CENTRAL WEST LONDON
SEXUAL HEALTH PROVIDERS FORUM
Wednesday 26th June 2013, 10.30am – 12.30pmKensington Town Hall
Chair: Justin Gaffney (Metrosexual Health)
Minutes taken by: Lev Pedro (KCSC)
Attendance list attached.
All presentations and publications mentioned are available at www.kcsc.org.uk/sexualhealth
Item / Notes / Action1 / The bigger picture across public health, Sarah Radcliffe, National AIDS Trust
Please refer to Sarah’s presentation
· New NHS architecture is very complex.
· Important to know who our reps are.
· HIV commissioning is now split – testing, clinical services, sexual health
· Important to engage with NHS England area team - 10 of the 27 have direct commissioning responsibility
· Clinical senates are not commissioning bodies, but strategic agencies, made up of a wide range of practitioners, thinking about overall health, not specific issues, new, did not exist before. London has a clinical senate
· Clinical Reference Groups – HIV is part of the cancer and blood programme. Have had to develop service specifications; rep for NW London is Dr Brian Gazzard (ChelWest)and chair is Dr Simon Barton (both Chelwest)
· Public health England is an advisory body, not commissioning – should provide local support and advice
· Read – ‘A Framework for Sexual Health Improvement in England’
· No longer specialist HIV commissioners – sorting out SH services has been such a big priority that HIV has been to one side, expecting there to be an HIV lead commissioner in NHS England, but there is not. Important that local commissioners keep an eye on all services
· EWAN’S COMMENT BY EMAIL AFTER THE MEETING:
· There is a service specialist in NHS England London Region with HIV in her remit. She’s now leading the HIV Service Review on the configuration of Acute HIV Services (all outpatient and some inpatient). Her name is Jess Peck and she was previously a sexual health commissioner in Lambeth, Southwark and Lewisham. There’s an Expert Advisory Group for the HIV Service Review. I’m the local commissioning representative on the EAG and Julie Billet, DPH from Camden is also expected to join the EAG.
·
2 / Local demographics, Gayan Perera, Tri-Borough Public Health
Please refer to Gayan’s presentation
· High proportion of workers and tourists in tri-borough which presents issues for commissioning, also big variations in wealth, health and cultures.
· Under 18 conception rates particularly high H&F especially College Park, Old Oak, Wormholt, White City. Also, Queen’s Park, Church St, Harrow Road, K&C rates are lower.
· HIV/AIDS – increasing in all boroughs, and 64-74% of new infections are men who have sex with men (MSM). Female HIV infection also increasing faster than before.
· Highest concentration of people HIV+ is Soho, West End, Earls Court, etc.
· Acute STIs for all boroughs above average – H&F 4th highest in London – across all acute STIs.
· Question: is there any more specific info about female HIV diagnoses? – Ewan says needs more investigation, working with epidemiologists in PH team to work out which specific communities are more at risk, etc.
· Miguel commented that no data is available for people w LD.
· Question: Late HIV diagnosis – any specifics? Ewan: Local data shows we’re on target compared to other areas. Locally we have better rates of HIV testing among MSM than BME populations. Not sure how detailed we can be, e.g. specific countries of origin.
3 / Commissioning intentions and processes, Ewan Jenkins (Tri-Borough), Foizul Islam (Camden), Isoken Aigbekaen (Brent)
TRI-BOROUGH (EWAN) - Please refer to Ewan’s presentation
· Now public health has moved from the NHS into Local Authorities, there is a significant increase in process. . Decisions are also subject to scrutiny and approval in the context of local democracy. As an example from tri-borough, payments to suppliers can only be made once a supplier is listed on two separate databases in each authority and a purchase order has been created. The process is different currently for each authority and has been very time consuming.
· There is no ‘lead commissioner’ arrangement in the tri-borough. However, Westminster as the Public Health host authority leads procurement. Any proposed procurement passes through Westminster processes first, then moves on to pass through other two boroughs.
· Anything over £100k for total contract value, not annual value, must go to competitive tender. Local Authorities use clear tender process and may operate according to MEAT (Most economically advantageous tender) –This does not necessarily mean cheapest bid; if outcomes are better and costs are more, contract may still be awarded
· All such procurement is considered corporate and is supported by a specialist corporate procurement team, based in Westminster
· Officers will make recommendations based on evidence, knowledge and expertise and process and, for lower value procurements, have certain discretion to award, but in a Council, most things have to go through democratic process – the higher the value, the more chance it will have to go to full cabinet. Thresholds are different in the 3 boroughs, which adds additional complexity.
· If there is evidence that a service is needed across 3 boroughs then it will be commissioned as a tri-borough service.
· HIV services need to be reviewed. For example,prevention services may not deliver according to most recent evidence ,so redesign is likely to be required.
· There will be a focus on young people, Chlamydia screening important, but placed in a wider context of young people’s health – integration of interventions, and important to work more closely with colleagues from (e.g.) children & family services. .
· Important to be aware of the agreed public health outcomes (see slide). PH team is trying to embed itself in all the councils’ work, so that all departments of the council can work towards achieving the PH outcomes.
· GUM and community contraception are mandated services / functions so are priorities . However, the Public Health Grant is fixed so costs must be controlled. Local Authorities will not bail out overspends. It is important that other services such as prevention do not face being cut due to uncontrolled costs of mandated services.
· Commissioning intentions are not set yet. We expect to be clearer about this from late summer / early autumn. There are a number of internal review processes ongoing to assist with the development of these. This includes a return to looking at the sexual health strategy.
· Pete Westmore is developing a third sector commissioning framework.
· Question: Will funding of GUM clinics be capped even if they over-perform? – Ewan: commissioners and providers will need to work together creatively and work out strategies.
· Question: How does the children’s safeguarding board fit in? – Ewan – relationship still developing. Need to understand what children & families commissioners are doing and create better links.
CAMDEN (FOIZUL)
· Camden & Islington now has a joint Director of Public Health (DPH), Julie Billett, transition is over, work is progressing.
· Camden is working on a local strategy for HIV and sexual health to be finished by August, will give direction for commissioning next 3 years. Not clear yet what sped savings will need to be made in 13/14.
· Julie Billett is supporting a pan-London HIV needs assessment, but this is now delayed to be published summer 2014. Therefore in Camden Foizul is talking to service users, and making adjustments as necessary. Foizul is talking to decision-makers in Camden about importance of SH work, especially prevention. Also, wants to put together a planning doc of contracts coming up for let. Still many things to be clarified.
BRENT (ISOKEN)
· Brent picture almost the same. Now has public health budget, £6M on prevention. Procurement processes as explained above, £100k threshold. Currently doing a health needs assessment, focusing on high-risk groups. High level of BME with HIV in Brent.
· Strategic priorities – increase partnership working across London and in with other areas such as substance misuse, create a more generic approach. Will update us as strategies develop.
DISCUSSION
· Ewan – The eight Local local Authorities authorities in North- West London are collaborating to place GUM contracts. This will result in a single contract for each GUM provider lead by one Local local Authority authority on behalf of itself and the other seven Local local Authoritiesauthorities.. The approach enables thinking about other areas where efficiencies could be made by collaborative working ,working, but it must also demonstrate benefit to service users and outcomes. Nothing currently planned, but aim for future.
· Miguel asked about people with learning disabilities – Brent – yes LD are part of high risk groups being looked into. Camden - Foizul will be liaising with other relevant commissioners.
· Marion asked why no strategic commissioning across London for black African prevention? Ewan – it was an incredibly difficult decision made by London Councils. Discussions have been difficult. For example, media work is commissioned at a national level so there is a question about duplication. Outer London borough commissioners have questioned the work in the past as they felt it may not deliver sufficient outcomes for their populations. Ewan would like to encourage scaling up really successful local African prevention work on a pilot basis to test if it can work across a larger footprint. Context of working from Local Authorities means new challenges exist in reaching agreement for commissioning pan London. May mean an increased amount of locally commissioned work in future. Marion commented that with small piecemeal projects there will never be a systematic gathering of evidence for success of African prevention work, and opportunities will be lost to find what works. Ewan stressed importance of feeding into the pan-London prevention needs assessment work being led by Julie Billett.
· Commissioners agree that funding should not be the sole driver of defining commissioning of good prevention interventions. Ewan confirmed that the role of good prevention is extremely important.
4 / Updates from forum sub-groups
· Young People – is trying to feed strategically, looking at SRE picture, JSNAs etc. Agreed that txtm8 should be best place for information about service provision.
· HIV – nothing significant to report.
· Sexual health – nothing significant to report.
5 / Forum business
· It was agreed that there is no need for an overall forum chair, rather that the three sub-forum chairs share the role. The following were elected to chair the sub-forums:
- HIV support – Kathryn Dombrowicz
- Sexual health – Justin Gaffney
- Young people – Dr Charlotte Cohen & Emily Mailes (jointly)
- Charlotte thanked her co-chair from last year Alison Robert of Brook London for her work and commitment to the forum and last year’s conference.
· Lev reported that 14 respondents had completed the survey; there were no common themes for training, and due to budget reduction, it was agreed at a Chairs meeting to not run training this year. Generally the feedback showed that people valued the forum, and the networking opportunities.
6 / Members news and updates
None
7 / AOB
None
Attendance list
Harjit – I’ve left the old names from the January meeting in to save you typing! … The apologies are correct
Name / OrganisationAlison Barnes / Body & Soul
Mary Makarau / Central London Community Healthcare
Shaun Watson / Chelsea and Westminster (Dean st clinic)
Kevin McPeake / Chelsea and Westminster (Dean st clinic)
Miguel Tudela de la Fuente / Family Planning Association
Simi Ryatt / H&F CAB