It's finally out. After weeks of speculation and rumour that it has been buried somewhere in Whitehall, the Government’s Prevention Green Paper is here. On the same day that our new Prime Minister is announced. Cynical? Moi?
This green paper sets out the Government’s thoughts on future prevention policy – a consultation piece – particularly ahead of a next Government spending review.
But what does it mean for those of us who work in HIV and sexual health? Scroll right to the end of the document (and I mean right to the end) and we have our answer:
- A commitment to a sexual and reproductive health strategy.
- A re-commitment of the Government’s ambition to end HIV transmissions by 2030.
- An underwhelming mention that the Department of Health is considering how to roll out PrEP (pre-exposure prophylaxis).
- A re-confirmation that sexual health services will move to co-commissioning between local authorities and the NHS. And inclusion of this line: "The move towards ICSs (integrated care systems) creates the opportunity to co-commission an integrated sexual and reproductive health service."
The sexual health strategy we fully support. With no national vision or commitment around tackling STIs and improving the nation’s sexual health, we joined colleagues in BASHH, ADPH and LGA to call for a strategy. The Health Select Committee heard our collective calls and included a strategy as a key recommendation in their recent report on sexual health.
At Terrence Higgins Trust we would like to see a cross-system, ambitious strategy which brings all players responsible for sexual health to the table, and has affected communities at its heart. We must now wait until the Government’s response to the Committee's report to hear more details on next steps on the strategy.
We of course welcome the inclusion of the Government’s current commitment to end new HIV transmissions, but this is somewhat countered by the missed opportunity to take affirmative, urgent action on PrEP.
PrEP is still not universally available in England (we lag behind Wales and Scotland on this) and just last month we had news of nine men being diagnosed with HIV in Manchester as they waited to access the PrEP trial. The green paper provided an opportunity to put up some cash for PrEP, to show that urgent steps are being taken to get PrEP to all who needs it. Instead we are told that the Government is just 'considering' how to move to mainstream commissioning of PrEP.
The paper gives a nod to the fact that rapid access to sexual health services is needed if we are to curb those STIs such as gonorrhoea that are rising, but there is no reflection in the paper on the fact that national government has slashed local council public health budgets to the tune of £700 million.
The recent rhetoric from national government, as so evidently set out in the green paper, is that "prevention is more than just public health, and public health is more than just the public health grant". That's all very well but how does that help us? How does that give reassurance to the sexual health professionals who can't see everyone that are having to turn away patients with symptoms of STIs?
Future public health, including sexual health funding will be decided in the Government’s next spending review. But that is now all up in the air. No one knows if, and when, the spending review will now happen. If it doesn't happen sharpish then it is likely that local authorities will simply get a one year, flat-line rollover budget. This is unacceptable and unworkable.
A quote from the green paper for you: "Prevention forms around 5% of all public funding on health. This means in the UK we are spending over £101 billion a year treating disease, and £8 billion preventing it. As a country, we need to ask ourselves some fundamental questions about how much we value prevention, and what this means for our public services."
I hear you! Abso-bloody-lutely. This is the question that needs to be asked. But the green paper goes no further. Did DH ask that question of itself? No answer is given and the paper gives absolutely no indications on how it is going to solve this chasm in public health funding.
In one way we can't complain. There were myriad rumours only a few weeks ago that HIV and sexual health were not even included in the green paper. Thank God ourselves, LGA, BASHH and others kept banging on about why it was a huge missed opportunity for them not to be included.
And yes, it is a huge step forward that the Government has said yes to a sexual health strategy. But the green paper still leaves a bitter taste...it should have been bold, ambitious, courageous in how we collectively could tackle HIV and sexual health. But it didn't. And the unanswered question remains – what is going to happen to funding for sexual health services in the year ahead?
Debbie Laycock is Head of Policy and Public Affairs at Terrence Higgins Trust.