Plans to toughen rules for prescribing specialist formula 'could put babies at risk'

Plans to toughen the rules for prescribing specialist formula milk could place babies at risk of “faltering growth”, malnutrition and allergic reactions, a report has found.

The measure is among a £5.7m package of cuts to be discussed at the Moray Integration Joint Board (MIJB), which is in charge of local health and care policy, on Thursday.

At the meeting, members are set to agree the savings alongside the board’s £230m day-to-day spending plan for the coming year.

This includes toughening prescribing rules for formula milk given to babies with a cow’s milk protein allergy (CMPA), as well as oral nutritional support (ONS) for adults and children at risk of malnutrition.

The plan is set to save £50,000 this year, and would come into force next month.

In the MIJB spending plan report, the author said it had been “extremely challenging” to find areas for further savings after previous rounds of cuts.

An impact assessment of the new prescription rules said the changes would impact on vulnerable people, but stressed that the service would not be removed entirely.

Along with tighter diagnostic criteria, the cuts would see shorter prescribing periods introduced along with an increased emphasis on food-based approaches, including for those in danger of malnutrition.

The impact assessment said the changes could result in some infants and adults being hit with a reduction to their access to nutritional support.

If introduced, the plans could have a “very significant impact” on poorer families – since CMPA formula is expensive and difficult to replace with cheaper alternatives.

The report added that this could lead to “unsafe feeding practices” including diluting formula, skipping meals and inappropriate substitution.

Babies could also be put at risk of an allergic reaction, or even faltering growth, if families left without a prescription could not afford the formula.

While, for adults who are prescribed ONS, the potential changes could increase the risk of “malnutrition or deterioration” as well as “slower healing and reduced energy”.

Reduced access “may worsen health, function and independence” of those with disabilities who access the supplements, the report found.

Both the risks identified to infants and adults would also have an impact on staff, resulting in a “higher likelihood of hospital admissions”.

This, the report found, could lead to a “higher workload” and increased clinical risks with staff being left to manage patients’ potential health complications due to no-longer having access to the supplements.

Moral distress to staff was also highlighted as they may have to turn away those who would have previously accessed the supplements.

The report found that although the risks can be reduced they cannot be entirely eliminated.

Any decision to proceed with the changes would be on the conditional on the available of dietitians, mitigations, engagement with affected groups and “robust monitoring of unintended consequences”.

The justification for the plan is to “ensure sustainable prescribing practices” while balancing “financial sustainability” with “the duty to protect equality, human rights and children’s wellbeing”.