Section:GDN 1N PaGe:10 Edition Date:190724 Edition:01 Zone:S Sent at 23/7/2019 17:51 cYanmaGentaYellow
- The Guardian Wednesday 24 July 2019
(^10) National
Human trial
of prevention
implant lifts
hopes in fi ght
against HIV
NHS wasted £76m in
fees on failed hospital
reorganisation scheme
Nicola Davis
An implant containing an HIV
prevention drug has been trialled
in humans, in a step experts have
hailed as an exciting development in
curtailing infections.
Pre-exposure prophylaxis, or PrEP,
with antiretroviral drugs has become
a hot topic , with the drugs shown to
substantially reduce the risk of con-
tracting HIV from a partner. PrEP pills
are already available through the NHS
Diane Taylor
Tens of millions of pounds have been
wasted on a major failed hospital
closure programme, according to an
internal NHS document that has been
passed to the Guardian.
A confi dential, draft document,
circulated to NHS North West London
Collaboration of Clinical Commission-
ing Groups, which serves more than
two million Londoners, admits the
blueprint for one of the NHS’s largest
reorganisation projects has failed.
“NHS commissioners and providers
in north-west London have therefore
decided to draw the SaHF [Shaping a
Healthier Future] programme to a con-
clusion,” the document states.
The proposal, at the forefront of
the then NHS strategy to replace some
acute hospitals with care in the com-
munity, launched in 2012 and involved
reducing the nine acute hospitals in
eight London boroughs to fi ve. The
leader of Ealing council, Julian Bell,
described it as “a monstrous plan”.
The document states that between
2010 -11 and last year £76m has been
spent on management consultants
for the scheme. It outlines how health
offi cials can respond to diffi cult ques-
tions about the failed scheme and
discusses preparing people for new
changes as part of the NHS’s long- term
plan which, it says, will involve “diffi -
cult decisions and trade-off s”.
The SaHF programme planned to
downgrade four acute hospitals in
north-west London – Hammersmith,
Central Middlesex, Charing Cross and
Ealing – losing more than 600 acute
hospital beds. The document states
there has been a reduction of only
seven beds in the past six years.
The closure of Charing Cross was
particularly controversial after the
Guardian revealed plans to sell 87%
of the valuable central London site. In
March the health secretary, Matt Han-
cock, announced that plans to close
A&E departments at Charing Cross and
Ealing hospitals would be scrapped.
The document says the plan is
no longer viable because of “con-
tinued growth in demand for acute
care, despite investment in primary
and community services, a growing
underlying budget defi cit and short-
falls in our ability to recruit and retain
in Scotland to high-risk individuals,
while trials are under way in England.
However, the new trial opens up the
possibility of an alternative to pills ,
an implant that slowly releases a PrEP
drug, meaning users would not have
to remember to take pills every day.
The trial, conducted by the pharma-
ceutical company MSD , is the fi rst of a
PrEP implant in humans – though the
company has previously carried out
work with animals.
Twelve healthy adults were given
an implant for 12 weeks, containing
either a 54mg or 62mg dose of a newly
enough staff with the right skills”. It
says A&E attendances across north-
west London have increased 4% every
year since 2012, with a waiting list in
2018 -19 of 177,395 patients, a backlog
that would require an extra 95 beds for
a year to clear. It adds there has been
a 40 % increase in patients waiting for
non-urgent surgery.
It reveals that offi cials plan to “spin”
this failure by citing improvements,
such as 100 new midwives and 90 new
children’s nurses.
Under the heading “incorrect/
sorry”, it poses the question: “Will
anyone resign over this?” The answer it
gives is “no’”. To the question: “What
have you learned from this and how
will you change the way you make
decisions in the future to ensure mil-
lions of pounds of taxpayers’ money
isn’t wasted?” the answer is “??”.
The idea that some acute hospitals
can be closed because NHS care can
instead be provided in the community
has been rejected in various independ-
ent studies, including a hard-hitting
report from the Nuffi eld Trust.
Merril Hammer, secretary of
Hammersmith & Fulham Save Our
Hospitals , said: “The leaked paper
is extraordinary. This was the big-
gest reorganisation project the NHS
has ever seen. We still don’t know
how much it has cost in total. Since
the initial plans were drawn up,
campaigners asked for the evidence
that ‘out of hospital’ provision could
reduce the need for acute hospital
beds. This was never produced.”
A spokeswoman for NHS North-
West London Collaboration of CCGs
said: “ There are now strict con-
trols on management consultancy
expend iture and we are not currently
incurring consultancy costs for the
development of our future plans, nor
do we intend to.”
developed drug called islatravir, while
a control group of four participants
were given placebo implants. Of the
16 participants, 14 were men.
The researchers monitored how well
participants tolerated the implant, and
measured concentrations of islatravir,
and its active form in the body, during
the trial and for four weeks after the
implant was removed.
While the trial was very small, the
results reveal the implant was well
tolerated, while modelling of the
drug concentration data revealed
the implants could last at least eight
months for the lower-dose device, and
at least a year for the higher-dose one.
Randy Matthews, a researcher
at MSD, said the results supported
further clinical development. How-
ever, the costs remain unclear. “It is
still early days,” he said. “The eventual
price of the implant is not yet known .”
Sheena McCormack, a professor
at University College London who
has led trials of PrEP, said: “This is an
exciting development. Pills are very
acceptable here but ... less so in sub-
Saharan Africa, and this is particularly
the case amongst young women .”
600
The proposed number of acute beds
to be closed in north-west London –
but in the end, only seven were lost
4%
The annual increase in A&E visits
in the region since 2012, while the
waiting list for surgery grew
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