APPENDIX 12
Memorandum by Dr Anne Edwards (SH 22)
1. MANAGEMENT
OF STI'S
(INCLUDING HIV)
A major problem for GUM services and the Government
has been generated by open access for overseas visitors who can
present "off the street" to GUM services for testing
and treatment. This is entirely appropriate for acute STI's but
when the diagnosis is HIV infection we are then committed to providing
lifelong expensive treatment for patients who are not, in other
settings, eligible for NHS care. Over 50% of new diagnoses of
HIV in our service last year were in patients from sub-Saharan
Africa of uncertain visa status. The drug costs alone for an HIV
patient are—£10,000 per annum. This pattern is repeated
around the country. The reason we have more heterosexual HIV than
ever before is because of an influx of patients from pattern II
countries (including the recruitment of nurses from countries
with 40% prevalence rates) not because of spread in the UK (yet).
There is an urgent need to address this issue. The problem of
African HIV will not be solved by piecemeal treatment of the relatively
wealthy who make it to the UK.
2. IMPACT OF
ASYLUM SEEKER
CENTRES
The government is planning to build a centre
in Bicester for 750 asylum seekers. The health costs are simply
supposed to be absorbed by local services. We are seeing a disproportionate
number of asylum seekers through GUM services with no additional
funding, high rates of infection and all the associated language
and cultural problems which make assessment and treatment a much
more complicated and lengthy process. Additional funding for the
health care consequences of these policies must be made available
if we are to minimise the impact on the local population where
rates of infection especially in young people (<20) have rocketed.
3. MANAGEMENT
OF STI'S
IN PRIMARY
CARE
We conducted an audit against national guidelines
of outcome for 100 patients diagnosed with chlamydial infection
outside GUM (primary care/gynaecology and Family Planning) of
those seen for follow up in GUM 80% required re-treating—this
illustrates the difficulties our colleagues have in managing STI's
effectively in non-specialist settings. I would urge you to think
very carefully about the future structure of STI care. Those who
do not learn from history are destined to repeat it . . . the
UK has a unique and highly effective network of clinics delivering
first class sexual health care. It seems to me crazy to think
about diluting the (non-existent) funding and asking GP's who
do not want to take this on and who are already burdened with
all the other targets etc. to become more involved. It would be
worth looking at ratios of numbers of consultants to new and rebooked
patients to establish the most effective work models and to re
examine staffing structures in GUM. NCCG posts are a very effective
way of delivering GUM services.
Current health care policies and the NSF do
nothing to facilitate investment in Sexual health services. By
definition many of our patients are deprived and underprivileged.
If we are to address current demands and avoid problems for the
future Government needs to think broadly about health care for
all, not just those sitting on waiting lists for varicose vein
surgery. GUM services are cheap and represent value for money.
| 
