Thinking the unthinkable
As PN goes to press, London HIV services are at a critical point with parts
of the NHS in the capital facing a cash crisis. And it is beginning to look
like the only way to balance the books (in time for a general election) is
to cut back services across the board in some boroughs. In one part of London
five out of six primary care trusts have insufficient funds to pay for modest
increases needed to keep London’s HIV clinics going.
Already patients are feeling the fall-out in longer clinic waits and cut backs
to services.
We are beginning to hear of cases where people have been refused supporting
medication like acyclovir at hospitals and told to get prescriptions from
GPs instead.
Because of the way HIV services are commissioned or ‘bought’,
HIV services across London face cutbacks. Other losers will be people with
haemophilia, babies requiring intensive care, children with cleft palates,
and a whole raft of ‘specialised’ conditions too small to be commissioned
on an individual PCT basis.
Our HIV doctors are understandably rebelling against cut back suggestions,
like offering patients the cheapest drug combinations when they may not be
the most effective in each individual case. That might save £6 million
a year, but up to six people could die in the process. So does that mean the
price on one person with HIV’s life is now £1 million pounds?
As we write, doctors and commissioners are locked in talks about how to resolve
the crisis.
Months of discussions have taken place to produce an HIV Strategy for London
which will end up as little more than a door-stop if there isn’t enough
money to put it into practice.
London has led the way in strategic planning of how clinics and hospital services
for people with HIV are provided. It has led the way in negotiating huge savings
in the HIV drugs bill through bulk purchasing for the whole capital. The list
of other savings achieved by London’s HIV Consortium is long, but until
now the savings have been reinvested in more and better hospital services
for us.
Thanks to the way Government now allocates money to PCTs through the Department
of Health, there is only enough money to treat the number of people with HIV
around in 2001. Since then there has been a 45 per cent increase in people
diagnosed with HIV. The 2001 census also plays a part in how money is handed
out and many London boroughs are reporting that census returns bear little
relation to the people they’ve got now, today, in 2005.
Unless the financial allocation formula is rapidly updated, by 2006 when current
allocations end, there will probably be 60 per cent more people being treated
at 2001 funding levels. So from us the message has to be loud and clear: with
new diagnoses going through the roof, hospital services for people with HIV
need an urgent cash injection.
Gordon Brown: please find £17 million for London’s specialised
services. Patients need it now, not in 2007 (by which time at least 12 of
us may have died thanks to just one of the ideas being put forward to save
money).
Bernard Forbes, chairman UKC
