By Baroness Thornton - 21st March 2012
The government needs to address concerns about HIV prevention and treatment measures, stemming from the health and social care bill, says Baroness Thornton.
There are two big HIV issues flowing from the new arrangements for HIV following the passage of the health and social care bill, prevention and treatment.
Under the proposed structure, Local Authorities will now be responsible for commissioning of the sexual health element, including HIV testing and prevention campaigns. The National Commissioning Board will commission the HIV treatment and care element.
Currently specialist HIV services are commissioned through PCTs as is sexual health and these will be abolished by the passage of the Health Bill.
These services provide clinical care and treatment to people living with HIV and are frequently hospital based services. They can be stand-alone HIV clinics or co-located within Genito-urinary Medicine (Sexual Health clinics) or Infectious Diseases Units.
The current model of care is highly specialist and centralised within PCTs. GPs may generally lack confidence or knowledge on HIV, there is a need to develop their skills and include them more in the delivery of simple aspects of HIV monitoring and care. Over time delivery of local services and Commissioning of local services should in theory bring services nearer to the patient.
Local HIV prevention work and campaigns will be commissioned by Local Authorities with, presumably, some additional national campaigns work overseen by Public Health England.
This does create an issue around the possible fragmentation of prevention working; between HIV treatment commissioned nationally by the Commissioning Board, prevention and testing work commissioned by Local Authorities, and national campaigns overseen by Public Health England.
If this seems a muddle with transition dangers for both HIV sufferers and for the prevention and early diagnostic programme you would be right. And the government needs to address the concerns.
The government needs to look into the possibility of NICE publishing comprehensive guidelines on care for people with HIV, including how to support HIV prevention and social care needs, as recommended by the Lords Select Committee on HIV in the UK last year, in order to mitigate the problems of fragmented commissioning.
The government needs to address the issue of Local Authorities who will not have the cost-saving incentive to invest in HIV prevention that PCTs have now, given that treatment costs will be charged to the NHS Commissioning Board, it is particularly important that there is national support for HIV prevention programmes?
And particularly will the government agree with the Lords Select Committee on HIV in the UK that these programmes need to be better funded, as they currently receive only £3million compared with about £800million spent on treating HIV?
Finally will the government ensure that the impact of these reforms on HIV services, including treatment, testing and prevention, will be closely monitored by the DH so that if there is a negative impact, action can be taken swiftly?
A former general secretary of the Fabian society, Baroness Thornton was raised to the peerage in 1998.