The late 1980s and the early 1990s was a time when the HIV and AIDS pandemic was in the news and high on the political agenda.
Professor Virginia Berridge, Director of the Centre for History in Public Health and author of AIDS in the UK, gives us this accurate and succinct historical context:
An expert advisory group on AIDS (EAGA) had been set up in 1985 in the Department of Health with input from clinicians and scientists involved. The Chief Medical Officer, the main public health government official, Sir Donald Acheson, led the group. Despite the level of expertise, the committee faced many problems. They included the attitude of sections of the press, which called for a punitive response to HIV/AIDS. An initial lack of political interest and the danger that, if political interest were awakened, the Conservative government led by Prime Minister Margaret Thatcher might take a punitive stance. Issues such as segregation and quarantine were freely talked about.
In 1986, a sense of national emergency materialised, and developed high-level political interest on the subject. A Cabinet committee on AIDS was set up, a major health education campaign was initiated, funds were released for research, and the main health education body, the Health Education Council, was reformed as the Health Education Authority. Despite this progress, there were still powerful calls for a punitive approach, such as when the Chief Constable of Greater Manchester, James Anderton, spoke of people ‘swirling in a human cesspit of their own making’. However, the general tenor of the government response was pragmatic – focussing on safe sex rather than no sex, and safer drug use rather than no drug use. This liberal response was influential at the international level too and was promoted through AIDS specific organisations set up as part of the World Health Organisation (WHO) and the United Nations (UN).
In South East London, the local HIV groups were formed in response to the direct experiences of people who faced barriers accessing health and social care. These specialist organisations included the Positive Place in Deptford – which started in an office in Sydenham where Cllr Alan Hall was a volunteer.
Sydenham is a very interesting area. Geographically it is on a hill which has a ridge with its apex at Crystal Palace. Crystal Palace is the place where five local authorities meet – the boundaries of London Boroughs of Bromley, Croydon, Lambeth, Lewisham and Southwark.
Locally, social services are provided by Councils and health services were overseen by regional health authorities at this time. The provision of HIV services were very variable and much of the work and support was provided by specialist sexual health clinics at the major London teaching hospitals. Hospital social work could provide some support but the end of life care and care at home fell to the patients’ home local authority.
By 1991 the Government had put in place a ringfenced Government Grant called the AIDS Support Grant (ASG) – this was to recognise the additional resources needed to provide services for people with AIDS.
AIMS OF THE GRANT SCHEME
To enable Social Services Departments to draw up strategic plans, based on local population
needs assessments, for commissioning social care for people with HIV/AIDS; and to enable Social Services Departments to finance the provision of social care for people with HIV/AIDS, and where appropriate, their partners, carers and families.
The grant is to assist local authorities with the costs of providing HIV related personal social services.
At the Positive Place – then in Sydenham – we became aware that people with HIV were having problem accessing social services in Bromley. There were general comments and complaints in the other neighbouring boroughs however, in Bromley people were routinely refused a social service.
After extensive enquiries and local research, a meeting with Bromley Social Services Committee Councillors was arranged and a briefing document produced. Richard Cowie, the Clinical Nurse Specialist for South East London Health Authority, David Thomas a Trustee of the Postive Place which had established as a centre for people with HIV in SE London based in Deptford – joined Alan Hall who had become a member of the Bromley Community Health Council and set up Bromley Positive Support Group in Beckenham.
The first section is instructive it is called: NO AIDS HERE
“The first response to deny HIV services is that there is ‘no demand’ for them. In effect, this means no AIDS in Bromley. In 1992 this was the reason used by the London Borough of Bromley for not applying for AIDS Support Grant. Every District Health Authority must submit returns regarding the number of HIV infections and AIDS related deaths yearly and much more detailed information under the provision of the AIDS (Control) Act 1987.”
“The figures are collated in a technical manner and require considerable caution interpretating them. However the latest report for Bromley (1993/4) shows that there are ’48 people living with HIV infection and 2 babies of indeterminate status’.
“It is accepted that this is an underestimate. This includes people who attend Bromley Hospitals or services. It does not include all the people attending specialist centres of excellence, eg Middlesex Hospital, King’s College Hospital, St Thomas’ Hospital, Chelsea & Westminster….of which we know there are several cases. We estimate that there are at least 60 cases – this does not include their families, partners or carers. The no AIDS in Bromley is a myth. Indeed, the Department of Health classifies Bromley as a “moderate” prevelance area.”
“Frequently, AIDS in Bromley has been dismissed as a small number of cases, insignificant. This is a favourite argument of Cllr Cooke. Clearly, 60 people with HIV plus their families is not a small number. Contrast this with the number of people receiving intensive personal care – this is in the order of 70 people.”
The conclusion of the document states: “All of the myths, I am sure you will find have their root in prejudice and bigotry.”
Whilst the Positive Place was in Sydenham the local MP, Jim Dowd agreed to ask a Parliamentary Question. This question revealed that Bromley Council had failed to apply for its indicative allocation of AIDS Support Grant in 1992-3.
Hansard records the written parliamentary question on 14th January 1993:
Mr. Dowd : To ask the Secretary of State for Health (Virginia Bottomley)
(1) on what date the London borough of Bromley applied for AIDS support grant for the current financial year ; and what efforts have been made by her Department to urge Bromley to apply for it ;
(2) what amount of AIDS support grant was allocated to each local authority in each year since 1990-91 :
(3) what extra costs she estimates to have been incurred by neighbouring boroughs obliged to deal with HIV/AIDS cases turned away by Bromley social services department ; and what steps she proposes to take to recompense the neighbouring boroughs ;
(4) by what date London boroughs should apply for the AIDS support grant for 1993-94 ; and what steps she will take to ensure that the London borough of Bromley applies for the grant on time ;
(5) how many people in each London borough have died from AIDS :
(6) how many cases of HIV have been reported in the borough of Bromley in each year for which figures are available.
The Minister for Health, Tom Sackville, MP replied:
Mr. Sackville : In December 1991 the Department issued a circular (LAC(91)22) inviting all social services departments in England to bid for extra resources for HIV and AIDS services in 1992-93 under the AIDS support grant scheme. Criteria for bids under this scheme are set out in the circular. Copies are available in the Library. The closing date for bids was 7 February 1992. The London borough of Bromley submitted an application in November 1992 although not in the form and detail set out in departmental guidance. By that time AIDS support grant moneys had been fully committed. The Department was, therefore, unable to allow Bromley’s bid to proceed. Although not in receipt of AIDS support grant money in 1992 -93, we understand that the London borough of Bromley plans to spend £15,000 on HIV and AIDS services in the current year. We have no information to suggest that the borough has been compelled to turn away people affected by HIV.
For 1992-93 local authority social services departments will again be invited to apply for an AIDS support grant allocation. The closing date for applications will be 8 February 1993. It will, of course, be open to the London borough of Bromley to bid for funds under this scheme.
Information on the number of HIV and AIDS cases reported in individual boroughs and of deaths is not held centrally.
The table shows the AIDS support grant allocations which have been awarded since 1990-91 for a full list in England see Hansard.
Allocations for Individual Authorities in London are shown.
|London Borough||Grant 1990-1||Grant 1991-2||Grant 1992-3|
|City of London||25,000||26,000||47,000|
Alan Hall followed up the lack of funding and more importantly, the lack of a strategy in 1993. On 11th October he received the following reply from Baroness Cumberlege, Parliamentary Under Secretary of State for Health in the Lords, this said: “The Department is aware that there has been an absence of a clear HIV/AIDS strategy in Bromley and has been monitoring the situation.”
If the Government were aware, why didn’t they act?
Perhaps, we will never know the answer to that. But the refusal of Bromley Council’s social services Committee members to allocate funding and support proposals for a change in direction led to protest.
The community activists in Outrage knew that Bromley Council were resisting change and they decided to mount a protest. Activists enetered the Council Chamber, chanting and holding placards. Labour and Liberal Democrat Councillors stayed in the Chamber whilst shocked tories walked out. The photograph below was taken by the acclaimed photographer, Gordon Rainsford.
The Pink Paper carried a report of the protest with the headline: “Tory Mayor flees AIDS protesters in Bromley”.
Outrage alleged that the Mayor of Bromley, Cllr Edgington attacked one of its members. This is particularly interesting as this is believed to be a counterclaim, when the Mayor of Bromley made a complaint to the Police that one of the protesters drank from his glass thereby assaulting him.
The fifteen activists held a “die in” where they laid down in the Council Chamber and held tombstone shaped placards with slogans such as killed by Bromley neglect.
In the press report, the case of a 28 year old man who was refused a home help and told to ‘try a private nursing home’ a day before he died is raised.
Daniel Winchester a local resident said that Bromley Council had shown ‘contempt’ to the ill and dying over the last ten years of the pandemic.
The independent voice of social workers – Community Care – carried an article on HIV and AIDS social service provision in March 1993 saying: “Bromley Social Services is behind with its HIV work. It’s bid for 1992-3 was late, so it did not benefit from the 50% increase and that there was great pressure to meet the standards for grant status.” In response a senior Bromley Council social services manager is quoted as saying: “Our services are pretty thin on the ground in this area.”
Leaders in the social work profession at the time, believed that there were additional benefits with specialised HIV services as they were ground breaking and that they benefit other areas of social work like confidentiality and increasing good practice more generally.
This article has appeared on the Socialist Health Association website