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NHS England: HIV Prevention

Volume 774: debated on Tuesday 18 October 2016


Asked by

To ask Her Majesty’s Government whether NHS England is informing patients that lifesaving drugs will be denied them if funding has to be made available for pre-exposure prophylaxis (PrEP) for HIV prevention.

Clinicians can apply for funding for the drugs in question where there is a clinically exceptional or clinically critical need. Each year NHS England receives many proposals for investment in specialised services. Difficult decisions then have to be made on behalf of taxpayers about how to prioritise the funding available.

My Lords, I am grateful to the noble Baroness. She will know that evidence from clinical trials shows that PrEP can be highly effective in reducing the spread of HIV when given to those who are at most risk. Quite disgracefully, NHS England has sought to avoid funding responsibilities by saying that it is the responsibility of local authorities, at a time when there have been big cuts in the public health budgets of those councils. Even more disgracefully, government sources appear to have briefed the media that if they were forced to fund PrEP, treatments for serious conditions would have to be stopped, including treatments for children with cystic fibrosis. This was deeply unpleasant, caused great offence and may well have added to the stigma faced by many living with HIV. Will the Government assure the House that this will not happen again, and instruct NHS England to fund the drug forthwith?

The decision on which drugs to prioritise and how it should happen should surely be made by clinicians and NHS England, and not by politicians. As with all new drugs, PrEP needs to be properly assessed in relation to cost and effectiveness to see how it could be commissioned in the most sustainable and integrated way, and how it compares with other cost-effective approaches.

My Lords, if the court’s decision on the appeal upholds the original decision of the court, NHS England is clearly responsible for providing PrEP. Will the Minister emphasise to NHS England that it should be considering PrEP as a highly effective preventive measure in the same vein as the highly effective vaccinations of babies?

Yes, certainly if they lose their appeal, it goes back into the normal commissioning process. Of course we recognise that studies have shown that PrEP has been a success, but we also need to remember that it is a matter of how it is used. There are several ways that we have been tackling HIV until now, and PrEP is only one in a range of activities to tackle it. We need to remember that, for it to work, PrEP needs to be taken daily, and sometimes it is difficult to get this group always to take it daily.

My Lords, will the Minister give us an assurance that life-saving drugs will not be cut back for people with HIV and other life-threatening conditions?

As I said earlier, we have difficult decisions to take. It is not up to the Government to decide this. As with all new drugs, these are properly assessed for cost and effectiveness to see how they can be commissioned in the most sustainable and integrated way.

Are the Government content to let expensive legal wrangling on this matter continue? Is it not time that the Secretary of State thought of using the powers that he possesses to intervene in this tragic and costly dispute?

I think that we are about to get a decision on the dispute; in fact, we thought it would be this week. It will probably be by the end of this week or the beginning of next.

My Lords, this method of preventing HIV is highly effective: one tablet taken a day has a success rate of 99%. The lifetime cost of treating one patient with HIV is more than £300,000. Are we not talking about a false economy here when we could prevent some 300 or more new cases a year and avoid the risk of these high-risk individuals passing on the HIV? This decision has been based on fundamental disputes about who should be funding it and not by the logic of successful treatment.

Truvada is clinically effective for HIV, as we know, but a number of other issues are also important to consider, including uptake and adherence, sexual behaviour, drug resistance, safety and prioritisation for prophylaxis and cost effectiveness. Clinical trials certainly did find that Truvada reduced the relative risk of acquiring HIV for between 44% and 86% of cases, and the PROUD findings showed the figure was 86%.

My Lords, the Minister has twice referred to difficult decisions. Are the Government sure that spending about half the proportion of GDP on health that North America spends and significantly less than, say, France or Germany spends will enable us to make the right decisions in the face of these difficult ones?

I agree with the right reverend Prelate, but it is necessary for these drugs to be properly assessed in relation to cost and effectiveness, as I said. It is not up to government to decide this; it must be done between the clinicians and the NHS.

The Minister referred to the difficulty, as she saw it, of getting people who might benefit from PrEP to use it effectively. I am not entirely sure what that has to do with the Question. However, does she not think it more likely that people will make proper and effective use of these drugs if they are available on the NHS, so they do not have to go through a much more complicated and much less well-funded system to get them?

As I said, it is up to NICE and NHS England to decide whether these drugs can be used. Until we know the result of the NHS appeal, it is difficult for me to comment further.