1. Health and Social Care Landscape Implications for us all Neil Beasley – Trustee, THT

2. Pressure on all sides On people with HIVOn our services Welfare Reforms Employment Poverty Access to healthcare Housing Ageing NHS Funding Voluntary Funding Increased Needs Healthcare Reform Local Government We need to adapt services and approaches to cope with this new reality

3. Economic environment Spending Review 2010: £81bn cuts package (UK-wide) Reduction of £20bn in NHS spending (England) Reduction of 25%+ in Local Government income (England) Reduction of £18bn in welfare spending (UK- wide) Unemployment up to 2.49 million (7.9%) across the UK with much higher rates in some regions

4. NHS reforms in England: An overview  Replacing 150 PCTs with about 250 GP led Clinical Commissioning Groups, responsible for spending about 80% of NHS budget  CCGs to have statutory duty to consult with service providers & specialist groups  GP and specialist services to be commissioned by NHS Commissioning Board  Public Health to be commissioned by Local Authorities, within a ringfenced allocation (between 2 & 4% of NHS budget)  Local Authorities to have responsibility for coordinating health, social care and public health commissioning within their areas  Implementation timetable is being extended

5. NHS England Reforms – Themes for us as consumers of care  Money will follow us and be based on outcomes  There is a potential expansion of the role of voluntary organisations as providers of some services to us  GPs who can be inexperienced in dealing with HIV will not have a role in commissioning our specialist services  Local Authorities will be responsible for commissioning sexual health and HIV testing services  Risk of fragmentation of our services across all the different commissioning groups  Investment risks to our care are already becoming apparent  Long Term Condition Management and need for greater primary care involvement in HIV not reflected in the commissioning structure

6. Implications for voluntary and charitable service organisations  Cuts planned across most sectors, e.g. CAB, Turning Point  VCOs in first wave of spending cuts  Job losses being reported  Unpredictability and local variation  Unclear expectations of VCO sector  2012/13 likely to be worse than 2011/12 We need to plan for the next few years, rather than hope that things will get better

7. Experience at THT  25% cut in statutory income  Cost pressures pushed down to us  That’s why THT took some difficult decisions to reduce its cost base and protect its services  Maintained most of its services  Built a platform for sustainability  Launched new services which fit into this cost constrained future  Will never stop trying to make HIV services a priority and protecting those at most need THT is now supporting more people with HIV than ever before

8. General implications  We all need to adapt our expectations in this new climate  We have a voice, and need to use it locally and nationally, engage in consultations and be a constructive force for quality services  We need to build models that will be sustainable over the next ten years not hold onto the models of the past  Services need to be protected for those most at need  We will have to engineer new ways of giving advice, support and services and consider community rather than clinic based care options in the future