End The HIV ‘Crisis’ in Lewisham

End the HIV Crisis in Lewisham this World AIDS Day’s theme is end inequalities, end pandemics and end the corrosive stigma

This World AIDS Day theme is ‘End Inequalities. End AIDS. End Pandemics.’ Many who have supported their friends, lovers, family members and colleagues living with HIV have experienced and challenged the corrosive stigma that still exists against people living with HIV. This year marks 40 years since the first cases of AIDS were reported. Since that time, where investments have met ambition, there has been huge progress, particularly in expanding access to treatment. By June 2021, 28.2 million people had access to HIV treatment, up from 7.8 million in 2010, although progress has slowed considerably according to the Joint United Nations Programme on HIV/AIDS (UNAIDS). 

World AIDS Day message from the United Nations on colliding pandemics

“The red light is flashing. Progress against AIDS, which was already off track, is now under even greater strain as the COVID-19 crisis continues to rage, disrupting HIV prevention and treatment services, schooling, violence-prevention programmes and more. And make no mistake: AIDS remains a pandemic. To stop it we urgently need a bolder view of pandemic response that is capable of tackling the inequalities prolonging the AIDS pandemic. Many of these missing pieces to fight HIV are also allowing the COVID-19 pandemic to continue and leaving us dangerously unprepared for pandemics of the future,” says Winnie Byanyima, UNAIDS Executive Director.

In the UK the National AIDS Trust has said that we are at a crucial point in the fight against HIV.

It is now scientifically possible to end new cases of HIV by 2030. In January 2019, the UK government promised that it would meet this goal. The HIV Commission’s report has now provided a route map. After months of delay, the government is starting to draft its HIV action plan. NAT says: “We cannot afford to delay this any more.”

“Any HIV Action Plan is worthy of its name must genuinely start the process of ending new cases of HIV and support people to live well with HIV and AIDS.”

The Elton John AIDS Foundation has a project which operates across Lambeth, Southwark and Lewisham. This focuses on increasing HIV testing, and re-engaging with people who have stopped HIV treatment. It has helped provide additional HIV testing in University Hospital Lewisham A&E department, primary care settings, and in community organisations, as well as recall of those who are no longer in treatment. Some 115 Lewisham residents living with HIV have received treatment and care since the project started in November 2018.

I has campaigned with the NAT and local HIV organisations like Metro for many years. Earlier this year, I wrote to Matt Hancock who was then, Secretary of State for Health, about the need for action.

Letter-to-Matt-Hancock-HIV-AIDS-2021-AH-headed

During the 1990s Lewisham did not have a specialist hospital based sexual health clinic. Following a successful campaign led by the voluntary sector, the local Community Health Council and LGBTQi+ groups a new clinic was opened at University Hospital Lewisham. The Alexis Clinic is much in demand as Lewisham’s centre for treating outpatients and inpatients with HIV in a confidential, comprehensive and patient-centred manner.


The Alexis Clinic provides a wide range of services for adults aged 16 and there are 850 registered patients. More than 50 per cent of them are heterosexual and most are of African origin. Many live on the poverty line and struggle with mental health problems. The Alexis Clinic say that the biggest challenge facing its clinical team is the issue of stigma.

Rates of HIV in Lewisham are amongst the highest in the country – figures from PHE accessed 290721

The rates of HIV infection in Lewisham need to be seen in the context that the UK maintains the largest HIV epidemic in western Europe. Lewisham as a London borough has one of the highest HIV prevalence rates in the country, with 1,693 diagnosed.

Recently published research in Ireland around stigma and HIV, in the well respected National AIDS Manual, concluded that despite improved access to HIV treatment and prevention, the Irish HIV epidemic remains a significant public health concern, with annual increases in the number of infections. In 2019 the number of new diagnoses of 11 per 100,000 was much higher than the European average of 6.2. The rise in HIV infections coincided with significant health funding cuts since 2008. People living with HIV continue to feel stigmatised and this impacts upon health in varied ways, such as not seeking out healthcare services.

Perhaps, there needs to be some research into how the public discourse around HIV and the media coverage of it is having an impact on HIV treatment, care and prevention in the UK?

HIV and AIDS non governmental organisations promote the positive advances in medicine – and these are real and beneficial. However, there is still a question of whether we are reaching those who need support. As the researchers in Ireland put it: “Whose ‘health’ counts in a politics ‘that produce conditions of systematic negligence’, which disproportionately affect individuals with less access to power?”

To redress the balance, then access to advocacy and support service for individuals with HIV – and other conditions – needs to be prioritised.

This is one of the many reasons that Lewisham needs an independent disability advocacy service. Since the Lewisham Association of People with Disabilities closed its doors in Bellingham in December 2018 there is no organisation to advocate and represent those with disabilities in Lewisham and the small budget of around £50,000 remains unspent. Politics is about priorities and this must be one of them – without delay.

In advance of World AIDS Day on the 1st December 2021, I tabled a formal question at Lewisham Council. The latest statistics available and the text of the reply

Cllr Alan Hall’s formal Question tabled at Lewisham Council meeting 24th November 2021

Taking up the need to address the “Crisis in HIV and AIDS in the UK, London and Lewisham” and pointing out that Lambeth, Southwark and Lewisham all have high rates of HIV and AIDS, in fact among the highest in Europe, I urged Lewisham Council to do more work and to address the issue of racism that I raised on the floor of the Council Chamber last year 2020.

Cllr Chris Best, cabinet member for Adult Services said: “I am not proud of the statistics at all” and she agreed there was more that needed to be done.

The full exchange between can be viewed here

Cllr Alan Hall moves a motion about HIV and AIDS services – Lewisham Council November 2017

A report on transforming sexual and reproductive health for BAME communities in Lambeth Southwark and Lewisham published on 3rd November 2020 says:

“Mainstream services must look at the way racial and HIV discrimination intersects when caring for BAME service users, so they can provide efficient care for individuals who may be coping with social isolation, stigma from the community as well as racial discrimination: something that is not necessarily relevant to the rest of the HIV positive community.”

I have joined campaigners calling for more government action to end new cases of HIV in the UK by 2030. I say:

“There is a failure to act to end HIV. To end the prejudice, to end the stigma. In the Budget – earlier this year – the failure to allocate resources means that action is needed more urgently, if we are to put the country on course to end transmissions by the end of the decade. History will look kindly on those who show real leadership and financial commitment now. We need to fund the fight and take the decision to end new cases of HIV by 2030. We need real action now to end the colliding pandemics.”

Winnie Byanyima, Executive Director of UNAIDS said: “Ending inequalities to end AIDS is a political choice that requires bold policy reforms and requires money. We have reached a fork in the road. The choice for leaders to make is between bold action and half-measures.”

UN urges action to end HIV

Cllr Alan Hall was a trustee of the London Lighthouse, the pioneering HIV and AIDS hospice and centre in London.

Serious Concerns about Plans to Reorganise the Public Health System

Cllr Alan Hall has joined public health professionals, campaigners and charities in signing a joint statement to the Government on Public Health Reorganisation.

The statement is endorsed by a wide range of leading health organisations, including the Association of Directors of Public Health, the Faculty of Public Health, the Royal Society for Public Health, the Academy of Medical Royal Colleges, the BMA, the SPECTRUM public health research collaboration, the Smokefree Action Coalition and the Richmond Group of health and care charities. The statement warns that:

“Reorganisation risks fragmentation across different risk factors and between health protection and health improvement. Organisational change is difficult and can be damaging at the best of times and these are not the best of times. A seamless transition from the current to the new system is essential.”

Professor Maggie Rae, President of the Faculty of Public Health said:

“Reorganisation of Public Health England (PHE) brings with it a real risk that some of the critical functions of PHE will be ignored. The pandemic has shone the light on the health inequalities that exist in the country and it is clear that those with the poorest health have been hit hardest. Scaling up, not down, the health improvement functions of PHE is a prerequisite if the Government is to deliver on its commitments to ‘level up’ society; increase disability-free life years significantly, while reducing inequalities; to improve mental health; increase physical activity; reduce obesity and alcohol harm; and to end smoking. Ensuring there is adequate funding, a robust infrastructure and sufficient public health expertise to deliver at national, regional and local level, is fundamental.”

A letter has been published in the British Medical Journal, the full text is here:

Dear Editor

Over 70 organisations and alliances committed to improving health and reducing inequalities have endorsed a joint statement which we have sent to the Prime Minister, the Secretary of State for Health and the interim leadership of Public Health England (PHE). This sets out the principles we all agree must underpin the reorganisation of the health improvement and wider functions of PHE.
We are deeply concerned that the Government’s plans for the reorganisation of health protection in the UK currently pay insufficient attention to the vital health improvement and other wider functions of Public Health England (PHE).

Chronic non-communicable diseases are still, and will remain, responsible for the overwhelming burden of preventable death and disease in this country. The communities hit hardest by COVID-19 are those suffering most from inequalities in health and wellbeing. It is a false choice to neglect vital health improvement measures, such as those that target smoking, obesity, alcohol and mental health, in order to fight COVID-19.

Reorganisation is difficult at the best of times and these are not the best of times. Avoiding fragmentation and ensuring seamless transition from the current to any new system is essential.
At this time of global pandemic and recession, health improvement is not a ‘nice to have’ but an essential component of a successful response to the challenges we face.

Yours sincerely,

Dr Nicholas S Hopkinson
Respiratory Specialist, Imperial College London, Chair of Action on Smoking and Health, on behalf of the Smokefree Action Coalition
Imperial College, London SW7

Professor Maggie Rae
President of the Faculty of Public Health

Professor Linda Bauld
Chair of Public Health at the University of Edinburgh and Director of public health research consortium SPECTRUM

Nicola Close
Chief Executive, the Association of Directors of Public Health, on behalf of the Public Health Network

Neil Tester
Director, The Richmond Group of Health and Care Charities

Sir Ian Gilmore
Director, Liverpool Centre for Alcohol Research, and Chairman, Alcohol Health Alliance UK

Caroline Cerny
Obesity Health Alliance Lead

Dr Peter English
BMA public health medicine committee chair

and others to view the full statement see here

Cllr Alan Hall has campaigned for better public health and an end to cuts to public health budgets for many years see press comments here and here

Lewisham Public Health Publish Covid-19 Plan

Lewisham Council has published a COVID-19 Outbreak Prevention and Control Plan setting out how the Council will work with partners, including Public Health England, to prevent, identify and manage any COVID-19 outbreaks in Lewisham and ensure that residents and communities are protected.

Local authorities have been responsible for improving the health of their local population and for public health services including most sexual health services and services aimed at reducing drug and alcohol misuse since the Government transferred responsibility from the NHS in April 2013

As the public health service was transferred, Chancellor George Osbourne, with a sleight of hand cut £200 million in year from the public health budgets of local councils in June 2015. The Academy of Medical Royal Colleges said: “This cut will have a direct impact on people and communities who rely on this funding, and it will have a direct impact on the NHS which will have to pick up the pieces by treating preventable ill health. The Faculty of Public Health’s own analysis suggests the eventual ‘knock-on’ cost to the NHS could well be in excess of £1bn. By any measure then, the planned move is a false economy.”

At the time in Lewisham, Councillor Alan Hall wrote in response to the Government: “Plans to reduce public health allocations in year directly contradicts the statement in the NHS plan: ‘the future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health.’

He added: “Imposing public health savings of this order within year will undermine our effectiveness and reduce our capacity to work with our NHS partners in prevention and public health and so will damage the long-term partnership needed to achieve public health goals.”

On top of this, many of the services delivered through the public health spend via Local Authorities fund clinical NHS care. Cutting this funding reduces NHS revenues so it is misleading to suggest that the NHS budget is being protected.

The tories continued to cut public health budgets but this March, in the midsts of the Covid-19 pandemic they belatedly announced an increase of £145 million on the public health grant 2019/20.

The Faculty of Public Health said: “Though an increase, further funding will be needed to reverse years of cuts to public health services and FPH has long called for a £1 billion increase for the public health budget. This will allow our members to restore public health services and protect and improve the health of the public, both during and beyond the current COVID-19 crisis.”

Lewisham Council’s public health service continues to provide a vital service. Their plans have defined “an outbreak” as is two or more suspected and/or confirmed cases associated with the same setting and with onset during a 14-day period.

A London-wide definition of a community cluster of COVID-19 is in the process of being
agreed. The following working definition has been adopted locally in Lewisham, in the interim:
“A community cluster is identified when 3 or more household member(s), living in the same
Middle Layer Super Output Area receive a positive test result for COVID-19 within a 7 day period and those people are not already known to be linked to a complex setting that is already the subject of an outbreak management plan (e.g. a care home, school, workplace etc).”

An outbreak in a complex setting can be regarded as taking place in a setting that has a number of complicating factors including:

  • vulnerable staff/residents/communities affected
  • the potential to result in a large number of cases/contacts
  • likelihood of requiring prolonged support for ongoing outbreak management.
    A number of action cards including standard operating procedures have been developed for
    outbreak management in complex settings for London.

Lewisham Public Health team will be part of the NHS Test and Trace service. This will provide a vital infrastructure to support this existing outbreak prevention work by scaling up the capacity to test, trace and isolate cases and contacts of COVID-19. The service was launched on 28th May 2020, to provide a comprehensive national contact tracing service for COVID-19 in England involving national, regional and local partners.

The team have launched a 7 day COVID-19 case rate for Lewisham in comparison to London and England.

7 day COVID-19 case rate (per 100,000) 
Reported from 8-14 August

LewishamLondonEngland
5.39.112.2
The numbers showing today – 21st August 2020

Full details are here

UK has the highest death toll in Europe – Public Health is a matter of life and death

The United Kingdom has overtaken Italy with the highest official death toll from the coronavirus, Covid-19 in Europe. New figures released on Tuesday, 5th May 2020 show that this is the trend, we ask, what does this mean for London and Inner London Local Councils?

London is a vast geographical area and has a complex demography. The inner London boroughs are more diverse, in general and the outer London boroughs are more suburban.

The incidents of coronavirus in the capital have been measured by the Office for National Statistics.

The ONS reports that overall, London had 85.7 Covid-19 deaths per 100,000 population, almost double the rate of the next worst-affected region which is the West Midlands at 43.2 deaths per 100,000.

Nick Stripe, head of health analysis and life events at the ONS, said: “By mid-April, the region with the highest proportion of deaths involving Covid-19 was London, with the virus being involved in more than 4 in 10 deaths since the start of March.”

The figures for the top ten London Boroughs are:

BoroughSMR
Newham144.3
Brent141.5
Hackney127.4
Tower Hamlets123
Haringey119
Harrow115
Southwark108
Lewisham106
Lambeth104
Ealing103

If we look even closer within each London borough, we can see the how each Super Output Area is affected. Super Output Areas are a small area statistical geography covering England and Wales. Each area has a similarly sized population and remains stable over time.

The following interactive map allows you to see the number of deaths in each area. You can zoom in and out or enter a post code.

Number of deaths involving COVID-19 in Middle Layer Super Output Areas:

The Index of Multiple Deprivation (IMD) is an overall measure of deprivation based on factors such as income, employment, health, education, crime, the living environment and access to housing within an area. [NB There are differences between England & Wales]

Age-standardised mortality rates, all deaths and deaths involving COVID-19, Index of Multiple Deprivation, England, deaths occurring between 1 March and 17 April 2020

Looking at deaths involving the coronavirus (COVID-19), the rate for the least deprived area was 25.3 deaths per 100,000 population and the rate in the most deprived area was 55.1 deaths per 100,000 population; this is 118% higher than the least deprived area.

In the least deprived area (decile 10), the age-standardised mortality rate for all deaths was 122.1 deaths per 100,000 population. In the most deprived area (decile one), the age-standardised mortality rate for all deaths was 88% higher than that of the least deprived, at 229.2 deaths per 100,000 population.

The bar chart shows how much higher each decile is compared with the least deprived decile for all deaths and deaths involving COVID-19.

For deciles 4 to 9, the percentage increase in age-standardised mortality rate of deaths involving COVID-19 is similar to that of overall deaths.

The rate of deaths involving COVID-19 is more than twice as high in the most deprived areas compared with the least deprived

Local responses will involve contact tracing. This graphic from Public Health England gives a brief description of the process.

contact tracing is part of a public health approach

Professor Allyson Pollock of Public Health at Newcastle University has been campaigning to raise the profile of a more localised approach, in a letter she has said that a massive increase in testing and tracing should be the next phase, but decades of cuts and reorganisations have whittled away the necessary regional expertise.

In the letter the dynamic nature of the pandemic across the country is aptly described as “not homogenous. It is made up of hundreds, if not thousands, of outbreaks around the country, each at a different stage.”

Her approach champions “classic public health measures for controlling communicable diseases such as contact tracing and testing, case finding, isolation and quarantine. They require local teams on the ground, meticulously tracking cases and contacts to eliminate the reservoirs of infection. This approach is recommended by the WHO at all stages of the epidemic.”

The history of public health is important including the recent changes in the Health & Social Care Act 2012. This abolished local area health bodies, created Public Health England to fulfil the Government’s duty to protect the public from disease and charged local authorities with improving public health.

As public health returned to local government, with a sleight of hand, the Government introduced the current programme of public health funding cuts. In 2019/20, the London’s share of the Public Health Grant had fallen to £630 million, representing a per head funding reduction from £80.75 in 2015 to £68.61 in 2019, a fall of 15% and the biggest regional reduction in England.

“Investing in public health is also hard for governments because the benefits accrue to their successors and there is little to show for spending at the end of the five-year election cycle.”

“Cutting public health funding would be an act of self-mutilation. If controlling spiralling demand is the priority, for goodness sake don’t cut public health.”

Luke Allen
Researcher, Global Health Policy, University of Oxford in the conversation

A localised response requires political will, expertise and attention to detail.

Public Health funding and status needs to be revitalised and restored. It is a matter of life and death.

Time to demand a wholly public NHS and to create a public National Care Service

Dr Tony O’Sullivan, a former consultant community paeditrician at Lewisham Hospital and Co-Chair of Keep Our NHS Public has released a video explaining why the herd immunity strategy was dangerous, the need for proper personal, protective equipment known as PPE for care workers, teachers, transport staff as well as NHS employees. He argues for serious policy changes.

Dr Tony O’Sullivan, former paediatrician at Lewisham Hospital and Chair, Keep Our NHS Public explains why policy needs to change now.

At the start, Dr O’Sullivan quotes Richard Horton, the editor of medical journal The Lancet when he says: “Coronavirus is the greatest global science policy failure in a generation. Austerity blunted the ambition and commitment of government to protect its people. The political objective was to diminish the size and role of the state. The result was to leave the country fatally weakened.”

Further question raised by Richard Horton, editor, The Lancet.

The years of austerity following the financial crash in 2008, have “undermined the ability of the NHS to respond to the Covid-19 pandemic”.

Specifically, the ideology of the free market, the ‘decimation’ of social care, ‘cruelty’ of universal credit and the ‘vicious hostel environment that has ended universal access’ to the NHS “endanger our entire population facing this national crisis” says Dr O’Sullivan.

Dr O’Sullivan explains and discusses herd immunity. A common implication of the term is that the risk of infection among susceptible individuals in a population is reduced by the presence and proximity of immune individuals – this is sometimes referred to as “indirect protection” or a “herd effect”. Immunity is often given by a vaccine or recovery from the infection itself.

In a quick calculation, Dr O’Sullivan reveals that 400,000 deaths in theory would result in a herd immunity policy that is thought to have been pursued by the Government in the early days of the pandemic:

“Some-one thought that was a price worth paying in order to keep the economy open” he says.

Dr Tony O’Sullivan supports and encourages concerned citizens to take action by signing a petition supported by Keep Our NHS Public and the Socialist Health Association.

“That’s why we’re calling on the UK Government and devolved governments to urgently take the following measures to protect NHS workers and the general public:

  1. COVID-19 testing and personal protective equipment (PPE) must be available for all NHS and social care staff now
  2. Those relying on social care (or ‘Direct Payments’) must be given immediate support if carers go sick 
  3. NHS support staff (including those outsourced) must receive at least living wage, paid sick leave for illness or self-isolation and an increase in statutory sick pay 
  4. Bring private health resources into public service without compensation to fight COVID-19 and aid NHS response 
  5. Make all information that the Government is basing its strategy on wholly available for public scrutiny
  6. An immediate end to legislation enforcing eligibility checks and charging in the NHS, including those related to residency status or national origin, allowing all patients to use the NHS without fear.”
To sign the petition follow the link here

Councillor Alan Hall agrees that we need to fund the NHS fully. We need to fund and fully integrate, in the public service, the NHS and social care. The links have never been clearer. We need to fund public health properly. The savage cuts continue and it’s time to stop this.

Dr O’Sullivan concludes with this message:

“Coronavirus is a tragedy. The response is a political scandal. But out of this, we need to seize the opportunity to learn from these mistakes and call on the public to demand a return to a wholly public National Health Service and to create a wholly public National Care Service.”

Protect all frontline healthcare workers

Personal Protective Equipment, known as PPE is in demand. There are reports that there is a shortage in hospitals and care facilities.

The Daily Mirror reports that hospitals listed as having shortages include Rotherham General Hospital, Bristol Children’s Hospital, Hillingdon Hospital in Uxbridge, Royal Devon and Exeter Hospital and at St Thomas, Lewisham and two other unnamed hospitals in London.

The view from the NHS frontline is explained here:

Dr Samantha Batt-Rawden, an intensive care doctor and president of the Doctors’ Association UK, told Nick Ferrari that more doctors will die unless they get proper equipment.

In a further twist, healthcare workers who raise their concerns are facing being “gagged”. Helen O’Connor, GMB says in The Guardian “It is scandalous that hospital staff speaking out publicly face being sacked by ruthless NHS bosses who do not want failings in their leadership to be exposed. Suppression of information is not just a matter of democracy, it is now a major public health issue.”

The Local Government Association has sent a letter to the Secretary of State for Health, Matt Hancock MP. It says that there is an urgent need for Government to move faster in making PPE available for the adult social care sector. Sufficient supplies that are of acceptable quality are needed immediately. Councils and their provider partners also need concrete assurances about ongoing supplies for the days and weeks ahead.

Councillor Alan Hall has written to the Director of Public Health for Lewisham seeking reassurances for both hospital and social care staff locally. The full letter is below:

Catherine Mbema
Director of Public Health – Lewisham

Dear Catherine,

I have been informed that the lack of Personal Protective Equipment for cleaning staff at Lewisham Hospital is a real concern. Trade Unions say that there is a shortage of supply and that staff are very worried. It has been described as “a total nightmare”.

As the Public Health Lead across Lewisham, I would be very grateful if you could raise the shortage of supply with the NHS and the Hospital and reassure us that PPE will be available.

Whilst I write, personal carers have reported shortages and inadequacies nationally. Can an assurance that all Lewisham Council and NHS staff have been provided with effective PPE?

May I take this opportunity to thank you and your team for all the incredible work that has been placed upon you. I have always campaigned against Public Health cuts and the short sightedness of this is surely been borne out now.

Kind regards,

Alan

Cllr Alan Hall

In an article on the United Nation’s website, there is a chilling message:

“COVID-19 will not be the last dangerous microbe we see. The heroism, dedication and selflessness of medical staff allow the rest of us a degree of reassurance that we will overcome this virus.

We must give these health workers all the support they need to do their jobs, be safe and stay alive. We will need them when the next pandemic strikes.”

A version of this blog appears on the Socialist Health Association website