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

    Something major happened in the NHS in February. No, not the new White Paper on rearranging the furniture; something else. This was the announcement, or lack of announcement, that a large number of GP Practices have been taken over by a US Health Insurance giant – Centene. AT Medics, a London based GP group, which runs 37 practices, has essentially been bought out by Centene. This means overnight hundreds of thousands of patients woke up with a new GP provider, without their consent. The acquisition makes Centene the largest provider of General Practice in England with 69 practices.

    The way this has happened follows a pattern seen in recent years. No consultation or public scrutiny; use of legal loopholes; and the use of the revolving door of ex-NHS leaders who know the system as gamekeepers turned poachers. It is possible by a sleight of hand similar to the methods of the cuckoo. The incoming company adds or replaces directors of the ‘host’ organisation, which technically still exists so keeps its NHS contracts, just as a cuckoo displaces the host’s chicks out of the original nest.

    The significance is twofold.

    Firstly, deep and comprehensive commercial involvement in our NHS is troubling. In this case the US health insurer is not only now the largest provider of GP services in the country, it also is providing contracts to NHS England and Integrated Care Systems to advise how they run the NHS – nationally and locally. This gives great insight into the decision makers and influence over how the money is spent. Combined with Centene having a major stake in private hospitals, it is not hard to join the dots- involvement in the design of systems, financing of services and the provision of services gives companies a great degree of involvement in our NHS.

    Secondly these developments are a logical conclusion to major changes for some years in the way family doctors services are organised and delivered. As a GP I have huge concerns and patients will do as well. Why does it matter?

    When invited in Parliament by his shadow, Jonathan Ashworth, to condemn the takeover, Secretary of State Matt Hancock declined, replying: ‘What matters for patients is the quality of patient care… what matters to people is the quality of care. That is what we should look out for’.

     Is he correct? Is the quality of care all that matters? Or do the people providing it, and their ethos, motivation, interests and agenda matter? Is it possible to disentangle ‘quality’, an abstract notion, from the specific people providing a service and their very non-abstract interests?

    One of the reasons I became a GP, and probably the major reason I have stayed in my practice working full time for nearly 15 years, is the deep-rooted feeling that I have of being part of something more than just a clinical service. Myself and my GP colleagues, similar to many across the country, both lead the service and work in it. Every day we see our patients and work in our communities, we know the people and the community. There is no escaping direct and sometimes blunt feedback. Our teams are small, if there is a problem, we are around to fix it. If something needs to change, we don’t need to enter into a large corporate machine for it to happen. We get the spanner out and make the adjustment.

    Can we really say the same for a company that has its eye on more than just providing a ‘good quality’ GP service for the 69 different sites it has control of? There are those who compare health care to supermarkets, or banks. The argument is that efficiency and scale are what is needed; the people who provide it can change and the patient-doctor relationship isn’t a problem, as long as the measurements prove ‘quality’. This may work for a simple transactional arrangement, such as buying some groceries or cashing a cheque, but healthcare – and especially holistic primary healthcare is a more complicated than that. It does matter who cares. It is all about the people, their motivations and their relationship with their patients and community. This is not to say that UK General Practice can’t be improved, but let’s at least keep the baby if we are changing some of the bathwater.

    If anything, General Practice feels more like farming than retail. When done well, looking after the health of the community well takes time, and deep commitment. When done badly it can result in destruction of the environment and soulless communities. Will this new huge, commercial type of model of healthcare care about this?

    I doubt it.

    https://www.theguardian.com/society/2021/feb/26/nhs-gp-practice-operator-with-500000-patients-passes-into-hands-of-us-health-insurer

    https://hansard.parliament.uk/commons/2021-02-23/debates/7CDE78FD-D275-41D3-B02E-D7690F054DB1/TopicalQuestions

     

    US Centene expands in the UK with increased stake in Circle Health

    2 Comments

    Posted by Jean Smith on behalf of Labour Trans Equality

    05.3.21

    First some background. NHS England Commissions GIDS (The Gender Identity Development Service) at the Tavistock & Portman NHS Foundation Trust. GIDS accepts referrals of young people with the features of gender dysphoria up to the age of 18 in England and Wales. The service at Tavistock & Portman in London has a regional centre in Leeds and satellite clinics in Exeter, Bristol and Birmingham.

    As a result of representations, to the Care Quality Commission (CQC) including by the Children’s Commissioner, the CQC undertook a focused inspection of GIDS in October and November 2020.  This resulted in a rating of Inadequate for the service..

    The CQC report presents a sobering picture of a service under considerable pressure. It finds that at the time of the Inspection the service was working with 2093 young people with a further 4677 young people on the waiting list resulting in a waiting time of at least 2 years for access to the service.

    While these figures would be cause for concern for any NHS service it is what lies behind them in terms of safeguarding and the risk to these young people which is most important and worrying. It is worth quoting directly from the CQC report….

    “Many of the young people waiting for or receiving a service were vulnerable and at risk of self-harm. The size of the waiting list meant that staff were unable to proactively manage the risks to patients waiting for a first appointment”.

    This is currently the reality for thousands of young people and the background to the current debate about the desirability of providing access to “hormone blockers” to young people below the age of 16 and cross sex hormones for young people from the age of 16. A debate heightened by divergent views about the legitimacy and safety of such therapies which has crystallised leading up to the recent Bell v Tavistock Court Case and its outcome now subject to Appeal. The case hinged on the role of parental consent in the treatment of trans children and young people Its impact has been significant for access to treatment and will remain so pending a conclusive outcome to the Appeal. (See commentary on the case by Robin Moira White & Nicola Newbigin of Old Square Chambers)

    This debate about treatment at GIDS frankly rather misses the point. In reality the number of young people currently being prescribed “hormone blockers” and cross sex hormones  at GIDS is less than a hundred. The NHS England treatment protocol for prescription of hormone blockers and cross sex hormones is very strict and following the outcome of the court case has become more so.  Meanwhile as the CQC report makes crystal clear thousands of young people are at varying degrees of risk because they are unable to access the diagnostic and clinical support which they desperately need from GIDS because of the size of the waiting list and the capacity of GIDS to assist them.

    It follows surely that if we are truly concerned about the care and wellbeing of a significant cohort of young people many of whom are at risk  this is what we must be focusing on.

    So what is to be done ? Simply we must focus on the reality rather than be influenced by myth and misinformation about the use of these treatments. Fortunately two key initiatives are now underway. Prior to the CQC Inspection NHS EI had already commissioned Professor Hilary Cass formerly President of the Royal College of Paediatric and Child Health to conduct a review. (The terms of Reference can be viewed on the NHSEI web site)

    Also and in response to the CQC’s findings, NHS EI is currently preparing proposals for establishing local support structures for young people seeking access to GIDS details of which will be revealed shortly. Implementation of these proposals will require support and engagement from people working with young people locally and especially in primary care.

    Meanwhile SHA members can play an important role in ensuring that the discussion about the care and support of these young people focuses on the realities facing thousands of them, their families and their carers and what must be done.  When NHS EI comes forward with its proposals for addressing this problem we must hope and expect that it will receive a positive response from primary care and local mental health services.

    References

    CQC Report

    Tavistock & Portman NHS Foundation Trust Gender Identity Service Inspection Report 20.01.21

    The Cass Review

    “Review of GID Services for Children & Adolescents”

    Click to access GIDS_independent_review_ToR.pdf

    Legal Commentary

    “What about Parental Consent in the Treatment of Trans Children and Young People”

    Nicola Newbigin & Tobin Moira White

    Click to access What-about-parental-consent-1.pdf

     

    Comments on this article can be sent to Labour Trans Equality at

    admin@labourtransequality.org.uk

    Website

    http://labourtransequality.org.uk/

    Comments Off on “Safeguarding Young Trans People; The Real Issues!”

    HIV i-Base continue to report on COVID-19 research and treatment as a supplement to HIV treatment research and information.

    Copying and distribution of i-Base infomation is encouraged – and free – but please credit HIV i-Base as source. You can see this Q&A here or read it below:

    Q&A on COVID vaccines: are they safe and effective?

    The following questions were for a community UK-CAB workshop on COVID vaccines. Answers by Angelina Namiba and Simon Collins.

    Are vaccines against COVID-19 effective?

    Yes, any approved vaccine has been very carefully studied in  a wide range of people.

    These first vaccines are highly effective. Both the Pfizer and Moderna vaccines prevent COVID symptoms in 95% of people. They also prevent severe COVID-19.

    These vaccines are much better than first thought possible. Early in 2020, a vaccine would have been approved if it was only 50% effective.

    Which vaccines are being used in the UK?

    The only vaccine that is currently approved in the UK is called BNT162b2.

    It is made by Pfizer/BioNTech. It was approved in the UK on 2 December and in the US on 12 December 2020. A second similar vaccine, developed by Moderna/NIH has just been approved in the US. It will also be approved in other countries too. The EU plans to approve these two vaccines within the next few weeks.

    However, other vaccines are being used in UK studies (see below). These include a vaccine from Oxford University and Astra-Zeneca called ChAdOx1. Another study using a Janssen vaccine is just starting. As new vaccines are approved we will add them to this page.

    Why should I get a vaccine?

    The main reason to get the vaccine is to protect yourself against COVID-19.

    COVID-19 can be deadly – it is much better to be protected. Even people who recover from COVID-19 often have symptoms that last for many months. This is called long COVID and is still being studied.

    If you have been offered the vaccine it is because of your personal level of risk. The vaccine may also protect your friends, family and contacts at work.

    Is my risk high enough to need the vaccine?

    Yes, there is only a limited supply of these vaccines. In the UK, for at least the next few months, you will only be offered the vaccine if your personal risk is high.

    This will be because of your age and your health or because you work in a high risk job.

    Do I have to get the vaccine?

    If the vaccine is for your own health, then this is always still your choice. You do not have to have the vaccine.

    Please talk to your doctor if you have any worries or concerns. Or if you’re unsure about having the vaccine.

    If you are offered the vaccine because of your job, not having the vaccine might affect the work you can do.

    Are vaccines against COVID-19 safe?

    Yes, based on the results from large studies, any approved vaccine will also be very safe.

    For example. the Pfizer vaccine was studied in more than 44,000 people without any serious side effects.

    There are only a few situations when this vaccine needs to been given more carefully. This includes people who have a history of serious allergy reactions to different foods or medicines – as with other vaccines. In this case the vaccine should only be given where there is medical support in case this reaction occurs.

    How do we know the vaccine is safe?

    Technically, no medicine or vaccine can be proved to be safe! This is because we can’t measure safety, we can only measure risk.

    So instead of saying something is safe, it is more accurate to describe the risk. With COVID vaccines we can say there is a very low risk of side effects.

    Compared to the very real risks from COVID-19, using the vaccine is much safer than not using it. This is known from research studies in tens of thousands of people. The studies recorded every side effect or any potential side effect.

    Additional safety data comes after the vaccines are used outside of studies. This will include from people who were not included in the main studies. This led to a caution in people with history of serious allergic reactions (see next Q).

    What if I have a history of allergy reactions?

    As in the question above, even people with a history of serious reactions can still use the vaccine. This includes people who have reactions to vaccines, medicines or foods.

    However, if you currently need to carry an anti-allergy syringe, you need to be vaccinated in a clinic in case a reaction occurs.

    Two health workers in the UK with a history of severe reactions did react to the vaccine. Both people have now recovered. More information will be collected on cases like this.

    Can I develop an allergic reaction to the vaccine?

    Yes, although the risk is small and relates to your history of allergies.

    For the Pfizer vaccine, anyone with a history of severe allergy reactions should have the vaccines in a setting that can safely manage reactions.

    What about if I have immune suppression from HIV or cancer treatment?

    Yes, the vaccine is still recommended if you are HIV positive or if you have cancer. This is because of the high risk from COVID-19.

    Although the leaflet that comes with the vaccine includes talking to your doctor first if you have a reduced immune system, this is not related to a safety of the vaccine. It is because the protection from the vaccine might not be as strong.

    This means that even after both doses of the vaccine, it will still be important to be careful, for example by wearing a mask and social distancing.

    As more people are vaccinated, researchers will look at responses in people who were not widely included in studies.

    What if I have other inflammatory or autoimmune conditions?

    As above, the vaccine is still recommended for people living with inflammatory or autoimmune conditions.

    In this, it is very similar to getting a flu vaccine. Anyone who can use the flu vaccine can use a vaccine against COVID-19.

    These include:

    • Inflammatory rheumatic diseases (rheumatoid arthritis, axial spondyloarthritis, lupus).
    • Inflammatory bowel disease (Crohn’s disease and ulcerative colitis).
    • Psoriasis.
    • Multiple sclerosis.
    • Organ transplant recipients.
    • People on chemotherapy.

    This is because of the high risks from COVID-19.

    Although many people with these and other complications were not directly studied in vaccine studies, there is no safety concern. As above, the caution is that the vaccine might not be quite as effective.

    Ongoing research though will be looking at this.

    Does the vaccine interact with other medicines?

    No. There are no medicines that can not be used with these vaccines. If you are taking other treatment, there is no need to stop this to have a vaccine.

    Although it is good to ask about interactions with current medicines, there are no interactions with the vaccines. If you are worried, it is easy to double-check this with your doctor.

    Your doctor will also know your medical history and whether one type of vaccine might be better for you than another.

    Could the vaccine interact with my HIV meds?

    There are no interactions between the COVID-19 vaccines and HIV meds.

    Will my HIV viral load blip when I have the vaccine?

    Technically though, there is not enough results from HIV positive people in the first vaccine studies to report this yet, though this will be reported later.

    However, based on other vaccines this is unlikely to happen.

    Any vaccine has the potential to increase viral load for a short time. This is the same as to any active infection (including flu and colds).  As with the answer to other questions here, it is okay to approach the COVID vaccination as if it was the annual flu vaccine – which is widely recommended for people living with HIV.

    If your viral load is generally undetectable any increase is likely to be very small. For example, with the flu vaccine, it might increase from less than 50 to maybe 80 or 100 copies/mL – and only for a few days or a week. This is too low to affect the risk of transmission.

    Other vaccines, for example for hepatitis B, don’t cause HIV viral load to blip.

    As a guide, unless you get symptoms from the vaccine, your HIV viral load is likely to stay undetectable. If you get symptoms, any small blip is likely to be undetectable again within a week.

    Can the vaccine interact with estrogen and/or testosterone treatment?

    There are no interactions between the COVID-19 vaccines and estrogen and testosterone.

    Are the vaccines safe in pregnancy?

    Great question. So far there is little data because pregnancy was an exclusion for the main studies. But if you are pregnant, the vaccine is still recommended.

    Also, women will still have become pregnant during these studies – and certainly afterwards. These data will all be collected during the study.

    When these data are available they will be widely publicised.

    Other studies are looking at vaccine responses during pregnancy.

    Are the vaccines safe in children?

    So far vaccines have only been studied in people who are aged 16 and over.

    Further research is planned to look at younger people.

    What is in the vaccine that they are going to offer me?

    None of the COVID vaccines in the UK contain any live viruses. There is no risk of catching coronavirus from the vaccine.

    The active parts of a vaccine though only use a protein from the outside of the coronavirus. Or they tell your boby how to make these proteins.

    This will not cause an infection though.

    Vaccines also include other ingredients that help the vaccine work. For example the Pfizer vaccine contains traces of sodium and potassium. This is sufficiently low to still be called sodium-free and potassium-free.

    It also contains sucrose and this, together with all other ingredients, is listed on the patient leaflet that you get before the injection. This is also online now if you want to check first (see fruther information in the final question).

    How is the vaccine given?

    The Pfizer vaccine is given as an injection into your upper arm. A second booster dose is given again, three weeks later. You reach the best protection seven days after the second dose.

    Do I still need to social distance after the vaccine?

    Yes, so far, it is still better to reduce the risk of catching coronavirus.

    A few people might not be protected by the vaccine. We also don’t know how long protection will last. You might also still become infected without symptoms. You could then pass this to other people.

    Even after the vaccine, please continue wearing a mask. Please continue recommendations for social distancing.

    Can I get COVID-19 from the vaccine?

    No. This is easy to answer.

    There is zero risk of getting COVID-19 from the vaccine.

    The vaccines do not contain coronavirus itself.

    What are the symptoms/side effects from the vaccine?

    Most side effects to the Pfizer vaccine were mild or moderate.

    Very common side effects were similar to getting the flu vaccine. They generally got better within a few days. These were reported by more than 1 in 10 people.

    • Pain at injection site.
    • Tiredness.
    • Headache.
    • Muscle pain.
    • Chills.
    • Joint pain.
    • Fever.

    Common side effects included injection site swelling, redness at injection site, and nausea. These were reported in less than 1 in 10 people.

    Uncommon side effects, in less than 1 in 100 people included enlarged lymph glands or just generally feeling unwell.

    Am I going to get sick with the COVID-19 vaccine like the flu jab?

    No necessarily, but maybe. So far the COVID vaccine is similar to getting a flu vaccine. And just like the flu vaccine, the response will vary for different people.

    The question above shows that symptoms are similar to the flu vaccine and are nearly always mild.

    Should I wait to see how people similar to me react first?

    This is a good question – and sounds very reasonable. But within a week or two another 500,000 people will have used the vaccine in the UK.

    Any serious concerns will be reported long before you are likely to be offered the vaccine.

    However, if you are okay leading a very isolated life, then waiting is a choice. But if you still want to interact with people, then waiting will be more risky than having the vaccine now.

    How long will protection last?

    This will only be known with more time. Protection should last for at least a year and hopefully a lot longer. Some vaccines, for example hepatitis B and tetanus only need a boost every ten years.

    Which vaccine is best?

    So far, all the leading vaccines look very good. Getting access to any vaccine now is more important than which vaccine you use.

    What if I already had COVID-19? Does it matter where this was severe or mild?

    People who already had COVID-19 are still recommended to use the vaccine. It doesn’t matter how severe or mild this was.

    Will my GP or HIV doctor give me the vaccine? Can I choose?

    Who gives you the vaccine will depend on which vaccine is being used.

    The Pfizer vaccine will generally be given at health centres or hospitals. This is because of limits in how it can be stored.

    If you are offered a different vaccine in the next month or two, this might be given by your GP. This is early stage for the vaccines but it is unlikely to be your HIV doctor. You are not likely to be able to choose.

    Why should I get the vaccine if the person giving me the vaccines hasn’t had it yet?

    The decision on who gets the vaccine first are decided by an expert advisory group.

    If this group recommends you get the vaccine, then this is because your individual risk makes this important.

    Will the vaccine stop me catching COVID-19? Or just from getting ill? Or maybe both?

    The vaccine will definitely reduce risk of getting ill, but the answer is “probably both”.

    The vaccines are approved because they reduce symptoms of COVID-19.

    The first studies didn’t measure whether people caught coronavirus, just whether they had symptoms of COVID-19.

    Most mild symptoms later confirmed as COVID-19 were in people who didn’t get the vaccine. Importantly, nearly all the most serious cases of COVID-19 were also in people who got the placebo (inactive) injections.

    Technically, some people might still catch coronavirus and be infectious but without symptoms. This is still an ongoing research question.

    Studies with the Moderna and Oxford vaccines include some results showing that the risk of catching coronavirus is also reduced.

    Is the vaccine safe if I have other health problems as well as HIV?

    Yes, vaccines are recommended in people living with HIV and other health problems.

    The more serious your other health problems, the more important it will be to be protected from COVID-19.

    Can I get the vaccine if I have or have had hepatitis C?

    Yes, vaccines are recommended in people living with hepatitis C or who previously had hepC.

    Is the vaccine safe if I use chems like crystal meth, GHB or mephedrone?

    Yes, the vaccines do not interact with drugs used for chemsex.

    However, taking a break from the chems for the week of the vaccine will make it easier to know whether you get any side effects.

    If the social context for using chems means you are having more partners, the protection from the vaccine will be especially important.

    Is the vaccine affected by ethnicity? Will it affect me differently because I’m black/brown?

    No, vaccines studies include people of different ethnicities. They are created for everyone.

    Ethnicity does not affect immune responses or risk of side effects.

    Are black and brown people more at risk of getting side effects?

    No, as with the question above, ethnicity has not been linked to any better or worse outcomes.

    Have vaccine trials included black and brown men and women living with HIV? Or do the findings just relate to the experiences of HIV positive white gay men?

    Unfortunately, most vaccine studies only included very small numbers of people living with HIV. So far, the ethnicity breakdown of the HIV positive group has not been presented. All the HIV positive participants might be black and brown women.

    For example, the Pfizer study with more than 44,000 people only included about 120 people living with HIV. The results did not show that HIV as any impact on how the vaccines work.

    However, there is a lot more data about ethnicity.

    About 10% of the people in the US sites were black or African American. There were no differences in how well the vaccine worked or in side effects compared to the rest of the study population.

    Who approved these vaccines? Were the interests of my community represented?

    Vaccine are approved by the same organisations that approve medicines. They were approved for all people.

    • This is the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK.
    • In Europe it is  the European Medicine Agency (EMA)
    • In the US it is the Food and Drug Administration (FDA).
    • Other countries and regions have similar organisations.

    Each of these groups is made up of expert advisors who are mainly scientists and doctors but that sometime include community voices.

    The panels are responsible for representing interests of all people who are going to be using these products.

    The FDA is especially open as it publishes the detailed study results online for everyone to read. It also webcasts the meeting that decide on where a vaccine or medicine is approved.

    How do I know I’m being treated equally? How do I know this isn’t experimentation in black people?

    These concerns are very real. Nearly all countries still have structures that are not equal. Many have a history where people were treated differently.

    In the UK, this still affects access to important services that include education and medical care. This is even when there are policies to make access fair.

    However, ethnicity has been linked to higher risk of COVID-19 in black, Asian and minority ethnic (BAME) communities. This actually makes access to the vaccines even more important.

    As all the studies included people from all ethnicities. There is good data to show they are at least as safe and effective.

    COVID vaccines will be offered to people of all ethnicities. As has been seen in the news all ethnicities have the choice to use the vaccine.

    If the government didn’t protect me from coronavirus, why should I trust them with the vaccine?

    Perhaps luckily, the government are not directly involved in either producing the vaccines or in running the studies that look at how well they work.

    The government is also not directly involved in deciding which vaccines are approved.

    Whether or not you use any medicine or vaccine is a decision that you make with your doctor as an individual.

    I’ve experienced racism in the health system and receiving HIV care. How can you tell me this won’t be the same?

    I am sorry for any previous experiences within the NHS. I am also sorry if you have not been treated fairly in the past.

    Although I can not guarantee this will not happen again, there is a lot of information about how to deal with this.

    I can however provide information on COVID-19 and the vaccines. This shows that the benefits of the vaccine so far are much greater than the risks from not getting the vaccine.

    Why did we get a COVID-19 vaccine so quickly, but there is still no vaccine for HIV?

    There are two answers here.

    The practical answer is that the threat from COVID-19 were so serious that many more resources became available. The urgency of COVID-19 led to a larger budget – and luckily, this has been more effective than anyone first hoped.

    A more technical scientific answer is coronavirus is relatively stable. Unlike HIV the structure of the proteins doesn’t change and so a vaccine based on these proteins with continue to work.

    HIV is still a more difficult virus to overcome because it makes small changes every day. So HIV vaccines that might work very well on Monday will be out-of-date on Friday because of these small changes.

    HIV does have at least 30 approved treatments. These enable to lead long and health lives.

    There are many other infections where we also need new vaccines. Hopefully the advances for COVID-19 will help for other vaccines.

    If vaccines are now available, should I still join a study?

    This is an important question because other vaccines are still being studied.

    In the UK this includes a vaccine from Oxford University and Astra-Zeneca called ChAdOx1.

    Another study is due to start using a vaccine from Janssen.

    Joining one of these studies might let you get a vaccine before you are offered on from the NHS.

    If you do get offered an NHS vaccine after joining a study, you can still use the approved one. The study will tell you whether or not you got the active vaccine. The researchers can also study your response to the second vaccine.

    In practice, new studies will hopefully look at switching between different vaccines.

    If the vaccine is lifesaving, why is not available to everyone in the world?

    You are right, for a vaccine to be really effective, everyone will need to use it. This includes in all countries.

    Many organisations, including the World Health Organization (WHO), have been working all year to also make access fair.

    For example, the international COVAX programme is aiming to vaccinate two billion people during 2021. This includes more than 100 low and middle income countries including across Africa, Asia and South America.

    So optimistically, at some point, everyone will have access.

    In practice, high income countries that could afford the first commercial vaccines have bought most of the first stock.

    But some of the next stock during 2021 – and more importantly newer vaccines – will be available for the COVAX programme. This might not be until later in 2021 and 2022 though.

    Where can I get more information?

    The following links are to different sources for more information.

    i-Base run an information service if you have individual questions that you would like answered.
    https://i-base.info/qa

    i-Base report news about COVID-19 treatment and vaccines in a monthly bulletin.
    https://i-base.info/htb

    British HIV Association (for information about HIV and COVID-19).
    https://www.bhiva.org/Coronavirus-COVID-19

    UK patient information leaflet for the Pfizer/BioNTech vaccine
    (PDF)

    FDA 50-page document with detailed results on Pfizer vaccine.
    https://www.fda.gov/media/144245/download

    YouTube website to watch the US CDC hearings for COVID vaccines
    https://www.youtube.com/playlist?list=PLvrp9iOILTQYiZunwmtiIRt52poVP8D02

    Article on why vaccine is recommended for people with immune suppression and autoimmune conditions.
    https://www.medscape.com/viewarticle/942853

    Website for WHO COVAX programme for global access.
    https://www.who.int/initiatives/act-accelerator/covax

    The People’s Vaccine – a collaboration of large charities including Oxfam.
    https://www.oxfam.org/en/tags/peoples-vaccine

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    The NHS are running a survey on Integrated Care – your views.

    The link to the NHS  Consulation Hub is below.

    https://www.engage.england.nhs.uk/survey/building-a-strong-integrated-care-system/

    Many thanks to David Taylor-Gooby of the North East branch for bringing this to our attention.

    3 Comments

    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