• HIV

For those of us who are concerned about how HIV services are commissioned, change is upon us. The NHS Plan, the National Strategy for Sexual Health and HIV, the abolition of the special funding allocation for NHS services, and the devolution of commissioning responsibility to primary care trusts, will all bring HIV services abruptly into the mainstream of the NHS. It is important that clinicians, managers, people with HIV, and all others with an interest in HIV services understand that it is not simply that the rules have changed; rather, we are now playing a different game altogether.

Historically, providers and commissioners of HIV services have had a number of benefits not available to many other parts of the NHS: dedicated money, a relatively high political profile, an articulate and well organised lobby from people with HIV and voluntary organisations, and identified commissioners with personal commitment to HIV and the time to focus on the development of services. Under this protective carapace, many services have flourished, and many people with HIV (though not all) have access to excellentsupport from their treatment centres.

The start of the current financial year on 1 April 2002 brought in at the same time a series of fundamental changes to the arrangements. The NHS no longer receives any money that is formally identified by the Department of Health as required to be spent on …