned consultations. CCGs should not withdraw gluten-free products without a consultation. My understanding is that in all cases where that has happened, a consultation has taken place. If he can provide me with evidence of that not being so, I will follow up and take action. The information I have been given is that consultations should always have taken place.

Finally, there is the issue of the postcode lottery. It is true that we give CCGs a lot of power in our system, in terms of making clinical decisions. The idea behind that is that they look at local considerations and balance the various options that they have. However, I will see to it that a review is done, hopefully within the next six months, of prescribing policies, and we will endeavour to come together with something that is more consistent, in a way that means we can actually make progress on this. I thank the hon. Gentleman for his contribution, and I thank everybody that has made an intervention in this debate. It has been a good debate, and a useful one for us to have had.

Question put and agreed to.