Just four years remain to meet the target of ending new HIV cases – it must not slip down the agenda
4 min read
Being able to access appropriate, high-quality care shouldn't be a postcode lottery
We have a real opportunity in England to be the first nation in the world to end new HIV cases. But there is no room for complacency and there remains much to be done if we are to achieve this unprecedented goal and support people to live well with HIV.
At the same time the government is starting to deliver on the updated HIV Action Plan for England, it is embarking on some of the biggest changes to the NHS in a generation. The shifts in heatlh care policy set out in the 10-Year Health Plan and the Health Bill will impact whether the 2030 goal is reached.
We are at a hinge point.
The changes proposed could be a catalyst for progress. But it is not a given – they could also result in delay, stalling of progress, and fragmentation.
That challenge was at the centre of a recent roundtable co-hosted by HIV Outcomes UK and the APPG on HIV, AIDS and Sexual Health which brought together multi-sectoral leaders in the UK’s HIV response. Discussions explored how we can ensure the new HIV Action Plan, the 10-Year Health Plan and the Health Bill all work together to find people living with undiagnosed HIV and deliver real improvements for the health-related quality of life for all people living with HIV.
Alongside commitments to expand testing and prevention, the HIV Action Plan includes welcome actions on retaining and re-engaging people in HIV care, tackling stigma and improving quality of life. But the roundtable made clear that the hard part starts now.
Discussions highlighted both the opportunities and risks of transferring HIV commissioning from NHS England to Integrated Care Boards (ICBs). Boards could use their new commissioning powers to develop robust local HIV Action Plans, be responsive to local health inequalities and ensure people living with HIV in their area can access joined up, person-centred care. But concerns were raised that HIV could slip down the priority list and regional variation in care will be entrenched. With just four years remaining to achieve the 2030 targets, we cannot afford to let progress slip as there won’t be sufficient time to tackle problems that could manifest.
Being able to access appropriate, high-quality care shouldn't be a postcode lottery. The Heath Bill should provide the platform to end postcode lottery through giving ICBs more power to determine what services are commissioned in their area, while ensuring strong national accountability to ensure consistent standards of care across England. The Health Bill should legislate to require a full impact assessment of the delegation of specialised services, and annual reporting to Parliament on performance against national standards.
We cannot afford to let progress slip as there won’t be sufficient time to tackle problems that could manifest
Also too often, we know that specialist expertise and community-led support are the first things to come under pressure when budgets tighten. HIV charities provide essential services that statutory provision frequently cannot, like peer support, prevention outreach, and supporting people with complex needs. Yet these organisations continue to face insecure funding and significant barriers to accessing NHS commissioning.
We will not achieve the goal of ending new HIV cases by 2030, nor meet the needs of people living with HIV, if we continue to accept a status quo in which HIV charities are increasingly forced to scale back, withdraw services, or close altogether. The Health Bill should strengthen the role of the voluntary sector in delivering the HIV Action Plan and 10-Year Health Plan.
To do this, amendments are needed to ensure meaningful representation of the voluntary and community sector within local health governance and to embed community-led services within NHS care pathways. And if the government is serious about delivering its shift from hospital to community, the bill should also give NHS commissioners clear powers to reserve appropriate contracts for voluntary sector organisations.
The Health Bill will help determine whether England meets its 2030 HIV targets. To ensure people can live well with HIV, the bill must strengthen local delivery, protect equitable access to care and champion the voluntary sector.
Baroness Barker is a Liberal Democrat peer and co-chair of the APPG on HIV, AIDS and Sexual Health
