Select Committee on Health Written Evidence


Memorandum by PACT (HA 23)

  Please accept the contribution of the Providers Association for AIDS Care and Treatment (PACT) to the "New Inquiry—New Developments in HIV/AIDS and Sexual Health". PACT is an independent subscription based organisation made up of HIV provider units from across the United Kingdom representing the views of clinicians, health professionals and managers.


  1.  Support the campaign of the Terrence Higgins Trust and the All Parliamentary Group on Aids to add HIV infection to those sexually transmitted infections exempt from the Overseas Patient charges. This support is based upon Public Health (reduce infectiousness from HIV and associated conditions eg MDRTB) and economic (ie less cost to treat with Antiretroviral drugs in outpatient setting, than wait until patient develops an infection such as PCP or CMV and requires expensive emergency inpatient admission) grounds, as well as humanitarian.


  2.  Reinforce the need to concentrate resources on preventing onward transmission of HIV and STI infection, through compulsory PSHE in schools, targeted Public Health campaigns, Chlamydia screening across the whole of the United Kingdom and increased access to "Rapid Testing" and "Point of Care Testing" diagnostics in the community (especially HIV antibody testing in primary care).

  3.  Increased screening in the community, utilising new diagnostic technologies, will identify and separate "Asymptomatic" and "Symptomatic" patients at the earliest point of access. Early diagnosis will improve referral patterns and access to main GU Centres of Symptomatic patients, develop integration of primary care and acute services and increase overall efficiency of capital and human resources.

  4.  The Health Committee recommended increasing access to GUM clinics and described the crisis in their funding, their fabric and their staffing levels. The governments own figures suggest the situation is worsening, there has been no targeted improvement of the buildings and consultant expansion has not increased. A study by Kinghorn et al in Int J STD AIDS in October demonstrated the failure of DoH monies to reach frontline services in England because of the failure of PCTs to pass on the targeted funding.

  5.  There is no published Sexual Health strategy in Scotland or N Ireland and this is unacceptable.

  6.  STI epidemiology is rising alongside teenage pregnancy and a falling age for Coitarche. If the governing bodies of each nation accept that this constitutes a Public Health crisis with major economic effects on NHS expenditure (eg from Infertility, Cervical Neoplasia, infectious Obstetric/Paediatric complications and the costs of Anti-retroviral Therapy) then surely an integrated and coordinated Public Health approach, based on accessible medical services, prevention and treatment and contact tracing are the keystones that history teaches us will work in reducing sexual ill health.

  7.  Where has been the promised impetus to funding the increased delivery of contraceptive care and STI asymptomatic screening in primary care? The lack of development of networks, including GUM and contraceptive specialist services alongside community screening facilities was much promised in the English strategy and much talked up elsewhere-the health committee should highlight the failure to develop this pivotal aspect of modernisation of integrated services.

  8.  Consistent flaws are emerging in the structure and process of commissioning Sexual Health and HIV services across the UK. The fragmentation of the commissioning base into small locally focused PCT's is failing to address the challenges of delivering national Public Health based Sexual Health and HIV services. Local cost pressures and a failure to identify the activity and disease drivers for Sexual Health and HIV within mainstream contracts is contributing to the restriction of funding and a lack of strategic thinking and vision around these services. These pressures are creating ever greater tensions between Commissioners and Provider Units, which are leading to the break down of the Public Health ethos that underpins "Open Access" services, a restriction on access to services and the development of a "postcode lottery" for treatment and care. Managed clinical networks and the integration of Sexual Health and HIV commissioning is now an urgent priority if we are ever to achieve the recommendations set out by the Committee.

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Prepared 21 March 2005