Sexual healthcare at risk from NHS changes
In April 2013 many health services are being put out to private tender – and will be overseen by amongst others the GP-led Clinical Commissioning Groups (CCGs).But CCGs will not commission sexual health or public health services such as obesity and smoking prevention.
This function will fall to local councils, and elected officials. The directors of public health who will advise on these decisions will need to be strong advocates for the disadvantaged and stigmatised.
HIV services, meanwhile, will be commissioned centrally by the NHS Commissioning Board.
This separation is fraught with difficulties: especially when both sexual health and HIV care are currently provided by the same healthcare professionals on the same premises.
It is similarly unclear who will pay for HIV prevention campaigns.
Over 85% of all people attending NHS sexual health clinics take up HIV testing, with referral and retention rates both excellent – resulting in world-class patient outcomes.
Currently, we are able to treat patients, map epidemiological trends (disease patterns in the population) and target our prevention campaigns in a manner which is the envy of the world.
Any private company tempted to bid for a contract from a local council, may have subtly different priorities.
There will certainly be a handsome profit to be made from delivering straight-forward tests for sexually transmitted infections and HIV.
But diagnosis, management and treatment of the more complicated cases or assiduous epidemiological data collection might not be such money-spinners.
Is the private sector willing to provide such expertise, to perform ‘contact-tracing’, the unique NHS service which helps us track the spread of pathogens and identify outbreaks?
The worried well are an easy market.
But will private companies really target the hard-to-reach populations who need the services most, such as prisoners, commercial sex workers and intravenous drug users?
The difficulty with splitting HIV service provision apart from sexual health provision will also begin to tell.
Relatively expensive HIV services may become untenable without the staff and stability offered by providing the two services together.
Instead, there is a very real risk that currently joined-up services will become fragmented, with huge variation in service.