• NHS England says it cannot guarantee funding for 18 new services until outcome of judicial review on HIV prevention
  • Jonathan Fielden says legal action “preventing us confirming the new opportunities for so many”
  • Charity behind judicial review insists delays “of the NHS’s own making”

NHS England has blamed a judicial review on HIV prevention for delaying the rollout of new treatments and services.

The national body on Monday announced 18 new treatments set to receive funding, including robotic surgery for kidney cancer and prosthetics for lower limb loss.



The 18 treatments include complex obesity surgery for children

However, NHS England claimed it could not guarantee patients would be able to access the new services as it might have to revisit its decisions if it lost a judicial review on whether it is responsible for commissioning HIV prevention.

NHS England has published the outcome of its prioritisation round – an annual process used to choose which new specialised treatments should receive funding.

Eighteen treatments have been provisionally earmarked for new investment such as complex obesity surgery for children.

NHS England judged four proposals as “not currently affordable” after they were given the lowest, “level five” priority ranking (see box, below).

However, the national body said the whole prioritisation process might have to be re-run if it loses the judicial review on whether it is responsible for commissioning HIV prevention.

Earlier in the year NHS England said it could not consider funding pre-exposure prophylaxis (PREP) – which involves HIV negative people taking an antiretroviral drug to avoid getting HIV – because it claimed it did not have the legal power to commission it.

The national body said local authorities were the responsible commissioner for HIV prevention, and claimed that considering PREP in its prioritisation round would leave it open to legal challenge from advocates of other treatments that could end up being “displaced”.

The move resulted in the National AIDS Trust lodging a judicial review to challenge the decision.

Jonathan Fielden, NHS England’s director for specialised services, said the organisation was “frustrated” it could not confirm funding for the 18 services “whilst we await the outcome of a judicial review”.

“This is because, if NHS England loses the judicial review, we will need to consider displacing some of the proposed new treatments depending on the PREP decision,” he said.

“NHS England is doing all it can to expedite these proceedings, which are preventing us confirming the new opportunities for so many.”

However, the NAT said the delays were “of the NHS’s own making”.

Deborah Gold, the charity’s chief executive, told HSJ: “NAT shares the frustrations of many that new treatments and technologies cannot be introduced on the NHS swiftly.

“After 18 months of development, the evidence for PREP as a game-changing innovation against the ongoing HIV epidemic was ready to be judged on its merits.

“Instead, NHS England pulled the policy from the process at the last minute leaving no clarity about which part of our health system is responsible.”

Ms Gold added: “It is incredibly important that decisions such as this can be challenged through the judicial review process in order to ensure accountability of our NHS and fair and equal access to treatments.”

Eighteen proposals set to receive funding

Priority ranking: level 1

  • Complex obesity surgery (children) for severe and complex obesity
  • Use of plerixafor for stem cell mobilisation (update to include paediatrics)

Level 2

  • Bone morphogenic protein-2 for spinal fusion
  • Robotic assisted surgery for kidney cancer
  • Stereotactic radiosurgery/radiotherapy for ependymoma, haemangioblastoma, pilocytic astrocytoma and trigeminal schwannoma
  • Tocilizumab for Takayasu arteritis
  • Treatments for Graft versus Host Disease (GvHD) following Haematopoietic Stem Cell Transplantation
  • Treatment of iron overload for transfused and non-transfused patients with chronic inherited anaemia
  • Penile prostheses for end stage erectile dysfunction (service currently being commissioned by CCGs which will become NHS England’s funding responsibility from April 2017)

Level 3

  • Auditory brainstem implants for children with deficiency or missing auditory nerves
  • Ivacaftor for children (aged 2-5) with cystic fibrosis (named mutations)
  • Pegvisomant for acromegaly as a third line treatment (adults)
  • Prosthetics for lower limb loss
  • Tolvaptan for hyponatraemia secondary to the Syndrome of Inappropriate Antidiuretic Hormone (SIADH) for patients who require cancer chemotherapy

Level 4

  • Haematopoietic stem cell transplantation (Lymphoplasmacytic Lymphoma, adults)
  • Pasireotide for Cushing’s Disease
  • Sodium oxybate for symptom control of narcolepsy with cataplexy (children)
  • Rituximab for immunoglobulin G4 related disease

Level 5 – proposals judged to be “not currently affordable”

  • Eculizumab for treatment of recurrence of C3 glomerulopathy post-transplant
  • Everolimus for subependymal giant cell astrocytoma (SEGA) associated with tuberous sclerosis complex
  • Riociguat for pulmonary arterial hypertension
  • Second allogeneic haematopoietic stem cell transplant for relapsed disease (adults)