New HIV Mental Health Standards

posted: 08/04/2011

The first standards for mental health services for adults living with HIV are now out for public comments, until the end of May.

The new Standards for psychological support for adults living with HIV  were written by a team of experts, with the help of patients’ representatives and the HIV community sector, including George House Trust, Terrence Higgins Trust and NAT (National AIDS Trust).

The new standards describe the care that adults living with HIV should expect to receive from all the services providing mental health and psychological support, from any time after HIV diagnosis. These are not designed for children and teenagers with HIV, but it is hoped that standards for younger people will soon follow.

Psychological support means ‘any form of support which is aimed at helping people living with HIV to enhance their mental health and their cognitive and emotional wellbeing’. Mental health support comes in lots of different ways and not just from experts.

Many people with receive really valuable support from other people living with HIV – at services such as spaces, groups, weekends, which is known as 'peer support'. Experts like psychologists and other professionals (counsellors, nurses, psychiatrists and others) working in HIV clinics, at doctors surgeries and other clinics, as well as in HIV and other community services, provide more specialist support, treatment and help.

Stepped Care and 9 Standards

The standards follow a four-stage 'Stepped Care' model, to match people's growing psychological support needs, as these get more serious and complex. 

• Standard 1: promotion of mental health and wellbeing
• Standard 2: support at the time of diagnosis
• Standard 3: screening
• Standard 4: competence to provide psychological support
• Standard 5: comprehensive psychological support services
• Standard 6: co-ordination of psychological support
• Standard 7: evidence-based practice
• Standard 8: evaluation and audit
• Standard 9: engagement of people living with HIV
   

Say what you think

Comments on the draft standards are very welcome from anyone with experience (good or bad) of using or providing mental health support for people living with HIV. They’d like people to use their special form for your response. This helps by asking questions, and gives you space for any general comments on the whole standards, and on each of the 9 standards.

The standards should be used by the people deciding what mental health support services for people with HIV are provided in each district and by the people providing those services for checking their services are up to the standards.

The Standards

Please use this consultation response form and send your comments to MedFash by 5.00pm on Tuesday 31st May 2011.

These standards are a joint initiative of the Faculty for HIV & Sexual Health of the Division of Clinical Psychology of the British Psychological Society (BPS), the British HIV Association (BHIVA) and the Medical Foundation for AIDS & Sexual Health (MedFASH).

New Government Mental Health Strategy - No Health Without Mental Health

Charging Migrants for HIV Treatment

posted: 04/04/2011

The government has said it will soon change the rules about charging people from abroad for most treatment at NHS hospitals in England. At the moment the rules do not affect many people in North West England with HIV but that is likely to change. New Rules will probably appear in June.

The government has also announced another, bigger review of NHS charges. This will look at anything and everything and is intended to save the NHS a lot of money.

The next step is the department of health will publish the new rules for NHS hospital and clinic charges and guidance quickly – probably before June.

They have just published their response to a public consultation so now we know something about what the new rules from June will probably say. George House Trust gave evidence and comments to this consultation.

The Department of Health's plans for the June rules are 

• They won’t change which treatments will be charged for yet – but may do so later.
• The rules will be changed to make it clear that refused asylum seekers who get Section 4 and Section 95 payments do not pay for NHS treatment
• Unaccompanied children will no longer have to pay, but children with parents here can be charged
• They will make clear in the new rules that anyone who has begun HIV treatment that is free of charge (e.g. because they have an asylum claim which has not been finally decided) will continue to receive free HIV treatment
• They will keep putting up posters about charging for treatment in hospitals and clinics, even though they know this frightens some people that need treatment away and can lead to discrimination by hospitals
• They will change the guidance that tells doctors to think about the cost of treatment, because this encourages discrimination
• They will start a new system of telling the UK Borders Agency about the people who owe the NHS money. This will mean people will be refused permission to stay longer, applications for citizenship may be refused and people will be refused a visa to return to the UK if they leave
• They will consider introducing a rule that will force visitors from overseas to have health insurance
• They will look at charging people for primary care (treatment by family doctors)

Free HIV treatment for all?
The Government still has not decided whether to make HIV treatment free for everyone who needs this on public health grounds, like for all other sexually transmitted infections. They say they are still considering this and will report “in due course”.

Next, an even tougher review
They have also announced another major review which is designed to save the NHS a lot of money. This will look at

• Changing the residence rules, including the definition of ordinary residence
• Changing some or all of all the types of treatment and types of people who do not have to pay for NHS treatment
• Making people pay for primary care (that is treatment by family doctors and dentists)
• Changing which bit of the NHS has to pay when people cannot pay
• Making the procedures for checking who should pay tougher before treatment begins
  Making the procedures for collecting charges tougher
• Using new ways to collect charges 
• Requiring migrants to have health insurance 
• They will consider anything and everything else.

They try to soften this tough new cost-saving review by saying “the NHS is, and must remain, ultimately a humanitarian organisation. In undertaking the review, we will be mindful of the NHS’s core values, in particular its obligations to provide urgent treatment to any person irrespective of their status or ability to pay, to protect the vulnerable and respect our obligations on healthcare provision under international treaties . There is no intention to consider policies that would deny access to any group, only whether an individual should be charged. It will consider the full benefits and costs of introducing new charges including risks of deterred or delayed treatment and any other societal costs. In addition, we will ensure that public health considerations are fully factored into proposed rules and processes (ensuring in particular that access policies do not compromise the identification and control of infectious diseases).”

A comprehensive package of confirmed proposals will be put to full public consultation on completion of the review work, in 2012. We may consult separately at an earlier stage on some options, such as primary care charging.
 

You can read the details of the government's proposals for the June regulations and this new review here. The new review details begin on page 24. 

Proposals and Review report

Axe for HIV quangos?

posted: 04/10/2010

Two expert HIV advisory bodies - quangos - could be abolished under government plans to save money. Both the 'Expert Advisory Group on HIV/AIDS' and the 'Independent Advisory Group of Sexual Health and HIV' are on a leaked list of quangos that are to be scrapped, according to a report in the Daily Telegraph. Two other quangos performing useful work for people with HIV could also be abolished - the Health Protection Agency (HPA), and the Equality and Human Rights Commission (EHRC).
 

Both of the HIV advisory bodies offer expert advice to the government from national experts; and the Health Protection Agency produces all the national HIV statistics and public health guidance, and the EHRC acts as a human rights watchdog, looking after the interests of people with HIV, among other groups.
 

After the election, prime minister David Cameron promised a "bonfire of the quangos" to save public money. Thousands of jobs are expected to be lost. The fate of these quangos should become clear after the autumn spending review is published in late October. Both the Expert Advisory Group on HIV/AIDS  and the Independent Advisory Group of Sexual Health and HIV are unpaid advisory bodies.

Scrapping these two advisory bodies will save almost no money, but the price we would all pay would be the loss of valuable HIV expertise the Department of Health does not have among its own staff and ministers. 
 

Source

AIDS Support Grant Changes

posted: 12/08/2010

The Department of Health wants people’s views about changes it plans in how it works out the amount of AIDS Support Grant (ASG) paid to each council. The deadline for comments is Wednesday 6 October.

Instead of working out the ASG amounts each year, The Department of Health wants to decide and tell councils now what they will get in the following four years. However they don’t guarantee anything about the future of ASG, because of the Autumn Spending Review, which will be announced in late October.
 

Two Options

They suggest two options. The first, which they prefer, is based on the current formula which would be frozen. This would mean using the most recent HIV data (on the numbers of people with HIV and of children with HIV in each district) to decide the grant for each year of the Spending Review. The second option uses another formula - the younger adults social care relative needs formula. This produces very strange results.

Impact in NW England

We have produced a table showing the amounts of ASG paid to NW councils this year and last year, and the amounts using the two formulas, that would be paid for the next four years. 

The consultation proposals and response form are here
 

The deadline for replies is Wednesday 6 October.
 

Work Incapacity Tests – Have Your Say

posted: 09/08/2010

You can have your say in an independent review of how people’s fitness for work is checked by a medical, when claiming benefits for being too ill or disabled to work. People who claim Employment and Support Allowance have medical assessments as part of their claim. These are called ‘Work Capability Assessments’. The fairness of these is now being checked. We know many people with HIV are having serious problems with these.

Also people in Burnley who are on Incapacity Benefit are being put through these medicals as part of a national pilot. Beginning in February, everyone else on Incapacity Benefit will have to have one of these medicals. Many people living with HIV claim these two benefits.
 

Problems lead to review

The fairness of these medical assessments is being checked by an independent national review, led by Professor Malcolm Harrington, who is an occupational health expert. He will produce a report by the end of the year on whether the assessments are fair and transparent.
 

Have your say

You can have your say, based on your experience by Friday 10 September.

They ask a number of questions, but you don’t even need to answer these – simply say what happened to you, and whether you think the system works for people with HIV, or you could give plain and simple answers to questions 2, 3 4, and 6. Most of the questions are aimed at benefits experts.
 

Email your comments

or post your comments to WCA Independent Review Team, Floor 6, Section B, Caxton House, Tothill Street, London, SW1H 9NA.
 

What benefits and disability experts think
Disability charities say the current assessments tests are inflexible, and fail to take into account how long-term conditions (like HIV) can vary from day to day, or from week to week. George House Trust knows there are serious problems with the way these incapacity assessments are done and that people with HIV face a high rate of wrong refusals.
 

Atos Healthcare (who have the government contract for doing Employment Support Allowance assessments) appear to refuse to record basic HIV information like people’s CD4 count, admit their own ignorance about HIV and unwillingness to learn about HIV, don’t refer people with HIV to doctors for a full medical assessment as they should do, refuse to consider the ‘exceptional circumstances’ rules (regulations 29 and 35), and ignore medical reports from HIV doctors.
 

The advisers at Manchester Advice who specialise in HIV have won appeals before they can even say a word. Independent Tribunals have shown they are disturbed and surprised that plain evidence of obvious incapacity for work due to HIV is ignored, and at the failure to follow the rules.