Sexual healthcare 'at risk from NHS changes'

Medic with money The experts fear pursuing profit will skew health priorities

Many NHS services are being put out to tender - and private companies can bid.

In this week's Scrubbing Up, Dr Steve Taylor, a sexual health and HIV specialist from Birmingham Heartlands Hospital and Dan Hartland from the HIV awareness charity Saving Lives warn there are unique dangers in allowing them to run sexual healthcare.

Many people may be unaware that one facet of the government's health reforms allows private companies to tender to provide NHS services - including sexual healthcare.

Traditionally, such services have been paid for using an internal NHS tariff system which covered basic costs, but also factored in associated costs such as contact tracing partners and providing prevention messages.

The tariff does not cover the cost of treating complicated cases, such as secondary syphilis, but ultimately the mix of simple and complex cases balances the books.

However, as of April 2013 things will change.

'Envy of the world'

Many services are being put out to private tender - and will be overseen by 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.

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What will happen in areas where councillors with staunchly religious views are in control?”

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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.

The reforms are therefore a challenge to the joined-up way of working we currently enjoy.

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, then, 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, meanwhile, will have subtly different priorities.

'Untenable' services

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.

It would be so easy for the 25,000 people in the UK who do not know they have HIV to become 50,000 as a result of non-targeted testing and the demise of contact-tracing.

Now is the time that we should be deepening the links between prevention, research, treatment and care if we are to really make an impact upon silent STI (sexually transmitted infections) epidemics, teenage pregnancies and undiagnosed HIV.

Instead, there is a very real risk that currently joined-up services will become fragmented, with huge variation in service.

We must work with our public health colleagues, who will for the first time be part of local government rather than the NHS, to put pressure on local councils to prioritise high quality sexual health services amid demands from many disciplines for unallocated funding.

But which councillors will want to champion STI and HIV services, when promoting an already stigmatised area of healthcare may not win many votes?

And what will happen in areas where councillors with staunchly religious views are in control?

We need brave advocates amongst politicians, patients and doctors alike.

The current NHS sexual health and HIV services are far from perfect.

But we are sure that the government and the public alike will not know how good they were until things start going wrong.


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  • rate this

    Comment number 128.

    "In a true free market, healthcare would be cheaper, better, more accessible" As you are fond of asking your evidence for this assertion is? With what guaruntees against "corporatism"?

  • Comment number 127.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 126.

    If I had my way, I'd insist on ALL Visitors / Immigrants to the UK - to be tested for HIV / AIDS on entry. Sadly, I don't suppose we could afford the cost. We've seen the resurgence of TB BACK in the UK since Labour's 'open-door' policy...

  • rate this

    Comment number 125.

    The usual Tory/UKIP attack on the NHS.
    All your analogies and anecdotes are so easily quashed with this simple observation.And that is Cuba.
    Despite being under economic siege from the U.S and a weather system that frequently stalls their progress.They still can provide Fee Healthcare for their citizens .
    Comrades , what stifles the NHS is not the idea,but the capitalist vultures around it.

  • rate this

    Comment number 124.

    Still no NHS cheerleaders up for my challenge @94 eh?

    Can anyone please point out the difference between a Ponzi Scheme & the NHS: ?

    From what I can see, the only difference is that a Ponzi scheme actually seems more moral; Participation is voluntary. You're FORCED to "contribute" to the NHS.

  • rate this

    Comment number 123.


    What are you basing this reasoning on?

    Sure, in Socialism everyone has Medicare, but there's no Drs, nurses, or medicines. = USSR's system. We don't have capitalism in healthcare. The USA, has corporatism thanks to an overly powerful central govt, able to pick winners (corporate pals) with regulations. In a true free market, healthcare would be cheaper, better, more accessible

  • rate this

    Comment number 122.

    95 EpicLoiz

    When was this strange time when all spectacles had to be bought through the NHS? When I was at school, a long time ago, it was always apparent who had NHS glasses and who didn't. I did. The frames were ugly, I agree but worked fine. They had to be cheap to be NHS affordable. Alternative? Well my parents couldn't afford the private specs.

  • rate this

    Comment number 121.

    The services have benefitted from 10 years' investment, expansion and integration, so it's important that the expertise in standards of clinical care, training and research must be maintained.
    But it's difficult to see how for-profit organisations could conserve quality without cutting corners - and if your local services suffer, what can the public do about it?

  • Comment number 120.

    All this user's posts have been removed.Why?

  • rate this

    Comment number 119.

    @117 'moggy'
    No, I don't have English comprehension issues. Nor do I have political; or life's nightmare comprehension issues either.

    Nor do I understand why your post @117 to me was removed by moderators. I was not offended by your post and would not have known about it if I had not remained online.

  • rate this

    Comment number 118.

    @116 'EpicLolz'
    Of course you have no idea what I'm talking about - nor are you interested in what others here have to say on this HYS.

    Everytime you post under different screen names - it's the same old and familiar one-sided rhetoric full of insults, yet nothing constructive to add to the debate. Sigh.

  • Comment number 117.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 116.

    108 I have no idea what you are talking about? I'm just railing against Beeb bias in a hyperbolic fashion for a laugh, I knew the BeeB was a hot bed of State funded, paid of the books but everyone must pay more tax hypocrisy but I didn't realise the message boards were so packed with holier than thous. I guess it's the bored, jobless vested interests.

  • Comment number 115.

    All this user's posts have been removed.Why?

  • rate this

    Comment number 114.

    @ 110 'moggy'
    "coram-populo-2010 you're a stupid person's idea of clever!"

    Well thank you 'moggy' - I'm delighted to hear that I am judged stupid by you.

  • rate this

    Comment number 113.

    Re 92 - thanks for your engagement.
    Interesting thought.
    The service (nurses, doctors etc) is nationalised - NHS
    The products can be privatised - machinery, tangibles, drugs etc
    Wonder if there is mileage thinking this through and having less knee jerk reaction to public vs private...

  • rate this

    Comment number 112.


    But yours is a strawman argument (that only works with select STI's too).

    Capitalists forget that with health issues, it can only ever be everyone or noone.

    It's no good having half the population treated and the other half not, as the untreated peoples illnesses will bring down the health of those who get treatment, negating the effects of medical advances.

  • rate this

    Comment number 111.

    @107 Rodders
    Nice strawman argument. If person A had been responsible & had insurance they could have an option for GP visits! They could've been responsible & used a condom! But now innocent person B who did do these responsible things, at their personal expense, is penalised financially by you, & the Ponzi scheme NHS.

  • Comment number 110.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 109.

    I see the milk og human kindness has gone off ! I DO NOT WANT TO HELP ANYONE I WANT MONEY ! this new big society is sick ! I want no part of it.


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