APPENDIX 67
Memorandum by Dr Simon Barton (SH15)
On behalf of the Directorate of HIV and Genitourinary
Medicine at the Chelsea & Westminster Hospital, I would like
to respond to your request for written evidence to the enquiry
on Sexual Health and HIV. I write as Clinical Director of our
unit which includes the largest HIV specialist treatment and care
centre in the UK, as well as three open access, sexual health
and genitourinary medicine clinics in a service network across
London.
It was with great enthusiasm and support which myself
and colleagues in genitourinary medicine responded to the National
Strategy for Sexual Health and HIV published in July 2001.
Although the publication of the Strategy had been delayed for
several months, we were optimistic that the consultation period
which ended on the 21 December, 2001 would be followed swiftly
by clarifications of the Strategy and the implementation plan
and identification of the resources to achieve this.
Unfortunately, since the end of the consultation
period, we are unaware of any formal response from the Department.
This is particularly disappointing and has contributed
to losing the momentum, which had been gained in the production
and consultation period of the Strategy. In particular, it was
essential that sexual health and HIV, united together in a national
strategy, would be identified for primary care trusts and strategic
health authorities as areas of health care requiring prioritisation
on public health grounds, as well as ensuring that they developed
an integrated approach between HIV and sexual health services
on a network basis. The failure to adapt the National Strategy
into a national service framework and the lack of prioritisation
from government for HIV and sexual health care has led to a lack
of prioritisation at local level for this area of healthcare.
In 1998, when I was invited to join the Ministers
of HIV/AIDS Stocktake group at the Department of Health, I and
others were absolutely clear that attempts to separate the commissioning
of HIV treatment and care from the delivery of sexual health services
would result in a chaotic and piecemeal service without the greatest
benefit to public sexual health. Despite assurances and, indeed,
the joined up National Strategy including HIV and sexual health,
it is now clear that HIV treatment and care funding has been separated
from sexual health care funding and that the commissioning streams
are beginning to diverge. I believe that it is essential that
clear ground rules are implemented from top down to ensure that
strategic health authorities, PCTs and acute trusts are involved
in a commissioning process which ensures maximum cost effectiveness
in the development of HIV as well as sexual health services. In
particular, this must ensure that implementation of the National
HIV and Sexual Health Strategy not become fragmented and undermine
any of the principles of genitourinary medicine and sexual health
care, namely, open access, confidentiality, seamless care and
partner notification.
The Committee asks for recommendations for action
as well as delineation of problems and we would like to advance
our specific suggestions.
1.In our unit's response to the consultation for
the National HIV and Sexual Health Strategy, we highlighted the
potential value of NHS Direct in providing sexual health information
and advice. Although we have tried to develop local initiatives
in West London, there does not appear to have been any central
development or prioritisation within NHS Direct to deliver sexual
health advice nor to try to better manage the increasing burden
of work facing genitourinary medicine clinics nationally.
2.We understand that elected representatives in the
field of HIV and genitourinary medicine last month met with the
Minister for Health, Yvette Cooper, who accepted the problems
associated with the increasing demand for sexual health screening
and the escalating incidence of sexually transmitted infections
in this country. Whilst we are assured that the Minister and the
Department have been briefed on the major problems facing departments
in trying to maintain open access, we still believe that in our
experience in London, the major driver for commissioners and Trusts
priorities relate to the HIV drugs budget and not the delivery
of sexual health and HIV services. The sheer size of the national
cost pressure relating to antiretroviral drugs for HIV infected
patients surely merits central direction via NICE. This would
prevent fragmented local decisions being made leading to movements
of patients between units with access to different drugs as occurred
in 1996-97 and lead to the DoH Stocktake.
Furthermore, detaching the HIV drugs budget from
local commissioning, establishing service networks for HIV and
sexual health care and prioritising open access integrated services
will enable acute and primary care Trusts to work together in
a more balanced way to achieve improved services.
3.We would welcome initiatives from Modernisation
to be applied to genitourinary medicine and sexual health services;
the ongoing work described (BMJ 1/6/02, Vol. 324, p1336) on capacity
and the "IDEA" project should be applied to our open
access services.
In summary, we feel that Sexual Health and HIV require
National prioritisation on Public Health grounds. The application
of service frameworks, NICE evaluation and modernisation to these
services is not achieved by the half-hearted introduction of a
strategy with no central support or prioritised funding. We are
relieved that the Health Services committee is addressing this
subject and hope that this will ensure a focus on the need to
support and develop integrated services at a time of unprecedented
demand. We would be pleased to provide further input into the
work of the Committee by written or oral report.
May 2002
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