Public health minister Melanie Johnson tells Martin Flynn why sexual
health
targets are a good thing and why HIV tests should never be routine
Melanie Johnson, MP for Welwyn Hatfield, is a parliamentary under-secretary
at the Department of Health. Her public health brief covers everything from
pandemic planning and global health to vaccines and, as the minister puts
it, “all the things we do in our behaviours which make us more or less
healthy”.
Millions for sexual health
Why doesn’t the government make more of the success story of HIV treatments
in this country with our better treatment outcomes than on mainland Europe
or in the US?
“We have a huge problem getting over our positive messages,” the
minister says: “Good news is not news. We’ve cut deaths from heart
disease by over 27 per cent but you never hear about that in the media.
“We’ve made a big investment in services around sexual health
and we’re going to increase that markedly over the next few years.
“We’ve put an extra £300 million into improving sexual health
services and that includes about £50 million towards a large campaign
to alert people to the dangers of STIs, including HIV.
“We’ve been really successful with children born to mothers exposed
to HIV. We’ve now got 92 per cent of women diagnosed before delivery.
Antenatal screening has been taken up by nearly everyone and has prevented
the transmission of HIV to about 180 babies in 2003. We can now ensure the
next generation has a better chance.”
Opt-out or opt-in HIV testing?
Debate still rages about HIV testing. Many doctors are now saying it should
be done routinely like other blood tests, but the minister disagrees.
“We do want people to come forward for HIV testing if they feel they
might have been at risk. We also want to prevent people from being at risk.
We want to cut down transmission rates and want to get as low a rate of new
diagnoses as we can possibly achieve. But if they need to be tested it’s
important there is the right environment for that to take place.
“I visited the Manchester Lesbian, Gay and Bisexual Foundation a few
weeks back and they’ve got a very good clinic, making it easier for
people to be tested. More testing will cut down the risks to other individuals
and will improve the life expectancy and life chances for people who can then
be appropriately treated.
“We know modern drugs are making a big difference to people who already
have HIV. But for a potentially life-threatening condition like HIV I don’t
think the tests are ever going to be routine or normal. I’ve had breast
cancer and you’d never see tests for something like that as if they
were normal. You wouldn’t just do these things routinely because they
affect people’s long-term life chances.
“I think it’s important people receive the right counselling and
support and wouldn’t be happy if testing was transferred into something
routine. It would never be routine for an individual if they got a bad result.”
GUM clinics failing access targets
Britain has record numbers of STI cases, and GU doctors say clinics can’t
cope with the number of new patients. Some have queues outside every morning
and others have long waiting times for appointments. Is the 48-hour target
for appointments feasible and is it working?
“We’re the first government to have a sexual health strategy,
the first to make this level of investment and the first to measure these
sorts of things.
“Until we did an audit last year, no government had ever had a measure
of waiting times at GU clinics. We knew that it wasn’t going to present
a terribly good picture. Latest figures show a small improvement and the figure
is currently 41 per cent for people meeting the 48-hour target.
“For the first time, primary care trusts (PCTs) need to aim at driving
forward the sexual health agenda. PCTs will have to do more about sexual health.
They’ve got money related to local HIV rates and that’s part of
the basis of their funding.
“We’re a government which has been unapologetic about targets.
Our achievements couldn’t have happened without encouraging people to
make targets. We think there should be some targets for sexual health too.
They will be a driver for change and improved services.
“Out of the extra £300 million, there will be money to improve
screening in both GU clinics and community settings. A more diverse provision
of services is good, and we want to see more access and a more personalised
service. We want to see more testing in the community; at GP surgeries and
even some STI tests at pharmacies. But that doesn’t mean that we won’t
be investing in traditional GU clinics.
“There’s a lot more money going in and there has been a real cash
increase across the country. Long term, it’s a very cost effective thing
to put more money into sexual health. If we can persuade people to adopt safer
sex practises, as well as diagnosing the diseases early and getting them treated
early, it means individuals will be less disadvantaged by being unhealthy.”
Is the PCT system working?
Why do PCTs struggle to carry out government heath policy?
“I think PCTs are generally doing a very good job. It’s right
to devolve health services to a local level because the health of different
populations varies from area to area. PCTs now control 80 per cent of the
health funding on behalf of their local population and they work with local
authorities and the voluntary sector in addressing health inequalities on
the ground. And people who know the most are at the local level.
“The PCTs are still newish organisations. We want them to do more on
sexual health which is why all of them now have sexual health leads. They
have a lot of priorities and there are a lot of demands on them.
“In areas like cancer and heart disease with targets, deaths have dropped
by 12 per cent since we’ve been in government. That’s because
of a mixture of investment, service modernisation and sensible targets.”
A
future for HIV and sexual health services?
How does she see the future for sexual health and HIV services in two or three
year’s time? Will they improve or will there be more untreated HIV positive
people because of decisions about asylum seekers?
“Anyone here who is legitimately seeking asylum is entitled to treatment.
If they are then deported it’s a different position. We don’t
think there should be open access for everybody to the NHS. We’re not
the world’s health service, we’re actually the National Health
Service.
“I think there will be a huge improvement in sexual health services
in this country.
“Of course we will never remove STIs from the face of the planet, they’ve
been here since time immemorial and they’ll still be a problem to be
addressed. But I think we can get it down to a much lower level with the investments
we are making.”
A big new prevention campaign?
Will the new HIV and STI prevention campaign be aimed at the general population
or ‘at risk’ groups like teenagers, gay men and Africans?
“We haven’t rushed into it. It was easier in the 1980s - there
were fewer forms of communication and a less segmented audience.
“We need to make sure we reach the people most at risk, but we also
need to get a much greater level of understanding in the general population
because we can’t afford to just target certain groups.
“We’ve had a very good ‘Sex Lottery’ campaign running,
but a lot of people in their 40s and 50s have complained. MPs are quite good
at complaining in the chamber when the subject is debated, that they don’t
see these things, but it’s not targeted at them.
“We’re looking at a campaign with a lot of different phases over
a period of time. It’s not just about having a bash of advertising over
a couple of months. We want a sustained campaign over time.”
Will there be more HIV cutbacks?
“There are no cuts that the government is doing. We haven’t cut
anything. We’ve only made extra investment available. There’s
a lot more money going in to clinics and to things like chlamydia screening.
“And now we’ve embedded some of the sexual health goals in PCTs,
we will drive forward more vigorous sexual health provision at a more community
level.”
And the future for Melanie Johnson?
We’re facing an imminent general election, Minister, and your majority
is only about 1,200 votes. What’s the future for you?
“We don’t know. Who knows? It’s all in the lap of the electorate
and the Prime Minister.
“I’m passionately keen to be re-elected to serve my own constituency.
I thoroughly enjoy being an MP. My overriding ambition is re-election and
then I’ll have to look beyond that. It’s an uncertain world, isn’t
it?”
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