Lords critical of HIV commissioning proposals

2 September 2011

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2 September 2011 | Angeline Albert

A group of peers has criticised UK government plans to split up the responsibility for commissioning services to deal with HIV.

The House of Lords Select Committee gave a warning the break up suggested as part of proposed NHS reforms could stop early diagnosis of the disease and hinder prevention efforts.

The Committee’s report published yesterday, No vaccine, no cure: HIV and AIDS in the United Kingdom, highlighted “significant concerns” about the proposed split in commissioning responsibility for HIV prevention, treatment and social care services. Under the government’s proposed NHS reforms, treatments for HIV will be commissioned by the national NHS Commissioning Board, while prevention and testing services will be purchased by local health authorities.

The Lords believe separating responsibilities for HIV prevention from HIV treatment, means commissioners would not be incentivised to aid prevention and early diagnosis. Pharmaceutical company Gilead Sciences told the Committee a division in authority could disincentivise prevention, testing and early diagnosis, because those commissioning such services would not gain any financial benefit from reduced treatment costs, should the number of new infections decline.

Spending by the NHS on HIV and AIDS services has increased by more than 50 per cent in the four years between 2006/7 and 2009/10, rising from £500 million to more than £760 million a year. The report said around two-thirds of the annual costs of treatment and care comes from the procurement of drug therapies. The document said: “Securing efficiencies in this area could have a major impact in limiting the overall costs of treating HIV.”

The Committee said the procurement of antiretroviral drugs should be carried out nationally, to achieve the greatest possible economies of scale and ensure regions of the country outside current bulk purchasing agreements are not being over-charged. Currently antiretroviral drugs are procured regionally.  

The report recommended the Department of Health ensures “those commissioning HIV services support the integration of all HIV services in their commissioning decisions”.

The Department of Health said it will respond formally to the Committee's recommendations later this year.

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