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Biggest challenge to HIV services is ‘merging the boxes’, experts warn

HIV services should look to specialties that have undergone organisational change as the problems faced are often relatable, it has been suggested.

Speaking the day before World AIDS day, Alex Baylis, assistant director of policy at the King’s Fund said yesterday: “A lot of the issues in HIV services are generalisable to other services.”

In 2013, prevention and treatment of HIV and sexual health moved from the NHS to become the responsibility of local authorities, whereas social care elements had always been in the hands of local authorities.

Sharing the experience of the transition of Hackney’s HIV and GUM services to local government, Professor Jane Anderson, HIV consultant, spoke at the King’s Fund’s Annual Conference yesterday.

With different elements of the service all in “separate boxes”, Anderson said that in her experience, the biggest challenge was to “merge the boxes.”

Not only that, but there was a difference in the language used amongst clinicians and local authorities, and in commissioning, contracting and procurement.

The new commissioners were interested in how services impact on the population that they hold a budget for, and services were taking up around 35-40% of public health budgets - a considerable increase from the proportion of NHS budgets that funding had previously come from.

Where the NHS may have been able to “fudge” figures if there had been an overspend, local government must break even, she explained.

Politics were “considerable,” with national politics in the form of the Health and Social Care Act, as well as local politics that clinicians hadn’t previously understood.

Anderson warned that it is important to understand local politics and where the power lies is  in decision making to really make a difference.

To deliver an effective service ensuring that resources are joined up is essential, she added.

The service providers in Hackney approached the STP in order to formulate a plan for sexual health which joined the local authority, NHS England and CCGs, leading to the prioritisation of the service by the STP, and a more robust sexual health contract was developed.

“The HIV epidemic has been one of the most changeable things that has happened in last 30 years,” Anderson said, adding that the current climate is one of the most difficult periods in terms of epidemiology of the disease, but also changing systems and finances in the healthcare sector.

Although Hackney has the third highest prevalence of HIV in the country, since the shakeup it has managed to see a reduction in new infections, through outreach, prevention and treatment of those infected - and hopefully soon will see the introduction of pre-exposure prophylaxis.

Referring to Hackney’s experience, Anderson said: “If it works for HIV it might work for other things.”

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