APPENDIX 45
Memorandum by Dr Paul Lister (SH72)
I would like to submit evidence on behalf of the
South West London HIV & GUM Clinical Services Network. I am
a Consultant in Genitourinary Medicine and Lead Clinician for
of the South West London HIV & GUM Clinical Services Network
which is a joint initiative of adult HIV and Genitourinary Medicine
Services provided at Kingston Hospital, Mayday Hospital, Queen
Mary's Hospital, St George's Hospital & St Helier Hospital.
These five hospitals provide comprehensive services for the diagnosis,
treatment and support of South West London residents with sexually
transmitted diseases and HIV/AIDS. The Network also links with
Commissioners and Public Health as well as Community HIV Nurse
specialists, Health Promotion and the HIV voluntary sector.
SUMMARY1.
The increased level of GUM and HIV activity throughout
South West London clinics is unsustainable
for the current number of doctors, nursing staff
and health advisors. Increased activity also means that
some clinics have insufficient space to deliver
services effectively.
2.
Access to GUM services has become seriously compromised
with clinics having to limit "walk-in"
services to try to cope with demand. This makes
it harder for all patients to access services but has serious
repercussions for the sexual health of teenagers
and other "harder to reach" groups.
3.
Effective implementation of all key recommendations
of the sexual health strategy in hindered by the
pressure on current resources.
4.
GUM and HIV services are further threatened by two
national changes in funding: GUM funding has
been frozen in 2002-03 with no inflation uplift
despite increased activity; GUM and HIV budgets are no
longer ring fenced and as outpatient services
our services are not seen as priorities by Trusts who are more
likely to channel funds towards inpatient and
acute services.
5.
There is a lack of centrally provided Sexual Health
promotion leaflets and resources since Health
Promotion England was disbanded. The Department
of Health has no apparent strategy to provide
Patient Information literature, even though this
is a key component of the Sexual Health Strategy.
6.
Strategic development of an effective and comprehensive
network of Sexual Health and HIV Services in
South West London will be lost without further
substantial investment in manpower and clinical
resources throughout the sector.
1. INCREASE
IN GU MEDICINE
WORKLOAD
The number of patients seen at South West London
GUM clinics has increased massively over the last few years (see
KC60 returns for exact figures). In the five years from 1996 to
2000 South West London Clinics reported a 184% increase in chlamydia
cases and a 115% increase in gonorrhoea cases. Attendances and
rates of infection have increased further in 2001-02. Demand has
now surpassed capacity and all clinics now have to triage patients
and turn away non-urgent cases. The pressure on clinics compromises
the ability of services to maintain quality of care and has a
serious impact on staff moral.
INCREASE IN
HIV WORKLOAD
In the five years from 1996 to 2000 South West London
Clinics had 75% increase in the number of HIV positive patients
under care. There has been an even greater increase in demand
for HIV care in 2001-02.
2. ACCESS
TO CARE
The public health control of sexually transmitted
infections requires open and rapid access to GUM services for
individuals with symptoms or other reasons to suspect they may
have an infection. The overall demand for GUM services has resulted
in clinics having to change some "walk-in" sessions
to "appointment-only". Those clinics who do operate
a "walk-in" service are having to limit the number of
patients that can be seen.
3. SEXUAL
HEALTH STRATEGY
TARGETS
With resources being already stretched and no prospect
for additional funding it will be extremely difficult to increase
HIV prevention initiatives and increase rates of HIV testing.
It is also unlikely that colleagues in Primary Care will wish
to take on a greater part of sexual health services as they are
currently inundated with additional demands on their time.
4. GUM FUNDING
It is astonishing that GUM budgets are being effectively
cut at a time that demand for services is increasing and rates
of infection are not under control.
5. PATIENT
INFORMATION RESOURCES
The Sexual Health Strategy emphasises the importance
of patient information resources, yet there is no plan to replace
the resources previously supplied by Health Promotion England.
6. CLINICAL
SERVICES NETWORKS
In accordance with the London HIV Strategy Group
recommendation we have formed a Clinical Services Network. The
formation of this Network has required a lot of commitment from
clinical staff, managers and commissioners and has the potential
to provide meaningful improvements in service delivery for patients.
However the pressure on resources and lack of new funding threatens
the strategic development of an effective and comprehensive network
of Sexual Health and HIV Services in South West London.
June 2002
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