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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Health and Care Standards
posted: 28/10/2010
There is a new law regulating health and adult social care services in England. From the start of this month every health and adult social care service in England is legally responsible for making sure it meets new essential standards of quality and safety.
The Care Quality Commission registers, licenses and monitors health and care services using these standards. The standards apply to most health services, council social services and care homes, nursing homes, councils, home care, and shared lives schemes.
The essential care quality standards
1. You can expect to be involved and told what’s happening at every stage of your care
- You will always be involved in discussions about your care and treatment, and your privacy and dignity will be respected by all staff.
- You will be given opportunities, encouragement and support to promote your independence.
- You will be able to agree or reject any type of examination, care, treatment or support before you receive it.
2. You can expect care, treatment and support that meets your needs
- Your personal needs will be assessed to make sure you get care that is safe and supports your rights. You will get the food and drink you need to meet your dietary needs.
- You will get safe and co-ordinated care where more than one care provider is involved or if you are moved between services.
3. You can expect to be safe
- You will be protected from abuse or the risk of abuse, and staff will respect your human rights.
- You will be cared for in a clean environment where you are protected from infection.
- You will get the medicines you need, when you need them, and in a safe way.
- You will be cared for in a safe and accessible place that will help you as you recover.
- You will not be harmed by unsafe or unsuitable equipment.
4. You can expect to be cared for by qualified staff
- Your health and welfare needs are met by staff who are properly qualified.
- There will always be enough members of staff available to keep you safe and meet your health and welfare needs.
- You will be looked after by staff who are well managed and have the chance to develop and improve their skills.
5. You can expect your care provider to constantly check the quality of its services
- Your care provider will continuously monitor the quality of its services to make sure you are safe.
- If you, or someone acting on your behalf makes a complaint, you will be listened to and it will be acted upon properly.
- Your personal records, including medical records, will be accurate and kept safe and confidential.
How is the new system different?
The Care Quality Commission looks at the care people get, rather than at any systems and processes. They say they listen to what people say about their treatment, care and support. They check how care services are meeting essential standards now, rather than looking at the past.
The Commission has wide powers to act if they find that a care service is not meeting the essential standards. It regulates:
- Medical and clinical treatment given to people of all ages, including treatment given in hospitals, ambulance services, and mental health services.
- Care provided in residential homes, in the community, in people’s own homes for adults, and in residential care homes for children. The Commission focus on more vulnerable people, including people with physical disabilities and long-term health conditions (such as HIV).
- Services for people whose rights are restricted under the Mental Health Act.
- Care provided either by the NHS or independently.
More information at their website and booklet
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HIV Rights Threatened
posted: 27/07/2009
Crisis at the top of the Equalities and Human Rights Commission has followed the controversial reappointment of Trevor Phillips as its chair for another three years. The commission took over from the Disability Rights Commission (and the other commissions for race and gender) and so is now the body responsible for promoting the rights of people living with HIV. The crisis at the top threatens the work of the commission on behalf of everyone living with HIV.
Queue of quitting commissioners, staff and tales of sleaze
- Six of the 16 commissioners (the board of directors) have quit so far and another is expected to go. Three of these were the disability commissioners.
- The chief executive and director of communications have both resigned.
- The National Audit Office earlier this month refused to approve the commission's accounts, as over £1m was misspent on making 7 senior staff redundant from the former Commission for Racial Equality he led, who were then immediately reappointed as expensive consultants.
- Phillips owns a majority stake in an equalities consultancy, and this risks conflicts of interest because he's in charge of UK equalities advice and regulation.
- A £300,000 contract for media work was awarded without following EU procedures to a company run by a close friend.
He's paid £110,000 a year for three and a half days a week of work. He's known by some as 'Teflon' Phillips, and denies he's done anything wrong. He's hidden himself away on holiday and refuses to answer his critics, while his commissioners and key staff abandon ship.
Equalities minister Harriet Harman surprisingly reappointed him last week despite the financial sleaze around him and complaints about his bullying, autocratic leadership style, and in the face of the strong advice against reappointment from her own minister Maria Eagle, and widespread rumblings and warnings. Apparently he makes sure you know he has friends in high places, including Peter Mandelson, and perhaps that explains Harriet Harman's surprising decision to reappoint him.
Troubled birth of bionic 'rights' body
The Equalities and Human Rights Commission is a very strange bureaucratic beast - the cobbling together of the three respected and effective commissions for race, disability and gender, with sexuality, age and religious rights bolted on, and then Human Rights added for good measure. There are now plans to add class to this long list.
The contradictions are plain - hardline Christian, Jewish and Muslim religious beliefs come into conflict with equal treatment for gay people wanting to adopt children, for example. The commission was set up in a rush and against the advice of many experts who warned that it has too many things to look after and some would be neglected, particularly disability and its new responsibilities, such as for sexuality.
Phillips has even managed to alienate ethnic minorities - Chinese and S Asian people particularly - and by his claim that 'multiculturalism is dead' and that Britain is 'sleepwalking to segregation'. People distrust this spin on inequalities that panders to some white people's fears and anxieties. He's criticised because the commission is supposed to be the champion for equalities and rights and shouldn't pretend things are fine when there is so much still to be done to make Britain fairer for all. He's also alarmed women by saying better maternity rights need to be balanced against job prospects.
Vacuum at top
The loss of so many national expert commissioners and of senior staff, including the three disability commissioners (Sir Bert Massie, Baroness Jane Campbell, and Alun Davies - who chaired the
disability committee) raises serious doubts about whether the commission can now function well enough for people with HIV and other people with disabilities.
The Disability Rights Commission did a good job generally for people living with HIV - it supported legal protection being extended to cover everyone diagnosed with HIV, was responsive, and it supported individuals with HIV complaints. There has been little apparent HIV progress since the new commission took over and its new three year plan is silent about HIV. The new website doesn't provide anything like the amount and quality of information and advice that the Disability Rights Commission published. That makes our job of supporting people living with HIV who are facing stigma and discrimination more difficult.
The Equalities and Human Rights Commission is a key body the HIV sector has to work with to secure better treatment for people living with HIV. Our task is now more difficult because of the disarray at the top of the commission and the allegations of sleaze around Trevor Phillips.
It needs to sort itself out but with so many key people now gone including the leading disability specialists, we are not hopeful of any rapid improvement. It has a £70 million budget and the conservatives are proposing a bonfire of quangos if they win the general election next Spring. There is not much time to resolve the crisis of leadership.
photo credit
More information and discussion
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