NHS Commissioning (Pre-Exposure Prophylaxis)

Ben Bradshaw Excerpts

Tuesday 7th June 2016 Commons Chamber

[Jane Ellison]

My hon. Friend is quite correct on his latter point about the impact of PrEP. Whether it was commissioned or not, and whoever it was commissioned by, we would still have the significant challenge that he describes around STIs. Drug-resistant gonorrhoea, for example, is a problem that we are increasingly aware of.

There are international comparisons that we can look at, as my hon. Friend mentions. I have looked at the matter in some detail, and the picture across the world is that many countries are in broadly the same position as the UK. They are trying to understand, leaving aside the question of clinical effectiveness, more about how PrEP can be used as part of an HIV prevention programme in broader cost-effectiveness terms, and how it compares in cost-effectiveness terms with other available interventions. My hon. Friend is right that there is work to do, and we are not resting easy on this. We are moving forward, and we are working on and planning these pilots now.

[Mr Ben Bradshaw (Exeter) (Lab)]

When does the Minister expect the damaging buck-passing between NHS England and local authorities, which is one of the disastrous results of the Health and Social Care Act 2012, to be resolved? Does she agree that it would be far more appropriate for NHS England to be the commissioner of something like PrEP than for local government to commission it? Finally, will she be very cognisant of the danger that we are going back to the bad old days when certain groups were stigmatised? Stigma is disastrous for public health policy, and it will result in an explosion of sexual disease in this country if we do not always bear in mind the danger that decisions by NHS England—not just on this, but on drug treatment for hepatitis C —may have a disastrous impact on public health.

[Jane Ellison]

The NHS England position is based on a legal argument, and as the matter is likely to go before the courts, it is not really appropriate for me to comment further. There was a little discussion this morning on this subject in the Health Committee, for which some Members were present. I have laid out a process by which we will work out how and where this is commissioned. Clearly, we need to identify the commissioner.

I do not accept the right hon. Gentleman’s challenge about fragmentation, simply because if we look around the world at a series of very different health systems, we see that they are all going through broadly the same process of understanding where PrEP sits. There are a number of options, but first we need to go through this work. On his latter point about stigma, he is right to identify that it is a significant concern, but I do not accept that that is what this represents. He knows my personal commitment to tackling stigma, and we could not have made it clearer that addressing rising HIV rates, addressing STIs in the MSM community and looking at the challenges surrounding things such as chemsex are all very much front of mind, and we have given considerable time and thought to them. We must challenge stigma wherever it rears its head.