Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 60-63)


27 JANUARY 2005

  Q60 Dr Naysmith: This special budget for HIV/AIDS which was seen as separate from—

  Ms Power: The ring-fenced budget. The money is still there. It is not ring-fenced, but the money should still be there, plus there are a number of special allocations. The question is to encourage primary care trusts to use that money for the purpose for which it was identified and not to move it into other budgets.

  Q61 Dr Naysmith: Some are moving it into other budgets, is the implication of what you are saying.

  Ms Power: Yes, that is right. And that spills over into the system in that primary care trusts throughout England are actually taking very different attitudes around this, and the cases that I have given to you are cases which we have been able to support, and sometimes we can get people treated in one place and not another because there is absolutely no uniformity of implementation around this and it makes healthcare an extreme lottery. It also means that clinicians are being encouraged to ignore government regulations, which is extremely unfortunate and not a good situation, and it means that there are severe health inequalities emerging for many African people, as Max has been talking about.

  Dr Sesay: The African HIV Policy Network is an umbrella organisation that has member organisations, most of them African-led organisations, providing services across the country. We have also established African forums and bringing together regional organisations to work together and to provide services. Since the removal of the ring-fence, what we have realised, what we have seen from our membership and what we have got from the membership of the AHPN, is that a lot of the organisations have collapsed. They have shut down. These have been extremely vital and crucial conduits to very hard to reach communities. They are simply not getting the funding that they need to be able to provide services to the communities at a time when the government strategy should be to enhance the capacity of these affected communities. Those are the contradictions that we are having at the moment.

  Q62 Chairman: Simon touched on the politics of this whole area earlier on and Richard's comment was that you have made the case completely, and I would concur with what he has said. Having said that, and in the run-up to a general election where asylum, immigration, race will be undoubtedly, as we can see already, play a key part, how do you address the Daily Mail agenda on this issue and actually get across the important points that you have put to this Committee today?

  Ms Jack: I think one general point is we need to divorce this discussion we are having today from general policies on asylum and immigration, because we are talking about people who are living in the UK already with HIV and, irrespective from any other debates around immigration, this is about a real and immediate problem which is not going to go away if those policies change. I think that is a challenge for us, but I think it is really important, because, once it gets sucked into those wider issues, you actually lose the ability to look at it as a very specific problem that can be addressed quite simply by making HIV exempt in the same way as other STIs and TB.

  Ms Power: This is not just an HIV issue. A very large part of this for us is co-infection with HIV and TB. We have a number of cases where people have abandoned their TB treatment, because they have been billed for the HIV portion of it, within a couple of weeks of starting it and walked out into the community still infectious to both conditions and with TB quite possibly multi-drug resistant because of partial treatment. That is a very immediate concern. This is about a change of regulations, not primary legislation. I think it would be something that could be put in with the next set of regulation changes which we know are about to happen, and I think it is really important we encourage the Government to put the public health of the nation first on this.

  Dr Sesay: We would encourage politicians to be conviction politicians.

  Q63 Chairman: That is a pretty old-fashioned concept!

  Dr Sesay: I know this can be extremely difficult with an upcoming election, but I think that, if politicians are provided with the evidence, I would encourage them, no matter how difficult it is, no matter . . . well, I do not want to say no matter what the political price, because that may well be a high political price to pay, but, when they are presented with the evidence, it is a case of arguing out the evidence and establishing a policy, putting in place a policy that is based on the evidence. One of the things we discussed at the Independent Advisory Group of the Sexual Health Strategy a couple of days ago was exactly that, that we know that sometimes the political terrain can be extremely hazardous for politicians, but if it is based on firm evidence they should be able to get the facts across, and we can only encourage politicians to go down that route.

  Chairman: We are most grateful to you. Thank you very much for your evidence.

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