MPs say NHS dispute over HIV-preventing PrEP drugs exposes flaws in health legislation

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The influential Health Select Committee has said a dispute with NHS England about HIV-preventing drugs has shown flaws in the government’s localised health legislation.

Pre-Exposure Prophylaxis (PrEP) drug Truvada can reduce people’s chances of being infected with HIV by up to 99 percent if taken daily – and is available in a number of countries to at-risk groups including sex workers, gay men, and people in serodiscordant relationships.

Health experts say rolling out PrEP in the UK would be cost-effective if it leads to even a small reduction in HIV infections, as the lifetime cost of just one HIV infection can be up to £380,000.

NHS England had claimed earlier this year that it was not responsible for commissioning PrEP, suggesting it is up to local councils – but a court battle last month concluded that the NHS does have responsibility.

But in a report released today, Parliament’s Health Select Committee warned that PrEP is a “cautionary tale” as an example of what happens when a life-changing prevention tool is allowed to fall through the gaps, because of the fragmentation and confusion caused by differing interpretations of the law.

Deborah Gold, Chief Executive at NAT (National AIDS Trust), said: “We share the Health Committee’s deep concerns that local authority public health cuts are a threat to the sustainability of the NHS and highlight the mismatch between the rhetoric and reality of the Government’s commitment to prevention and public health. The committee recommends welcome and important safeguards but we fear that if, as currently planned, the public health ring-fence is abandoned this could lead to a further postcode lottery and deepening inequalities.

“Critically, we welcome the attention the committee has given to the role of the NHS in prevention. Despite placing such significance on prevention in the Five Year Forward View, NHS England has yet to demonstrate that it takes its role in prevention seriously. The Committee has raised the issue of PrEP, the HIV prevention drug, and the lack of clarity over who should fund it. Despite the Committee’s recommendation that the NHS and Department of Health resolve this urgently, NHS England is currently appealing a legal decision that provided this clarity and said that it can fund PrEP, further seriously undermining its commitment to prevention.”

The dispute, which threatened the future of the HIV-preventing drugs in the UK, came down to a purported disagreement over interpretations of the 2012 Health and Social Care Act, which devolved many NHS decisions to local authorities, trusts and service providers.

Ian Green, Chief Executive of Terrence Higgins Trust, said: “Today, PrEP is being acknowledged as a cautionary tale of what can happen when an important, life-changing treatment doesn’t neatly fit into one category or another. It has fallen through the gaps between NHS England and local authorities, meanwhile 17 people a day are being diagnosed with HIV.

“Today’s report reinforces the mess and confusion that has prevented PrEP from being made available to individuals at risk of HIV. We would like to thank the Health Select Committee – a respected, cross-party body – for calling on NHS England and the Department of Health to immediately resolve who is responsible for commissioning this game-changing HIV prevention drug.

“We echo these demands and we must not give up on PrEP just because no-one can quite decide whose budget it comes out of.”

Ben Bradshaw, Health Committee member and Trustee of Terrence Higgins Trust, said: “PrEP, the game-changing HIV prevention tool, has been held up by squabbling, confusion and delays, amidst the fragmentation of who commissions public health services, as today’s health committee report highlights. This is a false economy as it leaves people at risk of HIV who, if they become infected, will need lifelong treatment and support from the NHS.

“The impact of this mess cannot be underestimated. We now need an immediate resolution on PrEP, and I and the Health Committee call on NHS England and the Department of Health to act without delay.”