The South Yorkshire, Derbyshire and Nottinghamshire Joint Health Overview and Scrutiny Committee met to discuss organisational changes within the NHS, potential changes to prescribing guidelines and policies, and non-emergency patient transport. The committee made no recommendations but requested more information and consultation on gluten-free prescribing and IVF policies, and acknowledged updates on NHS organisational changes and patient transport.

ICB Organisational Change Update

Gavin Boyle, Chief Executive of NHS South Yorkshire, briefed the committee on planned changes to the Integrated Care Board (ICB) following an announcement in March by Jim Mackey, the then Chief Executive of the NHS¹. The ICB is being asked to focus solely on strategic commissioning, and to reduce running costs by 50%. This means a reduction from 800 to 400 staff.

Councillor David Knight asked how the changes would impact remaining staff, governance and overall effectiveness. Gavin Boyle responded that the ICB would prioritise its strategic commissioning function, and would relinquish responsibilities for provider oversight and system management to NHS England.

Councillor Mary Lee asked about the future of Healthwatch², which the 10-year health plan indicated would be absorbed into the ICB. Gavin Boyle said that this was unexpected, and that he believed Healthwatch had a critical role. He said that the pause in the consultation had allowed some time to rethink this.

Councillor Eve Keenan asked how the ICB would maintain a focus on place-based services with reduced resources, and what role local authorities would play. Gavin Boyle responded that the ICB could incentivise partnership working and commission integrated services. He also suggested that health and wellbeing boards would have an elevated role.

Councillor Wright asked how Bassetlaw would be served under the new model. Gavin Boyle responded that commissioning for the people of Bassetlaw was principally the responsibility of the ICB in Nottinghamshire.

Engagement Plans for Potential Changes to Gluten Free Prescribing Guidelines

Dr David Crichton, Chief Medical Officer at the Integrated Care Board, introduced a discussion about potential changes to gluten-free prescribing, noting the financial challenges faced across the NHS. He explained that gluten enteropathy is a lifelong condition, commonly manifesting as coeliac disease, affecting around 0.5% of the population in South Yorkshire, though national estimates suggest it could be 1%.

A question was put to the committee from Nick Trott, a gastroenterology dietician from the Hallamshire, who expressed gratitude to the committee for allowing him to attend at short notice. Nick Trott questioned why option four of complete suspension of all adult gluten-free prescribing is the preferred route. He argued that the justification for this is no longer evidence-based, and that it would disproportionately affect those who cannot access gluten-free foods financially or geographically. He also stated that relying on naturally gluten-free foods reduces intake of calcium and iron, and that the argument that gluten-free foods are ultra-processed is a nutritional dog whistle.

Dr Crichton responded that the presentation was part of a process, and that no decision had been made.

The committee considered a report outlining options for consolidating gluten-free prescribing guidelines across South Yorkshire. The report presented four options:

• Option 1: Decommission gluten-free bread and mixes prescribing, except for those most at risk of malnutrition.
• Option 2: Commission gluten-free bread and mixes according to Coeliac UK guidelines for England.
• Option 3: Commission gluten-free bread and mixes prescribing to a level below Coeliac UK guidelines.
• Option 4: Commission gluten-free breads and mixes prescribing for children ≤18 years old only.

The report noted that NHS Leicester, Leicestershire and Rutland, and NHS West Yorkshire ICB have already restricted gluten-free prescribing, and that Nottinghamshire Integrated Care Board does not allow gluten-free products to be available on prescription.

The report also noted that the cost of gluten-free bread and flour is significantly higher than gluten-containing equivalents, and that there is less gluten-free food available at food banks.

Councillor Wright asked about mitigating the risk of non-prescribing bringing about health conditions. Dr Crichton responded that awareness and education were key elements.

Councillor Knight noted that the cost of gluten-free products has come down considerably, and asked that the options be reconsidered.

Councillor Lee asked about consultation with Barnsley and Sheffield, and about government advice to supermarket food providers.

The committee made no recommendation, but agreed that more formal consultation was needed.

Engagement Plans for Potential Changes to the IVF Policy with Regards Commissioning Cycles

Lisa Kell, Director of Population Health Commissioning, presented an update on engagement plans for potential changes to the IVF policy in regards to commissioning cycles. She explained that in vitro fertilisation (IVF) is a type of assisted productive technology procedure that supports many couples.

The current commissioning policy for IVF has two parts: the joint Yorkshire and Humber Access to Fertility Treatment Commissioning Policy, and the number of IVF cycles commissioned.

The NICE guidelines for IVF recommend offering up to three full cycles for eligible women under 40, and one full cycle for eligible women aged 40-42.

Lisa Kell explained that the NHS has been asked to prioritise access to care, and that the review would reconsider the number of cycles commissioned, with a view to understanding the implications of moving to one cycle across South Yorkshire.

Councillor Knight asked about consultation, and Councillor Lee asked how the consultation would be carried out in more deprived communities. Lisa Kell responded that they would work with voluntary sector partners and third sector groups, and that they would do more targeted work with communities that are hesitant to come forward.

Councillor Keenan asked if husbands and other young males that are affected in this way would be consulted as well. Lisa Kell confirmed that family members would be involved.

Councillor Keenan also stated that the five-week timescale was not sufficient, and that it needed to be extended considerably. She suggested working more closely with local authorities and Healthwatch.

The committee agreed that the five-week timescale was not sufficient.

Update on the Non-Emergency Patient Transport

An update was given on the non-emergency patient transport (NEPT) service. Lesley Carver, Urgent & Emergency Care Programme Manager, reported that the new national eligibility criteria had been implemented on 1 April 2025. West Yorkshire and Humber and North Yorkshire had also moved to the new criteria.

Since implementation, there had been a 55% reduction in bookings.

Councillor Knight raised concerns about patients using the Yorkshire Ambulance Service (YAS) in preference to mobility cars, and asked how much they were using or abusing the service. He also asked about remuneration for travel, and whether it could be a travel pass.

Councillor Wright asked when it would be possible to say how many people had been denied transport under the new criteria.

Councillor Keenan asked what measures were in place to evaluate the effectiveness of the new criteria.

Work Programme

Emily Stambrook-Shaw, Policy and Improvement Officer at Sheffield City Council, said that she would liaise with Katie and support officers from all authorities to work out a schedule and a reasonable timescale for the gluten pre-prescribing and IVF items to come back.