More People Treated

posted: 04/10/2010

The number of people using NHS HIV clinics has risen by 60% in just five years, official figures suggest. In 2005 46,714 people used NHS HIV clinics and this rose to 65,319 people in 2009.
In 2010 nearly 70,000 people can be expected to use NHS HIV clinics and 74,600 in 2011, health minister, Anne Milton, said in a written House of Commons answer to a question from Heidi Alexandra, Labour MP for Lewisham East (SE London).

In NW England 6,238 people used the region’s NHS HIV clinics in 2009.
 Predicting ahead

The health minister revealed how they worked out their predictions of 70,000 for 2010 and 74,600 for 2011. "The estimated numbers of diagnosed HIV-infected individuals receiving care in 2010 and 2011 (rounded to the nearest 100) have been extrapolated from the number of individuals seen for HIV care in the previous five years. Between 2005 and 2009, the annual increase in the numbers of HIV care has been between 4,200 and 5,000 and the average annual increase has been used to estimate the numbers that will be seen in 2010 and 2011."
 

Health Quango Cuts and HIV

posted: 27/07/2010

Eighteen health quangos will be cut to between eight and 10 over the next four years. The Health Protection Agency (HPA), which deals with HIV and infectious diseases, is one that will disappear within the next two years.
 

The Health Secretary Andrew Lansley justifies the quango cuts on the grounds that it would produce savings of more than £180m over the next four years by streamlining their functions and cutting their bureaucracy. Although the Department of Health's overall budget is being "ring-fenced", the growing demands on the NHS each year mean that significant savings need to be found.
 

Expert Criticism

Experts in infectious diseases criticised the plan to abolish the HPA as a statutory organisation and transfer its functions to the Secretary of State’s new Public Health Service. "It's a very bad idea because the HPA is an absolutely essential national resource," said Hugh Pennington, emeritus professor of bacteriology at Aberdeen University. "There is no merit in making changes to the HPA other than those that strengthen it. It's quasi-independent and a degree of separation between it and the rest of government gives it more scientific freedom and independence," Professor Pennington said.
 

The HPA plays an important role in monitoring and preventing HIV and other sexually transmitted infections in the UK. At the recent International Conference in Vienna it presented important research results and recommendations. Transfering its work to the Secretary of State’s new Public Health Service means its valuable independence disappears.

NAT concern

Deborah Jack, Chief Executive of NAT (National AIDS Trust) wrote to the Independent to say "We read with concern of the Government's plans to abolish the Health Protection Agency and merge it within a new Public Health Service directly accountable to the Secretary of State. As the UK's HIV policy organisation, for years we have benefited from the HPA's surveillance of HIV and other sexually transmitted infections. This information is vital in assessing the needs of the population and allowing effective targeting of resources, more important than ever in the present climate. We call on the Government to promise that public health surveillance and analysis will remain independent of ministerial interference to ensure impartiality, and that there is no deterioration in the quality and scope of the HPA's key public health functions, so essential to an evidence-based response to HIV."

The HPA in the Department's Quango Review

Here is what the Department of Health Review reports says about abolishing the HPA and setting up a Public Health Service within the Department of Health under the Secretary of State.
 

"3.42 We propose to support the cross-government public health strategy through the creation of a new Public Health Service directly accountable to the Secretary of State, to integrate and streamline existing health improvement and protection bodies and functions, with an increased emphasis on research, analysis and evaluation. As a part of that development we intend to abolish the Health Protection Agency and the National Treatment Agency for Substance Misuse as statutory organisations and transfer their functions to the Secretary of State as part of the Public Health Service.
[3.43 a paragraph about absorbing the National Treatment Agency for Substance Misuse into the Public Health Service.]
 

3.44 Our programme for public health will be set out later this year and more detail on what it means for these two organisations, and dedicated public health ring-fenced funding to support delivery of local services, will be set out in the context of the new Public Health Service. We will engage with the Health Protection Agency and the National Treatment Agency for Substance Misuse to ensure a smooth and orderly transition.
....

Legislative Changes
5.7 Many of the changes outlined in this document will require primary and secondary legislation. The Queen’s speech included a major Health Bill and a Public Bodies Bill for the first legislative programme. The Government will introduce these bills this autumn and the changes, where appropriate, will be enacted through one of these bills: our intention is that the majority of changes will be in place during 2012/13.
.....

The Public Health Service will in place by April 2012. (Annex C)"
 

NAT letter of concern to The Independent   

DH Arms Length Body Review report

Source

Department of Health press release

HIV Treatment Charging Harms

posted: 28/06/2010

The UK rules that mean some migrants have to pay for HIV treatment are harming the health of migrants and the UK public, says a new study in the journal AIDS Care.

The study of African migrants with HIV in London found some migrants delay taking HIV tests, some only go for HIV treatment when they are so sick they need an ambulance to take them to hospital, some use herbal treatments that don't work, and others send abroad for HIV drugs but don't take enough of these.
 

Findings and the government review

This Wednesday the government ends its public consultation on changing the rules and guidance about who has a right to free NHS treatment. Anyone who has a sexually transmitted infection (STI) or an Infections Disease always has a right to free treatment, but not if they have HIV. The proposed new rules and guidelines still bar some migrants from automatic free HIV treatment. While asylum seekers and those with leave to remain are entitled to free care in NHS hospitals, refused asylum seekers and undocumented migrants, including pregnant women with HIV, among others, are sometimes handed very large bills for HIV and other medical treatment.
 

The researchers interviewed HIV-positive migrants from Zimbabwe, Zambia and South Africa who live in London. 70 people took part in eleven focus group discussions.
 

Problems getting a GP
Even though there is no law stopping migrants from having a GP or free primary care, people said they had problems even registering with a GP. They are often asked to show documents that they do not have (for example, their passport – these are often held by the Home Office / UK Borders Agency because they are making an asylum claim or other application).
 

Waiting until you need an ambulance
The law says all treatment in a hospital Accident & Emergency department is free-of-charge for everyone. Many people in the survey knew this, and said they did not try to get treatment until their condition was so serious that an ambulance was needed. One man said:
“You would rather wait for a situation where you get taken to hospital by ambulance because even if you walk in they want to know who is your GP. And if you don’t have one they become very suspicious.”
Accident & Emergency (A&E) treatment is extremely expensive to provide. Moreover, in most cases, the person then needed immediate HIV treatment and a lengthy stay in hospital.

The rules say if you are admitted to a hospital ward after A&E, or are referred to another department (eg the HIV clinic) then you will be charged; but HIV treatment should always be provided because it is 'immediately necessary.' If you can't pay the bills, the hospital will have to cancel the debt anyway.

Some people had received bills for several thousand pounds for hospital admissions, surgery and treatment. The researchers found that these experiences often affected people’s feelings toward health providers.
 

In hospital but fearing bills and immigration
People who were entitled to free NHS care feared intrusive visits from immigration and hospital officials. For example one woman who had been recently diagnosed with HIV received a bill for hospital treatment:
“I was worried how am I going to pay this £4000? So what kills you first is the stress and worry . . . I found myself thinking if I did not have indefinite leave to remain in this country then what would I do?... You’d just try to go away, you’d remove the drip and run away from there before immigration got there.”
 

Do it Yourself treatment
Some people said they treated themselves. Some sent for drugs in their home countries, but said they took too few pills for them to work properly, for example. Some had depended on herbal remedies and other alternative treatments, and sometimes delayed taking a HIV test until it was clear herbal and alternative treatments were not working. One woman said:
"There are some people who do not have papers in this country, who can’t have access to a GP or a hospital and they have to rely a lot on the traditional medicines."
Although HIV testing is free for all (on public health grounds), HIV treatment is not. People said this discouraged others from HIV tests:
“If I cannot access services, then there is no reason for me to test. If I test and I know I’m HIV-positive, I know it will be very difficult to access [treatment].”

The researchers end by saying that current policies for charging some migrants may appease a part of the UK electorate but act as a barrier to the uptake of HIV testing and treatment. Moreover, these policies are pushing some people to resort to other forms of treatment that may be costly, harmful or ineffective. As well as having implications for the health of individuals, the policies are likely to have an impact on the onward transmission of HIV.
 

Campaigning for free HIV treatment for all
This Wednesday the Department of Health closes its public consultation on planned changes to the rules and guidance for free NHS treatment. This does not include adding HIV to the list of sexually transmitted infections and infectious diseases that would mean free treatment for everyone. George House Trust and the HIV sector are campaigning for free HIV treatment for all.

Source and reference 
Thomas F et al. ‘‘If I cannot access services, then there is no reason for me to test’’: the impacts of health service charges on HIV testing and treatment amongst migrants in England. AIDS Care 22: 526-531, 2010.

Budget Pain Worse With HIV

posted: 24/06/2010

Low income is a major problem already for many people living with HIV. The emergency budget and service cuts will now make a bad situation even worse.

Here we try to pick out how the budget that is claimed to be ‘tough but fair’ will affect people living with HIV in NW England. We find out how tough and unfair it will be on many people living with HIV.

The Institute for Fiscal Studies analysis shows that the poorest 10% of the population (typically people on benefits and workers on the minimum wage) will face the worst financial pain of the whole population. Excluding cuts in Disability Living Allowance, Housing Benefit and funding for important public services like social care, over the next five years they worked out that the spending power of the poorest 10% of the population will fall by 2.6%.

Add in the affect of changes in disability living allowance, housing benefit cuts and cuts to public services and the poorer part of the population will suffer even more than this.

The budget will cut the incomes of the richest 10% of the population by just 0.6% compared with over 2.6% for the lowest income tenth of the population. How fair is that?
 

What we have to tell you below makes for depressing reading.

We think people with HIV have a right to know how the planned changes over the next five years could affect them.

These changes are not all cast in stone. They have to go through Parliament and you can tell your MP what you think.
 

Disability Living Allowance
Many people with HIV receive Disability Living Allowance (DLA), a benefit paid at different rates to compensate for disability and mobility problems. The budget announced that people on DLA will have a strict new medical examination; these medical examinations will start in 2013. Some people will lose DLA, others will go onto a lower rate. The government aims to cut spending by £1.4 billion within two years of these medicals starting.

We do not know yet if people who have DLA ‘for life’ will have these medicals.
 

Housing Benefit
Housing Benefit / Housing Allowance will be cut after one year by 10% for people claiming Job Seekers Allowance. The amount of Housing Benefit will also be capped, depending on how many bedrooms you have.This and other changes will be cuts costing people on the benefit £1.8 billion a year.

People will either have to pay the extra for their rent from their other income, move somewhere cheaper or smaller, and if evicted for rent arrears are likely to be refused rehousing as a homeless person. Eviction for rent arrears is treated as making yourself intentionally homeless so people are not entitled to be rehoused.
 

Unemployment
There are around 2.5 million people unemployed and about 0.5 million job vacancies. Unemployment is higher in NW England than most other regions. The job vacancies are often low paid.

The budget alone will increase unemployment by another 100,000 and independent experts expect it to reach close to 3 million.

Job seeking prospects will worsen and it is already harder to find work with a condition like HIV.
 

Slow-burn cuts and taxes
Over the next five years people on benefits will slip further behind in what their benefits will be able to buy and with tax changes.

VAT rises at the beginning of January to 20% and VAT always hits people on low incomes hardest.

Most benefits will be uprated for inflation in a new way that will leave people increasingly worse off. This will cut £6 billion from benefits over the next five years.

Child Benefit is frozen for three years from next April – a £3billion cut. Parents who are working will be compensated by Tax Credits, but that doesn’t help parents who aren’t working.
 

Social Services
Local Government and other public services are most used by people who are on lower incomes. Social Services departments of local councils now face cuts of between 25-33%. Social Services provide essential services to people with HIV and they help fund HIV community services like George House Trust.

The AIDS Support Grant which is used to pay for extra support for people with HIV and community HIV services is no longer protected by a ‘ring-fence’. This means councils can now spend it on whatever they like.

We don’t know yet how cuts of between one quarter and one third will affect essential social services for people with HIV and community organisations but we should start to know more from October. We can expect some painful cuts and changes.
 

NHS cuts
The NHS in NW England has been told to save almost £1 billion within the next three years. We do not know whether this will affect people with HIV.
 

State Pension Age to rise sooner
Details are sparse but the government is planning to raise the age at which men and women will get a state pension sooner than was planned. Men who are now 59 will have to work one more year before they can claim a state pension. Pension age will be 66, not 65 as now, for men from 2016. It does not stop there.

They are consulting about raising the pesnion age to possibly 70. Pension ages for women and men could be raised by one year every five years until it reaches 70 for both sexes. If they start this in 2016 as they say they now plan to, men now aged 40 would not get a state pension until they reach 70. Three out of four people will have some disability by the age of 68. Many people with HIV (among many others) are not fit enough to work until the current pension age of 65, particularly in a region like NW England.

Benefit cuts and changes will make it harder for people with disabilities like HIV to live with a decent fair income before pension age.
 

Expect more pain
In October the government will publish its Public Expenditure Review. We can expect lots more cuts in government spending. The government is already saying that it will try to reduce cuts in education and some other public services (but it has not said that it wants to protect social services) by making even more cuts and changes to benefits.
 

Since the second world war, no government has managed to cut public spending for more than two years in a row. This government plans five years of cuts.
 

Some reputable economic commentators, and President Obama, are warning that European countries are behaving like a panicking herd, cutting spending harshly and that this has a high risk of plunging the world into recession once again. The harsh medicine of cuts could kill economic recovery and make the situation even worse.
 

Heath Inequality
The Marmot Review earlier this year was to help the government plan policies that will end harsh health inequalities. It showed that the poor die 7 years younger than the rich, and the poor become disabled 17 years sooner. Cuts to services and benefits in NW England will worsen the already bad record of ill-health, disabilities and early deaths in this region. More unemployment and low income harms people’s health and well-being.

Reductions in benefits, and those 25%+ public service cuts expected in the Autumn Spending Review are estimated to increase alcohol related deaths by about 2.8% and cardiovascular deaths by 1.2%. Both of these disproportionately affect people living with HIV. Every £80 cut in social welfare spending per person causes this, according to a Europe-wide analysis by Oxford University epidemiologist David Stuckler, reported in the Guardian on 25 June and in the British Medical Journal. There are likely to be between 6,500  and 38,000 more deaths in the next ten years. If the economy worsens, extra deaths rise steeply. Apart from benefits cuts, it is cuts to social services and health budgets especially that cause the most health harm. 

The Treasury is ending the public sector agreement with the NHS to raise the life expectancy of the poor. Marmot presented the government with a vision and plan to make sure everyone has a ‘healthy income’, enough money to live healthy lives and improve life expectancy.

The budget and cuts to come make it even more likely we will go backwards and poorer people and people with disabilities, like many people with HIV in NW England, will face worsening life expectancy and poorer health.

Sit back or act?
These changes are not all cast in stone. They have to be passed by Parliament and you can tell your MP what you think. With your postcode you can contact your own MP here.

Help for people on Low Incomes on our website

HIV Treatment Rights Review

posted: 23/06/2010

Wednesday 30 June is the last chance to tell the Department of Health whether its plan to update the law and official guidance on who is entitled to free NHS hospital treatment is right. At present some migrants with HIV are charged for HIV treatment, although every other sexually transmitted infection (STI) and infectious disease is always treated for free, for everyone. The rules affect lots of other people in other ways but our focus is on access for all people in this country to free HIV treatment.

Free treatment for STIs like HIV, and infectious diseases makes financial and disease management sense. It saves money and stops diseases spreading when states provide free treatment for these for public health reasons. Untreated conditions spread diseases and increase the total bill.

New Regulations - useful changes
The new regulations propose some useful changes:

• Refused asylum seekers getting Section 4 or Section 95 support will be exempt from charges
• Primary care services are explicitly excluded from charging
• Unaccompanied migrant children will be exempt from charges
• People with an Article 3 claim will be included alongside people seeking asylum or humanitarian protection, and so will be exempt from charges

New Guidance - some good bits

The new official Guidance is also better:

• Maternity treatment is now defined as 'immediately necessary' treatment. This means there will always be a right to treatment and it must be provided. But a bill could follow.
• The Guidance does not yet say, but we are hopeful that HIV will also be defined as ‘Immediately necessary treatment’ because that is what the British HIV Association has formally told the Department of Health.
• Overseas Visitors Managers and clinicians are instructed to tell patients that all ‘immediately necessary’ treatment will not be withheld, regardless of their ability to pay.

Want to help?

The major problem with the rules is that there is still no automatic right to free HIV treatment. The Department of Health says it is reviewing this rule. We think this shouldn't wait a moment longer and HIV community organisations are making the case now for free HIV treatment for all.

The review of the rules and guidance was started before the election. Now there has been a change of government, an emergency budget, cuts and more cuts to come in the autumn Spending Review, so it is important to support the positive changes they have made. We want to push the Department of Health to take the sensible next step of adding HIV treatment to the list of Sexually Transmitted Infections and Infectious Diseases which are all treated for free, whoever you may be. And we want to discourage the Government from making some unhelpful changes that it plans.
 

NAT (National AIDS Trust) response

NAT have prepared a fairly simple response for some HIV organisations. This deals with the key points. You could use this - just add your name and details in the first pages and send it to them by email. You can of course say whatever you wish and make your own points.
 

If you want to comment in more detail you could look for more in the Model Response you can find on a blog set up by Medact and other community organisations that are campaigning together.
 

Here are all the Department of Health papers for the consultation. 

George House Trust draft response

Here you can read the draft response of George House Trust.
Please note that this is not our final or official view but we are sharing this to help others, before the official deadline. We welcome any comments and suggestions.

We have considerable experience with HIV treatment charging and this draft is built on our experience, expertise, and we are especially grateful to NAT and the blog for their detailed work on this. 

This George House Trust draft is more detailed than the NAT response above and it includes some significant additions. 

Two of these George House Trust extras are 

• much better Guidance is needed on who fits the definition of 'ordinarily resident'. The details are for legal experts BUT this is really important. The poor Guidance on who is 'ordinarily resident' has caused most of the problems with charges for HIV treatment in NW England. We have won almost every case we have argued on this point. We have been able to argue that most migrants with HIV who are charged are in fact 'ordinarily resident' in this country and so should never have been charged. If you can show you are 'ordinarily resident' none of the charging rules apply.
• There is no system for independent reviews or appeals - like there is if your claim for a state benefit is refused, or your asylum claim or immigration appeal is refused. In the 21st century, basic rights like hospital care deserve a system of independent reviews and appeals considered by an independent Tribunal chaired by a judge, so people can obtain justice and justice is seen to be done.