Public health minister Caroline Flint
defends the government’s record on fighting HIV stigma and
tells Martin Flynn that some people who transmit HIV should be prosecuted
Photos Piers Allardyce
Caroline
Flint is definitely one of the more glamorous of the prime minister’s
‘Blair babes’; one of many female Labour MPs who entered parliament
after the landslide election victory of 1997.
Well before taking up her job as public health minister last year, the MP
for Don Valley, South Yorkshire was tipped as a rising star. In the early
1980s she worked at the now defunct Greater London Authority and later at
Lambeth Council and the GMB union until she was nominated as a Labour parliamentary
candidate.
She has already worked with a number of political heavyweights: as parliamentary
private secretary to John Reid, followed by jobs as junior home office minister
under David Blunkett and Charles Clarke.
But Caroline Flint has to be made of strong stuff herself to survive the public
health brief which is both high profile and huge. She is responsible for health
protection, radiation, the potential bird flu epidemic, communicable diseases
like TB, HIV and sexual health and government campaigns to tackle obesity,
type 2 diabetes, heart disease, cancer, smoking and alcohol.
Targets defended
HIV treatments are a great NHS success story with over 90 per cent of patients
on antiretrovirals achieving an undetectable viral load, living normal lives,
getting back to work and not being a burden on the state. But the newspapers
are currently full of stories about sexual health services in crisis, staff
cuts and long queues and waits at GU clinics. At a time of record STI infections,
the GU clinics are saying they can’t cope with the vast number of patients.
How will Caroline try to solve these problems?
“You’re right that we’ve got a very good news story in supporting
people with HIV. We’ve got to credit former health ministers John Reid
and Melanie Johnson for introducing some targets in sexual health. Among these
is a
target to reduce waiting times at clinics to 48 hours as well as the national
chlamydia screening programme and reducing rates of gonorrhoea.
“The targets have been reinforced in the last month by making sexual
health a priority target for the first time. The delivery team here is working
directly with chief executives of organisations on how these priorities will
be met. “We’ve now got 49 per cent of GU clinics meeting their
48-hour access target. Some are doing a lot better but some are doing worse.
“There will be lot of benefits from having targets. They are a challenge
to health commissioners and primary care trusts (PCTs) to get it right and
to explore how sexual health services can be delivered more effectively.”
Takeaway tests: the future?
Targets are all very well but will there be more cash for sexual health?
“There has been more money for sexual health and some of that has already
gone out. I know there is a concern whether the extra money has gone to frontline
services to meet these targets. Monies provided for sexual health should not
be derailed into other areas and we are watching any disinvestment closely.
“I’ve been visiting clinics to find how we can better deliver
our sexual health services. Some provide services in GU clinics and others
in the community. We have to discuss which model works best and how people
access the services they want.
“I visited the Bloomsbury Clinic in central London last month and was
told payment by results would help them enormously. Big city clinics attract
lots of patients but have problems getting money back from PCTs.
“Payment by results means they will be able to claim back money for
what they actually do to reinvest in services which means longer opening hours.
“They told me about staffing and how better to cope with the flow of
patients coming through. They are looking at takeaway tests and treatment
kits.
“I also learned that HIV clinics are starting to deliver people’s
medicines directly to their homes and doing this in a cost effective way.
“For patients coming to the clinics for many years, payment by results
can mean better service to meet their needs. It’s a way for HIV patients
to have more say in the NHS about how they want their service, rather than
being told to turn up every three months.
“It would be crass of me to deny there are some serious issues we’re
going through at the moment in terms of NHS financing and the delivery of
some services.
“We are asking if some of these services could be better, and be more
effective if they were delivered in the community rather than just through
big hospitals. We are asking how these services are designed and whether they
meet patients’ needs in a sustainable way.”
A
new national HIV campaign?
Caroline Flint’s predecessor Melanie Johnson talked last year about
a new national campaign on HIV prevention. When does she think this is going
to happen?
“Hopefully the campaigns will go out later this year. We’ve had
a lot of consultation in the NHS and with the advisory group and the voluntary
sector. We have to try and get people to understand the consequences if they
are not practising safe sex.”
Will there be targeted campaigns aimed at gay men, young people and the UK
Caribbean communities?
“The headline message is there for
anybody. STIs are not as unusual as most people think. The message will be:
getting an STI can happen to anybody if you’re not practising safe sex,
whether you’re 16, 35, male, female, gay or straight.
“And within that we may well target media, like radio, for young people.
I don’t think the campaigns will increase queues at GU clinics but we
have to be aware it could mean more people will become concerned and present
themselves.”
So you won’t be having mass scare campaigns like the iceberg and tombstone
ads in the late 1980s?
“I remember those campaigns because I was in my 20s at the time. One
of the reasons they were so frightening was we had so many people dying from
Aids at that time. But now, 20 years on, it’s a different world and
thank God people are getting the treatments they need. Now we have to have
a conversation with people, saying: ‘You may not die but there are consequences
for you if you catch one of these diseases.’”
Involvement of positive people
We’ve now got more than 60,000 HIV positive people in this country but
they’re not targeted or directly involved in HIV prevention campaigns.
How can we change this?
“I would hope HIV positive people feel they can be involved in prevention
campaigns. In the African communities we’re trying to find people who
can champion the work we’re trying to do. And we’re looking for
help around services and how they might exclude people. Also, there might
be lessons we can learn from the work the Department for International Development
is doing in African countries that we can use among African communities here.”
Battling HIV stigma & discrimination
“We’re doing a lot of work to de-stigmatise HIV. The work we do
with different organisations carries on and we’ve just produced guidance
and an action pack for PCTs on reducing stigma.”
One of the things you promise in the Department of Health action pack against
HIV stigma is to involve people with HIV in policy at local and national level.
Can you tell our readers how they can get involved?
“At the national level we work with a wide range of NGOs [non-governmental
organisations] and groups from which we seek advice and consult. At a local
level this can work well where patients are involved in how and where their
care is provided and what support is there for them. That can be in clinic
services with patient involvement programmes or through organisations like
your own which represent and campaign for people living with HIV.
“But we do listen, we do learn from you and we do want you involved.
We want to see people who use services having a bigger say.”
Treating asylum seekers with HIV
The government is often accused of being very generous about HIV abroad but
not at home. For instance, the denial of HIV treatments to failed asylum seekers
in Britain?
“The facts around the treatment of HIV positive asylum seekers are often
misrepresented. We don’t deny HIV treatments to asylum seekers. Anyone
who is an asylum seeker who needs treatment gets that treatment throughout
the process. And they can continue to get that treatment all the way up until
that time, if they are not successful, that they have to leave the country.”
Criminalising
HIV
What about the cases of people being prosecuted over HIV transmission in the
UK? Won’t that just increase stigma, drive the epidemic more underground,
stop people going for testing and treatments and therefore increase the public
health risk?
“It’s hard for me to comment on individual cases but it has a
lot to do with how an individual’s behaviour impacts on the lives of
their sexual partners.
“In some of the cases people in full knowledge of their HIV status have
been involved in sexual activity which is putting someone else at serious
health risk.
“If they’ve seriously endangered someone else’s life there
is a case to be made in law and I think the law will have to be pretty robust
because of that cause and effect.
“So in that sense I don’t rule out the criminalisation of HIV
transmission but it has to be judged closely on a case-by-case basis. We have
to look at the person’s motivation, at what they were doing and what
the outcome was.”
A personal relationship to HIV
Has HIV affected you personally and do you know people living with the virus?
“I have known someone who died of Aids and I do know people living with
HIV. All of that does inform me in my personal views and in my job. It makes
me think how better we can provide services in the future.
“We’re trying to have a better discussion about what services
we need in 2006 and that is very different from where we were in 1986.
“We have to redesign the services to fit the needs of different individuals.
We need better service planning and better commissioning of services and we
need to work with other departments, like the Department of Education, to
target young people and with the Department of Work and Pensions to fight
HIV discrimination in the workplace.”
Prevention is better than cure
So is government trying to be moreproactive about explaining to people how
to look after their own health?
“I think we’re at a crossroads. When Labour came into power in
1997 we had some of the worst cancer death rates in Europe. And there were
serious issues around long patient waiting times. We are saving more people’s
lives through effective treatments and drugs and we have got waiting times
down.
“Now we are having the debate about how to prevent people ending up
in hospital in the first place and we’re targeting prevention rather
than just treatment. We want a health service which is as much about being
healthy than just dealing with sickness.
“We’re looking at the rates of sexually transmitted infections
(STI) and the problems associated with poor diet, alcohol, smoking and lack
of exercise. And there is a clear investment and better use of money in health
if we focus on prevention rather than a possible cure.”
“We need a grown-up conversation about how individuals need to take
responsibility for their own health, too.
“We can provide the information about the problems and the consequences.
But people have to take responsibility for their own actions and realise there’s
a lot more they can do to protect themselves and have a good active sex life
without the fear of STIs and HIV.”
Coping with crisis
Twice married, and with three teenage children, how does Caroline find time
for her family, constituency work and one of the busiest briefs in government?
“Working for the Department of Health, like when I worked at the Home
Office, means always coping with crisis.
“Paul Boeteng once said to me that working in the Home Office is like
working in the salt mines of government. If you can survive that, you can
survive anything.
“From Monday to Thursday I’m a prisoner of the civil servants
in Whitehall. On Fridays I deal with constituency matters and that leaves
the rest of the weekend pretty much for me and my family.”
