Agenda item

6.1  Jess Peck, HIV & Sexual Health Commissioner presented the paper on the Lambeth, Southwark & Lewisham HIV Care & Support Review. The commissioning manager explained this is now open to public consultation and that they wanted the committee to feed in.

6.2  The commissioning manager went through the presentation. She started by explaining that all three boroughs have some of the highest rates of HIV, Sexually Transmitted Infections (STIs) and teenage pregnancy in the UK. Such exceptionally high prevalence of sexual ill health reflects the level of deprivation and inequalities experienced by our communities. She went on to outline the prevalence locally and nationally.

6.3  The commissioning manager highlighted the need for early testing as late diagnosis is related to high levels of mortality. She explained that the Lambeth, Southwark & Lewisham have achieved an increase of HIV testing.

6.4  HIV has been transformed from a fatal illness to a chronic illness that can be managed, albeit with some health complications - but only when diagnosed early.

6.5  She explained that this project has a number a phases. We are now how having a three month consultation process.

6.6  There are funding pressures; it is estimated that there will be 25 % reduction of budget. There is also a need to make efficiencies to invest more in early diagnosis.

6.7  Engagement has been central throughout the project by ensuring that a wide range of stakeholders have been identified to oversee the project via the steering group. Service user representation at the stakeholder events was significant, although this has been further strengthened with the development of a Service User Reference Group (SURG) to shadow the steering group.  She explained that we consider this to be a process of co production with service users.

6.8  There are two event events at Roben’s Suite, Guys Hospital Tower specifically for Southwark residents and other events in Lambeth and Lewisham.

6.9  We have found a lack of clear pathways and a tendency to rely on specialised services. We need to improve mainstream services. There will be a phased shift from specialist to mainstream care. The long-term direction is to mainstream but some specialist services will still be needed.

6.10  Specialist services that are needed include: advocacy because of prejudice; support to pregnant women and families; support for cognitive impairment; specialist HIV treatment services responsible for prescribing of anti-retro viral treatment and other medical interventions and expert patient programmes.

6.11  The chair invited committee members to ask questions and a member commented that this consultation does not talk about preventative work and asked if this is a separate process? The commissioning manager confirmed that it was.

6.12  There was a question about same day testing. The member commented that this has proved effective because some people take the test but do not return.  The commissioning manager explained that they are training staff and health care assistants to resource this. We do want to provide thus service and it will happen.

6.13  A member noted that that there is huge evidence base that early testing has a big impact on your health. He asked why testing was not promoted more and people invited to be tested. The commissioners noted that in GUM clinics there is a universal offer for HIV testing. Our testing strategies have moved to opt out rather than opt in. We have been doing pilot mouth testing for African communities who use Sexual Health services less.

6.14  A member asked if there had been a worrying rise in under 18 infection rates. The commissioning manager said she had seen some statistics showing a small rise in fewer than 25. However most infection takes place over 35. The was a follow on question about small clusters and asked if there was any evidence of this. The commissioning manager said that they can look at Ward level data...

6.15  A member asked about young women and their rates of infection and also the high levels of terminations. The member asked if this was indicative of people not using contraceptives. The commissioning manager advised that we do have a diagnosis service for women terminating

6.16  A member asked if this was about efficiency savings or cuts and the commissioning manager explained that we need a more sustainable strategy so it is about reinvestment as there are increased demographic pressures.

6.17  A member asked about mental health services and if people living with HIV will still get support. He commented that Mental Health services are under threat nationally. The commissioning manager responded that the changes to this are later. Some of our lower threshold users do not have mental health needs.

6.18  A member asked about prevalence and it was explained that the cohorts with the highest infection rates are gay man and black African heterosexual communities. This is national trend but deprivation exacerbates these trends. There was a follow on question about how these communities would be consulted with and the commissioning Manager explained there would be specific events and open events.

6.19  A member asked if there is a CAG for HIV as Kings Health Partners spoke about the benefits of bringing together clinical good practice. It was confirmed there was and this service sits under “infection and dermatology”.

6.20  A member asked about HIV testing and live births and commented that he heard there are none.  The commissioning manger confirmed that is correct.

6.21   A member asked what does mainstreaming mean. The commissioning manager explained that this is about de-stigmatising and a recognition that there a large number of people with HIV are being managed as a chronic condition in primary care. It is about normalising.  There will still be specialist services and a transitioning support for services such as Mental Health. A member noted that some GPs still harbour prejudices and this can hamper care given and recommended that work be done to overcome this.

ACTION

A joint letter will be written by the vice chair and chair in response to this consultation and on behalf of the committee