Introductory note: This week we take a break for the alphabet series. Today we have a guest post from my blogging buddy, Lucy Nixon of Free-From blog. She lives in the U.K. and writes here about the intersection of their government funded health care system and celiac disease. I love following her blog, seeing how different our systems are and the different brands available. The comments are fun too with the lovely British idioms.
Have you heard the rumours that the government provides food for celiacs in the UK? That you can get gluten free birthday cake for free?
No doubt we all enjoy a good story, and we like to think that someone else has it easier. But here’s the truth…
Food for free?
When you’re diagnosed with celiac disease here in the UK (we call it coeliac disease, but it’s the same thing), then your doctor will give you a prescription. You take the prescription to the pharmacist, who exchanges it for food.
So much is true. Mostly. Or partly.
· It is true that a visit to a UK National Health Service doctor is free (at the point of delivery – we pay taxes to fund the NHS)
· It is true that some gluten free basics are available on prescription (flour, bread, pasta, pizza bases, plain biscuits and crackers)
· It is true that for some people, prescriptions are free.
But like so much here in the UK, nothing is straightforward.
If you live in Wales, prescriptions are free for everyone. They’ll be free for everyone in Northern Ireland by 2010, and in Scotland by 2011. If you live in England, though, you pay.
Not everyone in England has to pay. You can get free prescriptions if you:
· are under 16
· are under 19 and still in education
· are over 60
· claim certain income-related state benefits
· are pregnant or have had a baby within the last year
· have certain medical conditions (not celiac disease!)
People on a low income can get help with prescription costs, and it is possible to buy a season ticket, which reduces cost if you use a lot of prescriptions. You’ll need it: if you live in England, then you pay £7.20 per item at the full rate.
£7.20 for a bag of flour or a loaf of bread is a lot of money – nearly $12.00 at today’s exchange rate. That’s more than it would cost you to buy gluten free flour or a loaf of bread in the supermarket.
Why would you get a prescription, then?
Many people qualify for free or reduced-cost prescriptions. 40% of us here in the UK are under 16 or over 60, and about 14% of the rest claim a key social security benefit. (See www.statistics.gov.uk). For everybody else, it doesn’t make good economic sense to ask for a prescription for gluten free food.
How can the NHS pay for it?
We pay taxes – about 13% of our taxes go to the NHS.
There has been a lot of debate over the last few years about how to pay for the NHS, and whether the NHS should pay for gluten free food. There’s an ongoing campaign for free prescriptions for people with long-term conditions; and there have been proposals for different schemes for issuing the gluten free food – one being vouchers to exchange for gluten free food in supermarkets.
Why does the NHS give away food?
Prescribing gluten free food reduces costs to the country in the long run. If a celiac doesn’t stick to the gluten free diet, then – as we all know – there are long-term health risks, and these are expensive for the NHS to have to deal with. If they can encourage celiacs to stay gluten-free, then we don’t get chronically ill, and our lifetime cost to the NHS – and therefore to the taxpayer – is less.
Sounds like a great system!
Well, yes and no. The National Health Service is an astonishing thing, and we feel great pride in it. But it is an ageing system designed for a much smaller population with a shorter life-span, and it is struggling for funds. Nobody likes paying taxes!
Because of the pressures on the NHS, in some places in the country there are severe restrictions by either the local health authority or the doctor’s practice on how much can be prescribed, despite the guidelines on the amount of gluten free food that should be prescribed.
So not everyone can get the prescriptions in the first place. It depends on where you live and which doctor you see.
There isn’t a free choice of gluten free products for prescribing. There’s a list, which is reviewed each year. It is very difficult for a manufacturer to get on the list, and quite rightly, there are rigorous tests.
So you can’t necessarily choose the products you’d like by the manufacturers you like. And what is available is plain, basic foodstuffs. No fancy chocolate biscuits or ice cream cones; no muffins or breakfast cereal!
flour photo by Daniel_Hurst_Photography
Perhaps a bigger problem, though, is that the system of prescribable gluten free food means that those manufacturers who are on The List have a huge market advantage over the others – because the NHS pays well, and so many people can get these things for free or for very little, it is hard for new companies who are not on The List to get established and their products tend to be very expensive to buy in the shops. A scheme such as vouchers to swop in supermarkets for products of choice would help these small manufacturers, improve the options available to celiacs, and potentially reduce the bill to the NHS.
So – free food? Yes, some food, in certain circumstances, but this isn’t a supermarket trolley dash!
What about the free birthday cake?
No such thing – perhaps free flour to make the cake, yes, even a cake mix so you wouldn’t have to pay for baking powder. But you’ll need to pay for the eggs, the sugar, the butter, the cooking, the icing and decoration and the candles. Sorry.
Lucy has a coeliac daughter, and blogs about the issues around living gluten free and raising a gluten free child.