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Hepatitis C

Volume 792: debated on Monday 9 July 2018


Asked by

To ask Her Majesty’s Government what plans, if any, they have to publish a strategy for the elimination of hepatitis C.

My Lords, the Government are committed to meeting the World Health Organization’s target of eliminating hepatitis C as a major public health threat. While there are currently no plans to publish a strategy, my department is working closely with NHS England and Public Health England to deliver a highly ambitious, whole-system approach that would achieve elimination in 2025—five years ahead of the WHO target.

I thank the Minister for his positive approach. I declare an interest as co-chair of the All-Party Group on Liver Health. In our recent inquiry, we demonstrated that hepatitis C specialists do not believe that the NHS is geared up to achieve the Government’s ambition, which the Minister has just outlined. Some 40% to 50% of those with hepatitis C remain undiagnosed. Do the Government intend to introduce a national campaign to raise public awareness of hepatitis C, thus encouraging more people to seek treatment?

First, I applaud the noble Baroness for her work on this. We know that hepatitis C is a truly horrible disease that affects some of the most vulnerable people in our society, which is why we want to eliminate it. In terms of the NHS being geared up, we are on track to treat 70,000 people by 2020. We need to keep finding people, and, of course, they become harder and harder to find. She is quite right about the need to raise awareness. We are doing other things as well, such as reaching into hard-to-reach communities. To give one example, there is now a 100% opt-out testing offer for people entering the prison estate, which is one of the areas where hepatitis C tends to be transmitted. There is clearly a need to do more, but we are looking at how to reach those hard-to-reach communities.

Can the Minister say a bit more about the steps the Government are taking to support the delivery of hepatitis C treatment in community settings, such as GP clinics, pharmacies, homeless shelters, substance misuse clinics and sexual health clinics? The King’s Fund estimates that spending on tackling drug misuse in adults has been cut by more than £22 million compared with last year, and funding for sexual health clinics by £30 million over the same period. How will the 2025 target for elimination of hepatitis C be met if vital education and work in these services, and the work they do in reducing reinfection rates, are not available?

The first thing I would say to the noble Baroness is that, in terms of sexual health clinics, local authorities are mandated to commission comprehensive testing services. Clearly, however, testing needs to happen in many more areas. We have introduced testing in pharmacies, for example, for hepatitis C. That has proved very effective in identifying it in people who take drugs, as well as offering other opportunities to test particularly high-risk communities. Another example is that there has been an increased screening of the south Asian population, where there is a much higher prevalence. It is about using the opportunities of community health services and taking testing into those communities, so that we can deliver on our target.

My Lords, direct-acting antivirals are the greatest advance that has occurred in trying to eliminate hepatitis C infection—it is effective in 95% of those who carry the infection. So a policy that does not treat everybody who is known to have the hepatitis C virus is wrong. Secondly, if we are to eliminate it, we need to identify those who carry the virus but are not diagnosed. Strategies focusing only on the prison population will not do that. Thirdly, we need to reduce the risk in the at-risk population by educating them. Unless we have a strategy across these three areas, we will not eliminate hepatitis C by 2025.

I agree with the noble Lord that we need a whole-system approach, but I do not think that we necessarily need to condense that into a document. There are lots and lots of things going on, some of which I have talked about. Of course, the WHO target is about the elimination of hepatitis C as a public health risk; it is not about elimination completely. As he said, it is very difficult to find everybody who has not yet been diagnosed. The main thing is that it is reduced as a health risk: it does not kill people anymore and cannot be transmitted. That is what we are on track to do by 2025.

What are the Government specifically doing for minority women who do not come out, whose community is unlikely to report any kind of illness, and who do not have the skills to access what is available?

I would need to write to the noble Baroness specifically about minority women. I do know that there are specific programmes taking place in towns and cities across the country to support minority groups where there is a high prevalence, and I mentioned the south Asian group, which has increased screening and diagnosis. It has reduced mortality, which has been affected. Clearly, that is something we need to do more of.

My Lords, does the Minister accept that NHS England may in the past have been too restrictive in its use of the relevant drugs? How might improved procurement policies result in greater use of those drugs, including more innovative products, as well as providing better value for the NHS in reducing the prevalence of hepatitis C?

The noble Lord asked an excellent question. It is very rare to come across diseases you can cure; that is one of the exciting potentials here. Unfortunately, the drugs were expensive when they came out and we did not come up with a way of paying for them over a number of years as we should have done. Happily, through competitive tendering, prices have dropped. The NHS is spending over £200 million a year. We have just engaged in a very complex procurement which I hope will yield some fantastic results. We are using that procurement process to drive down prices and to help find the people who need this treatment.