Thank you very much for the opportunity to speak and it’s an even bigger opportunity
than I realised after listening to today’s discussions and how absolutely fantastic they’ve
been.
In terms of my invitation to speak I’m not a policy maker and I’m not somebody who
works for PHE or NHS England, I’m a clinician from the Royal London Hospital and I am the
elected chair of the British HIV Association which means that I speak for other people
just like me, doctors at different hospitals, nurses, members of the community, junior doctors.
So this is the only perspective that I’m able to bring to the meeting so that's the
perspective that I’m going to bring.
So when we think about the future of HIV services for those of you who can’t decode the picture
it’s a few little zebra trying to cross a river through some crocodiles.
Being South African it seems a very obvious image to use, but I think in terms of the
future of HIV services sometimes it can feel like that.
We’re trying to negotiate very, very difficult waters at the moment and many times we’re
doing this on our own, okay, or following behind somebody but not very well represented
and as we know there are enormous challenges to delivering HIV care, a lot of them have
been mentioned today, and this is certainly not an exhaustive list, this is a very small
number of challenges, issues that range from changes in our curriculum to trainee vacancies,
dislocation of services are secondary to the health and social care bill, more social and
political issues such as criminalisation of HIV, a recent decision to share NHS record
demographics with the Home Office, issues around condition of PrEP and then the issues
that affect clinicians like me which is little money or time to attend conferences to develop
my education.
We’ve been talking at a macro level all day but my perspective I’m afraid is a micro
perspective and in terms of the King’s Fund report it’s an amazing piece of work and
it talks a lot about what larger bodies should do and what they could do to try and improve
things such as PHE, Department of Health, NHS England, Health Education England and
in terms of local services.
So a lot has been said about macro politics and I can’t say much more than what has
already been said because it’s all been said so eloquently and with such a lot of
insight, but as a job in clinician I understand this affects my daily ability to work as it
does the ability of other people and this macro politics affects us as clinicians in
terms of our ability to deliver things like PrEP, like HIV testing and the question is
could professionals advocate more effectively on policy than we currently do?
Okay, can organisations like the British HIV Association, like the British Association
for Sexual Health what can we do separately and together to try and advocate more effectively
on policy to bring our professional voice, the voice of clinicians, into the policy domain?
So I guess the question is in my view this is what we should do, okay, we need to try
to unite to get across this difficult river together and try and find ways of making it
out and it’s an obvious analogy but it’s really what I believe is at the heart of the
way forward.
In terms of our own organisation in terms of BHIVA we are engaged with a number of different
activities.
What we are undertaking at the moment is we’re trying to review the standards of HIV care,
we’re looking at guidelines, I’m sure BASH is of course doing exactly the same looking
at other guidelines, putting on conferences and we are doing audits and we’re also trying
to advance the way in which to deliver education through apps etc etc.
So this is our run of the mill work, this is our bread and butter, this is what we’ve
always done as an organisation.
The question is how might we adapt to advocate for better HIV services and our traditional
structure has involved a number of subgroups to deliver guidelines, audit, education and
conferences but we’ve this year developed a new subgroup which is external relations
and that is to deal exactly with policy issues, and it’s really to look at what should we
say in terms of the traditional media, how do we improve our spokespeople, how do we
improve the responsiveness, the speed of our social media responses, develop dynamic content
to Facebook for example because some people use that to try and make it come alive?
How do we invigorate our organisation to try to engage the membership to try and bring
people in to feel as though they belong within this organisation, to feel a part of this
organisation, to champion and to recognise the good things that have happened, our longstanding
relationship with each other, with the community, to develop Instagram accounts looking at photographs,
to try and come together and cross the river basically?
So we’ve been trying to engage and as I said to you this is a micro perspective and
it’s going to look like a micro perspective to all of you who have been listening today
by people who are making public policy for the whole nation and here I’m telling you
about the BHIVA response to the Medical Protection Society article on HIV testing.
You might be thinking oh my goodness, but the important thing is we’re not NHS England,
we are clinicians and what we can do is we can respond to things that are not okay, that
we as professionals can react to, issues which are … for example this article which was
written by an advisor to the Medical Protection Society.
Now the Medical Protection Society are incredibly influential, they provide the indemnity for
all doctors across the UK – well, those that aren’t with the other organisation
– and essentially they published an article about HIV testing, exercising caution and
citing ethical dilemmas, cultural sensitivities, occupational consequences and this was exactly
in response to the NICE guidance suggesting that every person should have a test.
If they have a prevalence greater than two per thousand in their population they should
be tested if they come in because they’ve stubbed their toe.
Instead of which we were listening to arguments about cultural sensitivities.
So we were involved in a strong antithetical reaction and there were hundreds of Tweets,
but more importantly we were able to try and create a space for our voice on HIV testing
on this occasion and this facilitated the ability to go and meet the Chief Executive
of the Medical Protection Society to try to work with them in the future.
We’re going to be writing cases to go out in their publications about testing, about
HIV issues, we’ve raised issue around criminalisation.
Hopefully we’re going to open the door.
It was a very unfortunate event, it was upsetting when I saw an article I was absolutely incandescent,
but the important thing is it gave us the opportunity to say that.
On International Women’s Day we were able to engage with colleagues in the community
and develop an educational campaign on Twitter with hourly Tweets with links to educational
articles and also championing people’s stories such as Silvia Petretti spoke up about her
story.
So I think really it’s about creating an audience and actually BASH has probably a
more sophisticated public and media facing approach than we’ve ever had and they have
a very quick responsiveness, but the question is about how we as organisations in our own
ways and sometimes together can try and push the voice of the oppressional forward.
So today we’ve heard a lot about STPs and the question is … if you forget all the
text, I’ll just talk about the first point first.
So in terms of STPs those people who have engaged with STPs, okay, with sustainability
transformation plans, understand what it involves to be at that table.
I’ve never been to one and I sat in the audience putting up my hand and asking Simon
Barton, “So how can we develop a toolkit for clinicians?
So if we go what should we say?” and all these sorts of questions and the trouble is
once you understand a certain strata of the hierarchy you forget that other people who
are a strata down don’t actually understand what is happening and I don’t understand
this.
So Elizabeth Kahn and I were sitting there together and we said to each other, “Maybe
we should look to develop together some frequently asked questions for members on how to engage
with this process, how to get ourselves to the table and if we do get to a meeting what
should we actually do at that meeting?”
because I wouldn’t know even if I got there.
For example it is opportunity for collaboration to develop campaigns, it’s 30 years since
the original Iceberg campaigns, what are these opportunities?
I’m not saying these are things we’re definitely going to do but I’m saying these
are things we could do, these are things we could think about as organisations and not
just be the own contributions in their own areas that they may wish to develop and I’m
speaking as a professional who works in an organisation.
Obviously in organisations we represent on the CRG this is an opportunity for us.
They are regional representatives who come from all the different parts of the UK but
then there’s me from BHIVA and there’s Laura from BASH and we are not representing
the regions and I think perhaps today I understood for the first time when I go there I am representing
the members of my organisation and therefore I need to know what the views are in my organisation
of what are the problems to bring to the CRG.
I'm not just there as another person at the table and it’s important that we need to
use online tools to educate on policy at our national conferences to give people the facility
and the ability to understand.
I write a newsletter trying to talk about issues that affect BHIVA members, my perception
is that about three people read it but nonetheless I try very hard to write about it and particularly
about the policy issues.
The policy issues that are occurring in terms of clinicians and how to deal with them and
how to understand them and what to do if they happen to you and I think perhaps this is
part of the thing that we as clinicians can contribute to the table.
So I’m very open to ideas, I think anyone in this situation would be very open to ideas
from the membership to try and understand what people think, what people want so I think
that’s pretty much all I’m going to say at this point, but I'm happy to take questions
at any stage.