Stakeholder Engagement Report - London Councils

Furthermore, with a move to more social enterprise involvement, and CCGs and other
qualified providers waiting to join the new market opportunities, stakeholders felt that
this would present challenges to both providers and commissioners. These emerging
opportunities for new and alternative organisations are relatively immature at present,
but for effective partnerships to work in the future, each needs to feel confident in their
roles and understand their responsibilities in order to achieve the best possible outcome
for patients.
The future role of the Health and Well Being Boards (HWBs) was unclear in relation to
HIV prevention, and few stakeholders were able to tell the interviewers whether HIV was
a priority on any HWB’s agendas at present. Given they can determine priorities locally;
concerns were expressed as to how they could jointly agree priorities for London if
required, and there were concerns regarding their influence London wide.
Stakeholders were anxious that the ‘Broader Determinants of Health’ are still unhelpfully
commissioned, with silos of commissioned activity, which does not reflect the individual’s
needs for support on the totality of their risky behaviour. For example drugs and alcohol
play a major role in risk taking behaviour, including sexual activity, but the opportunities to
work across departments and combining budgets is not facilitated or indeed encouraged.
There was confusion expressed as to the role of HIV Prevention England (HPE) in London,
and lack of clarity on their role with Local Authorities in planning the work. About 39% of
HPE spend is spent with specific benefit to London, there was a view that the Department
of Health should allocate the funding according to the epidemiology and give a larger
proportion to London.
Concerns were expressed as to how to better align clinical service provision with the
HIV prevention agenda. Stakeholders widely recognised the role of GUM and community
clinics in HIV prevention, and were keen to see this role enlarged. However capacity
issues, lack of specific commissioned activity for prevention, funding pressures, training,
skills and competencies were often cited as reasons why there was too little active and
proactive HIV prevention work incorporated into GUM service specifications. Given that
London councils are now responsible for commissioning GUM services, stakeholders saw
this as a major opportunity to improve the role of GUM in HIV and STI prevention and to
identify additional and alternative settings to increase uptake of HIV/STI testing.
Whilst NHS England is responsible for the treatment and care costs of people living
with HIV, most stakeholders would support a case for the £110 million for GUM (which
includes testing for HIV) to be maximised and encompass the breadth of interventions
required to tackle the increasing numbers of people with HIV.
Suggested approaches
Leadership and sound reporting structures were seen to be key in supporting the
strategic direction for the future.
There was overwhelming consensus from stakeholders that there needs to be a lead
commissioning HIV and Sexual Health co-ordinator for London with formal delegated
responsibility to support all 33 London councils. They would work closely with public
health leads, policy organisations, third sector organisations, the London local area teams
(LATs) at NHS England and service users, in order to develop a robust, strategic, evidence
based commissioning plan for London.
In addition, it was proposed that there be three cluster network coordinators (comparable
with LAT boundaries) that can support their local government colleagues leading on
sexual health and HIV in each borough, with specific support for discrete and appropriate
commissioning plans applicable to each borough’s differing needs.
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