The announcement of a substantial increase in funding for the NHS over
the next five years looks set to have important implications for the
funding of specialist HIV services. However, although the cost of HIV
treatments look likely to be met by the NHS in the foreseeable future,
the future of prevention services is already looking less rosy.
In his annual budget statement, UK Chancellor Gordon Brown outlined a
43% increase in NHS funding between now and 2007, equivalent to an extra
£40 billion in real terms. However, it is uncertain how well HIV
treatment, care and prevention services will fare as specialist NHS
departments bid for the much needed new cash.
This is a particularly critical question as special funding
arrangements for HIV treatments ended this year and changes were made to the system by which NHS HIV services are commissioned. This has led to anxiety being expressed in
some quarters that money previously used to pay for HIV treatments and
care will be diverted to make up short-falls in over-stretched and
politically sensitive cancer, cardiology, paediatric and geriatric
services.
HIV treatment costs are projected to rise from £316 million in 1996 to £556 million in 2004, as the number of HIV-positive people using treatment services rises from 13,400 at the introduction of HAART to 25,667 in 2004. Costs are projected to rise by 43% from 1999 to 2004.
However, HIV funding managers are not only welcoming the new NHS cash
but also appear to be taking a relaxed view of the funding changes – at
least as regards the future of funding for treatments. Jonathan
O’Sullivan is a senior public health strategist and works with the London
HIV Consortium, which is made up of Primary Care Trusts (PCTs, former
health authorities) from around the capital which plan London’s HIV
services. Like everybody working in the health service he welcomes the
Chancellor’s announcement of a substantial cash injection, “The
additional funding will make a huge difference and will mean that the
NHS is able to better meet the needs of a range of people including
those with HIV” he said.
Funding for HIV treatments already looked safe even with the ending of
specially earmarked cash for HIV and its incorporation into the general
NHS allocation, according to Jonathan O’Sullivan.
“HIV antiretrovirals are of proven
clinical benefit and are cost effective”, he said, suggesting that the government
body which decides which drugs the NHS should pay for, the National
Institute of Clinical Excellence (NICE) is likely to continue to approve
the prescription of antiretrovirals which have been proved effective in
clinical trials.
Outside London, PCTs appear to be responding to clinical data on the
benefit of antiretrovirals. In Birmingham an extra £600,000 was
allocated to antiretrovirals, bringing their annual HIV drug budget up
to almost £1 million.
However, there are concerns over future funding for HIV prevention
services. Howard Thomas, who has responsibility for commissioning HIV
services in Birmingham, pointed out that “our HIV prevention budget was
cut by £150,000 despite the fact that we’re expecting a 20% increase in
infections this year.” Indeed, nationwide the government’s own
epidemiologists have warned that the number of people living with HIV in
the UK is expected to increase by 50% within the next five years.
“We have to maintain our expertise in commissioning HIV services” said
O’Sullivan. He is hopeful that new PCTs can work together to ensure that
appropriate HIV services are planned, funded and delivered.