Stakeholder Engagement Report - London Councils

2. Introduction
2.1 Commissioning responsibilities
Since April 2013, local authorities have had the responsibility for their local public
health provision and commissioning. This includes responsibility for the Public Health
Outcomes Framework (PHOF), commissioning NHS Health Checks, smoking cessation,
well-being, substance misuse, sexual health promotion and HIV prevention work. This
includes sexual health service provision, primarily contraception and GUM (genito urinary
medicine). They have taken on this critical role for local health improvement at a time of
growing demand and diminishing resources.
In London the 33 London councils are now the commissioners for HIV prevention.
Specific commissioning arrangements vary across the city, with some multi-borough
arrangements, as well as individual borough commissioning, taking place. All have the
same sexual health commissioning responsibilities, which are:
• HIV and sexual health promotion
• Open access Genito-urinary medicine (GUM)
• Contraceptive services for all ages
Stakeholders taking part in the needs assessment acknowledge that London councils now
have to understand the complex and fragmented challenges posed by HIV prevention.
They felt the need for cooperation and communication between all stakeholders, confident
leadership, and excellent commissioning relationships in order to ensure seamless
pathways between clinical and other support services for patients and service users.
2.2 HIV prevention and local government
London Local Authorities account for 18 out of the 20 Local Authorities with the highest
HIV prevalence in the country. (PHE Review of HIV epidemiology in London 2011 data;
October 2013) The anticipated lifetime costs for treatment and care (including social
care) of those living with HIV are extremely high. Primary and secondary HIV prevention
work is considered to be a major priority for public health. In view of financial constraints,
Local Authorities as the statutory bodies responsible for their localities will have inherent
tensions as to what should be provided at borough or on a London wide basis. They
will also need to consider a whole system management approach, which respects the
sovereignty of each London council, and their individual population needs, without
creating unreasonable inequalities of access and outcomes for HIV prevention.
London councils are in a strong position to exercise their roles and functions for sexual
health, deliver improved outcomes for their residents, contain and reduce costs and work
proactively with partners. Making the right decisions will be critical if the changes are to
be supported by the many people they affect – local residents, service users, health and
social care and other professionals alike.
The Equality Act 2010 states that public sector bodies: -
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“Must, when making decisions of a strategic nature about how to exercise its
functions, have due regard to the desirability of exercising them in a way that is
designed to reduce the inequalities of outcome which result from socio-economic
disadvantage.”