A nationwide survey of HIV and sexual health clinicians in the United Kingdom has revealed that 35% of respondents reported that financial pressures were forcing them to consider – or to actually implement – drug rationing within HIV services. The survey, Disturbing Symptoms 5, published by the Terrence Higgins Trust today, also shows that many HIV and sexual health clinics in the UK are struggling to keep up with the demand on their services, primarily because government funding earmarked to improve sexual health is not reaching them.
Disturbing Symptoms 5 is the fifth annual survey of Primary Care Trusts (PCTs) and sexual health clinicians to be carried out by Terrence Higgins Trust (THT), the British HIV Association (BHIVA), the British Association for Sexual Health & HIV (BASHH) and Providers of AIDS Care & Treatment (PACT).
There was a substantial increase in the number of responses from clinicians, (from 88 in 2005, to 231 in 2006), suggesting, says the report “that there is real strength of feeling about recent developments in sexual health and HIV services.” Both PCTs and clinicians reported uncertainty and frustrations about some aspects of HIV and sexual health services.
The report notes that despite “sexual health...creeping up the English political agenda” and “despite national targets and funding commitments, and an increasing focus on the health improvement role of the NHS, the local picture has remained mixed. Services and staff have struggled with rising patient numbers, staff shortages, ongoing under-investment and dilapidated buildings.”
The report highlights a “continuing disconnect between national strategy and local action on sexual health”. These include:
- Two thirds of clinicians reporting that sexual health and HIV were not sufficiently prioritised at local level.
- Just under two thirds of responding PCTs indicating that all or part of their Choosing Health money had been diverted away from sexual health services
- Concern over the introduction of Payment by Results, for both PCTs and clinicians, who are worried that money generated by sexual health services will not be reinvested in sexual health.
- Over half of clinicians reporting that their budgets would be overspent by the end of the year, and a quarter of respondents reporting that they were unable predict their spending on drugs.
Of particular concern was the finding that restrictions on prescribing certain anti-HIV drugs or tests are becoming more common. The question asked was: ‘Has your PCT/Trust restricted prescribing of any specific HIV medications or tests due to costs?’
Although 55% said ‘No’, 13% said ‘Yes’ and 22% said “Not yet, but discussions have taken place’. A further 10% did not know.
In 2005, 24% of respondents reported that their PCT or Trust had discussed restricted prescribing with some degree of pressure, but last year’s question did not ask respondents to differentiate between PCTs that had implemented restrictions, and those which were considering doing so.
“Further analysis revealed that 41% of respondents who reported either existing prescribing restrictions or discussions about restrictions were based in London,” notes the report. “According to the HPA’s 2006 annual report 56% of people accessing HIV care in England in 2005 did so in London. The introduction of prescribing restrictions has the potential to affect over 24,000 people living with HIV.”
THT is calling for the ringfencing of the money that has been allocated specifically to HIV and sexual health within the NHS. “Ringfencing is not politically popular,” noted THT’s Head of Policy, Lisa Power, “but it would seem to be the only way to ensure money for sexual health services is not diverted elsewhere. Where the money does get through, improvements are being made.”
The full report, in pdf format, can be downloaded directly from Terrence Higgins Trust.