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    Barriers which prevent people accessing health care, including charges and co-payments

    HIV charities, community groups, health professionals and activists have today written to Matt Hancock, Secretary of State for Health and Social Care.

    They write to express their profound concern at the decision to roll back the Secretary of State’s commitment on PrEP (Pre-Exposure Prophylaxis for HIV) in England.

    Last week it was announced that the budget provided to local authorities for the implementation of PrEP would be reduced from £16 million to £11 million.

    The letter says this budget cut for PrEP jeopardises the ability to fully roll-out the most powerful prevention tool to help fulfil Mr Hancock’s commitment to end HIV by 2030.

    The HIV sector has requested an urgent meeting with Mr Hancock to discuss his decision to cut funding for this important HIV prevention intervention.

    Please read the letter here:

    Letter to Matt Hancock from HIV sector – PrEP funding July 2020

     

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    The late 1980s and the early 1990s was a time when the HIV and AIDS pandemic was in the news and high on the political agenda.

    Professor Virginia Berridge, Director of the Centre for History in Public Health and author of AIDS in the UK, gives us this accurate and succinct historical context:

    An expert advisory group on AIDS (EAGA) had been set up in 1985 in the Department of Health with input from clinicians and scientists involved. The Chief Medical Officer, the main public health government official, Sir Donald Acheson, led the group. Despite the level of expertise, the committee faced many problems. They included the attitude of sections of the press, which called for a punitive response to HIV/AIDS. An initial lack of political interest and the danger that, if political interest were awakened, the Conservative government led by Prime Minister Margaret Thatcher might take a punitive stance. Issues such as segregation and quarantine were freely talked about.

    In 1986, a sense of national emergency materialised, and developed high-level political interest on the subject. A Cabinet committee on AIDS was set up, a major health education campaign was initiated, funds were released for research, and the main health education body, the Health Education Council, was reformed as the Health Education Authority. Despite this progress, there were still powerful calls for a punitive approach, such as when the Chief Constable of Greater Manchester, James Anderton, spoke of people ‘swirling in a human cesspit of their own making’. However, the general tenor of the government response was pragmatic – focussing on safe sex rather than no sex, and safer drug use rather than no drug use. This liberal response was influential at the international level too and was promoted through AIDS specific organisations set up as part of the World Health Organisation (WHO) and the United Nations (UN).

    Source https://commons.wikimedia.org/wiki/Category:Epidemiology_of_HIV/AIDS

    In South East London, the local HIV groups were formed in response to the direct experiences of people who faced barriers accessing health and social care. These specialist organisations included the Positive Place in Deptford – which started in an office in Sydenham where Cllr Alan Hall was a volunteer.

    Sydenham is a very interesting area. Geographically it is on a hill which has a ridge with its apex at Crystal Palace. Crystal Palace is the place where five local authorities meet – the boundaries of London Boroughs of Bromley, Croydon, Lambeth, Lewisham and Southwark.

    Locally, social services are provided by Councils and health services were overseen by regional health authorities at this time. The provision of HIV services were very variable and much of the work and support was provided by specialist sexual health clinics at the major London teaching hospitals. Hospital social work could provide some support but the end of life care and care at home fell to the patients’ home local authority.

    By 1991 the Government had put in place a ringfenced Government Grant called the AIDS Support Grant (ASG) – this was to recognise the additional resources needed to provide services for people with AIDS.

    AIMS OF THE GRANT SCHEME

    To enable Social Services Departments to draw up strategic plans, based on local population
    needs assessments, for commissioning social care for people with HIV/AIDS; and to enable Social Services Departments to finance the provision of social care for people with HIV/AIDS, and where appropriate, their partners, carers and families.
    The grant is to assist local authorities with the costs of providing HIV related personal social services.

    At the Positive Place – then in Sydenham – we became aware that people with HIV were having problem accessing social services in Bromley. There were general comments and complaints in the other neighbouring boroughs however, in Bromley people were routinely refused a social service.

    After extensive enquiries and local research, a meeting with Bromley Social Services Committee Councillors was arranged and a briefing document produced. Richard Cowie, the Clinical Nurse Specialist for South East London Health Authority, David Thomas a Trustee of the Postive Place which had established as a centre for people with HIV in SE London based in Deptford – joined Alan Hall who had become a member of the Bromley Community Health Council and set up Bromley Positive Support Group in Beckenham.

    The first section is instructive it is called: NO AIDS HERE

    “The first response to deny HIV services is that there is ‘no demand’ for them. In effect, this means no AIDS in Bromley. In 1992 this was the reason used by the London Borough of Bromley for not applying for AIDS Support Grant. Every District Health Authority must submit returns regarding the number of HIV infections and AIDS related deaths yearly and much more detailed information under the provision of the AIDS (Control) Act 1987.”

    “The figures are collated in a technical manner and require considerable caution interpretating them. However the latest report for Bromley (1993/4) shows that there are ’48 people living with HIV infection and 2 babies of indeterminate status’.

    “It is accepted that this is an underestimate. This includes people who attend Bromley Hospitals or services. It does not include all the people attending specialist centres of excellence, eg Middlesex Hospital, King’s College Hospital, St Thomas’ Hospital, Chelsea & Westminster….of which we know there are several cases. We estimate that there are at least 60 cases – this does not include their families, partners or carers. The no AIDS in Bromley is a myth. Indeed, the Department of Health classifies Bromley as a “moderate” prevelance area.”

    “Frequently, AIDS in Bromley has been dismissed as a small number of cases, insignificant. This is a favourite argument of Cllr Cooke. Clearly, 60 people with HIV plus their families is not a small number. Contrast this with the number of people receiving intensive personal care – this is in the order of 70 people.”

    The conclusion of the document states: “All of the myths, I am sure you will find have their root in prejudice and bigotry.”

    Whilst the Positive Place was in Sydenham the local MP, Jim Dowd agreed to ask a Parliamentary Question. This question revealed that Bromley Council had failed to apply for its indicative allocation of AIDS Support Grant in 1992-3.

    Hansard records the written parliamentary question on 14th January 1993:

    AIDS
    Mr. Dowd : To ask the Secretary of State for Health (Virginia Bottomley)

    (1) on what date the London borough of Bromley applied for AIDS support grant for the current financial year ; and what efforts have been made by her Department to urge Bromley to apply for it ;

    (2) what amount of AIDS support grant was allocated to each local authority in each year since 1990-91 :

    (3) what extra costs she estimates to have been incurred by neighbouring boroughs obliged to deal with HIV/AIDS cases turned away by Bromley social services department ; and what steps she proposes to take to recompense the neighbouring boroughs ;

    (4) by what date London boroughs should apply for the AIDS support grant for 1993-94 ; and what steps she will take to ensure that the London borough of Bromley applies for the grant on time ;

    (5) how many people in each London borough have died from AIDS :

    (6) how many cases of HIV have been reported in the borough of Bromley in each year for which figures are available.

    The Minister for Health, Tom Sackville, MP replied:

    Mr. Sackville : In December 1991 the Department issued a circular (LAC(91)22) inviting all social services departments in England to bid for extra resources for HIV and AIDS services in 1992-93 under the AIDS support grant scheme. Criteria for bids under this scheme are set out in the circular. Copies are available in the Library. The closing date for bids was 7 February 1992. The London borough of Bromley submitted an application in November 1992 although not in the form and detail set out in departmental guidance. By that time AIDS support grant moneys had been fully committed. The Department was, therefore, unable to allow Bromley’s bid to proceed. Although not in receipt of AIDS support grant money in 1992 -93, we understand that the London borough of Bromley plans to spend £15,000 on HIV and AIDS services in the current year. We have no information to suggest that the borough has been compelled to turn away people affected by HIV.

    For 1992-93 local authority social services departments will again be invited to apply for an AIDS support grant allocation. The closing date for applications will be 8 February 1993. It will, of course, be open to the London borough of Bromley to bid for funds under this scheme.

    Information on the number of HIV and AIDS cases reported in individual boroughs and of deaths is not held centrally.

    The table shows the AIDS support grant allocations which have been awarded since 1990-91 for a full list in England see Hansard.

    Allocations for Individual Authorities in London are shown.

     

    London Borough Grant 1990-1 Grant 1991-2 Grant 1992-3
    Camden 471,000 489,840 730,000
    Hammersmith 1,003,359 1,042,000 1,300,000
    Kensington 627,500 652,600 970,000
    Lambeth 551,000 573,040 930,000
    Westminster 625,000 650,000 940,000
    Brent 290,000 290,000 400,000
    Ealing 250,000 260,000 290,000
    Greenwich 136,280 136,280 190,000
    Hackney 322,500 335,400 460,000
    Haringey 357,500 371,800 500,000
    Hounslow 231,250 240,500 320,000
    Islington 235,000 244,400 360,000
    Lewisham 163,750 170,300 240,000
    Richmond 135,000 140,400 200,000
    Southwark 215,000 215,000 300,000
    Tower Hamlets 309,000 321,300 481,000
    Wandsworth 165,122 120,152 188,000
    Barking 14,000 17,173 32,236
    Barnet NIL 26,000 40,000
    Bexley 25,000 26,000 46,000
    Bromley 8,500 9,520 NIL
    City of London 25,000 26,000 47,000
    Croydon 24,500 30,000 49,000
    Enfield 14,938 16,702 50,000
    Harrow 25,000 26,000 42,000
    Havering Nil Nil Nil
    Hillingdon 23,207 35,000 120,000
    Kingston 25,000 26,000 64,000
    Merton 14,000 17,178 66,000
    Newham 72,500 110,000 250,000
    Sutton 22,260 30,000 57,000
    Waltham Forest 70,000 90,000 135,000

    The Boroughs are listed in prevalence order and grant awarded

    Alan Hall followed up the lack of funding and more importantly, the lack of a strategy in 1993. On 11th October he received the following reply from Baroness Cumberlege, Parliamentary Under Secretary of State for Health in the Lords, this said: “The Department is aware that there has been an absence of a clear HIV/AIDS strategy in Bromley and has been monitoring the situation.”

    If the Government were aware, why didn’t they act?

    Perhaps, we will never know the answer to that. But the refusal of Bromley Council’s social services Committee members to allocate funding and support proposals for a change in direction led to protest.

    The community activists in Outrage knew that Bromley Council were resisting change and they decided to mount a protest. Activists enetered the Council Chamber, chanting and holding placards. Labour and Liberal Democrat Councillors stayed in the Chamber whilst shocked tories walked out. The photograph below was taken by the acclaimed photographer, Gordon Rainsford.

     

     

    Outrage in the Bromley Council Chamber

    The Pink Paper carried a report of the protest with the headline: “Tory Mayor flees AIDS protesters in Bromley”.

    Outrage alleged that the Mayor of Bromley, Cllr Edgington attacked one of its members. This is particularly interesting as this is believed to be a counterclaim, when the Mayor of Bromley made a complaint to the Police that one of the protesters drank from his glass thereby assaulting him.

    The fifteen activists held a “die in” where they laid down in the Council Chamber and held tombstone shaped placards with slogans such as killed by Bromley neglect.

    In the press report, the case of a 28 year old man who was refused a home help and told to ‘try a private nursing home’ a day before he died is raised.

    Daniel Winchester a local resident said that Bromley Council had shown ‘contempt’ to the ill and dying over the last ten years of the pandemic.

    The independent voice of social workers – Community Care – carried an article on HIV and AIDS social service provision in March 1993 saying: “Bromley Social Services is behind with its HIV work. It’s bid for 1992-3 was late, so it did not benefit from the 50% increase and that there was great pressure to meet the standards for grant status.” In response a senior Bromley Council social services manager is quoted as saying: “Our services are pretty thin on the ground in this area.”

    Leaders in the social work profession at the time, believed that there were additional benefits with specialised HIV services as they were ground breaking and that they benefit other areas of social work like confidentiality and increasing good practice more generally.

     

    Outrage blow fog horns and whistles to get attention from Bromley Council

    website link:  https://alanhall.org.uk/2020/06/30/bromley-council-and-hiv-the-fight-for-social-services/

     

     

     

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    On Friday 26 June 2020 HIV i-Base published the fifth COVID-19 supplement to HIV Treatment Bulletin (HTB). Please see this link.

    All i-Base reports are free to copy and i-Base encourages wide distribution. Please credit i-Base when distributing these reports.

     

    HIV and COVID-19: a new supplement to HIV Treatment Bulletin (HTB).

    This publication reviews the latest news on COVID-19, including research that is important for care of people living with HIV.

    All articles are online as html web pages. The PDF files use a single column layout that makes it easy to read each issue on tablets and other hand held devices.

    HIV and COVID-19 no 5 – (26 June 2020)
    HIV and COVID-19 coinfections including data from South Africa, dexamethasone effective in advanced COVID-19, hydroxycholoquine not effective in UK RECOVERY study, plus updates on remdesivir and other treatments…
    Contents online. (html pages)
    HIV and COVID-19 no 5 – 26 June 2020 (PDF)

    HIV and COVID-19 no 4 – (1 June 2020)
    HIV and COVID-19 coinfections, UK access to remdesivir, convalescent plasma, interferon, famotidine, tocilizumab, concern with hydroxychloroquine, UK research plus more…
    Contents online (html pages)
    Download: HIV and COVID-19 issue 4 (PDF)

    HIV and COVID-19 no 3 – (14 May 2020)
    Latest issue includes news on latest treatments, including US approval of remdesivir, plus tentative results with other drugs that reduce immune inflammation (anakinra) – perhaps as essential as antivirals – anticoagulants, ACE inhibitors. Plus latest guidelines and no effect from BCG vaccine.
    Contents online (html pages)
    Download: HIV and COVID-19 issue 3 (PDF)

    HIV and COVID-19: no 2 – (17 April 2020)
    The second supplement of HTB with more than 30 COVID-19 reports: hydroxychloroquine studies, antivirals, transmission and prevention research, online resources.
    Contents online (html pages)
    Download: HIV and COVID-19 issue 2 (PDF)

    HIV and COVID-2019: no 1 – (27 March 2020)
    This 20-page HTB supplement compiles links to articles and resources about COVID-19 including information for managing the care of HIV positive people. It includes short reviews of key studies and early guidelines.
    Contents online. (html pages)
    Download: HIV and COVID-19 issue 1 (PDF)

    Other news and resources on COVID-19 are at: i-base.info/covid-19

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    During the COVID19 pandemic, a lot of routine health provision has been suspended or reduced. As we plan to get get these back on track, lets not put prevention at the end of the  list, yet again. The SHA convened a group of its members with relevant expertise , who have developed a briefing on the risks to the public of the temporary reduction of prevention programs.

    Key Messages

    • Childhood vaccination programme: the recent increase in vaccination coverage after a long fall has now been thrown into jeopardy by COVID19, with little resilience in primary care and public health departments to systematically and actively promote catch up programmes.
    • Measles: there would be a significant risk of measles outbreaks because MMR coverage in England among children was well below the threshold required for herd immunity in most areas. Measles is highly infectious with an R0 of 16
    • Influenza vaccination programmes for children and adults will begin in September. It is vital to achieve a much higher uptake, to reduce the risks of having to manage a flu epidemic while COVID19 is still circulating.
    • Screening services should restart as soon as possible, with safety measures in place for patients and staff, and a plan for catching up all who have missed out
    • Sexual health and contraception: there is a serious risk of losing the excellent gains of the last Labour Government’s Sexual Health and Teenage Pregnancy strategies, after major cuts in the public health grant. We need a new sexual health strategy with a return to planning and collaboration rather than tendering of services
    • Prevention spend: The Government should restore public health expenditure in England to at least previous levels

    Prevention is so much better than cure: There are many prevention programmes designed to prevent and detect diseases at an early stage to stop them causing death and illness. These are some of the most highly cost-effective healthcare interventions; a review by NICE found that 85% of 200 case estimates of prevention programmes were cost effective. Vaccination programmes are the most cost-effective healthcare interventions

    Amazing efforts by staff: During the COVID19 pandemic, many services have been impacted through being suspended, or by reducing services. Some may also have been affected by the public reducing their uptake. Staff in public health programmes have been going to heroic lengths to deal with the pandemic while keeping essential preventive services going

    The paltry and reducing investment in prevention and early diagnosis is now under greater threat There is a high risk that prevention programmes will lose out for investment when finances are reduced, as will happen during the coming recession. Many of these programmes have already been deeply affected by austerity, in particular those commissioned by Local Authorities in England.

    Recovery plans: The NHS is attempting to restart, and this must be fully funded and adhere to principles of patient and staff safety and equity.  There has been a lot of great local integration and innovation in the face of a common threat, and this must be nurtured and not used as an excuse for cutting costs. Digital ways of working are not cheaper and not a replacement for face to face in many situations long term

    Emerging public health risks of suspending public health programmes FINAL

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    BASHH (The British Association for Sexual Health and HIV) reports significantly reduced service capacity during the coronavirus pandemic. They are monitoring this with an ongoing survey. Here is the most recent set of results dated 21 April 2020. You can click through to read the full results on the link below or on the BASHH site.

    The British Association for Sexual Health and HIV (BASHH) are running an ongoing survey during the coronavirus pandemic to understand how sexual health services are being impacted and where pressures are emerging.

    The most recent set of results found that service capacity has been significantly reduced with 54% of sites closing in recent weeks, and the majority of respondents (53%) stating they had less than 20% capacity for face-to-face services. Staffing levels have also dramatically shifted to cope with COVID-19 provision, with a drop in available staffing of around half compared to the baseline figures. At the time of responding, members said that 38% of staff had been redeployed and 17% were shielding, isolating or are ill.

    The survey results show that vulnerable populations are particularly at risk during this time, with almost 1 of 5 respondents saying they were only able to offer limited, or no care at all, to this group. Other challenging areas appear to be delivery of routine vaccinations (54% unable to provide) and provision of LARC as preferred contraception (54% unable to provide). 9% said they were unable to maintain PrEP provision.

    A new round of the survey will be circulated in the near future to help identify any changing trends and to provide latest insights which will be shared with national health leaders. Huge thanks to all members for their invaluable contributions so far.

    To see the full results from the first round of the survey click here.

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    The attached advice from the Faculty of Sexual and Reproductive Health provides details about the changes to provision of sexual and reproductive healthcare during COVID-19. It includes what type of care women can expect and how to get it – for example, how to get normal contraception prescriptions or treatment during the pandemic.  

    A link to the document is provided below, and a copy is also attached.

    FSRH has launched a comprehensive advice document for women seeking sexual and reproductive healthcare during the COVID-19 pandemic.

    The advice aims to inform and empower women to make the best choices for their sexual and reproductive health. It details the changes to provision of sexual and reproductive healthcare during COVID-19, including what type of care women can expect to access and how they can access it.

    FSRH – COVID advice-for-women-seeking-contraception-and-srh-during-covid-by-fsrh

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    Many migrants, refugees, and people with insecure immigration status in the UK will be particularly at risk during Coronavirus, due to lack of or restricted access to council services, healthcare, and housing.

    JCWI, Migrants Organise, and Medact have put together a short guide for Mutual Aid groups to consider how best to support at risk migrants. Please share this far and wide!

    https://docs.google.com/document/d/11cKMCy08ebN-lJQsP1jvsTcSfwC6YeE8FYrmAZCoZ1w/mobilebasic

     

    Some resources and information from the guide

    Docs Not Cops health rights advice

    • Advice from NHS 111, and treatment in a GP surgery or A&E department, are always free
    • There is no charge for examinations or tests to find out if a person has coronavirus.
    • There is no charge for hospital treatment for confirmed coronavirus

    For more information, contact docsnotcops@gmail.com and jamesskinnner@medact.org. 

    Doctors of the World

    • Free helpline for healthcare advice to people, regardless of immigration status: 0808 1647 686 from 10am to 12 midday, Monday to Friday
    • Coronavirus (COVID-19) advice for patients in 45 languages, produced in partnership with the British Red Cross. Download here: https://www.doctorsoftheworld.org.uk/coronavirus-information/#

     

    Changes to asylum and immigration process during COVID-19

    • Check updates here and here
    •  No Recourse to Public Funds Network have up to date information on changes to NRPF rules during COVID-19 here

     

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    2 informative and extremely worrying videos from our Vice Chair, Dr Brian Fisher on the dire state of social care in England.

    Video 1: the current state of social care.

    This brief video, made for Reclaim Social Care, outlines what social care is and how it operates at the moment in England.

    https://photos.app.goo.gl/6kqUa7nbCjg2CEjt9

    Video 2: the impact of the cuts to social care:

    This brief video, made for Reclaim Social Care, outlines the impact of the cuts to social care. It ends with a plea to avoid voting Tory – sadly, that aspect is redundant now. The Tories have pledged more money for social care and that is likely to make a difference. But not enough to change things significantly on its own. And as the IFS says, austerity is “baked in” to a swathe of Tory plans.

    https://photos.app.goo.gl/W2cZz5h7WRbW9v2S8

    3 Comments

    This article was first published by Simon Collins at HIV i-Base on 2 September 2019.

    On 2 September 2019, leading HIV charities including HIV i-Base and the UK-Community Advisory Board (UK-CAB), published an open letter to Rt Hon Amber Rudd MP in her capacity as Minister for Women and Equalities, calling for an urgent intervention to include sexual health in the upcoming Government Spending Round. [1]

    In England, the responsibility for sexual health was disastrously shifted from the NHS to local authorities, whose public health budgets have been cut in real terms by £700 million over the last five years.

    These cuts have directly reduced access to sexual health services, where many people are unable to routinely access treatment and testing due to limitations in allocation of daily appointments.

    Many of these cuts disproportionately affect lesbian, gay, bisexual and transgender (LGBT+) and black and minority ethnic (BAME) communities, and young people.

    A similar joint letter calling for increased funding for sexual health was also sent today by LGBT+ groups from the Labour, LibDeb and Conservative parties.

    Last year, a review of services in South London reported that 1 in 8 people with symptoms were being turned away from sexual health clinics. This included 40% who were under 25 years old and 6% who were under 18.

    References

    1. Green I et al. Urgent request to intervene: Funding for sexual health services. 2 September 2019.
      http://www.tht.org.uk
    2. Collins S. Almost 1 in 8 people with symptoms turned away from sexual health clinics in SE London: 40% are under 25 and 6% under 18 years old. HTB 01 May 2018.
      http://i-base.info/htb/33968

    Please see this Press Release from BASHH (British Association of Sexual Health and HIV) and BHIVA (British HIV Association) from October 2018: Government funding cuts leave sexual health and HIV care at ‘breaking point’

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    Today the Mail on Sunday published an article headlined ‘HIV treatment now costs NHS as much as breast cancer – Fears £606m annual bill for sexually transmitted disease is fuelled by flood of foreign health tourists‘.

    The only views to ‘balance’ the diatribe published in the paper and online was a short rebuttal from BHIVA  (British HIV Association) and NAT (National AIDS Trust) as well as a short statement from NHS England on how costs for HIV treatment are actually reducing:

    A spokesman for the BHIVA said: ‘In the UK, new diagnoses of HIV are now falling because of the success of testing and treatment.’

    An NHS England spokesman said the cost of HIV treatment had fallen £28 million from £634 million in 2017/18 to £606 million in 2018/19.

    A Department of Health spokesman said: ‘We’ve seen a decline of almost a third in new HIV diagnoses in the UK in recent years.

    ‘As with all other serious infectious diseases, we do not charge overseas visitors for treatment for HIV as, if left untreated, there is a significant risk to others in this country.’

    Deborah Gold, chief executive of the NAT, said: ‘The concept of health tourism for HIV treatment is an outdated myth.

    ‘It is actually a problem that we have such long average delays, usually years, between migrants’ arrival in the UK and them accessing HIV testing and care.

    ‘Universal availability of HIV treatment is a cornerstone of the response in the UK. Any suggestion this is a poor use of NHS money, or that access to treatment should be limited for anyone, is outrageous. In fact, it is evidence of the NHS at its best: saving lives and preventing ill-health.’

    UK-CAB (the UK Community Advisory Board) responded to the article via this tweet with the following statement:

    “The UK is a world leader in reducing the numbers of new HIV diagnoses and one of only six countries to have already met the UNAIDS 90-90-90 targets. This achievement would not have been possible without upscaling HIV testing and providing immediate antiretroviral treatment to all people living with HIV in the UK.

    People with HIV on effective antiretroviral treatment cannot pass the virus on to their sexual partners or to their unborn child during birth and pregnancy. The investment in free HIV treatment for everyone with HIV is fundamental to meeting the Government’s commitment to end new transmissions by 2030.

    Stigmatising information like that reported in today’s Mail on Sunday only serves to hinder the UK’s response to the HIV epidemic. Whilst we have made huge strides in reducing new diagnoses by an incredible 28% between 2015 and 2017, the numbers of people diagnosed late is still too high.

    Late diagnosis not only increases the chances of premature death but also heightens the risk of HIV being unknowingly transmitted to sexual partners. We cannot tolerate attitudes which put people off testing and finding out their HIV status.

    People living with HIV should not be pitted against other patient groups or conditions.

    Access to treatment and care for all people living with HIV ensures that individuals can live well and in good health and also stops transmission of the virus to others. Any insinuation that denying HIV treatment to those without ‘settled’ status would be a benefit to the nation’s public health or NHS budgets is nonsense.”

    Please circulate this as widely as possible.

    1 Comment

    Patients still make enquiries at busiest hours, despite 24/7 online access

    · University of Warwick publishes first independent evaluation of one of the main providers of online consultation platforms

    · Targeting services at younger patients and those with general administrative enquiries could be most effective

    · “In reality, patients were seeking access to health care at the same times and for the same sort of problems than they did using traditional routes.” Says supervising author.

    Patients are using online consultations in the same way they would arrange a consultation via traditional means, a new independent evaluation by the University of Warwick reveals.

    Despite this, the study identifies several opportunities to tailor online platforms to specific patient requirements and improve their experience.

    Primary care researchers from Warwick Medical School have today (26 March) published the first independent evaluation of one of the main providers of online consultation platforms in NHS general practice. Published in the British Journal of General Practice, it provides independently analysed information on the types of patients that are using online triage systems, how and when patients are using this platform, and what they think of it.

    Online triage is a system in which patients describe their problems via an online form and subsequently are telephoned by a GP to conduct a telephone consultation or arrange a face-to-face consultation. Practices aim to respond within one hour of receiving the request.

    The researchers examined routine information from 5140 patients at nine general practices using the askmyGP platform over a 10 week period. Highest levels of use were between 8 am and 10 am on weekdays (at their highest on Mondays and Tuesdays) and 8 pm and 10 pm at weekends, mirroring the busiest time for patients contacting their practice via telephone.

    Supervising author Dr Helen Atherton, from Warwick Medical School, said: “With online platforms there is an assumption that having a 24/7 ability to make contact with a general practice will cater to those who wish to deal with their health problem at a convenient time, often when the practice is shut, and that being online means they will perhaps share different problems than they would over the telephone or face-to-face.

    “In reality, patients were seeking access to health care at the same times and for the same sort of problems than they did using traditional routes. This suggests that patients’ consulting behaviour will not be easily changed by introducing online platforms. Therefore practices should be clear as to exactly why they are introducing these online platforms, and what they want to achieve for themselves and their patients in doing so – the expectation may well not meet reality.”

    The NHS Long term plan sets out that over the next five years all patients will have the right to online ‘digital’ GP consultations. The main way these are being delivered is via online consultation platforms. The online platforms claim to offer patients greater convenience and better access and to save time and workload for GPs, however there is currently a lack of independent evidence about their impact on patient care and care delivery.

    Patient feedback analysed as part of the study showed that many found the askmyGP system convenient and said that it gave them the opportunity to describe their symptoms fully, whilst others were less satisfied, with their views often depending on how easily they can normally get access to their practice, and on the specific problem they are reporting.

    The study found that two thirds of users were female and almost a quarter were aged between 25 and 34, corroborating existing evidence. The commonest reason for using the service was to enquire about medication, followed by administrative requests and reporting specific symptoms, with skin conditions, ear nose and throat queries and musculoskeletal problems leading the list.

    The researchers argue that practices should avoid a ‘one size fits all’ approach to implementing online consultations and should tailor them to suit their practice populations and model of access, considering whether it is likely to add value for their patient population.

    Dr Atherton adds: “Individual online consultation platforms are uniform in their approach, patients are not. We found that patient satisfaction is context specific – online consultation is not going to be suitable for all patients and with all conditions and that one approach is unlikely to work for everyone.

    “Practices could focus on encouraging people to deal with administrative issues using the platform to free up phone lines for other patients. It could be promoted specifically to younger patients, or those who prefer to write about their problems and not to use the telephone. Clear information for patients and a better understanding of their needs is required to capture the potential benefits of this technology.”

    · ‘Patient use of an online triage platform; a mixed-methods retrospective exploration in UK primary care’ published in the British Journal of General Practice, DOI: 10.3399/bjgp19X702197

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    The Pharmaceutical Journal reports that the Good Law Project threaten DHSC with legal challenge over “failure to consult properly”

    From The Pharmaceutical Journal 21 FEB 2019 By Carolyn Wickware:

    The Good Law Project has warned the Department of Health and Social Care that it will start judicial review proceedings if serious shortage protocol powers are not revoked on the grounds that the consultation was “insufficient and unlawful”.

    A non-profit group has threatened the government with legal action unless it revokes new powers designed to allow pharmacists to switch patients’ medicines if there is a shortage.

    The Good Law Project has said it will start judicial review proceedings over newly implemented “serious shortage protocol” powers if the Department of Health and Social Care (DHSC) fails to remove the amendments in legislation by 25 February 2019.

    Amendments to the Human Medicines Regulation 2012, which came into force on 9 February 2019, mean the government can now issue protocols asking pharmacists to respond to a medicines shortage in one of four ways: to dispense a reduced quantity, a therapeutic equivalent, a generic equivalent or an alternative dosage form of the drug.

    Under the protocol, the pharmacist would not have to consult the patient’s GP before making the switch.

    The Good Law Project is now seeking to launch a judicial review of the amendments, partially on the grounds that the government’s initial consultation – which lasted one week on 5–12 December 2018 – was “insufficient and unlawful”.

    In a legal document sent on 19 February 2019 from the group’s lawyers to the DHSC to inform them of their intent to start the review proceedings, the Good Law Project said it was “unclear exactly who the Secretary of State consulted with and how/on what basis”.

    It added: “The failure to consult properly with organisations representing specific patient interests was unlawful.”

    Ekklesia reports:

    Jolyon Maugham QC, Director of the Good Law Project, said: “Both doctors and patients have proper concerns about their safety in the event of medicine shortages. We want the Government to withdraw the prospect of SSPs [Serious Shortage Protocols] until it has complied with its legal duties and consulted properly on their use. If the Government does not take this step, the Good Law Project will launch judicial review proceedings in the High Court.”

    Professor Tamara Hervey, Specialist Adviser to Parliament’s Health and Social Care Committee, said: “In the event of a no-deal Brexit, there would be likely to be shortages of medicines. The absence of a legal framework for imports and exports drastically affects supply chains. Stockpiling plans cannot cope for more than a few weeks. This is a serious issue for people needing a regular supply of a particular type, strength and quality of medicine.”

    Jane Hanna, Chief Executive of SUDEP Action, who is supporting the judicial review said “Patients, doctors and pharmacists are used to prescriptions and the processes surrounding them. For people with long-term conditions, like epilepsy, what is on the prescription may represent months and years of trying out the best medication schedule. Changes made to this delicate balance can for some, undo this in an instant. For epilepsy this could lead to less seizure control, impacting on quality of life (ie: losing a driving licence, affecting home and work) and significantly for some this can prove fatal.  At present if a supply of medication is made in error, lessons can be learnt because of the clarity of who signed and who supplied the prescription.

    Deborah Gold, Chief Executive of NAT (National AIDS Trust) said: “We are deeply concerned that these changes were made without proper consultation. Prescribing HIV medication is a complex process which must take account of a multitude of factors. The only person qualified to safely alter the medication prescribed to a person living with HIV is that person’s HIV consultant.”

    • The Pre Action Protocol Letter can be seen here

     

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