HIV Future - National and Council
posted: 24/12/2010
In plans just published for shaking up public health services in the NHS, the Department of Health propose that HIV testing, treatment and care services should be funded and co-ordinated nationally, by the future NHS Commissioning Board.
At the same time, a wide range of sexual health services - including STI clinics, contraception and abortion services - will become the responsibility of local councils, as part of their new public health role.
The government announced radical reforms for the English National Health Service (NHS) after the election in May. The main proposal is to abolish primary care trusts (PCTs). Most of the PCT responsibilities for co-ordinating and funding services (“commissioning”) will be transfered to local consortia of family doctors. And the public health services that PCTs commission will be handed over to local councils to manage.
NHS shake up worries
Many health professionals have big concerns about any major NHS shake up while big spending cuts are also being forced through. The risks are significant. And one of these worries is that where there are relatively few HIV-positive people, the new GP consortia would not have the skills, experience or interest to commission high-quality HIV services.
However the proposals now published show that GP consortia will not be expected to manage HIV clinical commissioning and HIV prevention.
How will local authorities in areas where there are few people with HIV manage HIV and sexual health prevention and care well?
HIV testing, treatment and care – a job for new NHS national commissioning board
The government has just released further details of their plans for commissioning. HIV testing, treatment and care will, in fact, be commissioned nationally by the NHS Commissioning Board.
The government document states that these arrangements will allow efficiencies to be made in the procurement of drugs and services.
“We’re pleased that HIV treatment is not going directly to inexperienced GP consortia,” commented Lisa Power, head of policy and public affairs at the Terrence Higgins Trust.
Local HIV prevention and health promotion – a new service from councils
Another key part of the government’s reforms is that responsibility for public health programmes will shift from NHS primary care trusts to local authorities. They will be allocated a ring-fenced budget that must be spent on public health activities. Notably, this will affect local HIV prevention and health promotion projects.
STI clinics, contraception, abortion – a new council service
However the government also revealed today that a very wide range of open-access sexual health services which contribute to public health will be commissioned by local authorities.
This includes services for the testing and treatment of sexually transmitted infections (STI clinics), as well as partner notification, STI services in primary care, termination of pregnancy and contraceptive services that are not provided by GPs. Local authorities are likely to be legally required to provide open-access sexual health services, but with some flexibility about how they do so.
Lisa Power of Terrence Higgins Trust estimates that providing open-access sexual health services will swallow around 20% of the budget for public health activities in relation to all health conditions.
Drug services – a new council responsibility
Drug services, including prevention and treatment, will also be co-ordinated and funded by local authorities.
The government's proposals also make clear that tracking HIV and other conditions (currently done by the Health Protection Agency) will be moved to the new body Public Health England, which will become part of the Department of Health.
The proposals say nothing about the national HIV-prevention programmes CHAPS and NAHIP (for gay men, and for African people respectively). However they do say some national campaigns may be commissioned by Public Health England.
Public Health 'outcomes', not 'targets'
The new government doesn't like 'targets' but sets 'outcomes' instead. Maybe you can spot if there is any real difference between the two. The Department of Health has published its proposed Public Health Outcomes Framework. These are the indicators they will use to judge how well the public health system is performing. The list of 'outcomes', includes the proportion of new people diagnosed late with HIV, the rate of Chlamydia diagnoses among young people, and treatment completion rates for TB.
Cash for testing early 'outcomes'
The Government has included prompt diagnosis of HIV in their important ‘outcomes framework’.
That means money rewards will provide a cash incentive to the health system to diagnose HIV early.
Andrew Lansley, health secretary, commented: “I want to hear views from the people that this new [public health] service will benefit and from those who provide the services we seek to improve; this is your chance to comment on our proposals and to let us know how you think key elements of the service should be designed.”
The consultations and proposals
The proposals are open for public comment until 31 March 2011.
Healthy Lives, Healthy People: consultation on the funding and commissioning routes for public health, 2010.
Healthy Lives, Healthy People: Transparency in Outcomes. Proposals for a Public Health Outcomes Framework, 2010.
Health and Social Care Department of Health website about the various health and social care changes
Source
The current Department of Health Sexual Health Commissioning Toolkit for the NHS and Councils
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