December Issue: NHS on Trial

In today’s summary, we present Putting the NHS England on trial: uncertainty-as-power, evidence and the controversy of PrEP in England by Maurice Nagington and Tony Sandset. The authors provide a short explanation of their work below, and have also provided short audio that speaks to why the topic is important to them. Connect with them on Twitter: @NagingtonUoM and @TweetingTony


In this article we argue that the case of PrEP (pre-exposure prophylaxis, using Truvada) in NHS England is a concerning example of a strategy that we identify as “uncertainty-as-power”. PrEP is a highly effective medication at preventing HIV transmission when taken daily or on demand. However, whilst other countries have commissioned it, the NHS in England have not. Instead, preferring to repeatedly invoke notions of supposed “uncertainties” to leverage power. Firstly, uncertainty in relation to its cost-effectiveness, and secondly in relation to the legality of commissioning. Further uncertainty was then constructed to negate relevant clinical data from other countries in order to justify the IMPACT clinical trial, which did not and could not answer valuable questions. Because of this, the trial became a way of rationing PrEP which led to unnecessary delays meaning otherwise eligible people did not have access to it and became HIV positive. We acknowledge that uncertainty always exist in healthcare, but it should not be used to ration interventions which are widely acknowledged as being highly effective and safe. Instead, knowledge and research (if it is to continue to maintain the publics’ confidence) must serve the aims of increasing access to such interventions.

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