The Department of Health has acknowledged that due to new
commissioning and contractual arrangements in England, some NHS trusts “may no
longer find it viable to continue to provide HIV treatment services
When local sexual health services are put out to
competitive tender and provided separately from HIV treatment, the lack of
shared staff, premises and facilities may make the independent provision of HIV
services unsustainable. New clinical providers will have to be identified, not
necessarily at the same location.
In a letter last week, David Flory, the deputy NHS chief
executive said that he was aware that some local
commissioners had already invited NHS bodies, private companies and voluntary
organisations to pitch for contracts to provide genito-urinary medicine (GUM)
clinics, as well as other sexual and reproductive health (SRH) services.
For example, the private
company Virgin Care is already paid by the NHS to provide free sexual health
services to people living in Teeside, Surrey, Oldham and Milton Keynes.
Typically, there are
separate contracts for sexual health and HIV treatment services, and this trend
is only likely to accelerate when NHS reforms take place next April.
Commissioning responsibilities will be split, with sexual health a
responsibility of local authorities, and HIV treatment taken care of by a
national body, the NHS Commissioning Board.
But the letter acknowledges
the disruption this may cause: “Since the 1980s, many HIV services have been
co-located within GUM alongside services for STI diagnosis, testing, management
and treatment. This has included joint staff, premises and facilities. In many
areas HIV treatment and care is dependent on the wider infrastructure provided
by GUM being in place.”
“Where the tender exercise
results in a new provider for GUM and SRH services, an unintended outcome may
be that the NHS Trusts that previously provided joint GUM and HIV
treatment services may no longer find it viable to continue to provide HIV
treatment services independently from GUM,” it continues.
The result could be that HIV patients have their services
transferred to a new provider, according to the Department of Health’s letter.
“Our priority is to ensure a smooth transition to the new commissioning
arrangements,” it says, “avoiding fragmentation and continuing to provide high
quality services for all patients”.
People with HIV using treatment services should be
consulted about possible changes, the letter says.
But when the letter was reported in the Health Service Journal one anonymous online contributor expressed cynicism: “This separation of responsibilities is a direct
consequence of the legislation, policy framework and organisation restructure.
To feign surprise of the emerging collateral damage at this stage is deeply disingenuous.”
The reader also suggested that under competition law, a local
authority commissioner would be unable to specify that GUM services must be
provided alongside HIV services, as the latter would be outside the
commissioner’s authority and would give an advantage to the existing NHS
And the British HIV Association (BHIVA) has been warning
for some time that a risk of the NHS reforms is that commissioning – and
service provision – becomes fragmented. People with HIV need good provision of
HIV prevention and sexually transmitted infection services, while those who are
newly diagnosed need smooth and rapid access to specialist services, BHIVA told
the House of Lords last year.
The House of Lords select committee on HIV in the United
Kingdom shared those concerns. “We recommend that the Department of Health
place a duty to promote service integration upon those commissioning sexual
health and HIV services,” it said. The government responded that this would be
unnecessary as all health commissioners should be promoting integration anyway.
The Department of Health letter raises the prospect of
some existing HIV treatment services closing, with patients needing to transfer
to new providers and new arrangements. This is likely to be a particular risk
in some smaller clinics where relatively few people with HIV are
treated alongside a larger number of people seeking sexual healthcare.