The effectiveness of treatments now available for HIV means that most people in the UK with HIV are able to live a reasonably normal life. However, people with HIV often require support to help them achieve this. Social care is one of the main ways in which this support is provided
What is social care?
Social care covers a wide range of interventions, from peer support or counselling, to personal care and respite care. It can entail practical support to help people live with treatment side effects or the physical impact of HIV, or emotional support to help cope.
Social care for people living with HIV is often delivered by both social services and voluntary sector organisations. The specific roles of each of these providers differ from area to area.
Social care provides a vital lifeline for many people living with HIV and NAT want to ensure that despite changes to funding local councils continue to support people with HIV. This is a particular concern in the current climate, as councils are being asked to make significant savings, so services are vulnerable to cuts.
The case for social care for people living with HIV
NAT has produced a briefing which sets out the reasons why it is vital that local authorities continue to provide social care services for people living with HIV. The briefing can be downloaded here.
People are encouraged to use this briefing, alongside other NAT documents, to argue for effective and adequate social care funding for people with HIV in their local area.
The impact of social care support for people with HIV
People living with HIV often experience a range of complex social care needs as a result of physical, psychological and social factors associated with their condition. NAT surveyed healthcare professionals working with HIV, with support from BHIVA, CHIVA, NHIVNA and the Society of Sexual Health Advisors, to collect their views on the impact of social care for their patients.
In the context of current financial pressures on social care funding, the report of the survey findings illustrates how important social care support is to people with HIV and the value placed on social care by HIV clinical staff. The report can be downloaded here.
Funding for HIV social care
The Government provides specific funding to local authorities to meet the social care needs of people living with HIV. Previously this funding was provided through a ring-fenced grant call the AIDS Support Grant (ASG). Recently the ring-fencing on this funding has been removed and the money has been rolled into the Formula Grant (the large pot of money given to local councils to fund all their activities).
However there is still specific, named funding allocated to each local council for ‘HIV/AIDS Support’. Additionally the Grant itself will increase from a total of £25.5 million in 2010/11 to £36.2 million in 2014/15. You can see the allocation for 2011/12 here, and for 2012/13 here.
NAT campaigned to ensure that funding for HIV social care was protected in the October 2010 Spending Review. Although we were pleased with the outcome of the campaign, we are still concerned that in the current climate funding for HIV social care could be at risk at the local level.
Survey of local council spending on HIV social care
NAT carried out a review of how local councils are using the funding allocated to them through the HIV/AIDS Support funding line in the Formula Grant. The review's findings, when compared to NAT’s previous survey of the ASG, shows how social care spending and services have changed over time.
Since 2008 the number of local councils spending all of their allocated funding on HIV social care has dropped by 25%. Despite this the review shows that a wide range of services for people living with HIV continue to be funded nationally. However, within some individual areas the range of services available has been reduced.
The research also revealed that in order to access to social care people are increasingly required to meet the standard local council FACS eligibility threshold. The majority of local councils set their thresholds to ‘substantial’.
It is clear from the survey responses that even though it isn’t ring-fenced, the specific HIV/AIDS Support funding line within the Formula Grant remains immensely important. Without this indicative funding it appears unlikely that service would continue at their current level.
Read the report, HIV Social Care in England: a survey of local council funding, to see the full results and recommendations. NAT’s report, The AIDS Support Grant: Making a difference? sets out the results of the previous survey and provides an interesting comparison. NAT will be lobbying to get the recommendations from the report implemented. If you would like more information on this, or would like to find out what you can do at a local level please contact Laura Dunkeyson: firstname.lastname@example.org
Protecting HIV social care locally
NAT is campaigning to make sure that despite changes to funding, social care for people with HIV is protected across the country and we encourage everyone to take action to make sure that good quality social care support is provided in your area.
If you would like to take action now you can email your Local Councillor via SHout Loud, the sexual health campaigning website that helps have a say about local decision making. A template email is available on the SHout Loud website.
NAT's Chief Executive has written to the Director of Adult Social Care in every council that receives funding for HIV social care to emphasise the importance of these services. The letter was also published as an open letter in Community Care.
If you feel strongly about this issue and would like to find out more about what you can do, or if you know of cuts to HIV social care in your local area, please contact Laura Dunkeyson: email@example.com.
Social care reforms
The Coalition Government are planning significant reforms of the adult social care system and we expect a white paper on social care to be published in the first half of 2012.
A number of recent reports have set out the challenges facing the social care system and made reform proposals. The Dilnott review sets out proposals for overhauling funding for the adult social care system. It includes a recommendation for a standard national eligibility threshold which should be set at ‘substantial’. NAT support the idea of a national eligibility threshold but believe that a ‘substantial’ threshold will prevent many people with HIV who have social care needs from accessing support. You can read more about the Dilnott Commission and download their report from their website.
The Law Commission produced a report in 2011 recommending social care laws be reformed and a coherent modern social care system created. The report proposes clear legal rights to care and support services for people needing care, and clear and concise rules for local councils governing when they must provide services. You can read more about the project and download the report from their website.
As part of the reforms the Government have proposed a greater integration between health and social care. NAT believes that improved integration between social care, health and other services has the potential to provide more joined up services, which in turn can provide a better level of care for people living with HIV.
NAT responded to the consultation on the Government's Vision for Adult Social Care and outcomes framework for adult social care. Our response is available here.
The House of Commons Health Committee report on Social Care
The House of Commons Health Committee published the report of their inquiry into Social Care on 8 February 2012. The report focuses on older people, which is disappointing as 49% of people receiving state funded personal care services are not in this category. However, it does raise a number of general issues of relevance to disabled people including people living with HIV. In particular the report highlights concerns around the fragmentation of services and the need for improved integration of health and social care. The Committee is now calling on the Government to do more to ensure that this integration happens at a local level. The Committee has also highlighted concerns that funding for social care is insufficient, especially given the efficiency savings the Government expects, and that this will result in cuts to services.
A copy of the Social Care report can be downloaded from the Committee’s website. You can also download a copy of NAT’s evidence to the inquiry.
Further information about HIV social care
If you would like to find out more about the AIDS Support Grant and HIV social care, including the history of the grant and the current situation, Andrew Pearmain, HIV Consultant Practitioner, has produced a comprehensive report entitled Feast to Famine: HIV Social Care and the AIDS Support Grant.