Stakeholder Engagement Report - London Councils

4.2. The how
4.2.1 the strategic direction
and leadership
“These are exciting times - we could really get this right now, if there is the will
and commitment! Very exciting!”
“How on earth are local authorities in London going to make sense of all this
chaos, and filter all the crap so that we can get a proper coordinated commissioning
approach for both pan-London and local work? It seems to be chaos and the numbers
are going up? It needs to be sorted as a matter of urgency.”
Key issues
Stakeholders agreed that the epidemiological evidence illustrates the need for a
coordinated response driven by collaborative work as a matter of urgency. London was
described as the “worst city in the developed world for the response to HIV prevention,”
with few strategic London-wide responses approached with London-wide ownership of
the challenges. This is in stark contrast to other major cities where city-wide responses
are in place to ensure a strategic and appropriate flexible response to HIV (e.g. New York,
San Francisco, Washington DC).
Tensions are apparent between inner and outer London boroughs, and between high
and low prevalence areas, with serious concerns expressed that localism and politics will
impact on the future commissioning of HIV on a city-wide London basis. A real sense of
“tinkering around the edges” was regularly expressed as a concern if commissioning was
not appropriately coordinated.
Commissioning leadership has been really challenged as part of the re-organisation
and transition. There was consensus that there needed to be clear demarcation of roles
and responsibilities in future, but a fear that there will be confusion and chaos until it is
more clearly understood and a coordinated response owned by all the commissioners.
It was acknowledged, though, that the transition is recent and new relationships, roles
and responsibilities will be developed and determined over the coming months/years.
It was noted that some provider stakeholders had not fully understood the changes in
commissioning and the move of public health from the NHS to Local Authority.
Fragmented HIV commissioning arrangements are now a reality, with commissioning
sitting across local government and NHS England. London is disproportionately affected
as it has 33 London boroughs, all with different HIV prevalence rates, diverse populations
and no strategic coordinated commissioning capacity or leadership roles to ensure
consistency or equity to HIV prevention interventions across the capital. Stakeholders’
believed that an appropriate response to sector development would be dependent on
Local Authorities’ ability and willingness to collaborate on a London wide basis. Failure
to do so will lead to further fragmentation, expensive duplication, and ineffective
interventions.
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“Not coordinating HIV prevention commissioning across London Boroughs is like giving
providers a blank cheque book!”