People at risk of HIV in Scotland to be given PrEP drug on NHS

People at risk of HIV in Scotland are to be given drugs on the NHS that will protect them from infection, it has been announced, in a move that Aids campaigners say will put pressure on the authorities in England to end delays in providing the same medication despite two major court rulings.

In a major victory for campaigners, the Scottish Medicines Consortium (SMC) said pre-exposure prophylaxis (PrEP) would be free on the NHS to those who need it because they are at risk – for instance, if they have a partner with HIV. Access to the drugs could begin within weeks.

NHS England resisted rolling out PrEP due to its cost, although it is a lot cheaper than a lifetime of HIV treatment which could cost £360,000. It lost to campaigners in the high court and then the court of appeal, but those who want to take PrEP have been told they must wait for a big new trial to answer “significant outstanding implementation questions”.

The National Aids Trust (NAT), which funded the court battle in England, said it was delighted PrEP would shortly be available in Scotland. “This game-changing prevention tool has the potential to massively reduce HIV rates and turn Scotland into a model internationally of how to do HIV prevention well. The speed and decisiveness of the Scottish process contrasts starkly with delays in the other three UK nations,” said Deborah Gold, NAT’s chief executive.

“Though we were jubilant when, following our two successful court cases, NHS England agreed steps to fund PrEP, we remain concerned that since that date, progress towards the ultimate goal of PrEP in England has been slow. It is difficult not to think of the possible thousands of HIV diagnoses that could have been prevented had the NHS in England not prevaricated, and we urge them to pursue the promised trial with appropriate urgency.”

The PrEP4Scotland Coalition (made up of HIV Scotland, Terrence Higgins Trust Scotland, Waverley Care and NAT) which has campaigned and negotiated with the Scottish authorities on the introduction of PrEP, said: “We applaud the SMC for taking this bold step to tackling HIV in Scotland. PrEP provides opportunities to reinvigorate how people at higher risk of HIV exposure engage with testing and prevention opportunities, and it is a vital opportunity to make a real reduction in the number of new HIV transmissions.”

Trials in several countries around the world including the UK have shown beyond doubt that PrEP works. The drug used is Truvada, which is one of a cocktail used to treat people infected with the virus and keep them well. PrEP has been hailed as one of the tools that could help end the Aids epidemic and efforts are being made to get it introduced into high-burden countries such as South Africa.

Every year about 5,000 people become infected with HIV in the UK and the rate among men who have sex with men is rising fastest. This was the group in whom the trials in the UK were done and where the evidence is strongest.

But NHS England dragged its feet because of the cost – estimated at potentially £20m a year to treat everyone who could benefit. It attempted to shift the bill to the local authorities, who are now responsible for public health, including HIV, obesity and smoking.

The local authorities said they could not afford to pay either. NAT sued NHS England in the high court and won last August. NHS England took its case to the court of appeal and lost again in November.

In December, NHS England said it would make the drugs available through a trial, which would enrol at least 10,000 people over the next three years.

NHS England said there were issues that needed addressing in a trial – which may include how consistently people take the daily tablets and how long they stay on the regime. But a trial also allows the NHS to obtain cheaper generic versions of the drug, rather than paying the market price to Gilead, the manufacturer and patent holder of Truvada. NHS England has already asked various companies to tender to supply the pills.

Prof Noel Gill, head of Public Health England’s HIV and STI department, said: “All the detailed work underpinning the clinical trial of PrEP is well under way and we expect it will commence by the summer 2017.”

Scotland’s decision to part with the NHS in England follows a huge community effort and years of campaigning, said HIV Scotland. “In 2016 HIV Scotland published a PrEP good practice guide, and administered Scotland’s expert group which produced prescribing criteria, cost assessments, and mapped information and training needs of workers and the community,” said its chief executive George Valiotis.

“Today, Scotland has made history in the fight against the HIV epidemic,” said
Robert McKay, national director for Terrence Higgins Trust Scotland. “PrEP can now be used as a vital tool – alongside condom use, regular testing and early treatment – to help bring an end to HIV transmission in Scotland.

“Not only will this make a life-changing difference to individuals by protecting them from a lifelong and stigmatised condition, but for every person who would have become HIV positive without PrEP, NHS Scotland will save £360,000 in lifetime treatment costs.”

People at risk of HIV in Scotland to be given PrEP drug on NHS

Women"s groups urge Scotland to scrap two doctors abortion rule

The Scottish government should scrap the legal requirement for two doctors to approve a termination, effectively decriminalising the procedure, and consider regulating abortion drugs for use by women in their own homes, according to a report by a coalition of women’s rights organisations.

With abortion law devolved to Holyrood as part of the Scotland Act 2016, the report argues that the SNP government must now “be bold in creating a distinctive approach” by removing it from criminal statute and regulating it like any other healthcare procedure.

The campaigners – including Amnesty Scotland, NUS Scotland and Scottish Women’s Aid – are calling on politicians to “make a woman’s legal right to choose a reality” by removing the two doctors rule.

Under UK law abortion is permitted for non-medical reasons up to 24 weeks and with the permission of two doctors. The SNP reaffirmed its commitment to current legal protections and to maintaining time limits in line with the rest of the UK in its spring manifesto.

But the report insists it is time to go further, arguing: “There is an opportunity within the devolution of abortion law to develop a distinct Scottish approach to women’s reproductive health and the strengthen women’s rights.”

Since the devolution of abortion law was announced last November, some pro-choice campaigners have raised concerns about the risk of anti-abortion groups exploiting cross-border differences.

Others have suggested the surge in political engagement, particularly among women, brought about by the 2014 independence referendum campaign could bolster any forthcoming drive to extend abortion rights in Scotland.

On a visit to Dublin two weeks ago, Scotland’s first minister, Nicola Sturgeon, said her government would explore how to allow Northern Irish women to obtain free access to abortions in Scotland’s NHS hospitals.

Abortion is legal in Northern Ireland only when the pregnancy poses a direct threat to the mother’s life. The NHS has so far refused to pay for abortions for Northern Irish women who travel to Britain.

Emma Ritch, executive director of the feminist campaign group Engender, which spearheaded the report, said: “It does seem there is a very unique status given to abortion, in that it is the only type of healthcare in which this criminalisation exists. We would want to see decriminalisation happen so that abortion was regulated in the same way as any other type of healthcare.

“Any Scottish approach to abortion should be based on international best practice, so we could adopt a situation as in Canada where there is no criminal law when it comes to abortion. While the debate around time limits is not a focus of the report, there is no compelling evidence of a reason to have time limits at all. Research shows that women want to access abortions at the earliest possible stage, and allowing later-term abortions does not significantly increase demand.”

The report criticises NHS Scotland for lagging behind England in its provision of later-term abortions, with terminations for non-medical reasons not normally available after 20 weeks, forcing some women to travel south.

It also suggests the Scottish government should consider regulating the provision of medical abortion drugs to allow terminations in early pregnancy to be carried out at home. A total of 12,082 abortions were carried out in Scotland in 2015, about 80% of which took place before 12 weeks of pregnancy.

The report counters the assumption that Scottish social attitudes, influenced by strong religious traditions, are more anti-choice than elsewhere in the UK. It says that according to polling carried out in the last year, 75% of Scots support a woman’s right to choose.

Women"s groups urge Scotland to scrap two doctors abortion rule

NHS England sending anorexic patients to Scotland for treatment

The NHS in England is sending patients who are seriously ill with eating disorders to Scotland for treatment because chronic bed shortages mean they cannot be cared for in England.

Vulnerable patients, mainly teenagers and young adults, are being taken hundreds of miles from their homes in order to receive residential care in Glasgow and near Edinburgh.

Mental health experts voiced deep concern about the trend and said it could damage patients’ chances of recovery, increase their sense of isolation through the separation from their families and even increase their risk of dying.

Doctors, eating disorders charities and patients have told the Guardian that the quality of care received by patients, some of whom are at risk of dying, is being compromised by the NHS in England having far too few beds to cope with the growing number of cases of anorexia, bulimia and other forms of psychiatric illness linked to eating habits.

“I’ve seen a rise in calls from people saying their children have been sent far away, miles away, to be looked after because there are either no services nearby or they are full”, said Jane Smith, chief executive of Anorexia and Bulimia Care. “This is a life-threatening situation for young people. People are in inpatient care because they are at risk of dying. They are in a very fragile, risky state.”

Rebecca Doidge, 20, from St Albans in Hertfordshire, spent six months in the Priory private hospital in Glasgow earlier this year because she was desperate for treatment and could not find anywhere else. The distance had negative side-effects, she said.

Despite being well looked after there, “being sent so far away does compromise care”, she said. “The outcomes are going to be better if you can stay near home. It’s really hard to integrate back home or go to another environment when discharged if you are in a different country. It makes communication between those treating you in hospital and those at home difficult.”

During her stay in the Priory, which has 25-30 beds, “about seven of the people there were from Hertfordshire,” she said. “The number of English people there massively outnumbered Scots.”

Anup Vyas’s stepdaughter has been receiving treatment for a rare eating disorder in Huntercombe private hospital in Livingston, near Edinburgh, since February. After previous stints in units in Watford, London and Colchester in Essex, the 17-year-old’s condition is so serious that “now she is basically being kept alive in Scotland”, said Vyas.

“NHS England acknowledge that her being so far away is not ideal. Her brothers haven’t visited her since June and no friends have gone up. Most people in the unit are from England, especially the north of England – places like York and Manchester.” The family’s home is in Hemel Hempstead, 350 miles from Livingston.

The health secretary, Jeremy Hunt, criticised the practice as “completely unacceptable”. He recently said NHS children and adolescent mental health services were the NHS’s worst area of care.

“It is clearly unacceptable for people to be sent hundreds of miles away for care at a time when they need the support of friends and family the most”, he said. “That’s why in April we committed to a national ambition to eliminate inappropriate out-of-area placements by 2020-21.” Ministers had also earmarked £150m for enhanced services in community settings to help ensure that mental health problems in young people were tackled before their health worsens, he said.

NHS England, despite its professed commitment to openness, refused to say how many patients from England were receiving treatment for eating disorders in Scotland. Expanding the supply of specialist beds to treat people with those conditions would take time, it said.

“It’s extremely distressing for parents to have a child who is so unwell that they require inpatient care, and it’s even worse when they can’t easily visit their child because of long travel distances”, said Sarah Brennan, chief executive of Young Minds. “For many young people the distance from family and friends is one of their biggest fears when they are hospitalised. Being separated from loved ones doesn’t help with recovery and makes the stress of hospitalisation worse.”

Dr Jon Goldin, a consultant psychiatrist in London specialising in children and adolescents, said he had heard of patients being moved long distances. “But it shouldn’t be happening,” he said. “It’s a concern. Patients should be treated nearby and should be in contact with family. They need support and it’s much harder to get that when families have to travel long distances.

“Part of their recovery may involve therapy with their family, especially for children aged 14 and under.”, said Goldin, who is also a spokesman for the Royal College of Psychiatrists.

More young people were developing eating disorders, he said. Genetic factors, personality factors and socio-cultural factors, such as images in the media of models “which glamorise thinness” are among the many reasons for the trend, Goldin said.

A spokeswoman for the Priory hospital in Glasgow said it took patients from all over the UK. “The Priory hospital in Glasgow has a reputation for providing some of the highest standards of mental healthcare in the country, and has been given a ‘very good’ rating by our regulator, Healthcare Improvement Scotland, for staffing, management, information to patients, and the environment it offers those we care for. As such, we support patients from across the UK and overseas.”

A spokeswoman for NHS England said: “The NHS recently laid out very clear plans to expand staff and services for specialist eating disorders and other mental health problems, in order to tackle and eliminate distant out-of-area placements. Transformation won’t happen overnight but work is under way to improve services for everyone and to make sure care is available at home or as close to home as possible when a patient needs more intensive therapy.

“To help achieve this, the government has allocated a cumulative £1.4bn to children and young people’s mental health services over the next five years, and the new waiting time for eating disorder patients will ensure patients get better care more quickly.”

NHS England sending anorexic patients to Scotland for treatment

Which way now for public providers in Scotland?

Would an independent Scotland be able to reverse the Uk government’s austerity measures? Photograph: Jeff J Mitchell/Getty Photographs

Housing policy has been devolved for many years. The Scottish government controls budgets for investment and capital subsidy. The austerity axe has fallen heavily on social housing. We would welcome reinvestment to supply a lot necessary cost-effective housing, at a lower value to the public purse. The most powerful way to remedy the bedroom tax is full repeal. We welcome cross-party assistance in the Scottish parliament to mitigate the impact of the tax with additional investing. The tax underlines the tensions between social security and housing policy just above half of all social rents payable in Scotland are sourced from housing benefit, but housing benefit expenditure is a lot reduce per capita simply because rents are decrease here. Policymakers have no management in excess of the means by which individuals are supported to shell out rental expenses. In the event of a no vote, we would seem for even more devolution of powers to allow Scotland to workout management above how to assistance housing charges. But if there’s a yes vote, we would expect a social security system to meet Scottish needs and policy objectives. 

Enhanced homelessness rights, the abolition of appropriate to buy and fuller rights for tenants are a sample of the measures that signify the divergence among housing policy in Scotland and the rest of the Uk. What ever the vote, housing policy will proceed to evolve. That’s not to diminish the significance of a yes vote. Taking complete handle of welfare and taxation are the two biggest policy levers on supply. With rewards and taxation powers firmly held at Westminster, landlords nevertheless dance to those tunes far more than those of Holyrood. Whatever the end result of the vote, there are two certainties – Scotland’s immediate want for a new lengthy-term prepare on homelessness and to build at least 10,000 new inexpensive residences every single year for the foreseeable potential.

The present Uk strategy to dealing with asylum and refugees is not match for purpose. It’s getting dealt with in the broader immigration technique, which is yet another area of public policy that is a toxic debate. Asylum is swept up in that when it is a separate situation that demands to be accomplished in a different way to border manage and determining who gets to operate right here. We’re pleased that a variety of the suggestions we place forward [for how the asylum and refugee system would perform in an independent Scotland] have been included in the white paper on independence. Principally, the idea of establishing a separate agency just to deal with asylum and refugee troubles – free of charge from day-to-day political interference. A specific agency separate from immigration, signifies we will have decisions that will be more primarily based on proof. It’s about restating the truth that claiming asylum is not a crime – it truly is component of the global human rights framework.

At a individual degree, I am quite fearful that if the vote is yes, all the other problems such as currency, debt and political welfare methods will take precedence, and there will be absolutely nothing happening [in migrant rights] for a handful of years. I know the Scottish government feels that the immigration and asylum situation is all about integration. I think that integration is a two-way process. In the United kingdom, it really is also one particular sided – “how can migrants fit in?”. Integration smacks of “tolerance” and I would a lot choose “acceptance”.

When you speak to folks in nearby communities, the actual story is not about the internal workings of Holyrood or Westminster. It is about the local providers that communities need to have, and giving people a say about what matters locally to them. Efficient regional democracy is fundamental to the variety of nation we want to dwell in. The options and difficulties that we face in different parts of the country demand regional selections and neighborhood accountability. More solutions are run by distant bureaucracies, and frequently people providers are becoming accomplished to individuals rather than delivered with them.  Generating Scotland a fairer, healthier and wealthier spot will not be attained from the top down. The actuality is that strengthening lives means empowering nearby democracy and letting regional people determine on their priorities, their solutions, and their spending. 

Social operate legislation has been separate from England for many years. Though the 32 councils make a decision on certain social work funding, considerably latest policy is perceived as more and more centralised, for instance, grownup assistance and protection. It truly is yet to be witnessed how social care partnerships could be influenced by the vote. Some really specialist assets are accessed in England this kind of as detox, therapeutic residential care, and secure care – despite the fact that councils consider to steer clear of this, at times there are no amenities right here. Also, some charities offering care, this kind of as Barnardo’s and Action for Children that are Uk-wide with Scottish offices, may review their position in an independent Scotland. Social function delivery in Scotland has been significantly impacted by the impact of welfare reform imposed by Westminster. Our members have to deal with people’s confusion about universal positive aspects and the resulting penalties that can depart young children and households in enhanced poverty. There is a view that a yes vote could help repeal some of this legislation. Several of our members want social workers to be freed up to return to their direct position as modify agents within communities. A smaller country, both independent or with elevated devolved powers, may possibly permit for that debate.

Our roles as campaigners, service providers and neighborhood builders will not disappear. There will often be a require to mobilise citizens, regardless of whether to help in hospices or put an end to poverty and inequality.  Independence will neither support nor hinder the improvement of the correct approaches to keep older folks out of hospital, youngsters off the dole or offenders out of prison. What will adjust for us is the leverage to challenge a lot more and to construct the type of inclusive value-primarily based society and sustainable economic system that some of us dream of. With the criminal welfare cuts and the austerity policies of the United kingdom government, the big query is: would large levels of poverty and inequality stand a better likelihood of becoming addressed in an independent country? Would it pave the way to create an financial technique that works for the bulk? With independence, we would count on an immediate turnaround in approaches to welfare – from belligerent harassment to support and empowerment. Voluntary organisations would play a huge portion in the immediate task of nation building, but whether it’s a yes or no vote, there will usually be a lot more to do to develop a much better, fairer society.

Amongst disabled individuals in Scotland there is a huge volume of dread about the new personal independent payment (PiP), universal credit score and the impact of bedroom tax. Even though massive [policy] regions are devolved in Scotland, there is a mismatch at policy level. For instance, Inclusion Scotland favours houses for life [designed to accommodate people"s altering care wants] but the bedroom tax undermines that [as it forces individuals to move to smaller sized properties]. We can now meet with crucial policy and selection makers and give them our account of what is necessary – they do not often act but we can speak and get a hearing. There is a challenge in going down to Westminster and getting access to ministers. It is physically attainable to lobby [members of the Scottish parliament], which can make achieving political modify simpler.

Public well being is a severe matter for Scotland. Given that devolution, the Scottish government has brought in daring initiatives, including the abolition of prescription fees and the provision of cost-free eye tests for all. And let’s not overlook that we had been the 1st United kingdom nation to introduce the smoking ban. Now the Scottish government is pushing ahead with strategies for plain packaging on cigarettes and minimum unit pricing on alcohol. These stage to a distinct set of government priorities than individuals of Westminster. The Scottish government factors to cuts in welfare investing brought in by Westminster exacerbating bad well being. Independence would give Scotland the power to target on strengthening wellness by seeing wellness, social care and wider social problems as all portion of the exact same picture.

Devolution has led Scotland down a different path from the rest of the Uk with commitments to universal public providers, no privatisation and free of charge schooling. But “mitigating Britain” cannot be our long term. We are caught with the unbalanced United kingdom economic system and each and every time Westminster cuts funding from public companies, our budgets fall. You saw this just lately in which Scotland diverted funds from other budgets to lessen the affect of the bedroom tax. Scotland is presently halfway in the direction of being a different variety of nation. Independence is an opportunity to try out and complete the occupation.

Civil and criminal courts are already inside of the competence of the Scottish parliament, and Scotland’s prison services is separate from England’s, so there is no purpose for significantly to modify immediately in the realm of criminal justice. However, if we obtain wider powers in relation to social protection this may well have an impact on criminal justice problems. The explanation a lot of men and women end up in Scottish prisons is tied to poverty. Selections about how people on benefits are dealt with – advantages being suspended or stopped, for example – have an effect on offending costs. Independence delivers higher scope for joined-up government, for welfare policy choices to be taken in a certain Scottish context rather than being determined by Westminster.

Which way now for public providers in Scotland?