Tag Archives: funding

Dear Jeremy Hunt, please #StopHIVCuts

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#StopHIVCuts have written to Secretary of State for Health, Rt Hon Jeremy Hunt calling for a meeting to discuss the impact of significantly reduced funding for HIV support services.

Read about the #StopHIVCuts campaign here.

Dear Secretary of State

We are writing to you as a group of HIV and sexual health organisations and people with HIV to share our increasing concern at the trend by local authorities across England to decommission HIV support services.

Coping with an HIV diagnosis and living with HIV long-term can be stressful and challenging, with personal relationships, long-term health, employment and finances all being significantly affected. HIV support services are an integral part of helping people deal with changes brought on by a condition that still carries with it much stigma and affects some of the most vulnerable and excluded people in our society.  They also prevent further HIV transmission by supporting people with HIV in safer sex and adherence to medication.

With over 103,000 people in the UK living with HIV in 2014, HIV support services are needed more than ever. Evidence suggests more than a third of people with diagnosed HIV need to access these vital services in any 12-month period. They are widely agreed to be an essential element in the HIV care pathway, supporting long-term condition management, by (for example) NHS, England and BHIVA.

2015, however, saw a worrying trend of local authorities across the country defunding totally HIV support services. In Oxfordshire, Bromley, Norfolk, Portsmouth, Slough, Bracknell Forest and Bexley, the local councils are set to scrap this essential provision. We understand more councils may follow – either defunding completely or cutting funding to the point where meaningful provision is impossible.

Many of the organisations affected by these cuts also provide HIV prevention for individuals at the highest risk of HIV – vital interventions that will ultimately prevent new HIV infections and save the NHS much needed cash in HIV treatment costs. The estimated cost of lifetime HIV treatment is up to £360,000 per person.  The future of such preventive work is also put in jeopardy by this disinvestment.

These funding cuts are short-sighted and ill-thought through as they will ultimately lead to extra cost pressures on health and social care as people with HIV fall into acute need and crisis, as well as significant costs to the NHS from an increase in onward HIV transmission.

Whilst of course these cuts are being made by local authorities, we strongly believe you can and should influence these decisions. The Health and Social Care Act 2012 left HIV support services without a clear commissioning home, and therefore especially vulnerable to defunding.  As a result, we risk the loss of community-based services which have been a mainstay of our HIV response since the early days of the epidemic and of which we should be very proud. A clear statement from the Government on the importance of these services and action to bring stakeholders together and agree a sustainable basis for their commissioning and provision are urgently needed.

We are asking for a meeting as soon as possible with you to discuss how we can together provide a health and social care system that works for the needs of people living with HIV.

Please correspond with Deborah Gold, Chief Executive, NAT

[Letter Ends – Signed by #StopHIVCuts]

Support people with HIV: Stop the cuts’ is also appealing to members of the public to take an e-action to show their support – write to their local council leader and ask what the council is doing to support local people living with HIV.  You can do this right now by clicking here: http://act.lifewithhiv.org.uk/lobby/stopcuts.

Will you  offer your support?

HIV & sexual health sector unites in action against government cuts as budgets are slashed by councils #StopHIVCuts

Funding for HIV services across the UK are at risk.  Today we joined almost 30 other HIV charities to call for HIV services to be protected.  We have written to Secretary of State of Health Mr Jeremy Hunt to help protect HIV services.  Read on to find out how local HIV services are at risk.

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HIV charities from Liverpool (Sahir Trust) to Leicestershire (LASS) to London have come together with health professional bodies, British Association for Sexual Health and HIV (BASHH), and British HIV Association to launch a new national campaign opposing cuts to HIV services across the country -‘Support people with HIV: Stop the cuts’.

Jeremy_Hunt_OfficialIncreasing numbers of local authorities are pulling funding from HIV support services.
The campaign has written to Secretary of State for Health, Rt Hon Jeremy Hunt calling for a meeting to discuss the impact of these cuts, demand effective commissioning, adequate funding, and access to support services for all people living with HIV.

HIV services in both Berkshire and Oxfordshire, run by Thames Valley Support and Terrence Higgins Trust respectively, have been cut by over £100,000 between them. In Berkshire this equates to a loss of a third of funding, and will directly affect 300 people living with HIV in both Slough and Bracknell.

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In David Cameron’s back yard, Oxfordshire County Council has cut Terrence Higgins Trust’s £50,000 funding, which is forcing the closure of its local centre. The reality is that there are will be no HIV Prevention and Support service in the whole county after April 2016, with almost 500 people left with no alternative support service.

In Portsmouth the HIV support service, provided by Positive Action, has been cut by approximately £26,000 by Portsmouth City Council. Its Hampshire service has been granted an interim support payment of £30,000, less than half of the amount it historically received.

In Bexley and Bromley, equality and diversity charity, METRO is facing cuts to HIV support services of over £80,000.

Public Heath England’s national HIV figures show that in 2014 alone over 6,000 people were diagnosed with HIV, while People Living with HIV Stigma Index UK– found that stigma had prevented 15 per cent of people surveyed from accessing their GP in the last year, and 66 per cent had avoided dental care.

14 per cent had received negative comments from healthcare workers. Despite the obvious roles specialist HIV support services play in combatting this they are being reduced to almost ineffective levels, or cut completely, in a short term cash save measure.

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Alex Sparrowhawk, Involvement Officer Terrence Higgins Trust said:

“At a time when rates of HIV are increasing, stigma is as apparent as ever, we are seeing the start of an alarming trend of local authorities across the country scrapping HIV services.

“As a person living with HIV, I can tell you that HIV support services are vital to dealing with your diagnosis and managing this health condition. The national campaign is about sounding the alarm to policy makers, councils, and the public – these essential services are under serious threat and we need your help.”

Yusef Azad, Director of Strategy National Aids Trust:

“HIV remains a stigmatised and misunderstood condition. It’s not the same as other health issues where people can rely of support and sympathy from friends and colleagues.

“HIV support services can be the only place where people are open about their status, the only places they can find advice and support, the only place they can talk to other people with HIV.

“They are an essential component of the long-term care of people with HIV. To remove them would leave a lot of vulnerable people stranded.”

Dr Greg Ussher, METRO Charity CEO, said:

“People living with HIV can be some of the most vulnerable members of our communities.

“Proposed cuts of up to 100 per cent to HIV support services will decimate vital provision for people that cannot speak out against their local authority’s plans for fear of the stigma publicly disclosing their HIV status might bring.”

The Treasury last year announced it was cutting public health budgets in-year by £200 million with reductions in the funding for public health set to continue this year. The feasibility of the Chancellor’s plan to allow local authorities to income generate to fund social care services will be tested in poorer areas of the country – those areas that also see the highest rates of HIV.

Support people with HIV: Stop the cuts’ is also appealing to members of the public to take an e-action to show their support – write to their local council leader and ask what the council is doing to support local people living with HIV.  You can do this right now by clicking here: http://act.lifewithhiv.org.uk/lobby/stopcuts.

More information will be available on this blog and our website soon.

Will you  offer your support?

 

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Another commissioning crisis – Sexual Health

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A third of NHS contracts awarded since health act have gone to private sector, BMJ investigation shows

We were very concerned to read the BMJ investigation on NHS contracting, which reported that one third of NHS contracts were awarded to private providers and described ‘cherry-picking’ of simple procedures.1 Both the Royal College of Ophthalmologists1 and the British Association of Dermatologists2 have expressed serious concerns about threats to complex service provision, fragmentation of services and training.

Many of these concerns are also emerging in the sexual health and HIV service provision across England. These were not covered by this investigation as they are predominantly commissioned outside the NHS. We believe the quality, safety and future of these key clinical services are under threat, as a result of dysfunctional commissioning practices.

In April 2013, for the first time local authorities became responsible for commissioning services for sexual health, HIV prevention and testing. Treatment and care for HIV remained as a specialist service commissioned by the NHS and abortion services, after a brief period of commissioning by local authorities, became commissioned by clinical commissioning groups.

After a short moratorium local authorities in some areas started to procure sexual health services using tender processes. Since then our Association has received reports from its members across England about issues with commissioning, compromised patient pathways and fragmentation of sexual health services.

We are aware of models of contracting where the focus on cost efficiency appeared to override that of quality; where patient pathways, including those for complex sexual infections and specific groups, such as men who have sex with men (MSM), have been put at risk; and where postgraduate training has been seriously compromised because the service specifications have failed to take these requirements into account.

Some local HIV services have been de-stabilised and access to testing and treatment for sexually transmitted infections (STIs) for people living with HIV has been reduced.

Sexual health is a key clinical component of public health. A much higher proportion of adults in a local community are sexually active compared with those who smoke, are obese or have drug and alcohol problems. Overall, 1 in 5 adults will visit a sexual health clinic at least once in five years.3 Over 1 million HIV tests were performed in STI services last year, with a total of almost 450,000 new STI diagnoses recorded.4 Most STI services also offer HIV outpatient treatment, giving the UK one of the best performances in the world for retention of those diagnosed HIV positive into care, into treatment and to successful suppression of viral replication, thereby reducing transmission risk.5

We call for a strong national steer for co-commissioning of HIV, sexual health and reproductive health services.

Robust model contracting templates need to be used that recognise the requirement to deliver both basic and complex sexual health care, encompass specific groups, and retain seamless care from HIV testing into ongoing outpatient HIV care. Workforce development and specialist services of local relevance need to be contracted for alongside routine clinical care.

The clinical nature of the local authority contracts for sexual health needs to be recognised by sustained ring-fencing of resources. Sexual health does not feature in the NHS plan for sustained and protected funding. In fact, ring fencing of the public health budget will disappear in 2016/17 leaving services highly vulnerable.

We believe an investigation of the processes in local authority procurement exercises should be undertaken to reveal the extent of fragmentation of, and risk of damage to, one of the most important public health interventions we provide – clinical services to detect, treat and prevent HIV and other sexually transmitted infections.

We fear that a serious risk to public health is developing and urgent revision to the procurement process for sexual health is required to address these crucial issues.

1. A third of NHS contracts awarded since health act have gone to private sector, BMJ investigation shows. BMJ 2014;349:g7606.

2. Eedy DJ, Levell N. Dermatology decimated. http://www.bmj.com/content/349/bmj.g7606/rr/826246(Accessed 20 December 2014)

3. Sonnenberg P, Clifton S, Beddows S et al. Prevalence, risk factors and uptake of interventions for sexually transmitted infections in Britain: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal3). The Lancet 2013;382:1795-1806.

4. Public Health England (PHE). Sexually transmitted infections: annual data tables. London.https://www.gov.uk/government/statistics/sexually-transmitted-infections… (Accessed 20 December 2014)

5. Public Health England (PHE). HIV in the United Kingdom: 2014 report. London.https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil… (accessed 20 December 2014)

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HIV Patients Losing Out From Cuts To Specialist Social Workers

People with HIV are losing out on vital social care support due to cuts to specialist social worker roles and rising eligibility thresholds.

That was the warning from a report published yesterday by the National Aids Trust, based on a survey of 149 healthcare professionals involved in the care of HIV positive patients.

Over three-quarters of respondents said the social care received by their patients benefited them, with 74% citing social care’s valuable role in providing physical or personal care, 71% citing emotional support and 65% saying social care helped patients adhere to treatment.

Specialist social work support was the most valued intervention by healthcare staff, with 77% citing its benefits.

However, several respondents warned that such posts were being cut, creating problems of stigma for service users who did not feel comfortable approaching generic social work teams.

“The current move to a ‘generic’ approach to social work is very unhelpful for HIV-infected patients, who often have complex medical histories and complex needs – requiring someone with some appropriate HIV-related knowledge to address these,” said one respondent.

Almost half of respondents (45%) said their patients had trouble accessing social care support, due to high and rising eligibility thresholds, lack of capacity in teams or referral processes being too slow.

The report concluded:

“These findings suggest that HIV-specialist social care support should, wherever possible, be maintained (particularly in high prevalence areas). Innovative solutions should be considered such as a number of local authorities sharing some HIV specialist social care staff to whom complex cases can be referred and who can also act as trainers for generic social care providers.”

Funding for social care for people with HIV/AIDS has traditionally come through the aids support grant. This was rolled into councils’ overall formula grant this year, although the government made notional allocations to local authorities for this purpose.

“Local authorities should put arrangements in place to ensure these funds are spent as intended, whether through greater flexibility or eligibility thresholds, greater provision of lower-level one-to-one social care support or greater support for voluntary sector open-access tailored services.”

By Mithran Samuel from Community Care

If you would like to find out more about the AIDS Support Grant and HIV social care, including the history of the grant and the current situation, Andrew Pearmain, HIV Consultant Practitioner, has produced a comprehensive report entitled Feast to Famine: HIV Social Care and the AIDS Support Grant.

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