Memorandum submitted by the Black Health
Agency (SH 143)
INTRODUCTION AND
BACKGROUND
Evelyn Asante-Mensah who is Chief Executive
of Black Health Agency and Chair of Central Manchester Primary
Care Trust is submitting this paper. BHA's work is provided locally
within Manchester and regionally across the Greater Manchester
and the North West as well as having a national focus through
the provision of the African AIDS Helpline. This paper attempts
to bring together the two perspectives (i) as a voluntary sector
provider delivering sexual health services to a diverse Black
and Minority Ethnic population and (ii) a PCT perspective as both
a provider of sexual health services and a commissioner of services
within Manchester. This places us in a unique position as we bring
both the voluntary sector issues as well as having an understanding
of the complexities within which PCTs are delivering their sexual
health agendas.
The Black Health Agency was established in 1990
as Black HIV and AIDS Forum as a community response to deal with
the emergence of HIV. Our initial aims were to mobilise and raise
the awareness of Black and Minority Ethnic Communities focusing
on HIV and Sexual Health issues, and to act as a pressure group.
The breadth of our current service provision spans the wider aspects
of health and social exclusion as it affects BME communities.
The agency exists to work with and for African, Caribbean and
Asian Communities.
Central Manchester Primary Care Trust was established
in October 2000 as a second wave PCT. It is the largest of 3 PCTs
in Manchester. The PCT has responsibility for an ethnically rich
and diverse population of 175,000 with an annual budget of £179
million. Within its main responsibilities the Trust has leads
on the provision of Family Planning and Teenage Pregnancy services
on behalf of the other two Primary Care Trusts. Historically the
majority of HIV Prevention, Sexual Health Promotion and the delivery
of voluntary sector HIV Care Provision have been delivered in
and around the Central Manchester boundaries. Whilst the provision
of HIV Treatment services was delivered in North Manchester by
the North Manchester NHS Acute Trust. The current picture is that
North Manchester Primary Care Trust is now leading on HIV services
in the interim until a long-term strategy has been established.
Both Black Health Agency and Central Manchester
Primary Care Trust are actively involved in the Sexual Health
Strategy Group for Manchester. The Manchester sexual health strategy
group have developed a response to the Government's National HIV
and Sexual Health Strategy which is designed to be a cohesive
local implementation plan.
KEY ISSUES
FOR CONSIDERATION
BY THE
SELECT COMMITTEE
PCT perspective
PCTs have a heavy agenda to deliver for their
populations. HIV is a relatively new responsibility, which has
been taken over by PCT as part of STBoP and has brought additional
pressure for PCTs. In Manchester lead arrangements have been agreed
for the commissioning of HIV services particularly from the voluntary
sector, however, there needs to be more cohesion in approach to
ensure there is no duplication and resources are effectively deployed.
There are two clear and distinct areas for PCT around the implementation
of the strategy (i) process issues and (ii) meeting the objectives
of the National HIV and Sexual Health Strategy. Within the PCT's
key issues are:
— Who is leading on the work;
— How the work is divided up (i.e.
GUM, Family Planning, HIV, Voluntary Sector etc.);
— Loss of expertise in the transition
from HAs to PCTs;
— Changing roles and responsibilities;
— How do PCT's reconcile "grass
root" public involvement/acceptable issues with politically
sensitive or not socially acceptable issues (drug users, gay men,
asylum seekers and refugees, sex workers);
— Statutory sector are feeling overstretched
and over measured (for inclusion of Gonorrhoea as a performance
indicator); and
— The National Strategy proposes a
high profile education campaign, particularly aimed at young people
from Summer '03. How will PCTs manage the inevitable call on already
overstretched and under-resourced services as a consequence of
such national initiatives?
The national strategy has clear actions for
PCT, which are:
— Identifying a sexual health and HIV
lead, with appropriate seniority and public health expertise,
to lead implementation of the strategy at local level by Summer
2002—Manchester has agreed that North Manchester PCT will
commission services on behalf of the other two PCTs;
— To use the Commissioning Toolkit
to develop and implement PCT and LA plans—from 2003;
— To implement 3 levels of sexual health
services, including the role of GPs, nurses, wider primary care
teams and NHS walk-in centres—to start to implement by April
2003; and
— To tackle inequalities in access
abortion by offering access within 3 weeks of first appointment
with GP or other referring doctor from 2003.
The above have to be implemented within a tight
budget with no ringfencing. The recommendations will require a
great deal of effort on the part of PCTs and will raise issues
around resourcing and training of staff. A big push in the strategy
is the 3 levels of service provision which necessitates GPs being
able to offer HIV testing and recognises that some GPs who have
a specialist interest in sexual health may want to gain level
2 status. This will have to be facilitated within existing resources
and currently the staffing level is unable to support and sustain
such training and implementation.
Sexual Health and GUM
— Rising cases of STIs, including HIV.
North West in 2001 had a greater percentage increase in HIV than
nationally (16 per cent as opposed to 11 per cent);
— Manchester is currently in the middle
of a syphilis outbreak (>380 cases);
— HIV and STIs do not remain within
PCT boundaries therefore who takes responsibility? (e.g. Manchester
has a citywide condom distribution scheme—not split by PCT);
— Have to be aware of local picture
and population and how it affects the work— e.g. Gay Village,
large and diverse Black and Minority Ethnic population, dispersal
of refugees and asylum seekers;
— No NSF—how do PCTs make this
a priority with all other competing issues; and
— What should and is the role of the
StHA—reporting back and performance management issues?
WORK WITH
BLACK AND
MINORITY ETHNIC
COMMUNITIES
BHA's experience is that work with Black and
Minority Ethnic communities needs to be innovative and creative
and should build on cultural norms and understanding as well as
involving, engaging and developing the capacity of the communities
that we are working with.
It is extremely important that we acknowledge
the diversity that there is within the Black and Minority Ethnic
communities and not develop services, initiatives, and projects
that assume homogeneity within these communities.
As a voluntary agency, BHA has worked for the
past 12 years in an uncertain environment with yearly funding,
which has negated the ability to plan successfully. Shifting the
Balance of Power and the reorganisation of the NHS structures
within which we are working has compounded these issues and made
them more challenging in terms of accountability, funding, expectations
and lack of clarity in the direction of services and what purchaser/commissioners
are expecting from us as a provider. BHA works with a client group,
which is marginalised and often excluded from society. The current
political climate is working against the social exclusion agenda
and continues to marginalise the parts of society we are trying
to engage. However despite this challenging context BHA has been
able to develop initiatives, projects and services that respond
to the complex needs of Black and Minority Ethnic communities.
Key examples of areas of work we have undertaken,
which have proven effective
— Peer Education Work with young marginalised
Black people which recruits and trains the target group to deliver
sexual health promotion and HIV prevention to the their peers
within school as well as community settings;
— Sexual health development work particularly
with African and Asian communities which is delivered by people
from those communities;
— African AIDS Helpline, which provides
advice, information and counselling support to African people
with, concerns around HIV and Sexual Health in England;
— Lead agency on the training aspect
of implementing the national strategy on Antenatal HIV Testing
in Manchester; and
— Engaging in the wider social exclusion
agenda—we cannot look at sexual health and HIV in isolation
from the rest of people's lives and experiences. BHA has played
and full and active part in a wide range of social inclusion policy
areas such as Teenage Pregnancy Strategy; SRB (Single Regeneration
Budgets); Employment access project (through the Neighbourhood
Renewal Fund).
In a regional context BHA has been at the forefront
of the development of a joined up Primary HIV Prevention campaign
across the North of England. BHA has also played a key role National
strategic bodies and For a—for example we were involved
in the development of the Health Promotion Strategy for the National
Sexual Health and HIV Strategy as well as steering group members
for the Sex Education Forum.
November 2002
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