The South Yorkshire, Derbyshire and Nottinghamshire Joint Health Overview and Scrutiny Committee met to discuss reports on public involvement in proposed changes to gluten-free prescriptions and IVF cycles, consider revisions to their terms of reference, and review their work programme. The committee heard that the South Yorkshire Integrated Care Board (ICB) is considering changes to both policies in light of financial pressures.

Gluten-Free Prescribing

The committee reviewed the South Yorkshire ICB's report on its public engagement regarding potential changes to gluten-free prescribing guidelines. The ICB Deputy Director of Involvement, Katy Davison, presented the findings of the 12-week involvement period, during which the ICB sought feedback on proposals to reduce the availability of gluten-free bread and mixes on NHS prescription.

Dr David Chrichton, ICB Chief Medical Officer, reminded the committee that coeliac disease, which affects around 1% of the population, requires a strict gluten-free diet for life.

The ICB had presented four options in its consultation:

• Option 1: Stop providing gluten-free prescribing, except for those most at risk of malnutrition.

• Option 2: Provide gluten-free breads and mixes to Coeliac UK guidelines for England (current policy).

• Option 3: Provide gluten-free breads and mixes to 75% of Coeliac UK guidelines.

• Option 4: Provide gluten-free breads and mixes to Coeliac UK guidelines for England for those under 18 years only (the ICB's preferred option).

The consultation received 1,117 responses to the survey, with the majority of respondents (95%) living in South Yorkshire. The main themes emerging from the qualitative questions were:

• Harmful consequences due to the cost of living
• Health and dietary impact
• Cost and affordability
• Access for vulnerable populations
• Impact on mental health and wellbeing

Katy Davison noted that while there was media coverage and conversations with community groups, uptake from community groups was limited, with some leaders unaware that prescriptions were available.

Councillor Eve Keenan raised concerns about the small number of responses from Barnsley compared to other areas and asked if a different approach should have been taken to reach deprived areas. Katy Davison responded that the same approach was taken in all areas, and the council helped push messages out in Barnsley.

The committee discussed the potential impact of the proposals on different racial groups. Dr David Chrichton said that there was no evidence to indicate that a specific racial group is more affected, but Councillor David Harvey expressed surprise at this finding. Dr Chrichton acknowledged that this may be due to a lack of awareness and diagnosis of coeliac disease within certain communities, particularly those with cultural diets containing gluten.

Several committee members raised concerns about inequalities and potential legal challenges if the decision to reduce prescribing led to harm. They also highlighted the importance of providing readily accessible information and support for people with coeliac disease.

The committee discussed alternative schemes, such as the voucher scheme in Wales, which would give people more flexibility to supplement their diet. However, it was noted that any scheme would need to be within a cost envelope that the ICB could afford.

The committee was asked to give their views on whether the involvement approach had been robust and contribute other views on the proposals.

IVF Commissioning Policy

The committee also reviewed the ICB's report on its public engagement regarding potential changes to the IVF policy. Lisa Kell, ICB Programme Director for Population Health Commissioning, presented the findings of the survey, which received 1,706 responses.

The ICB is considering reducing the number of IVF cycles commissioned from two to one, to align with other areas and save money.

The survey found that 82% of respondents would like the ICB to continue funding two cycles of IVF, as per NICE (National Institute for Health and Care Excellence) guidance. The main themes emerging from the qualitative questions were:

• Right to parenthood
• Psychological impact of not being able to have children
• Financial hardship and cost burden
• Emotional and mental health impact
• Cost-saving vs. societal policy priorities

Katy Davison noted that there was limited feedback from community leaders, as IVF is not a topic that is widely discussed in some communities. She also mentioned that the ICB had received a letter from South Yorkshire MPs expressing their views on the proposals.

Councillor Dave Knight noted that the strongest feelings represented were from Doncaster, including a letter from half of the council and a meeting with Healthwatch Doncaster.

Several committee members raised concerns about the potential mental health consequences of reducing the number of IVF cycles, with one member sharing their personal experience of their daughter undergoing fertility treatment.

Councillor Eve Keenan asked what safeguards were in place to ensure that individuals with complex cycles would receive appropriate treatment. Dr David Chrichton responded that the ICB has an individual funding request board that considers any exceptionality.

The committee discussed the success rates of IVF treatment, with Dr David Chrichton stating that approximately three out of ten women become pregnant after the first cycle, and another two and a half after the second cycle.

The committee sought assurances that any proposed changes would be carefully managed in terms of phased implementation, so that nobody would suffer a detriment. Dr David Chrichton responded that this was a decision for the board to make, but he would make a recommendation that nobody should suffer a detriment.

One committee member noted that Nottinghamshire was going through a similar process and asked about the potential for opening out the policy of access to make it more inclusive if savings were made. Dr David Chrichton responded that the ICB's access policy is based on the NICE guidance and that there were no plans to change it.

Another committee member raised concerns about the potential for people to seek unsafe treatment abroad if access to NHS-funded IVF was reduced. Dr David Chrichton responded that it was the ICB's responsibility to continue to evaluate the impact of any new policy.

The committee was asked to give their views on whether the involvement approach had been robust and contribute other views on the proposals.

Terms of Reference

The committee considered a report from the Policy Officer regarding revisions to the committee's terms of reference. The revisions clarify the hosting and chairing arrangements for meetings. The committee agreed to the revised terms of reference.

Work Programme

The committee reviewed its work programme for the upcoming year. Alice Nicholson, Policy and Improvement Officer, presented the report, which set out the proposed items for the next few meetings.

Councillor Eve Keenan requested that stroke response and aftercare be added to the work programme, citing alarming data from South Yorkshire and inconsistent access to rehabilitation and aftercare. She also raised concerns about stroke care in deprived communities and ethnic minority backgrounds.

Councillor David Harvey requested that the potential side effects of a new drug be added to the work programme, expressing concern that the consequences of taking the drug were not properly understood.

The committee agreed to add these items to the work programme. The next meeting is scheduled for Wednesday 7 January.