Over 100 people from London’s health and care sector, and the wider London HIV community joined us on 13 July 2018 to help shape plans for London’s Fast-Track Cities Initiative. The aims are to have zero new HIV infections, zero preventable deaths and zero HIV stigma, as well improving the quality of life for people living with HIV in London by 2030.
Throughout the day, participants made pledges for how they would play a part and were given an opportunity to comment on the London Fast-Track Cities dashboard which was launched at the event.
Highlights from the day…
Kevin Fenton (London Borough of Southwark and Public Health England) chaired proceedings, beginning by inviting everyone to reflect on two constructive challenges.
Bakita Kasadha (person living with HIV and an independent consultant) challenged London to make sure that involving people living with or at risk of HIV was really meaningful. Fast-Track Cities must learn from real-life experiences of services and their users – both good and bad. Its aims should be framed so that they reflect what people need and want. The initiative must ensure that London does not rest on its laurels of already significant progress, but goes further in exceeding the UNAIDS 90-90-90 targets and, in particular, focuses on the diverse and specific needs of the people who are undiagnosed or not engaged with services.
Chris Naylor (the King’s Fund) challenged London to learn from other cities. The King’s Fund report The role of cities in improving population health gives food for thought about what it looks like when different organisations and work programmes function as one city-wide system, and how the process of collaboration can be managed.
Bella Grant (Pathway Analytics) introduced an ongoing project to map out the assets that London can draw on to make more progress on HIV prevention, treatment and care, and to identify where there are gaps. Participants worked together to generate extensive lists of assets, gaps, and the best ways to access further information about them. Themes in the discussion included:
- variations in the range and quality of services by area
- the need to ensure there are suitable services for all those affected by HIV including women, heterosexual people and BAME communities
- the need to go further in joining up fragmented services (especially between GPs, HIV clinics and other hospital services)
- planning for the needs of older people living with HIV
Alex Baylis (The King’s Fund) asked participants to propose priorities for Fast-Track Cities’ action plan, and how it involves people and organisations in its approach. Proposals for priorities and the full range of suggestions will be reviewed further by the Fast-Track Cities kickstart group. Themes in the discussion included:
- ways Fast-Track Cities could be a catalyst for action, including promoting approaches to both service provision and commissioning which cross boroughs and reduces fragmentation
- ensuring that HIV services receive priority
- the need to drill down and fully understand the diverse needs of different groups, so that they can be fully involved in Fast-Track Cities and engaged in care
- the need to spread learning of effective approaches, for example in shared care across GP and specialist health services.
Jemma Gilbert (Healthy London Partnership) described the leadership group that is being set up to lead and oversee Fast-Track Cities, and how it fits into a governance structure reporting up to the Mayor of London’s Health Board. Healthy London Partnership will be publishing an invitation to apply to be a member of the leadership group. The Fast-Track Cities approach is one of dispersed leadership and co-production, so membership of its leadership group will be just one of the many ways to get involved.
As the workshop drew towards a close, Kevin Fenton thanked participants and speakers, and invited reflections on key messages – the most frequent of which was the need for Fast-Track Cities to foster more integrated approaches to HIV services and commissioning, which are currently fragmented. The workshop ended with two closing reflections:
Jose Zuniga (IAPAC) was optimistic that London could make real progress towards zero new cases of HIV, zero AIDS-related deaths and zero stigma. As well as the city’s achievements in having exceeded current targets even while simultaneously managing fragmentation of the system and austerity. He expected there to be learning from London for other cities and announced that IAPAC will hold its international Fast Track Cities conference in London in 2019.
Jane Anderson (IAPAC) gave a reminder that although signing up to Fast-Track Cities was a big step forward for London, signing up by itself is not enough: meaningful inclusivity would now be needed, to coordinate and encourage action. The emphasis on dispersed leadership meant that everyone would be asked to take responsibility for leading progress, not just the leadership group, while the nature of Fast-Track Cities as a coordinating rather than commissioning group (there is no automatic, additional budget) meant it would need to share insight and learning and promote the use of all available levers.