Public health minister Jane Ellison faced a hostile and protracted grilling by MPs from both sides of the House of Commons on Tuesday over the NHS's refusal last week to fund the drug that prevents HIV, in a regime known as PrEP.
During an urgent question posed by shadow public health minister Andrew Gwynne MP on the subject of PrEP (pre-exposure prophylaxis), no fewer than 15 MPs rounded on the minister variously accusing her, the government and NHS England of "having their head in the sand", of "passing the buck", and of being "incompetent".
This, they argued, has led to the "worst of all scenarios, which is a legal challenge", which will have "disastrous results" and warned that the delay will "lead to the death of hundreds of people in Britain".
The decision by NHS England – on the grounds that HIV prevention is the responsibility of local authorities – sparked a legal challenge on Friday by the National Aids Trust, which argues that NHS England is duty bound to commission the medication.
In an attempt to avoid a costly, lengthy court battle to decide who is responsible, Gwynne demanded that Ellison "show some leadership" and use "Section 7a powers" – which enable the health secretary to delegate commissioning services to NHS England – to force the organisation to reconsider. Other MPs also sought clarification on the legal situation.
But Ellison repeatedly refused to be drawn on the NHS's predicament regarding the forthcoming challenge in the courts and instead announced that the government has tasked NICE (the National Institute for Health and Care Excellence) with undertaking an "evidence review" of PrEP over the next few months to ascertain not only its cost effectiveness, but also its "effectiveness" and "safety".
Several MPs pointed out that the efficacy of the drug has already been proven by both British and international studies, thus NICE's work would be partly pointless. And concerned that such a review would merely stall decision making further, the SNP's Stewart McDonald asked the Speaker if it would be possible to trigger an emergency Commons debate on PrEP – to which the Speaker replied it would be "a possible approach" – while condemning the government for having its "head in the sand" over the issue.
The furious questioning continued for half an hour as even Conservative MPs expressed their disdain over the NHS's block on the drug.
"I have lost too many friends over the years to Aids, to not challenge the decision of NHS England not to fund PrEP," said Mike Freer MP, chair of the all-party working group on HIV/Aids. "HIV infection rates in this country are on the increase, existing strategies are not working and to suggest we simply do the same going forward is not acceptable."
Freer did, however, manage to get the minister to agree to meet with HIV charities on 13 June to discuss the situation. It was more of a direct answer than that afforded to Andrew Gwynne, who asked Ellison, to no avail, whether she would be giving councils more money to pay for this drug, and whether she was concerned by the precedent that would be set were councils forced to start funding medication.
Meanwhile, Dr Philippa Whitford MP attacked NHS England as "poor" to "have made the decision on [an] ‘it’s not our job, it's your job’ [basis]." She added: "I think that's the most insulting bit to the community."
Labour's Ben Bradshaw continued on this theme accusing NHS England of "damaging buck passing" and suggesting that the continued absence of PrEP is "going back to the bad old days where certain groups are being stigmatised" which in turn "will have a disastrous impact on public health".
Again Ellison refused to comment on imminent legal action but stated her "personal commitment to tackling stigma". Several more MPs attempted to seek clarification on who was legally responsible for commissioning the drug, but the minister remained mute on the subject.
Helen Hayes said it was "unworkable" for local authorities, rather than the NHS, to fund PrEP; Ben Howlett described the current stalemate situation as the "worst of all scenarios" and Diana Johnson alluded to the 2012 Health and Social Care Act, which re-structured the NHS and split HIV care between treatment provided by the NHS and prevention provided by councils:
"I’m flabbergasted that she’s come before the House today to say that the legislation which her government introduced around the reorganisation of the NHS is so incompetent that NHS England are now having to go to court to work out who’s entitled to commissioning these services," said Johnson. The Department of Health admitted to BuzzFeed News that it does not know who is responsible.
But even Fiona Mactaggart's intervention, in which she told the minister that the endless delays in implementing PrEP will "lead to the death of hundreds of people in Britain" did not rouse Ellison who instead pointed to the home testing kits for HIV that the government has brought in.
The debate follows months of uncertainty around the implementation of PrEP, beginning in March with NHS England shelving an 18-month consultation process with the HIV sector, before then agreeing to reconsider the decision and then finally reverting to the original decision.