Select Committee on Health Written Evidence



  At the end of September 2004, LASS analysed our half-year Service User trends, outputs and outcomes:

    —  It has been a deeply disturbing six months. In that time, 28 people with HIV surviving on nil income, many on an ongoing basis have emerged.

    —  This is a direct result of Government Policy (see previous briefing "Local HIV Health and Social Care Crisis: January 2003").

    —  The results for our services have been immediate. We have had to cut our Foodbank Voucher service to a time-limited three-month only service, as it is simply unsustainable for the increasing number of destitute people coming to us. It is nothing short of shocking that we are having to cut something designed to assist people with HIV to meet their basic nutritional needs. After twelve weeks of giving people £7.50 per week for food we must now say "We are sorry, we cannot give you any more food vouchers." We are left wondering how such people will eat; and therefore how they have any hope of adhering to their HIV medication presuming that they have any, or maintain basic health.

    —  The focus of our other direct services is shifting to work with other organisations, to try to help people meet the most basic of survival needs; to producing information about soup kitchens; looking for places for people to sleep and for coats and shoes.

    —  If the current trends continue; then 40-60% of the new service users with HIV that we see each month will end up destitute within 12-18 months of our first seeing them. We now see 14 new people with HIV every month. 40-60% of that is 6-8 people each month. This means that the dozens of destitute people with HIV could become over a hundred in a year.

    —  The impact of this will affect us all as service providers, planners and commissioners.

    —  Our concerns are worsened by further recent Government Policy changes. In April 2004, hospital charges were introduced for overseas visitors requiring people to prove they have a right to free treatment. Charges are now being proposed for Primary Care, excluding emergency treatment. HIV drugs are not excluded. This means that someone with HIV who cannot produce evidence in a hospital to prove they have a right to free treatment will not be given anti-retroviral HIV drugs (ARV). They will only be treated in A&E if they become seriously ill and require admission. The likely consequences of this include:

—  People without HIV treatment will become ill much faster, and for longer.

—  "Treatment" would then occur in cases of serious illness via A&E requiring hospitalisation, at £500 bed-costs per day; as opposed to £800 a month for the preventative ARV treatment.

—  Healthcare resources are being diverted to provide a surveillance system for the immigration services.

—  It is unethical to wait for someone to become critically ill before giving any treatment when the situation could be cost-effectively averted by an earlier intervention.

—  Like section 55 of the NIA Act last year; these changes in National Policy are potentially disastrous for our work.

  These developments have profound implications on all levels. For the individuals with HIV, their health and survival needs are under serious threat. For local Service-Providers, the acute needs of destitute people may overload capacity. There are also serious crime and disorder implications as well as Public Health issues. People who are destitute and unable to work are likely to turn to crime, including theft or prostitution, to live. Even without selling sex, recreational sex is likely to be one of the few pleasures available, and a human comfort. We suggest that it is highly unlikely that destitute people will be able to prioritise obtaining condoms.

  Further implications for forward transmission include:

    —  To deter people from being tested for HIV—if there is no treatment, what incentive is there to test?

    —  To increase the number of undiagnosed people.

    —  To in turn increase the number of infections.

    —  People not on ARV are more infectious due to higher levels of detectable virus.

  This paper is not a comprehensive explanation of all of the issues but is a very brief overview of some of the most disturbing trends we have seen in the last six months. We first mapped out our concerns in the briefing "Local HIV Health and Social Care Crisis: January 2003", copies still available. Prior to that point, we had worked with people on nil income relatively rarely; and almost always in a transitional situation whilst awaiting benefit decisions. The question was about how much assistance the person might receive and when; not about whether they would receive anything at all. Nevertheless, our Foodbank expenditure rose from £4,827 in 2000-01 to £23,176 in 2003-04.

  By April 2004, we were providing services to seven people on nil income; of whom four were in a temporary nil-income situation but three had no prospect of any further income. By the end of September 2004 this had risen to 28 people on nil income, of whom nine are in a temporary transitional situation (awaiting benefits and likely to qualify) six are "uncertain" (we do not yet know if they are likely to receive benefits due to uncertain pending decisions) and 13 have no prospect of any further income. We have extrapolated our predictions overleaf directly from this.

  We are flagging up what we are seeing as a direct result of Government Policy changes and feel that we have a responsibility to work together with our partner agencies in an attempt to avert the growing crisis. This will require attention to service provision and into planning for people in such dire straits; but also requires lobbying at the highest levels. These developments run counter to almost every aim, objective and target set out in the National Strategy for Sexual Health and HIV.

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