The effects of the Health and Social Care Act 2012 are beginning to be felt in the HIV care sector. According to this Act, sexual health services – not including HIV, which will remain nationally commissioned – must now be paid for and delivered at a local level. This means that local authorities must issue a tender notice to interested parties in their region, and would-be providers – including the potentially multiple NHS organisations which have been looking after patients in the area for years – must submit a bid.
This has very real impacts on HIV care, because sexual health and HIV cannot be separated in the way the Act supposes: in reality, HIV services are delivered alongside sexual health clinics, and the two benefit from this close correlation. The tendering process is forcing a breaking-up of this profitable partnership, and creating unnecessary churn and expense as doctors and nurses attempt to cope with the fall-out.
All of this is playing out in Chester, where the tender process has cost half a million pounds over six months. As this piece in the Chester Chronicle shows, excellent clinics there are being closed down after a deeply disputed tender process. No doctor or nurse was on the assessment panel, which selected the more expensive bid as the ‘winner’ (and did so twice – the first decision was appealed); our contacts in the city believe that the winning bid includes use of ‘flexible’ buildings – that is, temporary structures which will be moved around every six months, to “follow patient demographics” and avoid planning permission. This will remind many people of the poor standards of HIV and sexual health care in the 1980s, from which we had thought we’d progressed.
Dr Colm Mahoney, who works at Countess of Chester Foundation Trust Hospital, one of the ‘losing’ bidders, had this to say: “We now have to leave this superb, spacious, fully IT serviced, city centre, hospital clinic by the end of January. Regular patient feedback is absolutely glowing. Local GPs highly regard the service, and they are furious.
“If the tendering process needs to go ahead, councils need to be absolutely told how to do it properly. The specification should have a sexual health consultant involved in drawing it up. The assessment panel of the tenders should include a local GP, a sexual health consultant and others on it. Interviews should be part of the process to expose the slick tender management companies who are just producing brilliant paper exercises. There should be a two week period after the initial award of tender for the other bidders to be reassured that the process was done properly.”
All of this is of huge concern to patient groups and charities like ours. Traditionally, it has been extremely difficult to persuade patients of sexual health services to campaign for their clinics – to do so is to admit you have accessed them, and stigma remains too strong. Bravely, one of Dr O’Mahony’s patients has already spoken out. The patient voice is absolutely crucial when it comes to persuading commissioners where resource should be allocated. A winning bidder need not close down its ‘competitors’ – instead, it can choose to co-operate and allocate the funds released by the local authority in such a way that existing and excellent infrastructure can be properly used … and services kept together.
We’ll be watching the situation in Chester – and nationwide – carefully. Please keep us up to date about your own area – and get involved with the campaigns to save these services!