Question Tullulah Medical Sciences

What is the significance of the High Court's ruling over NHS England's appeal on the cost implications of public administration?

PrEP has shown to reduce the risk of HIV infection by more than 90 per cent in people who are at high risk. What is the significance of the High Court's ruling over NHS England's appeal on the cost implications of public administration?

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PrEP, which is short for “pre-exposure prophylaxis” using the antri-retroviral drug Truvada. It has been shown to prevent HIV in individuals who are at a high risk of contracting this disease due to their lifestyle, and its discovery represents a significant opportunity to reduce the spread of HIV/Aids and potentially even lead to the eradication of the disease altogether. Unfortunately, however, the drug is expensive, and NHS England has tried to claim that does not have the power to pay for this drug, since the responsibility for preventative public health services lies with local authorities, and not with the NHS. The High Court ruling has rejected this view, insisting that the NHS will now be obliged to “formally consider” whether to fund this therapy or not (Telegraph Reporters, 2016, p. 1).

This ruling is significant because it clarifies the responsibilities of the NHS and requires NHS England to a) decide whether the NHS will fund the drug and b) justify this decision, whichever choice is taken after due debate. The NHS website (2016) notifies the public that the NHS will also lobby the drug manufacturer and explore generic alternatives, because of the pressure that the high price of the drug would put on their budgets, which are already stretched because of other common health conditions. These are all positive impacts which could reduce the cost burden of this treatment for public administration in the long term.

In the meantime, however, there remains some uncertainty about the role of local authorities, and the likelihood of the NHS being able to fund, or partially fund this therapy, because the High Court Ruling does not consider issues such as funding to provide this service. It does not compel the NHS to fund the drug, but merely rules that it must consider such funding. These debates will continue, and public administration managers will still have to make difficult choices about prioritising this therapy or other vital preventative and treatment therapies for similarly serious conditions. This problem is part of a much bigger trend of increasing pressure on public administration budgets but if the NHS commits to prescribing this drug, it could reduce the cost of HIV/Aids in the longer term, as fewer people would be infected, and all the costs of fully-developed Aids for these people would be avoided.


NHS (2016) Update on PrEP. (10 November) Available at: [Accessed 10 November 2016].

Telegraph Reporters (2016) NHS to consider funding ‘game changer’ HIV drugs as High Court Dismisses appeal. The Telegraph (10 November) Available at: [Accessed 10 November 2016].