Archived decisions

HAMPSHIRE COUNTY COUNCIL

Decision Report

EXECUTIVE SUMMARY

1) Summary of Decision Area

1.1. This report seeks approval for making two grants to Positive Action in the current financial year to provide specialist well-being services to people who are infected with HIV and their relatives and partners.

1.2. This report also seeks approval to provide one grant to Groundswell who provide specialist at home well-being services to people who are infected with and affected by HIV.

2) Issues Covered in Report

2.1. Details of the level of funding sought by these two agencies, the reasons for the funding and the source of the funding - The AIDS Support Grant.

2.2. Background information relating to the incidence and effect of being HIV+ in Hampshire.

2.3. Background information relating to the present and future of specialist services for people who are infected and affected by HIV in Hampshire.

3) Recommendations - It is recommended that:

3.1. The Executive Member for Adult Social Care approves a grant of £22,000 to Positive Action to provide specialist well-being services for those who are infected and affected by HIV in the south and southwest of the County

3.2. The Executive Member for Adult Social Care approves a grant of £35,900 to Positive Action to provide specialist well-being services for those who are infected and affected by HIV in the north, centre and southeast of the County

3.3. The Executive Member for Adult Social Care approves a grant of £16,000 to Groundswell to provide specialist at home well-being services for those who are infected and affected by HIV in the south, centre and west of the County

MAIN REPORT

1) Contextual Information

1.1. In 2007 there were 553 people diagnosed as HIV+ in Hampshire. It is estimated that a further one third of people who are HIV+ are unaware of their condition, this leads to a total of 730 in Hampshire. This figure is consistently rising each year and is currently expected to continue to do so. Hampshire is, in national terms, a low prevalence area. The rise is spread across all groups of people who are infected.

1.2. Being HIV+ in the United Kingdom is now considered to be a long term condition, assuming appropriate and timely treatment, however it remains a challenging and complex disease for the individual to manage combined with profound implications for people living in the community in respect of the general antipathy often experienced by those who are HIV+.

1.3. Specialist services to people living with HIV in Hampshire are provided from the AIDS Support Grant (ASG) to deliver a combination of direct services by the Adult Services Department and commissioned services from the local specialist voluntary sector, in partnership with and reflecting the specialist medical services commissioned by Hampshire PCT.

1.4. Both health and social care services have evolved over time, and are continuing to do so, in response to variations in demand and with reference to the changing incidence of the disease, its treatment and impact on individuals living with HIV (both infected and affected by HIV).

1.5. Awareness raising and training, linked to wider sexual health issues, and information provision, have been and are, a key part of the provided services.

1.6. The existing services for whom these grants are recommended are;

a) Positive Action - a voluntary sector service provider which offers a drop-in centre that also provides, counselling, group work support, advocacy and information. In addition it provides housing related support and employment related support. This service is based in Aldershot, Southampton and Portsmouth.

b) Groundswell - provision of home based one-to-one support and information services particularly for those newly diagnosed or in the acute phase of illness. This service is based in Southampton City and provides services across the centre and west of the county.

1.7. The services that are supported by these recommended grants to the above agencies are for the prevention, care and after care of people who are suffering or recovering from illness.

2) Key Issues - Commissioning service provision

2.1. Traditionally HIV services have been provided in a manner to allow individual choice of where both health and social care services are sought. Individuals seek both their health and social care support from locations of their own choice and not necessarily the most immediate venue.

2.2. Specialist HIV social care services have traditionally been provided with a significant involvement of the service users and their carers and continue to be so. These services are significant sources of information on a wide range of topics in relation to living with HIV.

2.3. Maintenance of existing services in order to maintain choice for the individual. During the course of 2008, one provider - The Ribbons Centre - who provided services in the south and southwest of the county was merged with Positive Action. This process will be completed during 2009/10 and the service reinvigorated.

2.4. Ensure the move in service provision from welfare to well-being to reflect the changing nature of living with HIV. Being HIV+ is now regarded as a long term chronic condition if correctly managed.

2.5. Service provision to be flexible enough to adapt to changing individual needs and be able to respond to the Personalisation agenda. Although the funding is not involved HIV services already respond to the chosen needs of the individual.

2.6. Services to reflect and respond to the varied communities they serve. In Hampshire the major groups are gay men, the heterosexual community and the immigrant community from sub Saharan Africa.

2.7. Develop the concept of joint authority commissioning with the cities of Southampton and Portsmouth and Hampshire Primary Care Trust (HPCT). HPCT may become lead commissioner for the City PCTs and the Isle of Wight for HIV services and is working towards joint commissioning with Hampshire County Council and the two cities.

2.8. Ensure that people who live with and/or care for someone who is HIV+ are able to recognise and access services to support their own needs.

3) Finance - The AIDS Support Grant

3.1. This grant is currently provided by the Department of Health (DoH). The allocation for Hampshire County Council in 2008/9 was £190,000 (including an increase of £57,000 during the financial year). For 2009/10 the grant will revert to the base total of £133,000 with no growth announced at this time.

3.2. Historically this grant has always risen significantly above the base budget and not reduced. Early indications from DoH are that the grant will rise in line with the continued rise in diagnosis - SOPHID data on diagnosis and treatment - which is collated by the DofH in May each year.

3.3. It is expected that the grant may exceed £200,000 for 2009/10. If there is a rise there will be further grant applications this financial year in respect of Positive Action to increase their grants by up to £14,500 and £14,100 respectively.

3.4. The recommended grants to Positive Action and Groundswell amount to £73,900. The same as in 2008/9 for Positive Action i.e. £22,000 and £35,000 but for Groundswell it is increased from £6,000 to £16,000 due to a significantly under reported and increased workload.

3.5. The balance of the AIDS Support Grant is used to fund specialist services within the Adult Services Department which primarily consist of a specialist HIV Care Manager, commissioning and other development costs.

4) The Future Provision in Hampshire

4.1 Although the treatment for HIV/AIDS has and is continuing to improve exponentially in the United Kingdom since the first awareness of the disease in the 1980's, being HIV+ remains a very significant challenge in many aspects of life for the individual and their immediate relations and friends. Not least because of the very real antipathy by wider society towards those who are HIV+.

4.2 Immigrants arrive in this country for many reasons, however for those infected with HIV there is a greater incentive as all too often being HIV+ in the so-called `third world countries' is effectively an early death sentence. This presents a particular challenge for services in the county to reflect the cultural needs of these people.

4.3 The antipathy experienced by people who are HIV+ is potentially aggravated in a county district, as opposed to an urban area, by issues of comparative population sparsity and low level prevalence where identification can be seen as a greater potential risk, thus raising the challenge for specific services to meet needs. Quality of specialist service and trust in service remain key requirements for those both infected and affected by HIV.

4.4 As treatments and therefore survival rates change so the issues that arise for individuals may change - for example employment, pensions, long term relationships and finance. Services need to reflect these changes as well as the changes in the different infected populations in the community - flexibility and responsiveness is the key both for commissioning and provision. This will be guided in particular by those who may need access to services.

5) Outline of Options

5.1 These grant applications are a continuation and development of existing long term specialist provision following a joint needs analysis undertaken in 2005/6 by the University of Southampton and in line with Adult Services' commissioning framework for HIV services.

5.2 The current AIDS Support Grant period expires in March 2011 and consideration will be given to the future in 2010 if there is no confirmation of a continuation of the grant.

6) Conclusions

6.1 These three grants combined will provide a comprehensive set of specialist HIV social care services across the county which aligned with existing health provision and health promotion and prevention services provide a comprehensive package of service for people in Hampshire who are infected or affected by HIV.

6.2 The agencies that provide the services are responding to changing demand and need and as part of this response greater coordination and partnership with the commissioners in the region will be developed in order to provide an increased range of service and service options.

7) Recommendations

7.1 The Executive Member for Adult Social Care approves a grant of £22,000 to Positive Action to provide specialist well-being services for those who are infected and affected by HIV in the south and southwest of the County

7.2 The Executive Member for Adult Social Care approves a grant of £35,900 to Positive Action to provide specialist well-being services for those who are infected and affected by HIV in the north, centre and southeast of the County

7.3 The Executive Member for Adult Social Care approves a grant of £16,000 to Groundswell to provide specialist at home well-being services for those who are infected and affected by HIV in the south, centre and west of the County

Integral Appendix A

CORPORATE OR LEGAL INFORMATION:

Integral Appendix B

IMPACT ASSESSMENTS:

1. Equalities Impact Assessment:

In compiling the attached report, account has been taken of the requirements of the Corporate Equalities Plan and Race scheme. The One Compact for Hampshire has social inclusion as one of its principles and states that all partners are committed to the importance of promoting equality and opportunity for all people regardless of race, age, disability, gender, sexual orientation and belief. Additionally, equal opportunity and race relation policies are sought from voluntary organisations that apply for grants above £5,000

2. Impact on Crime and Disorder:

The County Council has an obligation under Section 17 of the Crime and Disorder Act 1998 to consider the impact of all decisions it makes on the prevention of crime. People living with HIV experience bigotry and discrimination in many aspects of life which generates fear and secrecy. By promoting greater awareness of the condition and its implications these specialised HIV Services seek to tackle the ignorance in the wider society of living with HIV.

3. Climate Change:

a) How does what is being proposed impact on our carbon footprint / energy consumption?

· These grants propose to contribute towards the costs of local agencies providing services within local communities. This reduces the need to travel and therefore reduces both the carbon footprint and energy consumption

b) How does what is being proposed consider the need to adapt to climate change, and be resilient to its longer term impacts?

· Not applicable