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Radical reform and the recession: implications for HIV

Radical reform and the recession: implications for HIV. Sir Nick Partridge February 2011. Outline. Liberating the NHS: 'most radical reorganisation for 60 years' Welfare reform: 'most radical shake-up for 60 years'

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Radical reform and the recession: implications for HIV

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  1. Radical reform and the recession: implications for HIV Sir Nick Partridge February 2011

  2. Outline • Liberating the NHS: 'most radical reorganisation for 60 years' • Welfare reform: 'most radical shake-up for 60 years' • Localism: ‘most radical shift in power to communities and individuals for 60 years’ • Public spending cuts: ‘most radical reductions for 60 years’ • Implications for NHS, Local Authorities, Voluntary Sector • Implications for PWHIV • Legal aid cuts will make unfair decisions harder to challenge

  3. Liberating the NHS – putting patients first • Shared decision making to be the norm: no decision about me without me • An information revolution: • Patient access to information to make choices about their care and increased control over their records • Patient choice of any provider, consultant-led team, GP practice and treatment • Patients to rate hospitals and clinical departments on quality of care • System focus on personalised care

  4. Liberating The NHS - providers • Move to deliver all NHS provided services through Foundation Trusts (as social enterprise) • Expansion of role of other social enterprise providers, voluntary organisations and private sector providers on a level playing field • Establishment of ‘any willing provider’ policy to increase consumer choice • Money follows the patient, with payment reflecting outcomes and activity

  5. Liberating the NHS:Commissioning • Replacing 150 PCTs with up to 400 GP led commissioning consortia, responsible for spending about 80% of NHS budget • GP and specialist services to be commissioned by National Commissioning Board • Public Health to be commissioned by Local Authorities, within a ringfenced allocation (between 2 & 4% of NHS budget) • Local Authorities to have responsibility for coordinating health, social care and public health commissioning within their areas

  6. Healthy Lives, Healthy People • The New Approach aims to be: • representative – owned by communities and shaped by their needs • resourced –with ring-fenced funding and incentives to improve • rigorous – professionally-led, focused on evidence, efficient and effective • resilient – strengthening protection against current and future to health • and will focus on improving the health of the poorest fastest

  7. Healthy Lives, Healthy People • Public Health England – the national public health service • Directors of Public Health transfer from PCTs to local government, working across education, health, transport, leisure and communities through new health and wellbeing boards • Ring-fenced budget, and a new health premium rewarding progress on key outcomes and tackling health inequalities • Top-down targets will be replaced by a new strategic outcomes framework

  8. Public Health Outcomes Framework • Three specific sexual health outcomes are proposed in the Public Health Outcomes Framework: • Proportion of persons presenting with HIV at a late stage of infection • Under 18 conception rate • Chlamydia diagnosis rates per 100,000 young adults aged 15-24 • Vitally important that you support these by responding to Healthy Lives, Healthy People: Transparency in Outcomes by 31st March • Question 7: We need to arrive at a smaller set of indicators. Which would you rank as the most important?

  9. HIV – Future Commissioning Structures • Specialist HIV treatment: NHS Commissioning Board • National HIV prevention: Public Health England • Integrated sexual health services: Local Authorities • Risk of fragmentation • More complex for pooling budgets and cross border working • No role for GP Consortia

  10. Implications: HIV • Avoids handing commissioning to GPs who can be inexperienced in dealing with HIV • At odds with Long Term Condition Management and need for greater primary care involvement HIV • More complicated arrangement for commissioning HIV services provided from GUM • Local Authorities responsible for commissioning sexual health and HIV testing • Sexual health services cost £700- £750 million: up to 20% of the ring-fenced budget for Public Health

  11. Implementation • New NHS architecture to be in place by 2013 • Key milestones: - First GPC in place from April 11 - NCB & Monitor new powers April 2012 - PCTs and SHAs abolished from 2013 onwards • Pre-emptive strike on management costs with 45% cutbacks at PCT & SHA level • Consolidation of PCTs as current structures become unsustainable

  12. Impact on THT • Current budget £22 million • 25% voluntary income, 75% statutory income • Over 200 contracts with PCTs, LAs and DH • From April, voluntary income up 12%, statutory income down 32% • Need to make £5 million cuts

  13. Economic environment • Spending Review 2010: £81bn cuts package • Reduction of £20bn in NHS spending • Reduction of 25%+ in Local Government income • Reduction of £18bn in welfare spending • Unemployment up to 2.49 million (7.9%)

  14. Welfare Reform • Introduction of the Universal Credit • Reform of DLA in to Personal Independence Payment, with target of 20% reduction in DLA spend. Claimants will face a greater burden of assessment and reporting • Introduction of Employment and Support Allowance - after one year people will go onto a much lower rate of support • Increasing the age threshold for the Shared Room Rate from 25 to 35 – confidentiality and disclosure issues for PWHIV under 35 • Housing benefit cap - some PWHIV, particularly in London, may have to leave their homes  

  15. What do you need? 2007-08 Sigma Research • 47% were not in paid employment • Women were worst affected with 60% not in paid employment • Almost half (48%) lived on less than £15,000 per year • Over 35% felt that housing and living conditions had worsened in the last year • Amongst those experiencing money problems who received help, the largest proportion (34%) received it from an HIV organisation

  16. 50 Plus - ageing and HIV THT 2010 • One in ten respondents had an income of less than £96 a week, or £5,000 a year • This rose to more than one in four among the black African women • 50% were living on under £15,000 a year • 45% said that they sometimes or never had enough money to cover basic needs • 10% never had enough to cover basic needs. This included half of all the black African women respondents

  17. Respond to Healthy Lives, Healthy People:Transparency in Outcomes by 31st March, supporting the three HIV and sexual health outcome indicators • Sign up to Shout Loud at www.shoutloud.org.uk • Sign up as THT campaigners at www.tht.org.uk • Sign up to the HIV activists network at www.nat.org.uk • Sign up at www.myhiv.org.uk • Thank you! nick.partridge@tht.org.uk

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