Jeremy Hunt ‘should give NHS England power to commission HIV treatment’
Jeremy Hunt has been urged to give NHS England the power to commission an HIV prevention treatment which could be a “game changer” in stopping the spread of the infection.
NHS England has said it will not commission pre-exposure prophylaxis (PrEP) for adults at risk of contracting HIV on the grounds that it is not its responsibility to do so.
That decision has sparked outrage with campaigners demanding a rethink.
Ministers have now announced that the National Institute for Health and Care Excellence (Nice) has been asked to carry out a review of the effectiveness of the treatment.
Shadow public health minister Andrew Gwynne called on the Health Secretary to intervene without delay and give NHS England the power it needs to provide the treatment.
NHS England decided in March this year that providing PrEP would constitute a preventative service and therefore was not its responsibility.
It said such services should be provided by local councils.
However, NHS England did agree to look again at its decision after the National Aids Trust (NAT) threatened a legal challenge.
But the organisation subsequently said at the end of May that it intends to stand by its original decision not to commission the drug with the NAT now seeking a judicial review.
NHS England has said that it does not have the legal power to commission PrEP.
Mr Gwynne, raising the issue as an urgent question in the House of Commons, said PrEP had the potential to be a “game changer” as he insisted the Health Secretary could intervene.
He asked Public Health Minister Jane Ellison: “Do you accept that under section 7a, a mechanism by which the Secretary of State can delegate power, the Health Secretary can give NHS England the power to commission PrEP?
“If so, can you explain why he has not done this?”
But Ms Ellison stressed the need for more work to be done on the cost effectiveness of the treatment before any final decisions are made.
She said: “It is crucial that we have a full understanding of all the issues surrounding PrEP and, as with any new intervention, PrEP must be properly assessed in relation to clinical and cost effectiveness.
“That’s why we have today asked Nice to conduct an evidence review of Truvada for PrEP of HIV in high risk groups.”
The findings of the Nice review will inform any subsequent decisions on the commissioning of PrEP.
Ms Ellison said the review will run alongside a PrEP pilot scheme in which the Government is investing up to £2 million.
She also pointed out that the Truvada drug has not yet been licensed for PrEP use in the UK.
“There is work yet to do but we are not standing still,” she said.
“We have announced this important pilot, we have committed money to it, we have asked NICE for an evidence review and all of this will go into our consideration.”
PrEP has been shown to reduce the risk of HIV infection in people who are at high risk by more than 90%.
The treatment comes in the form of a daily pill.
Mr Gwynne asked whether the Government would be making more funding available for local authorities given NHS England’s insistence that preventative services should be commissioned by councils.
He said: “If the Government is expecting local authorities to commission PrEP, can you say how much additional funding you will make available to councils?
“Can we assume that there will be no further cuts to public health grants or is this just a case of passing both the responsibility and the financial buck?”
He also called for ministers to “show some leadership” and sit down with key stakeholders to discuss a way forward that does not involve “costly protracted legal action”.
Mr Gwynne said: “We know that PrEP has the potential to be a game changer.
“It has proven to be effective in stopping HIV transmission in almost every single case and yet as a result of this latest decision this life changing drug will remain inaccessible to people at risk of HIV.”
Ms Ellison said: “NHS England has made its position clear in how it feels in terms of it being the commissioner based on a legal argument which they have published.
“No decision has been made about who the commissioner is.”
The minister said the evidence review is expected to be completed in the autumn while Public Health England is working on plans for a two-year pilot programme.
Tory Mike Freer, the chairman of the all party parliamentary group on HIV and Aids, who has watched friends die as a result of the disease, urged the Government to look again at NHS England’s decision
He said: “I have lost too many friends over the years to Aids to not challenge the decision of NHS England not to fund PrEP.
“HIV infection rates in this country are on the increase. Existing strategies are not working and to suggest that we simply do the same going forward is not acceptable.”
His Tory colleague Dr Andrew Murrison also appealed to the minister to recognise the urgency in seeking a solution.
The South West Wiltshire MP said: “The process you have outlined is correct but will you recognise that the French government has already approved Truvada for pre-exposure prophylaxis and will you also understand the urgency in this, since the UK Proud study funded by the MRC’s (Medical Research Council) results are quite unequivocal and therefore we really do need to get this going now.”
The minister said she has also lost friends to the Aids epidemic and took the issue “extremely seriously”.
She said: “PrEP, while it no doubt will have an important part to play, is not a silver bullet when it comes to sexual infections particularly in some of those high risk groups and it is important to understand that we have to continue to look at a whole range of measures.”
Labour’s Ben Bradshaw blasted the Government for allowing “buck-passing” between the NHS and local authorities to delay the drug’s availability.
The Exeter MP said: “When do you expect this damaging buck-passing between NHS England and local authorities, that’s one of the disastrous results of the 2013 Health and Social Care Act, to be resolved?”
He warned that the UK is “going back to the bad old days where certain groups are being stigmatised” which could result in an “explosion of sexual disease in this country”.
Ms Ellison insisted other health systems around the world are going through “broadly the same process” regarding how to commission PrEP.
Labour MP Fiona Mactaggart said areas such as Slough where local authorities have suffered 50% cuts under the Government have “no prospect of being able to fund a challenge of this size”.
She added: “This delay in sorting out who is going to pay for PrEP will lead to the deaths of hundreds of people in Britain.”
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