§ 4. Lynne Jones (Birmingham, Selly Oak)If he will make a statement on how specialist HIV work will be protected and monitored under primary care trust commissioning. [19658]
§ The Minister of State, Department of Health (Jacqui Smith)For the year ahead primary care trusts must honour existing agreements, financial and otherwise, negotiated by regional specialised commissioning groups and current specialised service commissioners. Implementation of the sexual health and HIV strategy will include effective performance management through the use of, for example, information collected under the AIDS (Control) Act 1987.
§ Lynne JonesAs my hon. Friend will know, last year saw the greatest number of AIDS cases—or HIV infection cases—ever recorded. Many organisations, including the Birmingham-based charity Freshwinds, have said that the mainstreaming of HIV prevention work is premature. I know that health authorities will be commissioning the work for next year, but is there not a case for postponing the new arrangements at least until a review of the AIDS (Control) Act reports has been conducted, and robust measures are in place to identify instances in which primary care trusts are not taking their responsibilities seriously enough and are not catering for the needs of vulnerable groups such as gay men and asylum seekers?
§ Jacqui SmithMy hon. Friend is right to mention the large number of new HIV infections identified in the past year. One reason may well be the increase in antenatal testing, which I am sure we all agree is very important. The reflection of that in higher figures for infection enables us subsequently to treat the women involved to make it less likely that the infection is passed to their children.
My hon. Friend underlined the need to monitor what is produced in the system. We should aim for a system in which more services are commissioned at PCT level, because that will allow more flexibility and responsiveness in decisions about the delivery of local treatment and care. We need to ensure that the targets identified in, for example, the sexual health and HIV strategy—which include a 25 per cent. reduction in new HIV infections by 2007—are monitored. As we move to a locally responsive system, it must be ensured that we deliver on those targets.
§ Mr. Peter Viggers (Gosport)Can it really be true that, as stated in a parliamentary answer to me, the national health service is recruiting HIV-positive nurses from sub-Saharan Africa, and that that poses no health hazard?
§ Jacqui SmithI do not know of the specific case to which the hon. Gentleman refers, but if he writes to me I will certainly respond. It is important for us to recruit 701 people, from this country or from overseas, who both meet the necessary health requirements and can contribute to the national health service.
Careful controls apply to those employed in our health service who may be HIV-positive. I do not think that raising particular cases is helpful in ensuring that we recruit the numbers that we require, or in avoiding stigmatising people with HIV while making certain that NHS patients have the necessary protection.
§ Mr. Neil Gerrard (Walthamstow)As the Minister knows, the AIDS (Control) Act requires health authorities to report on the use of the ring-fenced budget. Does she accept that, given that health authorities in their present form will disappear—along with that ring-fenced budget—we need to get on with reviewing the Act, so that when the budgets go to primary care trusts there will be a mechanism to track what they are doing and establish whether they are spending effectively?
§ Jacqui SmithIt is true that the Act currently requires health authorities to report annually not just on the spending of their money but on the number of new infections, treatment provided and investment in HIV prevention work. In April 2002, the requirement will pass from health authorities to PCTs, so we can go on monitoring that activity.
My hon. Friend is also right that we should review the operation of the Act to ensure that we have information, not just locally but nationally, to enable us to measure the outcomes of investment in the tackling of HIV, and our success in lowering levels of infection.
§ Sandra Gidley (Romsey)Traditionally, health authorities have been allocated money for prevention and money for treatment and cure. Everybody must get the prevention message across when the budget effectively goes into the primary care trust pot, but the incidence of HIV varies around the country. It is low in my area, but extremely high in parts of London. Will areas with a high incidence be vired more money to cope with the larger problem or will they be expected to manage on the existing budget?
§ Jacqui SmithNo, a revised allocation formula was developed to ensure that PCTs receive a share of funds in line with the number of residents with HIV receiving treatment in their boundaries. That will be incorporated as a component of the unified formula to ensure that money is distributed to the areas that need it for treatment.