Why coeliacs like me need gluten-free food on prescription | Lyndsey Jenkins

I have coeliac disease, the autoimmune condition which means that if I eat gluten – which is found in wheat, rye or barley, and many common foods – my body starts to attack itself. There is no cure for this lifelong condition, which affects one in every 100 people in the UK, and the only option is to eat a gluten-free diet.

Under current national prescribing guidelines I can receive up to 14 items – such as a loaf of bread, box of pasta, or packet of spaghetti – on prescription every month. I never claim everything I might be entitled to, but I do usually get a few items a month. In order to access this list, I pay £104 a year for a pre-payment prescription.

For many people, this is the only way they can afford to access gluten-free products. But under new plans announced on Tuesday by NHS England’s chief executive Simon Stevens, the NHS plans to stop this provision, as well as travel vaccinations and some drugs that are available over the counter. Stevens has said they need to tackle some of the waste in the system, with £114m being spent each year, “on medicine for upset tummies, haemorrhoids, travel sickness, indigestion, and that’s before you get to the £22m-plus on gluten-free that you can also now get at Morrisons, Lidl or Tescos.”

As Stevens says, gluten-free products have become much more widely available in recent years. But for many people, the cost of these products can be prohibitive.

Gluten-free spaghetti in my local Sainsbury’s is £1.35, whereas basic spaghetti is just 40p. Nestlé gluten-free cornflakes are £2.20 while own-brand cornflakes are £1 for 500g. A gluten-free loaf of bread can be as much as £3 – and is often much smaller than a normal one. To me the idea that bread should be considered a luxury is pretty ridiculous. Stevens notes that gluten-free digestive biscuits are also available, but the NHS’s own prescription guidelines state that these are only available in exceptional circumstances anyway – why not just tighten up the list of products instead of throwing it away altogether?

I am lucky; I will be able to absorb this extra cost into my household budget, but for others this will be impossible. Without the prescriptions, many won’t be able to follow their GP’s nutritional advice – and that could have serious consequences for their health. People with coeliac disease who don’t go on a gluten-free diet are at increased risk of conditions including anaemia, osteoporosis and bowel cancer. Obviously, this is especially serious for people who are elderly, vulnerable or suffer from other illnesses.

In recent years giving up gluten has become associated, generally, with being a faddy eater. This is absolutely not the case for those with coeliac disease; if I eat gluten by accident it has a serious and immediate impact on my health. But I think the association of gluten-free foods with celebrity diets may actually be keeping the prices high, and is leading to perceptions that this is a lifestyle choice, rather than the debilitating condition that it can be if not managed properly. Being a coeliac or gluten intolerant isn’t just something that happens to wealthier people who can live off avocados and courgetti spaghetti, whatever some might suggest.

People are more aware of the condition today, but that does not mean they necessarily take it seriously or understand it fully. In restaurants, for example, there are more gluten-free choices these days, but people also often assume this is a preference, not a necessity. I always check what I eat with the staff, but have been “gluten poisoned” many times because people think: “Oh, a bit of gluten doesn’t matter.”

People need appropriate and affordable options or they just won’t be able to take care of themselves. This shortsighted move, which is only making minimal savings, could lead to further stress on NHS budgets when people develop complications and related diseases. I recognise the need to make savings but, like many current policies, this will hit the people who can least afford it the hardest.

Why coeliacs like me need gluten-free food on prescription | Lyndsey Jenkins

The banana republic of Surrey has shown local council funding is broken | Simon Jenkins

The algebra is simple. The NHS is having another terrible winter. It does not collapse, but “spills demand” on to the next line of defence, local government welfare. But while the NHS gets more money annually from the Treasury, local government gets less, some 30% less since 2011. It cannot cope with the new pressure.

The equation resolves itself into rationing, by quantity and quality: fewer care places, fewer home visits and fewer district nurses leads to more bed-blocking, fewer operations, longer trolley waits.

Tory Surrey is a responsible supplier of post-hospital care. Like all councils, it is allowed by the Treasury to increase its council tax by 5%, specifically to boost its care budget and thus ease pressure on the NHS – which the Treasury is responsible for funding. Surrey county council regarded this as nothing like enough. It therefore activated its statutory right to hold a referendum on a 15% increase.

Far from showing delight at a wealthy council accepting this burden, the Tory government was appalled. Tories do not increase taxes. The chancellor (and Surrey MP) Philip Hammond duly did what Jeremy Corbyn called a secret deal. If Surrey abandoned its referendum and the 15% hike, it could retain revenue from a different tax – the local business rate, which normally went to the Treasury. That is, the Treasury would in effect spend more on health and care in Surrey, but secretly and, so far, just for Surrey.

This is the stuff of a banana republic. If Britain wants to spend more on health and elderly care, it should raise it and spend it honestly. Instead, the Treasury is running around its fiscal A&E department, staunching the flow of political blood by slamming on plasters wherever a patient screams or twists an arm.

Leaked Surrey council tax texts allow Corbyn to ambush May at PMQs

Some might argue that an NHS free at the point of delivery has had its day. New disciplines and incentives, through fees or insurance or more prevention, must constrain marginal demand. But for the time being, it makes no sense to squeeze the NHS at the top – where politicians are exposed – and dump its problems on to local government and different funding streams at the bottom. It wastes money and distorts priorities. It is illiterate public finance.

If Surrey is harbinger of a new health and care service, and business taxes are to relieve an ever-burgeoning NHS, so be it. But few places are as rich as Surrey. Revenue will have to be redistributed from rich to poor areas. In other words, it is not just the NHS that needs rethinking, but the whole murky world of local government finance.

The banana republic of Surrey has shown local council funding is broken | Simon Jenkins

Small is best. The NHS demands to be broken up | Simon Jenkins

‘Even when David Cameron swore he would not introduce any far more meddlesome leading-down restructuring he pushed through an additional.’ Photograph: Stefan Rousseau/PA

Hundreds of asthma victims die needlessly “simply because NHS guidelines are routinely neglected”. Diabetic children’s “lives are at danger since physicians miss threat”. Eleven thousand heart individuals every year “died due to the fact of bad care”. Ten thousand cancer sufferers “die needlessly because of blatant ageism between medical doctors”. And this is just last week. Is this our dear old NHS, or has it become a morticians’ conclave?

All NHS news appears bad. “Cuts are forcing twice the amount of mental individuals” to travel out of spot as two years in the past. 1 in 5 hospitals is dealing with a deficit. GP surgeries are “approaching crisis” with millions left with out a medical doctor. A quarter of walk-in centres are closing. Half the senior posts in A&ampE are now “left vacant”, driving emergency wards “beyond capability”.

The public may reasonably ask if the scandals at Morecambe Bay, Colchester, Mid Staffs and now Panorama’s Old Deanery are exceptions or the norm. Two knights of the NHS, Sir David Nicholson and Sir Bruce Keogh, have the two been scathing in their attacks on the service’s leadership and quality: the former castigated politicians for “wasting many years” on reform and demanded far more “painful change” the latter for the NHS’s inefficiency and ”lack of compassion”. Doctor in the House has given way to Green Wing.

Back in January, the stories had grown so terrible that “crucial NHS chiefs” wrote to the Guardian pleading for an end to the “bash-the-NHS culture”. Little can they have anticipated how futile was their cry. The services is utterly at the tabloids’ mercy, the place a well being story now indicates “Alfred, 69, left sleeping in a chair with dried blood on him … his clothes not altered … soaked in urine … heart assault on the way house”. On Tuesday came a suggestion that the greatest cure for numerous ills might be Buddhist “mindfulness”. It might apply to the NHS.

The public used to profess a quasi-religious faith in the NHS on a par with the monarchy and the British army. Anybody who went to a hospital and was truly cured was not the beneficiary of what a hospital is supposed to do, but of some heroic miracle. The NHS was Britain’s Lourdes, its personnel priests and acolytes (with consultants as bishops). For many years their practices, monopolies and privileges had been divinely ordained and as a result went unchallenged.

That state of grace could not final. At least given that the 1980s, the NHS has been in turmoil as politicians of the two parties struggled to adjust it. Modify grew to become a ruling obsession. There need to be as a lot of “change managers” in the NHS as there are heart surgeons. Even when David Cameron swore he would not introduce “any a lot more meddlesome leading-down restructuring” he pushed through yet another. The surest way to enrage a physician is to inquire if the NHS is now in the appropriate form.

It have to be debilitating for any profession to see its failings trumpeted nationwide, its requirements attacked and its practitioners dismissed as grasping and uncaring. Several hospital trusts encounter economic ruin. As for the pride of the latest reform, primary care, it seems to hover in between meltdown and seize-up.

An growing amount of individuals – like Labour’s former overall health minister Norman Warner – propose the unthinkable: charging something for care, farming out basic exams and procedures to the personal sector, even letting nurses perform straightforward operations. Anything to break the logjam.

Nevertheless one topic that is unmentionable – and as a result untouchable – is the dimension of the NHS itself. A public services that, for a generation, has effectively nationalised its virtues finds it has now nationalised blame for its vices. The place glory after shone down on the Commons dispatch box, now there is only scandal.

It have to make sense that, when every conceivable reform – devolution, centralisation, purchaser-supplier split, inner markets, fundholders, commissioners – has been tried and seen to fail, somebody must challenge the really idea of a central service. It might be worth searching at how other people do it, and not smugly concluding that the public likes the NHS the way it is.

The well being services is not useless or uncaring or that undesirable at generating people far better. It is just also big. Aneurin Bevan was wrong to nationalise it back in 1948 – and his excellent foe, Herbert Morrison, was appropriate in wanting a new service based mostly on charitable and municipal hospitals, as remains the situation virtually all over the place in the world.

Bevan mentioned he desired “a maximum of decentralisation to neighborhood bodies and a minimal of itemised central approval”. No government ever achieves that. Nationalisation led inevitably to the pricey shambles of Tony Blair and Gordon Brown and to a £12bn IT program that by no means worked.

Men and women, particularly the bad, obviously need support with their healthcare. The wealthy are voting with their feet and going personal. But there is no reason why Britain could not go the route of other European countries, with overall health cover becoming a national obligation but with the services presented at the neighborhood, charitable or private degree. What has failed is not care as such but the attempt to regulate, fund and administer what was when a single of the world’s most extravagant industries, overall health, from that apogee of inefficiency: a Whitehall division.

Caring for a human entire body is a individual, intimate issue. It is like teaching and policing, an in essence regional services. Centralise it and turn it into a transaction and its incentives get distorted. Care comes to depend on targets, contracts and a futile struggle against “postcode lotteries”. EF Schumacher was appropriate. Small is gorgeous. The NHS wants to be broken up and returned to surgeries and local hospitals, postcode lottery and all. As the Danes have shown, only a little number of hospital specialisms need to have national interest.

No big nationalised business dismantles itself, particularly one now investing a staggering £15bn on administration alone. People that try out, such as British Rail and nuclear energy, see governments reinventing them in other varieties. As lengthy as shrouds and bleeding stumps are waved more than the Commons, ministers will sense that “anything need to be accomplished” and intervene. It does not work. Denationalisation is now the only model of a public wellness service not tried.

Small is best. The NHS demands to be broken up | Simon Jenkins