Politics

Considerable progress has been made in preparing for the HIV pre-exposure prophylaxis (PrEP) trial that was announced by NHS England and PHE last December as a major extension to the national HIV prevention programme. The trial, called the PrEP Impact Trial, will include at least 10,000 participants over the next 3 years and will answer key outstanding questions on the extent of need, uptake and duration of use of PrEP in the setting of sexually transmitted infection (STI) clinics in England. Our aim is to have the trial started by the summer of 2017.

The trial protocol is complete, trial participant eligibility criteria have been endorsed by experts in the field and by community representatives, and independent peer review has been conducted. The Medicines and Healthcare products Regulatory Agency (MHRA) has been consulted about trial categorisation and a relevant opinion received. Submission for ethics committee approval is imminent.

STI clinic attendees considered to be at high risk of acquiring HIV will be eligible to participate in the trial. Heterosexual and transgender individuals and gay men will be clinically risk-assessed as part of combination prevention and those at high risk offered PrEP. To ensure equity of access across the country, the trial sites will include as many as possible of the over 200 level-3 STI clinics.

A number of STI clinics have expressed an interest in joining the trial. Site participation standards are being finalised and all level-3 STI clinics will be written to in the next 2 weeks enquiring about capacity, willingness to meet the standards and to be a trial site. The likely trial site and per-participant costs are being assessed prior to detailed discussion with the trial management team which will include STI service provider representation.

PHE’s Prevention Innovation Fund in 2017 to 2018 is seeking proposals that will address knowledge, awareness and understanding of PrEP and other PrEP related questions, especially in currently under-served populations in the community (e.g. higher-risk heterosexuals, black and minority ethnic group gay men and transgender communities). To register interest in the fund please send an email with your name, email address and organisation name to hiv.prevention@phe.gov.uk.

PrEP drug supply will be paid for and secured by NHS England. Competitive procurement has begun and all relevant supplier-manufacturers have been written to. A market engagement meeting is scheduled for later in April as part of this process.

Overarching governance arrangements, in the form of a PrEP Programme Oversight Board with joint leadership from PHE and NHS England, is in place to support the trial and to use the findings to prepare for a subsequent PrEP programme. Membership includes the Local Government Association (LGA) and the Association of Directors of Public Health (ADPH).

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Litter louts could be hit with £150 fines as part of ambitious new plans to tackle rubbish in England.

Environment Secretary Andrea Leadsom unveiled the Government’s first Litter Strategy for England to reduce the near £800m burden to the taxpayer of clean-up costs.

Under the new measures, the most serious litterers could be hit with the £150 fines, while vehicle owners could receive penalty notices when it can be proved litter was thrown from their car – even if it was discarded by somebody else.

The new motoring rules, which are already in force in London, make owners liable even if they didn’t throw the litter themselves.

Environment Secretary Andrea Leadsom said:

Litter is something that affects us all – blighting our countryside, harming our wildlife, polluting our seas, spoiling our towns, and giving visitors a poor impression of our country.

Our litter strategy will tackle this antisocial behaviour by building an anti-litter culture; making it easier for people to dispose of rubbish; and hitting litter louts in the pocket.

We want to be the first generation to leave our environment in a better state than we found it, and tackling litter is an important part of our drive to make the country a better place to live and visit.

Further new measures drawn up by environment, transport and communities departments include:

• Issuing new guidance for councils to be able to update the nation’s ‘binfrastructure’ through creative new designs and better distribution of public litter bins, making it easier for people to discard rubbish.
• Stopping councils from charging householders for disposal of DIY household waste at civic amenity sites (rubbish dumps) – legally, household waste is supposed to be free to dispose of at such sites.
• Recommending that offenders on community sentences, including people caught fly-tipping, help councils clear up litter and fly-tipped waste.
• Working with Highways England to target the 25 worst litter hotspots across our road network to deliver long-lasting improvements to cleanliness.
• Creating a ‘green generation’ by educating children to lead the fight against litter through an increased number of Eco-Schools and boosting participation in national clean-up days.
• Creating a new expert group to look at further ways of cutting the worst kinds of litter, including plastic bottles and drinks containers, cigarette ends and fast food packaging.

Communities Minister Marcus Jones said:

It’s time we consigned litter louts and fly-tippers to the scrap heap of history. Through our first ever National Litter Strategy we plan to do exactly that.

Our plans include targeting the worst litter hotspots, cracking down on litter louts with increased fines and getting people to bin their rubbish properly.

For too long a selfish minority have got away with spoiling our streets. It’s time we sent them a clear message – clean up or face having to cough up.

Transport Minister John Hayes said:

Litter on our roads is a major and costly problem to deal with. It makes our roads look messy, can threaten wildlife and even increase the risk of flooding by blocking drains.

To combat this needless blight on our landscape, I am working with Highways England to target the worst 25 litter hotspots on our road network, on which hundreds of thousands of sacks are collected every year with the clean-up bill running into millions of pounds.

By increasing fines and working with local authorities, the Government is taking decisive action to clean up our environment.

The strategy also outlines measures to protect seas, oceans and marine life from pollution. It builds on the success of the 5p plastic bag charge, which has led to a 40% decrease in bags found on the beach.

Funding will also be made available to support innovative community-led projects to tackle litter that could turn local success stories into national initiatives.

The Government will follow the strategy with a new national anti-littering campaign in 2018, working with industry and the voluntary sector to drive behaviour change.

The consultation on the new enforcement measures officially opens today. Guidance will then be issued to councils to accompany any new enforcement powers, to make sure they are targeted at cutting litter, while preventing over-zealous enforcement or fines being used to raise revenue.

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From 10 April, we are removing .gsi from our email addresses.

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