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'
 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
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
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
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
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
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
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?
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
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
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
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
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%)
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
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
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
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