February 2006:

ALL-PARTY PARLIAMENTARY PRO-CHOICE AND SEXUAL HEALTH GROUP and APPG AIDS

Minute – Meeting 14^th February 2006

Joint APPG – Pro-Choice and Sexual Health and AIDS

Present: Baroness Lockwood, Baroness Masham, Neil Gerrard MP, Sandra Gidley MP, Laura Moffatt MP, Lynda Waltho MP, Peter Bottomley MP, Anne Weyman (fpa), Dr Angela Robinson (BASHH), Dr Jan Clarke (BASHH), Anne Quesney (Abortion Rights), Lisa Power (THT), Rowan Harvey (THT), Caroline Davey (fpa), Rachel Stewart (fpa), Aviva Bresky (APPG AIDS), Ann Mette Kjaerby (APPG PopDevRH), Helen Christodoulides (Leeds Teaching Hospitals Trust), Dr Simon Croker (BASHH), John Metcalfe (BASW), Maria Thomson (ICW-UK), Steven Penrose (London Ecumenical AIDS Trust), Martin Flynn (Positive Nation), Bernard Forbes (UK Coalition of People Living with HIV and AIDS).

Apologies: Baroness Gould, Andrew Dismore MP, Cheryl Gillan MP, Ian Stewart MP, Joan Ruddock MP, Baroness Cumberlege, Bill Etherington MP, Barbara Follett MP, Kali Mountford MP, Emily Thornberry MP, Rudi Vis MP, Mike Hancock MP, Stephanie Whitehead (Brook), Val Buxton (Brook),

Presentation 1 – Caroline Davey – Review of Local Delivery Plans 2005-2008

fpa, THT, NAT, Brook and MedFASH completed a review of PCTs’ Local Delivery Plans (LDPs) in Autumn 2005. 2 plans were evaluated (where possible) from each SHA, which were assessed on their prioritisation of sexual health in the area for 2005-2008. PSA targets, which had been set out in the Choosing Health White Paper, should have been mentioned, as well as contraceptive, HIV and abortion services; scrutiny was also given to the PCT’s plans to improve and invest in sexual health services, and how they plan to improve sexual health in their locality.

The results were varied. The vast majority of the plans demonstrated that sexual health, and particularly teenage pregnancy, was an issue that PCTs saw as a local priority. However, the specific mentions of STIs were on average much less prevalent, and contraception, abortion and HIV were even less likely to be mentioned. Only 30% of LDPs surveyed mentioned any planned targeted investment to improve sexual health services. Sexual health is far down the priority list, despite Choosing Health, and LDPs did not demonstrate how services would be redesigned or investments would be made to achieve central targets. The main priority for PCTs was seen to be financial balance. PCTs must be supported to increase capacity and skills in sexual health commissioning, with sexual health becoming a top priority for each PCT.

Presentation 2 – Lisa Power – Disturbing Symptoms 4

THT, BASHH, BHIVA and PACT completed their 4^th annual Disturbing Symptoms report. This is an anonymised twin survey to PCTs and clinicians, whereby contributors are identified only by region and position. Findings included that that two thirds of GUM clinics had turned people needing a service away in the previous year but that increasing numbers of clinics appeared to be meeting waiting time targets. Half of PCTs had increased spending (therefore, half had not) and while 89% of clinicians reported increased activity, only 3% of clinics had increased staffing. 25% of clinics had discussed prescribing restrictions with their Trust, but the majority of clinicians did not feel in control of their budgets. Structurally, only 26% of PCTs have a managed service network, though 94% have a planning body of some kind for sexual health, but local authorities are increasingly under-represented on both. Patient input (despite government intentions to improve patient and public involvement in health services) into services is low, being represented on only 11% of planning bodies.

The survey concluded that there was disconnection between central targets and what was happening on the ground, and that there was increased evidence of ‘gaming’ around targets. The survey also found that there was insufficient evidence of service redesign to increase capacity and improve service.

Presentation 3 – Helen Christodoulides and Dr Jan Clarke - Supply and demand: estimating the real need for care while meeting the 48 hour waiting time target in a genitourinary medicine clinic by a closed appointment system.

Helen and Jan set out the findings of a week-long survey which had taken place in the GUM clinic in Leeds, to assess demand for services. It found that even during a quiet time of year (July 2005), demand outstripped supply by 4 – 1. Please see attached summary paper for this presentation.

Discussion

Baroness Masham asked if people who didn’t get appointments were traced by the GUM clinic, to come in and get tested / treated; and contact tracing for partners of those infected.

Jan Clarke replied that if a positive infection was identified, sexual health advisors would attempt to monitor progress and provide treatment and health education advice, as well as encourage patients to tell their partners and ask them to attend for treatment. But it is necessary for people to be in the system before this can happen.

Helen Christodoulides stated that there had been concerns that there would be double counting in their survey in the course of the week, but in fact most people only rang once. Jan Clarke pointed out that 14% of people overall rang twice for an appointment, and only 7% rang three times.

Lisa Power pointed out that HPA research demonstrated that 34% of symptomatic people don’t stop having sex while they wait for a GUM appointment.

Anne Weyman asked what had happened since the survey in Leeds?

Jan Clarke responded that the hospital was in the same position it had been since July. There has been no increase in funding for staffing to increase capacity as well.The hospital has been collaborating with local groups including chlamydia screening - although there is a screening site for chlamydia and relationships are very good between the clinic and the programme, and screening is accelerating in volume, there has been no improvement in access.

Maria Thomson asked about age profiles of the people who were calling for appointments, as it seemed to be looking at younger people. Was it possible that over 35 year olds were too shy to come forward to be tested?

Helen Christodoulides stated that the peak group of people asking for appointments were 25-34 year olds.

Jan Clarke outlined that the study didn’t look specifically at HIV, but at all STIs; but that there was a separate phoneline to deal with patients with HIV so that they would be able to get through.

Angela Robinson raised the issue of money. BASHH’s recent survey shows that £8 million a year just doesn’t reach front line services. Clinicians are not shown budgets and don’t know how much they are allowed to spend, or where the money has gone. 15-20% of money allocated to sexual health is not getting to services. There has also been a lot of ‘gaming’ around the 48 hour target – i.e. GUM clinics only booking appointments two days in advance. Many PCTs will use the Choosing Health money for other financial pressures. Dr Robinson stated that 45% of clinics did not have access to the new method of chlamydia testing and urged MPs to investigate this issue.

Neil Gerrard spoke of the difficulty of finding out what happened to the money within PCTs, as the Trust may commission services from other bodies, and this is not always clear at the quarterly meetings he attends.

Baroness Lockwood asked if the survey had been presented to DH (it had been). Neil Gerrard said that Strategic Health Authorities should be taking more of an interest and a lead on this issue. Baroness Lockwood said that the reorganisation could lead to this happening – time would tell.

Steven Penrose pointed out that the money set aside for HIV was not going to make an impact. The gay community had done a lot of education on prevention during the 1980s, but there had not been much recently, or else it had not made much impression. Education is the only way to make people responsible for themselves.

Martin Flynn asked for a photo of the queue from the Leeds presentation, and asked Lisa Power which areas were restricting HIV drugs.

Lisa Power reiterated that the survey only identified regions to ensure anonymity and honesty in the responses to the survey. There needs to be a discussion about this – clinicians must of course ration their supplies to enable best access for as many people as possible, but not turn symptomatic people away either.

Martin Flynn said that Caroline Flint MP has vowed to make sexual health a priority, but how much would it actually cost?

Neil Gerrard said this was an impossible question, but was pleased that the government had made sexual health a priority. How the priority was translated into local services depended on DH pressure on the SHAs and PCTs, as well as how targets were interpreted (there is concern over the ‘gaming’ issue in the 48 hour target, as happened with GP access). His local GP is confused about how to handle the issue of waiting times. It is all very well setting targets, but are you actually measuring something meaningful? Tackling sexual health was completely achievable but the money allocated thus far was probably not enough – especially if it wasn’t reaching the frontline services.

Jan Clarke said that they could calculate how much it would cost and feed that information into the group. Baroness Lockwood said that the two groups should work together on this issue over the coming months. Baroness Masham asked if Parliamentary Questions could be placed to raise the issue and get some answers, Ministers need to put pressure on PCTs – Neil Gerrard said that MPs have been written to and asked to pursue this issue locally with the PCTs.

Angela Robinson said that if there was some transparency over the issue of money – if you knew you as a service were going to get it – you could make plans to increase capacity. As it was, people cannot make these plans.

Baroness Lockwood thanked the presenters for three very interesting and informative presentations.

Update on current campaigns

Neil Gerrard reported that the majority of interest in the Commons on HIV and AIDS was from an international perspective, and they plan to focus on the UK and raise national awareness. The APPG on AIDS will continue to campaign on access to treatment for failed asylum seekers and others whose status in the UK is under question but are HIV+. The APPG had had a meeting with the Home Office and was due to have a meeting with DH.

Rachel Stewart reported that Baroness Gould had written to all English MPs as chair of the APPG, outlining the percentage of their constituents who could get a GUM appointment within 48 hours, and how much funding their PCT would receive in 2006-7 from Choosing Health, specific to sexual health. There has been a good response so far, many MPs are writing to the Chair of their PCT to investigate what is being done to improve services.

Contraceptive Awareness Week – 13-19 February 2006

This year’s focus is on long acting reversible methods of contraception (LARC) – the IUD, IUS, implant and injection. fpa carried out two surveys – of GPs to see if LARC was provided at their practices, and among pill-users who telephoned fpa’s helpline, to see if they were aware of the alternatives. The surveys found that women were not being offered alternatives to the pill, even when the GP had capacity to provide this service. Further statistics can be seen here: http://www.fpa.org.uk/news/caw06survey.htm

MPs were also asked to support EDM 1619 regarding Contraceptive Awareness Week.