Health: HIV

Lord Scriven Excerpts

Monday 5th September 2016 Lords Chamber

[Lord Scriven (LD)]

My Lords, I start by thanking the noble Lord, Lord Black of Brentwood, for this timely and important debate. I personally believe that the good work that has happened with HIV prevention and treatment in the UK is now at a crossroads because of public policy. That may not be intentional, but we are at a crossroads. It is going to need political leadership—not the courts—to deal with the increasing number of HIV infections happening in the UK. I shall come back to that in a moment.

It is very nice to see our new Lord Speaker, the noble Lord, Lord Fowler, in his place. His voice has been not just important but critical in the fight against HIV, not just in the UK but across the world, and many thousands and millions of people owe him personal gratitude for the work that he has done.

I am not going to concentrate significantly on the key issues already raised about education, access to testing, treatment and stigma—although I shall come back to the point about stigma. I will major on one issue—that of PrEP, a treatment to stop the replication and transmission of HIV within the UK. It is a treatment widely available in France, the United States, Israel and Kenya, and other countries are using it. It is a treatment that Public Health England modelled: if PrEP were widely available to high-risk groups, particularly men who have sex with men, it could prevent 7,400 cases by 2020.

Noble Lords have already referred to the PROUD study, which showed that the treatment is 86% effective in preventing HIV transmission, and also to the cost. The noble Lord, Lord Black of Brentwood, made it very clear that the lifetime cost of treating somebody with HIV is up to £380,000; the cost of PrEP is £400 a month. That is the equivalent of 83 years’ worth of PrEP to treat one person living with HIV. The economics are not questionable in terms of the costs of PrEP.

So how have we got to the position whereby two parts of government are slugging it out in court over who is going to pay for this preventive treatment? Interestingly, as I am sure the Minister is aware, both parts of government are funded by the Department of Health. Local government’s prevention is funded by the Department of Health, as is NHS England. In July, I asked House of Lords Question 1425—what stops the Secretary of State intervening and asking the Department of Health to commission PrEP? I got a very nice Answer about NICE, but I did not get the answer to my Question. So I will ask the Minister: what legislation stops the Secretary of State tonight telling NHS England that it can commission PrEP? What law stops that? The advice given to NHS England made it very clear that that could actually happen, so I am interested to know why it does not happen, particularly when the NHS national plan puts prevention at the heart of future health care. The whole argument about why NHS England cannot provide PrEP is that it is a prevention measure. If the whole NHS five-year plan is about prevention, why cannot the NHS step up to do this?

There is a lack of political leadership on this issue. It is not a lack of managerial leadership, although there may be with NHS England. There is a lack of direction from the centre to say that PrEP is so important, as the studies have shown, that it should be commissioned by NHS England. I declare an interest in that my partner works for NHS England in specialised commissioning. The work does not have anything to do with this area, but it is an interest that needs to be on the record.

Political leadership is needed because NHS England is taking a particularly aggressive and nasty approach on PrEP and in the arguments for why it cannot be used. A statement by Dr Jonathan Fielden on 2 August, on the day of the judgment—he is the deputy medical director of NHS England and the director of specialised commissioning—was at best unfortunate and at worst showed institutionalised homophobic language by NHS England. I do not use those words simply for effect. I shall read out what the statement said, because it was highly emotive and highly charged and used language that I do not think is worthy of a senior doctor of this country. He said that PrEP is,

“to prevent HIV transmission, particularly for men who have high risk condomless sex with multiple male partners”.

He went on to compare it with not being able to afford treatment for children with cystic fibrosis or children who do not have limbs.

That is clearly an attempt to put it into the public mind that there are deserving and non-deserving people with regard to specialised commissioning, which is not the kind of approach or language we would expect from our National Health Service. As a number of noble Lords have said, it creates a stigma. It is not acceptable for a senior doctor in the commissioning part of one of our national treasures—the National Health Service—to use that kind of language about deserving or non-deserving people. Does the Minister agree with the sentiment or tone of that press release? If not, will he say exactly why he disagrees with what the deputy medical director of NHS England said?

Finally, I will turn to the pharmaceutical company manufacturing the drug Truvada, which is the PrEP drug of choice in the UK. It is clearly about to come off patent, so what discussions have the Government had to reduce the cost? One issue is to do with cost—that NHS England or local government cannot afford the drug. As someone who has been a council leader and is still a councillor, on the issue of local authorities buying the drug, I can go to any sexual health clinic in the country and be anonymous and get PrEP as a preventive measure. If it was down to one local authority to give way on this, everyone would go there, but if it is a national preventive service that we are trying to provide, only one organisation can provide it—the National Health Service. That is why it is important that NHS England is asked to look more seriously and urgently at providing PrEP as part of its National Health Service provision.

I hope that the Government will discuss these matters with the pharmaceutical industry, and in particular with the company promoting the drug, to reduce costs. That way, even if it were to go through NICE, the cost-effectiveness question would be unanswerable.