My Lords, HIV services are, and will continue to be, comprehensive. They include surveillance and national and local prevention, treatment and care. The NHS Commissioning Board will lead on commissioning treatment and care services. This recognises that HIV treatment is specialised and that prevalence varies. Local authorities will commission HIV prevention services in line with their wider remit regarding sexual health and health inequalities.
I thank the Minister for that Answer, which confirms that HIV treatment and care will be commissioned by the national Commissioning Board, that some preventive work will be conducted by local authorities and that national HIV prevention will be commissioned by Public Health England. However, it is unclear who will commission post-exposure prophylaxis following sexual exposure, PEPSE, which is vital specialist work to halt the spread of HIV. Who will commission that work, and how do the Government intend to ensure that all the services will not be diminished by being commissioned by at least three different bodies or lost when those bodies begin their work?
I assure the noble Baroness that the current high level of care and commissioning will continue. The reason the Commissioning Board is taking responsibility nationally is that this is a costly disease to treat and its prevalence is varied around the country, so it makes sense if the board has overall responsibility for that. As the noble Baroness knows, public health has moved to the local authorities, which is why it is appropriate for prevention to be placed at that level. With regard to joining up care, as she knows, the health and well-being boards locally will do a great deal to ensure that they look at the needs of the population in that locality and that care is delivered appropriately in their local area.
My Lords, in preventing the spread of HIV, does my noble friend agree that the most important step taken in the process of the health Bill was the Government's decision that free HIV treatment should be made available for everyone in this country? When I withdrew my amendment, it was on the understanding that the Government would introduce their own statutory instrument. When will that happen, and when does my noble friend expect the new system to be in operation?
I thank my noble friend Lord Fowler for all that he has done in this area, not least on this particular change, which we were very happy to announce we would be taking forward. The important thing here is the protection of our population. The House of Lords Select Committee had rightly flagged that if some overseas visitors who were not currently covered were left in that situation, there would be an increased risk to our population. I am extremely glad to say that we have extended treatment to cover that group so that we can look after our population. We are on course for the timetable that we laid out before, and this should be introduced in the autumn.
My Lords, what incentives does the Minister think there will be for local authorities, once they have public health responsibilities, to invest properly in the prevention of HIV/AIDS when the treatment costs will not fall to them? Can she confirm that currently a very much smaller proportion of funds is spent on prevention compared with the enormous cost of treatment? It would be in everyone's interests if that balance were addressed somewhat.
The local authorities will commission the prevention and testing services. They have a public health outcomes framework that they need to address to drive up the situation across the board in public health. There are incentives within that for them to try to improve the health of their populations. Local authorities are best placed to understand the public health pressures, which are not just in this area, on their local populations.
On prevention and treatment, the emphasis in recent years-under the previous Government, as under ours-has been on the high-risk groups, particularly gay men and people from the sub-Saharan region. Those are the groups at greatest risk. However, a sexual health policy document is being worked on at the moment. If it is felt that it is important to feed into it that there is a need for nationwide emphasis on this matter, now is the time to emphasise it.
As with every other area, this will kept under close review to make sure that things are suitably joined up and that we have high-quality prevention and treatment. As for NICE guidelines, the British HIV Association produced clinical guidelines for HIV treatment in 1999. They were taken forward and are widely accepted by clinicians and commissioners. The association is currently revising its guidelines and we will see what it suggests.
Yes, indeed, the UK National Screening Committee will remain as an independent advisory body and will continue to advise the Government and the NHS on all aspects of screening. The NHS constitution, which was drawn up by the previous Government, commits the Government to providing screening programmes as recommended by the UK National Screening Committee. The NHS Commissioning Board will commission national screening programmes on the Secretary of State's behalf.
Will the noble Baroness explain how what she said about frameworks in the early part of her rather lengthy answer to my noble friend Lady McIntosh differs from having targets in the National Health Service?
I have been allocated much more time for this Question than my colleague was for the previous one, so I apologise if I am taking too long to answer. The noble Lord will have to wait to see how that transpires.
My Lords, does the noble Baroness agree that one of the difficult problems in the area of prevention is the fact that it is not ethically possible to take a blood sample to test an individual for HIV without their informed consent? The problem that arises is that a number of people who are at risk refuse to give consent, even though they continue to have sexual contact, and that is very difficult to overcome.
The noble Lord is absolutely right. From my other area of international development, I know only too well that that is true world wide. Things have improved enormously in the United Kingdom, where people with HIV are now living normal lives and there is much less discrimination than there used to be. That helps in encouraging people to come forward for testing. However, the noble Lord is absolutely right and it is extremely important that we reduce the stigma so that they are content to do so.
My Lords, as health is devolved to Scotland, Northern Ireland and Wales, how does the United Kingdom national screening project include them? Is there any particular mechanism or understanding there?
Public Health England will be liaising with the different parts of the United Kingdom to ensure that what is learnt in one area is propagated to others so that the different parts of the United Kingdom can learn from each other. We look to what happens in England, Scotland and Wales. That came up frequently in the Bill and will continue to be the case.
I was accused of answering at too great a length. The Commissioning Board will oversee commissioning. It is working out how that can best be delivered and whether various things should be commissioned at the local level. If the noble Baroness would like to feed into that process, that would be very welcome.
My Lords, this may be slightly wide of the Question, but can the noble Baroness say what progress has been made in reducing maternal transfer of HIV in this country, and how that compares with the progress made on that issue in sub-Saharan Africa? That may be very wide of the Question and she may like to write to me.