An NHS England claim that they are not responsible for funding pre-exposure prophylaxis (PrEP) for men at risk of HIV has just been successfully challenged in the High Court. This does not mean that the drug will definitively be provided by the NHS – its cost-effectiveness relative to other potential health technologies is currently being investigated by the National Institute for Health and Care Excellence (NICE) – but, subject to the outcome of a planned appeal, it does mean local authorities will not be responsible for funding it.
Following the 2012 Health and Social Care Act, local authorities were made responsible for the provision of Public Health services, including HIV prevention. This could be taken to suggest that the NHS could wash its hands of preventative health interventions. Yet even the NHS’ own Vision Statement, published in 2014, implies they have a role to play before ill-health sets in; with the vision that “Everyone is … supported to live longer, healthier lives”. In the context of sexual health, NHS England is responsible for funding post-exposure prophylaxis following sexual exposure (PEPSE) and treatment for HIV positive pregnant women and their babies to prevent mother-to-child transmission: the exact position of the boundary between local authority and NHS responsibilities for the prevention of HIV is therefore challenging for anyone to locate. Showing that these treatments are substantively different from PrEP will likely be one of the challenges for the NHS England lawyers as they appeal the initial decision.
This may not be the last legal battle over whether NHS England or local authorities are responsible for funding a particular aspect of preventative or even other health care. Ironically, legal costs mean that such battles reduce the funding available for actual health care of any type, so whatever the outcome, it is the patient who loses. Patients benefit from joined-up care and in the long-term, all providers – but particularly the NHS - benefit from early investment in preventative health services. Lessons from the lack of investment in efforts to prevent the current obesity crisis need to be learned by all – let’s hope this high profile case provides an incentive for all those responsible for providing health care work together to achieve those long-term gains.
Celia Taylor, Associate Professor at Warwick Medical School
3 August 2016
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