In England, health policy is localised and in the last 12 months we have taken legal action where a CCG policy presented a blanket ban on gluten free prescribing. Once the results of the consultation are known we will consider next steps. The grounds for making a legal challenge may be very restricted if the implementation of change follows the law on the required consultation approach and appropriate changes in the regulations.

There are currently no proposals to amend services in Scotland, Wales or Northern Ireland. The consultation only covers England.

We understand having coeliac disease is not a choice, and that under its constitution, the NHS should be providing a comprehensive services available to all and that access is based on clinical need and not an ability to pay. This is what we are arguing for.

However, the government is insisting that savings must be made within the NHS. As the government has made a decision that gluten free food is an area where efficiencies can be found, we need to present strong arguments that show patient need and how prescribing can be more efficient. We have done this by presenting options for improved NHS procurement and management.

If we fail to convince the government of the validity of our arguments, we must be prepared to say that there are some very vulnerable patients whose health will be at risk if clinical discretion is not allowed.  

All gluten free foods are covered by the same legislation and therefore need to reach the same standard to be labelled gluten free whether they are available from shops or on prescription.

Vaughan Gething AM said:

Gluten-free products are an essential part of the clinical treatment of coeliac disease. National prescribing guidance was published in 2013 to support healthcare professionals in the management of patients with coeliac disease. Coeliac UK has supported the development of the guidance including the updated version published in March 2016.

Read in more detail at:

30 June 2017

www.assembly.wales/en/bus-home/pages/plenaryitem.aspx?category=written%20question&itemid=3431&c=Written%20Question&startDt=24/05/2017&endDt=30/06/2017

13 July 2016

www.assembly.wales/en/bus-home/pages/qnr.aspx?meetingid=3617&assembly=5&c=Record%20of%20Proceedings

You can find a full transcript of the debate here.

The Parliamentary Under Secretary of State for Health committed to completing a review of the issue within six months of the debate, which was held on 1 November 2016. The Department of Health consultation was issued on 31 March 2017. Coeliac UK was not contacted during the intervening period. 

The consultation is proposing to change secondary legislation only. The options are for gluten free products to be “blacklisted” ie GPs would be banned from prescribing them on the NHS, or to add differing ranges of products to the prescribing list, or to maintain the list.

The consultation does not propose minimum levels of access, and does not propose changes to the Health and Social Care Act 2012. Therefore, it must be assumed that Clinical Commissioning Groups (CCGs) will continue to have the ability to make local policies in this area.

This means that where prescribing has been ended, that this is likely to continue, and that CCGs will continue to make proposals to adjust policies in this area, if they feel it necessary. The framework being proposed facilitates the continuation of local policy making by CCGs. However, if the outcome of the consultation is to allow the continuation of prescribing we will use the Department of Health response to go back to the CCGs and point out that the Government have clearly accepted that it is legitimate to prescribe gluten free products.

We have been talking to manufacturers for many years about the possibility of changes in access to prescriptions and we would welcome better access in retail to all gluten free foods for people with coeliac disease. In the end individual companies will need to make the business decisions on where best to supply their products.

Increase in product recalls reflects increase in product availability in retail and most product alerts relate to mislabelling rather than problems with contamination. Both prescribed and non-prescribed products have to meet regulatory standards and in fact most companies supplying to the NHS also provide retail products. Contamination risks need to be properly controlled regardless of supply chain.