Dr. Tom Scanlon
Director of Public Health
NHS Brighton and Hove
Prestamex House
171-173 Preston Road
Brighton
BN1 6AG

20th January 2012

Dear Tom,

I am writing as a member of the All Parliamentary Group on HIV and AIDS about plans to alter the arrangements for antiretroviral purchasing in the south of England.

As you will know, last year London adopted a new therapeutic drug list for the treatment of HIV, in an attempt to reduce the cost of purchasing anti-HIV medicines. The list includes a limited but effective number of antiretroviral drugs. The same list is planned for adoption in the south of England. I share concerns about the need for reduced and efficient spending within the NHS but at the same time am concerned to see any savings also take patient care into proper account I hope you will take the following concerns into account as the process for adopting the new list gets underway.

To date there has been no publication of the evidence base used for the antiretroviral drug selection - this is crucial if patients are to get the best possible care available. Nor, as I understand it is there a plan for arranging consultation with prescribers or patients in advance of rolling out London's scheme in the south of England. The plan is to be implemented within a matter of weeks, and I fear that speedy adoption in the south of England will compromise the NHS's ability to give patients the best care possible. A 12 month consultation and stakeholder engagement programme was undertaken in London before introducing the changes, and I very much hope NHS Brighton and Hove can learn from this approach.

I am concerned too about the possible introduction of perverse incentives into the doctor-patient relationship, as a balance is sought between squaring a limited cost-driven drug list and informed consent. I also think it is crucial to provide a guarantee that patients on stable treatments will not be required to switch medication. As you will be aware, tailor made HIV treatment can take many years to perfect and I am keen to see that constituents are not forced into a situation where the individual knowledge built up over time is disregarded. Finally, I would like to see some assurance that if treatment guidelines change, the NHS will have a mechanism for adapting, as well as for responding to new studies and research.

I look forward to hearing from you and hope that NHS Brighton and Hove will do their best to ensure that the change to antiretroviral purchasing arrangements are done in such a way as to best protect current and future patients.

Yours sincerely,

Caroline Lucas, MP, Brighton Pavilion