Training - No Recourse to Public Funds

posted: 20/05/2011

No Recourse to Public Funds (NRPF) Training will be provided in Manchester on Tuesday 7th June (10am – 4.30pm) for Local Authority representatives with responsibilities for people with NRPF.

There will be NRPF training specifically for the voluntary sector in London, on 10th June. Details about Voluntary Sector NRPF Training are here

Voluntary sector people are also welcome at the Manchester training but in Manchester the training focuses on social services assessments.

This training is provided by the No Recourse to Public Funds network.

Limited places available

The cost of the training is £125 per person and will take place at Manchester City Council. Limited places are available. To book a place, please complete the booking form and return it to No Recourse to Public Funds at Islington. The training terms and conditions are here.

The Manchester training for local authority workers covers key issues, legislation and social services assessments, for adults, children and families, and includes human rights obligations.
 

• No recourse to public funds - introduction and overview
• Key legislation
• Assessing eligibility for support
• General considerations in assessments of need - adults, children and families, human rights
• Community care and community mental health assessments
• Child in need and human rights assessments
• Good practice in assessing and supporting people with NRPF
• National NRPF Network and the policy context of NRPF
• Case studies

Booking Form

Terms and Conditions

Enquiries and bookings to nrpf@islington.gov.uk

More information on the No Recourse to Public Funds training programme for Local Authorities

More information on the No Recourse to Public Funds training programme for Voluntary Sector

More information on No Recourse to Public Funds from the network

More information on No Recourse to Public Funds from UK Border Agency
 

Guides for More HIV Testing

posted: 04/04/2011

The number of people who got infected with HIV within the UK in the last 10 years has almost doubled. New infections that happened in the UK (rather than abroad) rose from 1,950 in 2001 to 3,780 in 2010.

In response the National Institute for Clinical Excellence (NICE, the body that tells the NHS what healthcare works and is good value for money) has issued new guidance for the testing of the two groups most at risk of getting HIV in the UK, gay/bi men and African people.

HIV testing helps people keep good health

Testing and treating people with HIV helps the person with HIV stay healthy and to live a near-normal life, helps avoid passing on HIV to others, and can save the NHS a lot of money.
 

The NICE guidance aims to increase the numbers taking HIV tests to reduce the number of people who do not know they have HIV and so help prevent HIV being passed on by Africans living in the UK and gay men.

Gay and bisexual men remain the group most at risk of becoming infected with HIV in the UK with 70 per cent more men being diagnosed with HIV in the past 10 years (from 1,810 in 2001 to 3,080 in 2010).
 

‘NAT welcomes the new NICE guidance on increasing testing among African communities and gay men. Not only is the number of people being diagnosed with HIV still too high, late diagnosis is an extremely important problem as it means a person is likely to have had HIV for a number of years – with a high risk of transmission to sexual partners – and it can also reduce the effectiveness of treatment,” commented Deborah Jack, Chief Executive of NAT (National AIDS Trust).

‘It is crucial that HIV testing becomes ‘normalised’ in our society, not just among gay men and African communities, but also amongst health professionals. Many people with HIV attend NHS services for years without being offered an HIV test and this neglect needs to be addressed and stopped.’

'The importance of HIV testing should now be reflected in Government plans as they reorganise the NHS and public health. In particular, it is essential that HIV late diagnosis remain a key outcome indicator to assess progress in public health at the local level. It is also vital that the extensive reorganisation of the NHS does not undermine recent momentum in HIV testing.’
 

‘Public Health England must ensure that the vision for HIV testing amongst gay men and African communities set out in the NICE Guidance is consistently implemented across the whole of the NHS and public health system.’
 

NICE HIV testing guidance for gay/bi men

NICE testing guidance for Africans living in the UK

Source – HPA press release

Image

HIV and Gay European Migrants

posted: 06/01/2011

Gay men from Central and Eastern Europe who now live in the UK are at risk of HIV and other sexually transmitted infections, according to a new study.
 

Around one in four of the men surveyed said they had unprotected anal sex with a casual partner of a different or unknown HIV status, and 15% of men reported being paid for sex. The risks faced by gay and bi men from central and eastern European countries are broadly no worse nor better than the risks run by British men. But the men need culturally appropriate HIV and STI information.
 

The study looked at what happened after the ten central and eastern European states joined the European Union in 2004. Joining the EU gave people the right to live and work in the UK. The men were from the Czech Republic, Cyprus, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Slovakia and Slovenia. Most (80%) of those surveyed live in London.
 

Online recruits
Using the internet cruising sites gaydar and gayromeo, the investigators recruited 691 men. They answered in-depth on-line questionnaires. The men had a mean age of 29 years, most were working and 54% had a degree. The majority (83%) have lived in the UK for over a year and mainly live in the capital.
 

Risks taken
There is a high level of risk behaviour raising the chances of HIV transmission.

• 13% were paid for sex in the UK, with 22% having a history of being paid for sex
• 37% said they recently used recreational drugs
• 31% have had a sexually transmitted infection
• 62% had ten or more sexual partners in the past year
• 23% had unprotected anal sex that involved a risk of HIV transmission.

But HIV testing rates were high, with 79% stating that they had ever tested, and 64% said they had tested since arriving in the UK. British men could learn something helpful about taking regular (at least annual) HIV tests, from some of these European men.
 

HIV is less common than for British men
Prevalence of HIV was 5%, much lower than prevalence among UK gay men, which some studies have suggested is as high as 12% in London, and 1 in 10 in Manchester.  Most of the men diagnosed with HIV, were diagnosed in the UK (78%).
 

Britons' bad example? Risky behaviour rises after arrival
The longer men lived in the UK, the more likely they were to report risky sex. Levels of drug use are higher after men have been here a year, and partner numbers also rise.
 

Condomless risks
Unprotected sex with casual partners of an unknown or different HIV status was linked significantly with being HIV-positive, or untested, recreational drug use, and being paid for sex in the UK.
 

“CEE (Central and Eastern European) MSM (Men who have Sex with Men) are at significant risk of the acquisition and transmission of HIV,” write the investigators, who emphasise the UK’s “duty of care to ensure that MSM from CEE countries are aware of their sexual health services in the UK and are able to access them.” They call for HIV prevention materials to be tailored to meet the needs of these men.

“Our findings suggest that CEE MSM report comparable levels of risk to those in the general MSM population in London and the UK,” comment the investigators, “interventions aimed at MSM should be accessible to CEE MSM.”

Source with reference

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

Putting HIV in Public Health

posted: 02/11/2010

Public Health will soon have a major shake up in England as part of the new government’s NHS changes. What needs to be in any public health policy that is HIV and sexual health friendly? Better sexual health is one of the public's top three health priorities. This is not surprosing, England has one of the worst rates of poor sexual health in Europe.

Public Health Manifesto
Leading national sexual health and HIV organisations have drawn up a manifesto for better public HIV and STI health. The British HIV Association, National AIDS Trust and others have published an expert’s guide and better public health action list for the government.

HIV and sexual health services will soon be reorganised in England’s NHS. The new National Commissioning Board, GP commissioners and Local Authorities will need to work together in the new NHS system for HIV and STI prevention, treatment and care.

The public health manifesto for HIV sets out the good it will do, the things that need most attention, what needs doing, and the cost of NOT making HIV and sexual health a public health priority.

 

1. The benefits of improving sexual & reproductive health and HIV

• Health economic - The NHS bill for lifetime HIV treatment is rising by £1 billion each year. Preventing one new HIV infection saves over £350,000
• Health benefits – early diagnosis of HIV and other sexually transmitted infections (STIs) cuts treatment costs and the number of new infections
• Reducing Health Inequality – Poor sexual health is much more common amongst people who are already vulnerable because of youth, gender, ethnicity, sexuality, or poverty. Existing inequalities are worsened by HIV stigma, poor sexual health and teenage parenthood
• Impact on societal and economic well being – The social cost of poor sexual health is high:
  - Failure to diagnose HIV infection on time leads to avoidable serious illness and early deaths
  - HIV is a long term condition, but people with HIV age sooner, and have poorer health
  - Teenage parenthood reduce the life chances of young people
  - undiagnosed STIs cause long term and life threatening problems
• Unintended pregnancy, STIs and HIV are avoidable by changing behaviour
  - Unlike many other areas of public health, STIs and HIV can be reduced through good quality prevention work, prompt treatment and partner notification, bringing rapid benefits to the NHS, the individual, and our community.

2. Improving sexual & reproductive health and HIV health outcomes

Priorities:

• reduce avoidable HIV deaths, ill health and onward HIV transmission by cutting late HIV diagnosis
• reduce the high numbers with Chlamydia by screening young people
• cut the numbers with other STIs, including gonorrhoea and genital warts
• fewer births to young women

Being able to see a clinic within 48 hours is critical. There is strong evidence that open access to sexual health services within 48 hours is crucial to controlling STIs.

3. What needs to be done

Support people to take responsibility for their sexual behaviour, through:

• local and national public health programmes that influence positive behaviour change
• improved Sex & Relationships Education in schools and in the home
• providing education and information for those attending sexual health services
• access to sexual health vaccination and screening programmes
• access to good quality, evidence based sexual health information and advice services
• encouragement to contribute actively to both the management of their own sexual health and wellbeing and to the reshaping of community and social norms.

Transform sexual & reproductive health and HIV services by:

• ensuring that effective, quality services are cost effective by better linking into community health and primary care services
• ensuring that all services are part of a local clinical network for the best care 
• joining sexual health and reproductive healthcare so that people use both at once
• encouraging self management
• offering more choice of services
• 48 hour access to treatment and care so people get the level and quality of care they need
• ensuring health staff are well skilled and trained.

Effective leadership and commissioning by ensuring:

• sufficiently skilled commissioners working within a consistent framework of service standards and outcomes
• proper coordination of commissioning for sexual & reproductive health & HIV
• services across the National Commissioning Board, GP commissioners and Local Authorities; this should ensure that services are commissioned at the most appropriate level in the new NHS system
• high calibre leadership from those individuals and organisations responsible for commissioning
• national leadership and comprehensive independent public health surveillance.

4. The cost of NOT improving sexual health & HIV

• the economic cost to the country of more STIs, HIV and unintended pregnancies
• the human cost as people suffer from avoidable infections, illness, premature mortality and from unintended pregnancies
• the social cost of poor sexual health harming communities that already have poorer health.

We want better Public Health

It is not surprising that a government survey in 2010 found that the public iin England rate sexual health as one of our three most important public health priorities.

The real challenge and opportunity is for Government, civil society and the public to work together, as part of the ‘Big Society,’ to make this a reality.

Source