HIV Treatment

Jim Shannon Excerpts

Wednesday 29th March 2017 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure, as always, to serve under your chairmanship, Mrs Main. It was a particular pleasure to hear the hon. Member for Finchley and Golders Green (Mike Freer) set the scene for us on a subject that is close to his heart and one that he has become a champion for in this House. I congratulate him on that. I have always been here to support him in his endeavours, and I am pleased to do likewise again.

When we think of HIV, as we are doing in this debate on the report, our thoughts automatically go to African nations. They do in my case, and Swaziland in particular, as my parliamentary aide visits and supports an orphanage there. One in every two people there has AIDS, so there is naturally a massive need for care and support of orphans. My heart has long been touched by the needs of the people in that country who have been ravaged by the spread of AIDS, and by the work of the World Health Organisation and other charities such as Teen Challenge and Elim Missions, which are active in my constituency.

However, this debate is about the report, which makes it clear that this is an issue much closer to home as well as one in Africa. We can relate it to our own constituencies. I understand that health is devolved to Northern Ireland—at least it is now; we will see how these talks go. The Minister might be the person making the decisions. We will have to see what happens in relation to that. With great respect, I hope she will not be making those decisions; I hope we will be making them back home, but that is by the by.

In Northern Ireland in 2015 there were 103 new diagnoses of HIV, bringing the total to almost three times what it was in 2006. Some of these figures are shocking and worrying. That is the highest number of HIV diagnoses to ever be recorded in a single year in Northern Ireland. From 2000 to 2014, a total of 557,000 HIV tests were carried out in Northern Ireland.

In Northern Ireland a total of 126 people diagnosed with HIV have died. That includes AIDS and non-AIDS-related deaths. Data obtained from the Public Health Agency showed that 114 pregnancies were affected by HIV from 2005 to 2016. Encouragingly—there is always a good message to be told—the pregnancies were managed to prevent the infection being transmitted from mother to child. That is certainly a bonus and highlights the importance of knowing about infection and managing the birth of babies correctly. We have come forward with medicine and medication over the years in an innovative and very effective way.

In 2015, there were some 6,095 new cases and 88,769 people being treated for HIV across the UK. This is not an African infection; it is a problem in the UK that we must address. In setting the scene for us, the hon. Member for Finchley and Golders Green focused attention on where it should be in this debate: where we are in the United Kingdom. Some 101,200 people were estimated to be living with HIV in the UK by the end of 2015.

As with many illnesses, many people are living with the disease without knowing it. I would like to hear the Minister’s thoughts on how we can reach people out there who are carriers and perhaps do not know it. The clear fact is that, if people are not diagnosed, there is a much greater danger of them unwittingly spreading the infection.

It is estimated that 87% of people are diagnosed; 96% of those diagnosed are accessing treatment; and 94% of those accessing treatment are virally suppressed or “undetectable”—the virus will not show up on tests; it is unable to be transmitted to others. Those are some of the facts. That means that around 13% are undiagnosed and unaware of their infection—they are not able to access care to protect their wellbeing and prevent the onward transmission of HIV to others.

It has been estimated that each new infection costs the NHS between £250,000 and £360,000 in direct lifetime treatment costs. That is something we need to address, and the Minister must at least consider it. The number of new diagnoses in 2015 was slightly lower than in 2014, but new infections have remained roughly static since 2010. The fact that there are new infections each year is something we cannot ignore and needs to be addressed. I am keen to know the Minister’s thoughts on the best way of doing that.

Some 39% of people are diagnosed late, which has a potential impact on their immediate health and therefore the cost of treatment at the point of diagnosis and beyond. The fact that people are diagnosed late indicates that there was a possibility of diagnosis earlier. If that is the case and it has not been done, why? There must be a proactive approach to encourage screening and to reinforce education and learning about the prevention and spread of HIV and sexual health in general.

I tabled a question some time ago, to which the Minister responded, on the increase in sexual infection among those in the 50-to-70 age bracket. The figures indicate a rise in HIV infection among that group as well. I ask this question because it is important to do so. When people get to a certain age in life, they may not be involved in those activities as much as they may have been in the past, but there has been a rise in sexual diseases in that age bracket. I know the Minister responded to that question last year, but I would like to hear an update on her thoughts.

Some of the recommendations in the 2016 report from the all-party parliamentary group on HIV and AIDS on the impact of the Health and Social Care Act on HIV services bear highlighting. The first one that I want to mention states:

“While public health has been devolved, the Secretary of State must ensure that local authorities have enough guidance to ensure there is a minimum service requirement, which they must provide.”

The hon. Gentleman mentioned that in his introduction and clearly outlined the issue. With respect, at the moment the Act is not providing enough clarity or accountability, and it is the Department of Health’s responsibility to ensure that it does.

I look to the Minister, as I always do—she is a very responsive Minister—and ask what co-operation there has been with the regional devolved Assembly in Northern Ireland and the Health Minister there. What plans are in place for such engagement, involving the Secretary of State or Minister of State for Northern Ireland, should we return to direct rule? We cannot afford for health to suffer due to the reluctance of Sinn Féin to enter into government with the party with the largest mandate—the Democratic Unionist party. It is the responsibility of Ministers in this place to step in and step up if necessary and ensure that the people of Northern Ireland have the right strategies in place.

I was quite encouraged by the Library briefing on this debate, which has been extremely helpful. It mentions the pre-exposure prophylaxis drug Truvada, to which the hon. Gentleman referred. There are some excellent medications today, and that is one of them. It is a brilliant, new, innovative drug that can make a difference. It can save lives, stop or at least control HIV infection and give a longer life. We must welcome some of the things that are happening out there and that the NHS is providing, because it is tremendous news.

Lastly, it is clear that the Department of Health needs to ensure there is mandatory guidance for sexual health service bidders to undertake risk assessments and produce action plans, detailing how the HIV treatment service will be transitioned and implemented. We need to have that in place. It is not enough to put a couple of adverts in the media. Although that is good and should be done, it is not enough. We must have a strategy to deal with the prevention of this disease. We must also remember that it is not something that affects only one nation; it affects us all in this nation of the United Kingdom of Great Britain and Northern Ireland, and we must deal with it effectively. I look to the Minister for an indication of how she intends that to be done.

--- Later in debate ---

[Nicola Blackwood]

I think the right hon. Gentleman slightly misunderstood me on the ring fence. We have kept it because we believe that transparency and accountability measures need to be put in place, so that when local authorities move to business rates retention, their decisions can be made in an appropriately accountable way that can be scrutinised properly. We do not feel as though we have that yet, so we have moved the date back a bit. We want to do that effectively and to have proper consultation on the mandate. On his other point, I think it is a bit early in the process to start discussing that.

Given the time, let me move on to service specifications. During the debate we have heard examples of contracts for sexual health services becoming divorced from the provision of HIV services. A key recommendation from the APPG report was to create a joint service specification for sexual health and HIV services. We recognise that the existing service specification for sexual health needs strengthening, which is why it is now being updated. PHE has committed to building on existing commissioning guidance to provide more focused advice and examples of locally designed systems to support the commissioning of HIV and sexual health services.

NHS England is responsible for the service specification for HIV treatment and care, and we think that that remains a sensible division. However, the development of a new integrated service specification for sexual health services will allow us the opportunity to join up our advice to produce a more integrated offer.

I want to recognise the continuing priority of PrEP, which many colleagues mentioned, and the trial that was announced last year by PHE and NHS England. Up to £10 million has been set aside to fund the trial, which is anticipated to include at least 10,000 participants over the next three years. We expect the trial to be under way this summer. It has the potential to change the lives of thousands of people who are at risk of contracting HIV.

[Jim Shannon]

I asked about where the older generation featured in things, as did the right hon. Member for Exeter (Mr Bradshaw), but the Minister has not touched on that yet. If she is not able to do so now, perhaps she can come back to us in writing.

[Nicola Blackwood]

The whole point of developing a much more systematic process and having a commissioning programme that does not allow the fragmentation of services, but instead is much more integrated, is that it will take into account more ageing people living with HIV. We believe that that will deal with the issue.

The hon. Gentleman also asked how we will tackle the issue of undiagnosed people living with HIV in the community. We believe that the strategy of increasing education and introducing compulsory sex and relationships education will be part of that, as will improving our performance, testing and early diagnosis. The work being done through the innovation fund is a key plank of that. Having clear specifications in commissioning guidelines so that we have coherent services for all who seek them is the strategy. We think that is a coherent response.