Councils and NHS England row over who picks up bill for new HIV treatment

The Local Government Association has accused NHS England of “a selective and untenable reading” of regulations after the health body announced that councils are to be responsible for funding a new HIV treatment.

Pre-exposure prophylaxis (PrEP) is an approach where HIV-negative individuals use anti-HIV medications to reduce their risk of becoming infected. Recent evidence has suggested that the approach can be highly effective in preventing HIV as long as the drugs are taken regularly.

In an update published this week on commissioning and provision of the treatment, NHS England said: “As set out in the Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) Regulations 2013, local authorities are the responsible commissioner for HIV prevention services.

“Including PrEP for consideration in competition with specialised commissioning treatments as part of the annual CPAG prioritisation process could present risk of legal challenge from proponents of other ‘candidate’ treatments and interventions that could be displaced by PrEP if NHS England were to commission it.”

On the next stages of rollout, NHS England claimed that while it was not responsible for commissioning HIV prevention services, it was committed to working with local authorities, Public Health England, the Department of Health and other stakeholders as further consideration was given to making PrEP available for HIV prevention.

It will be making available up to £2m over the next two years to run a number of early implementer test sites. These test sites will aim to provide protection to an additional 500 men at high risk of HIV infection as well as inform future arrangements for the commissioning and provision of the intervention, NHS England said.

NHS England and Public Health England are to launch a process to seek expressions of interest for the test sites from local authority areas with a view to confirming successful applications by June 2016.

Responding to the NHS England announcment, the Local Government Association’s Community Wellbeing spokeswoman, Cllr Izzi Seccombe, said: "This is a missed opportunity to launch a ground-breaking prevention method that could halt the spread of HIV, potentially save lives, and make a significant breakthrough in reducing the risk of HIV infection. Councils have invested millions in providing sexual health services since taking over responsibility for public health three years ago, and this treatment could help reduce levels of HIV in the community.
 
"It is also not right that councils should be made to foot the bill. In stating that local authorities are responsible for commissioning HIV prevention, NHS England adopts what is, in our view, a wholly inadequate position."

Cllr Seccombe added: "During the transition period to implementation of the NHS and Care Act 2010, NHS England sought to retain commissioning of HIV therapeutics, which the PrEP treatment clearly falls into. It is, and should remain, an NHS responsibility unless it is fully funded for local authorities to pass on.  
 
"NHS England's statement is a selective and untenable reading of the Public Health Regulations 2013 and an attempt to create a new and unfunded burden on local authorities."