Charities have criticised the way HIV services in London are commissioned following the release of a report which highlights “significant management failings” and a “lack of strategy”.
The Pan London HIV Prevention Programme (PLHPP) Needs Assessment report highlights “failings” of the pan London HIV commissioning group, which spends £2.3m a year.
HIV treatment in London costs £500m with almost 30,000 people accessing care and that number rising by 5% annually. The PLHPP provides prevention work targeting gay men and African communities and treatment information for people with HIV.
HIV prevention charity African Health Policy Network (AHPN) chief Francis Kaikumba said he was “shocked, annoyed and heads need to roll” in light of the report. Meanwhile, Caspar Thomson, director of the National Aids Manual, which provides information on HIV and Aids, said: “The whole process is moving too slowly. There’s an urgent need to address HIV prevention in London.”
But Mark Creelman, director of strategy at Inner North West London Primary Care Trusts (INWL PCTs), which leads the pan London HIV commissioning group, said: “We are working to ensure the programme has the right leadership and the right governance in place to be as effective as possible.”
The needs assessment report was prepared by the INWL PCTs on behalf of the Pan London HIV commissioning group and will be used to guide future commissioning intentions.
It identified “significant failings with the management of the programme” and said “providers have fallen far short of their activity targets”.
HIV IN LONDON
- Almost 30,000 people with HIV accessing care in London
- About 26% of Londoners affected with HIV remain undiagnosed
- People diagnosed with HIV rising by 5% annually
- 46% of those diagnosed in London are men who have sex with men
- Black Africans make up 5.5% of London population but 32% of those newly diagnosed with HIV
- Treatment costs are £500m per year.
Failings identified by the report included “a lack of clarity over leadership” and “inconsistent direction from commissioners”. The programme “appears to have evolved over time without any explicit strategic direction”, the report said.
Mr Thomson responded to the report saying: “Over the course of the years of the programme, I think the strategic direction was lost.”
Mr Kaikumba said: “HIV prevention work in London is at an all-time crisis level. Where is the accountability? Why has there been a lack of leadership?” he asked.
“Heads need to roll in terms of what the PLHPP is going to do about it.”
But Mr Creelman said: “The basis for the needs assessment was to give us a more strategic direction.
“Across commissioning and providers, we have a joint responsibility to ensure we’re spending taxpayers’ money effectively.” Francis Kaikumba, head of the AHPN AHPN chief Francis Kaikumba says the proportion of money going towards Black Africans is “poor”
The report highlights the need for an “urgent” exercise “to inform commissioning intentions”. Another report, entitled PLHPP Final Evaluation Report, published last February, showed of 17 projects commissioned, only two “merited continued commissioning”.
A total of 11 were said to “merit no further investment” while four needed “fundamental restructuring”. Nevertheless, these projects all continue to receive funding through the programme, nearly a year after the report was published.
Mr Thomson stressed the need for urgent action, saying: “Organisations are under threat because of the delays and if some of them go a huge amount of knowledge and expertise will be lost.”
But Mr Creelman said: “The needs assessment is very much the start of the process. We understand the urgency but we wanted to make absolutely sure within the evidence that has been collected, that organisations look at the needs assessment.”
Contributors to the report now have until 6 February to comment further, before new commissioning intentions are “developed”.
The needs assessment report also highlighted that the PLHPP spends £320,000 per year on the black African community, compared with £1.3m on “men who have sex with men”.
“Spend targeted at the black African population appears disproportionately low” the report said.
Mr Kaikumba said: “The amount of money that goes towards Black African work is ridiculous – it’s really poor. We’re shocked and annoyed how few pennies are being spent to support black Africans with HIV,” he said.
But Mr Creelman said: “The needs assessment supports that Black African work is much better served by being done at a local level. Lots of PCTs have Black African HIV prevention programmes and those programmes were set up to address their local needs.”
Mr Kaikumba said the report showed: “We’re spending such a tiny amount on prevention.” Can we get away with spending so little?” he asked.
But Mr Creelman stressed: “This is a programme within a wider prevention portfolio. The local PCTs also fund localised services”. Meanwhile, with 26% of Londoners affected with HIV remaining undiagnosed, there appear to be no plans to reduce the amount spent on HIV prevention.
“Chief executives are absolutely committed to not taking any money out of prevention in this programme,” Mr Creelman said.
Original Article By Andy Dangerfield at BBC News