A Mixed Day for Gay Men’s Sexual Health

Jane Ellison, Minister for Public Health, announced yesterday that NICE will start looking at the evidence surrounding the clinical effectiveness of pre-exposure prophylaxis for HIV, or PrEP. This is in addition to £2 million being spent on cost-effectiveness studies for PrEP.

The idea behind PrEP is that someone could take medication and prevent themselves from catching the HIV virus when exposed to it, similarly to how people take malaria tablets, and was so effective in placebo controlled trials it was deemed unethical to continue giving a placebo. That same trial found that PrEP was also cost-effective.

I’ve written about PrEP before, achieving my highest accolade in journalism when Dr Christian off the telly retweeted my story. While the decision to have NICE look at effectiveness of PrEP is a positive step forward, it does illustrate the fragmentary nature of sexual health policy in this country. NHS England is looking at cost-effectiveness. NICE looks at clinical effectiveness. Local councils say they can’t afford to fund it if it ever gets approved, NHS England says they have to.

Lacking a central body to coordinate policy on PrEP, the government seems to be floundering on what is a potentially life-saving drug. This floundering will disproportionately affect gay men and other men who have sex with men (MSM).


More happily, the government has agreed to pilot a program of HPV vaccination for MSM thanks in part to the persistent efforts of Mike Freer, officially the MP for Finchley and Golders Green, and unofficially chief parliamentary rabble-rouser for gay and LGBT affairs.

HPV is the sexually-transmitted virus responsible for genital warts and most cervical cancers, and since 2008, a national vaccination program has been in place for girls. HPV is also linked to an increased risk of cancers of the mouth, throat, head, neck, penis and anus, and it doesn’t take the most active imagination to realise MSM might be at higher risks for sexually-transmitted HPV.

The pilot will aim to reach 40,000 MSM in England- around 35% of those who attend sexual health clinics annually. As health is devolved to the national legislatures, Wales, Scotland and Northern Ireland are hoping to develop their own pilot schemes.

Freer has developed a highly effective niche as a  backbencher on LGBT and HIV/AIDS issues. He memorably came out to his parliamentary colleagues during a passionate speech on gay marriage.


Random sexual health story – good news comes out of Eastern Europe. Armenia has eliminated mother-to-child transmission of HIV; Moldova, who’ve done the same for syphilis; and Belarus who’ve done the double. These countries may not have made Euro 2016, but they’ve got a much better achievement to celebrate.

The junior doctor contract is not a left-wing only issue; it’s a bad idea no matter which way you look at it

The Junior Doctor Contract Forum on Facebook is the hot bed of activity for planning and debating all elements of the junior doctor dispute. So much so that the Daily Mail and Telegraph like to hang out there looking for quotes that make doctors look bad. Hello if you’re reading this.

Something I find worrying is that they are increasingly likely to find these things on the JDCF. I’ve recently got in arguments over Labour anti-semitism and the BBC’s coverage of Tory election expenses. Why?  They really have very little to do with the contract being disputed. The answer seems to be that like a lot of social media, an echo chamber has developed and is getting increasingly echoey.

Legitimate criticisms of the Tory decision to impose a contract have extended into criticisms of anything slightly left of centre on any issue. Anyone who says ‘I think the Tories are bad for this contract, but generally they’re better on economic and foreign policy’ is shot down quicker than a Blackhawk in Somalia.

This is probably not a good idea.

The support for junior doctors exists because we all believe we are in the right. Start sniping over your fellow junior doctors over the difference between anti-Semitism and anti-Zionism will do nothing to further the demise of the contract and only serve to alienate previously supportive colleagues.

The Hunt’s assertion that the BMA is a millitant left-wing organisation is nearly as stupid as the contract he proposes. But looking at the vast majority of discourse on amongst the largest group of junior doctors in both physical and virtual space he’s looking increasingly correct. The contract dispute is being used to drag in supporting stupid petitions calling for things that will never happen, and crank conspiracy theories. As a Labour member, I can’t help but feel we really need to not alienate Tory supporters. Especially at a time when concerted rebellion among Tory backbenchers would more than likely force a U-turn on any ideas the Tories put forward. Instead of asking Tory supporters to go to their MPs and say ‘look this contract isn’t just a left-wing gripe; it’s just really dumb’, anyone with a Tory leaning is being crucified for not thinking Corbyn is the solution to all the world’s ills.

 

This contract is not a bad idea because it’s Tory. It’s a bad idea because it’s going to decimate the medical workforce and stretch resources to a point of danger.  This contract is being proposed by Conservatives, and will most ably be resisted by Conservative MP and members. Alienating them is simply bad strategy and will do infinitely more harm than the few likes that are garnered from people who already support your ideas on a post that’s completely unrelated to the contract at all.

Labour retains majority on Sheffield Council but there’s signs of resurgence among the Lib Dems

Sheffield City Council has recently been solid Labour territory, as you would expect in the largest city in the Socialist Republic of South Yorkshire. After Thursday’s local elections, Sheffield Labour was still in an imperious position, but it wasn’t all good news for Corbyn and his Red Army. They lost two seats to the largest local opposition, the Liberal Democrats, though still have 57 out of 84 councillors so its not a drastic problem.

However, examining what Thursday’s votes would mean for Sheffield’s MPs provides a slightly more interesting picture.Ignoring the wards that make up Sheffield Brightside and Hillsborough, as there was an actual parliamentary by-election that Gill Furness won convincingly for Labour, I took each ward and assigned votes to the parliamentary constituency it comes from to hold four pseudo-parliamentary elections. This produced some interesting patterns.

Sheffield Central

This was one of Labour’s  biggest success stories in the 2015 general election, as Paul Blomfield increased the Labour majority by thousands and the Lib Dems collapsed from an extremely close second to a distant fourth. The Greens also did well as Jilian Creasy increased their vote share from 3.7 to 15.8 %.

The Greens managed to do even better on Thursday increasing their notional share of Central to 33% – nearly double last years share! Unfortunately, this isn’t that much better than their 2014 local election share of 30.52% in the constituency. Still it’s nice not to be going backwards. Look for the Greens to make gains in some wards here when the local elections don’t coincide with the hype and furore of the London mayoral and regional parliamentary elections.

 

Sheffield Hallam

Labour’s vote fell away by 10.8% to 25%, while the Lib Dems consolidated in Nick Clegg’s seat with a 4% gain to 44%. This will be a slight disappointment to Labour but a drop support was always likely to occur in an area where they campaigned very heavily last year and couldn’t replicate this year.

The Greens once again see a huge increase in  support going from 3.2% to 13%. The Conservatives continue to slide in an area where they were once a huge force, dropping to 10%.

 

Sheffield South East

The seat with the least change, as Labour drop from 51.4% to 51% which I’m sure will leave the incumbent MP Clive Betts quaking in his boots. This is the constituency of Sheffield with the largest UKIP support and they had a small gain of 1.1% taking them to 23%. Nothing for them to be too upset about but still 29 points of winning the seat.

 

Sheffield Heeley

As with every other area of Sheffield, the Liberal Democrats made gains, jumping from 11.% to 26%. This is close to their largest ever support in the area, only beaten by their best ever national result in 2010. The Greens once again made a dramatic leap, doubling their support to 12%.

Labour saw a drop of 8.2%, meaning they lost support in every constituency area in Sheffield, except the one which was actually being fought (once again showing that Labour tends to do even better at national elections than local ones in Sheffield).

 

So why these changes? First, it’s local elections. The Greens (and smaller parties) do better for all the reasons I wrote about last year just before the general election. There’s also been some ward boundary changes so some people will now be included in a different constituency to the one they voted in in 2015.

Secondly, the Lib Dem fightback is gradual but real. They gained 41 seats nationally and were the only party to gain control of a council. I don’t think anyone predicted that. It seems people are either starting to appreciate what they did in government in holding some of the sillier Tory ideas back, or the Lib Dems are becoming the repository of dissatisfied Tory/Labour voters they were in the past.

Third, and almost certainly least importantly, the Corbyn effect has not seemed to have invigorated the Labour vote in  a way some predicted. In Sheffield Central, Labour saw a decrease of 14,000 voters from last year. Before you say that less people vote in locals so of course their numbers will drop, the Greens actually increased their numbers from 2015 to 2016 so it is possible. Many Corbynites said he’d bring out non-voters – on the evidence in Sheffield, he didn’t even invigorate previous Labour voters in one of Labour’s best constituencies in the country.

What will be interesting to see is how parties perform in local elections next year. Changes from 2016 to 2015 are probably a reflection that only the most motivated electorate turns out in local elections. Changes from 2017 to 2016 might reflect a more substantial change in party support.

 

No minutes kept during Jeremy Hunt’s eight meetings with senior media figures

No minutes kept during Jeremy Hunt’s eight meetings with senior media figures

After the Department of Health released its list of ministerial meetings, I was able to find out that Jeremy Hunt met senior media figures eight times between October and December. These figures included the editors of the Sun, the Independent and the Spectator, as well as the Director-General of the BBC. This was during the period when Mr Hunt was gearing up for his ongoing fight against junior doctors.

My original FoI request asked for a few too many things, including details of other ministerial meetings, and was denied on the ground of cost. Thanks to the sterling work of Paul Winwright and his much more sensible request, the DoH has revealed it didn’t keep minutes of the meetings between Jeremy Hunt and his new friends in the media.

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Jeremy Hunt also met Tony Gallagher for a breakfast meeting as well as those meetings listed above.

What could possibly give the Health Secretary cause to have secret meetings with all the major right wing newspapers, the most influential right-wing political magazine in the country and the BBC, the media organisation with the single biggest reach in the country? Given that the worst industrial dispute in NHS history was just around the corner, there’s probably plenty of reasons.

I very rarely think of conspiracy before cock-up. Governments are terrible at conspiracy and better at cock-up. But a senior minister having unminuted meetings with editors who have subsequently given Jeremy Hunt very good coverage is too much of a coincidence. Especially when Hunt didn’t meet any editors once in the previous 12 months.

Despite the fact junior doctors are expected to be so transparent that their own personal reflections can be used against them in court, it seems that Jeremy Hunt has chosen the cowardly option of briefing against junior doctors to already friendly media executives.

The fact the taxpayer is not allowed to know what was said by Jeremy Hunt in these meetings, despite being the ones who pay his salary and expenses, is quite simply appalling.

Corbyn and McDonnell join protesters near Downing Street in support of junior doctors

Corbyn and McDonnell join protesters near Downing Street in support of junior doctors

Jeremy Corbyn and John McDonnell joined hundreds of demonstrators who rallied around junior doctors on the day of the first ever full-walkout by doctors in the history of the NHS. They spoke to the crowd outside Richmond House, home of the Department of Health (DoH), having marched across Westminster Bridge from St Thomas’ Hospital.

During his four-minute speech, Jeremy Corbyn described a free health service as a human right, and said the Government were ‘more interested in attacking those who work in the NHS’. The Leader of the Opposition said Jeremy Hunt’s behaviour was ‘utterly contemptible’ and that the NHS was not safe in his hands. Other speakers included John McDonnell (Shadow Chancellor), Caroline Lucas (Green Party MP for Brighton Pavilion) and Johann Malawana (Chair of the BMA Junior Doctor Comittee (JDC)).

Dr Jayne Lim, who stood to be the Labour candidate in the upcoming Sheffield Brightside and Hillsborough by-election, said she was pleased to see her party leader join the demonstration and said: “This dispute has seen a lot of doctors realise they are in the same boat as other public sector workers.”

Dr Jeeves Wijesuraj, a member of the JDC, spoke from a picket line outside St Thomas’: “I think today is very sad. I, and my junior doctor colleagues, have never contemplated striking before. We’ve been forced into this position by a health secretary who is not listening to his own doctors, the Royal Colleges or the Patient’s association when they say the contract is not safe.”

Doctors have been maintaining a vigil outside the DoH for two weeks, offering Jeremy Hunt the chance to come and speak to them about the contract. Dr Carrie Thomas, an A&E registrar from a South London hospital, said she’d received unanimous support from the DoH employees she’d spoken to. “I think it’s horrendous in 2016 that Jeremy Hunt has introduced a gender pay gap into a profession where previously it didn’t have one.”

Dr Thomas was referring to the DoH own equality analysis that admits the contract ‘indirectly discriminates against women’ but that this is acceptable because is is for a ‘legitimate aim’. When asked about the safety concerns some have raised about the junior doctor strikes, Dr Thomas pointed out that her hospital today had 19 fully-trained consultant doctors in A&E when there would normally be 3 or 4.

Doctors were not the only people making their voices heard in the demonstration against the Government. Paula Peters, a Disabled People against Cuts (DPAC) activist, was concerned about how the contract would be yet another change for the worse in the lives of disabled people. “For us, [DPAC] it’s personal. Jeremy Hunt has voted for every cut and attack on disabled people. An unsafe, unfair contract that produces tired doctors at risk will put my services at risks. I’ve lost 22 friends [to suicide] as a result of these cuts”

 

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Disabled People Against Cuts activists attended the march alongside doctors

The actions of Jeremy Hunt comes as no surprise to Aine Hall who campaigned  with the National Health Action party against Jeremy Hunt in the 2015 general election. “I was grief-stricken when he increased his majority. I have relatives who are junior doctors, and it’s so upsetting how this dispute is making them feel.”

The Department of Health was asked for comment on the story but did not respond. Two of its employees were spotted wearing BMA badges.

Five major NHS areas are missing their targets

Five major NHS areas are missing their targets

Much criticism of the NHS has been made over the years of ‘chasing targets’. Politicians from both sides have condemned chasing targets for the sake of targets.

The problem with this is that targets are targets for a reason. They  measure how well a system is performing, and should be used to indicate when problems are  going wrong. Unfortunately, the Department of Health seems to not paying attention, as five key NHS area are missing their targets.

1. A&E

A&E has just had their worst ever month. A&E departments have a target to see 95% of patients within 4 hours. In February 2016, the most recent month for which data is available, they managed just under 88%. Not only is this 7% worse than their target, it is the lowest ever recorded. Only 5 hospitals managed to meet the 95% target.

A&E Targets (2)
133 out of 138 hospitals missed their A&E targets

 

2. Diagnostics

Diagnostics tests  can range from complex things like an MRI scan or a urine dynamics test to simple stuff like ultrasounds or blood tests. Nationally, it is expected that less than 1% of patients will wait over 6 weeks to get a diagnostic test.  This target was not met.

In addition, there were 863,100 people waiting for a diagnostics test at the end of February 2016. This is 6.1% more than at the end of February 2015.

3. Transfers of care

Transfers of care occur when people move from NHS (hospital) care to social (community) care. A common example would be an  elderly person who had a fall and and now needs daily carers as he or she returns home. There has been a 17% increase in delays to these transfers of care from February 2015 to February 2016. In fact, January and February 2016 are the two worst months on record for delayed transfers.

More of these delays came from the community than in 2015 – 32.2% compared to 25.9%. This comes after councils have had their social care budgets slashed over recent years.

 

4. 111

What used to be NHS Direct, 111 is supposed to offer people medical guidance in non-emergency situations. Ideally, calls are answered quickly, and if the correct information cannot be provided there and then, a return phone call is offered as soon as possible

Unfortunately, that is not the case. The percentage of phone calls answered in under a minute fell by 13.5% between February 2015 and 2016. For those that needed return phone calls, only 35% received them in under 10 minutes. That is the worst proportion ever recorded.

111 calls (2)
Nearly three times as many people had to wait over a minute to have their 111 call answered in 2016 compared to 2015.

 

5. 999 

999 calls about life-threatening medical emergencies are categorised as Red 1 or Red 2. These include cardiac arrests and strokes. The target is that 75% are answered in 8 minutes or less. In February 2016, 68% of Red 1 calls and 60% of Red 2 were answered within the target time. These were the worst months ever recorded.

Both these measures have been under target for the past 9 months. In fact these target have been missed every month since April 2014, with the exception of March/April 2015.

Every missed target here is worrying individually. Put them all in the same system and its a recipe for catastrophe.Whether poorly-managed or under-resourced, the NHS is in a sorry state, and only seems to be getting sorrier under the Government’s noses.

Reminder: Jeremy Hunt met media execs eight times between October and December

This post originally appeared on WestminsterWorld.com. I’ve republished it now as by the end of this week I’m expecting replies from the Department of Health on 20 Freedom of Information requests. These requests covered these meetings and other meetings between Jeremy Hunt and his junior ministers that seemed of interest.


Jeremy Hunt had eight meeting with senior media figures between October and December, a period that coincided with escalating industrial action by junior doctors.

Jeremy Hunt, the UK Secretary of State for Health and Dr. Mark Davies, Director of Clinical and Public Assurance at the Health & Social Care Information Centre, visited the Kaiser Permanente Center for Total Health for a tour, given by Bernadette Loftus, MD, Mid-Atlantic Permanente Medical Group, Kim Horn, President, Kaiser Permanente, Mid-Atlantic States, and Phil Fasano, Chief Information Officer
UK Secretary of State for Health Jeremy Hunt and Dr. Mark Davies visit the Center for Total Health. Credit: Ted Eytan

These media figures included: Fraser Nelson, Editor of The Spectator; Amol Rajan, Editor of The Independent; Tony Hall, Director-General of the BBC and Tony Gallagher, Editor of The Sun.

Additional meetings are known to have occurred with the editorial teams at BBC News, The Daily Telegraph, The Mail on Sunday and The Daily Mail. Hunt also attended the BBC Proms twice with his wife, courtesy of complementary tickets on both occasions.

Hunt’s eight media meetings over three months contrast sharply with a total of zero meetings over the previous nine months.

The meeting and hospitality were revealed in the latest release of ministerial gifts, travel, hospitality and external meetings from the Department of Health. Exact details of who was at the meetings and what was discussed have yet to be revealed. Westminster World has sent Freedom of Information Requests asking for further details of the meetings.