8. Conclusions
The consultation on the proposed Action Plan for Hepatitis C attracted a large number of responses from individuals representing a wide range of agencies and groups. Many respondents clearly had an in-depth understanding of issues related to Hepatitis C and other blood-borne viruses, and warmly welcomed the publication of the Action Plan. The view was expressed that action was urgently needed in this area in Scotland.
It is clear from this consultation that further work must be done on Scotland's Action Plan for Hepatitis C. Respondents were very much in support of the general aims of the draft Action Plan, but felt that the Action Plan lacked important detail for planning. A number of important issues had been omitted. Many respondents requested clarification about particular actions, and expressed the view that certain actions were vague or open to interpretation. Respondents wanted to see explicit targets and SMART objectives.
However, the main concern expressed by nearly every respondent was that, without sufficient funding, the publication of an Action Plan would fail to result in any significant change or improvement. Targets and objectives can be set, but they will not be met. Furthermore, respondents argued that any action to identify infected individuals, or to improve education and training among professionals, could potentially do more harm than good unless substantial new funding is made available to improve the accessibility of testing and treatment services.
This is a rather gloomy message. However, it is clear from the results of this consultation that there is some scope for improvement over the next few years, even without additional funding. This situation is far from ideal, but neither is it completely hopeless. There are many on-going initiatives in many areas which could be consolidated and better co-ordinated to meet the needs of those who have, or who may be at risk of acquiring Hepatitis C.
In addition, respondents have recommended the establishment of standards in many areas - standards for training and education of professionals, standards for drug treatment services, and standards for needle exchange. If these recommendations are accepted, work could begin immediately on this. The inclusion of Hepatitis C within the school curriculum could also be taken forward.
The creation of SMART objectives for the Action Plan will, in itself, make clear what can and cannot be achieved without additional funding.
In the meantime, it will be crucial for further work to be undertaken to quantify the need for additional resources. Respondents to the consultation have already clearly identified where the greatest needs for funding are. What is not clear, however, is the precise level of resourcing that is required. This information will be necessary if a case for increased funding is to be made to Scottish Ministers.
The economic analysis being undertaken by Health Protection Scotland to estimate future HCV burden of care is very important, and respondents made recommendations about how that work should be extended. However, there may also be some benefit from undertaking a national needs assessment to identify the costs associated with developing improved, community-based prevention, testing and treatment facilities. This work could be linked to an evaluation of the impact of the revised formula for allocating blood-borne virus prevention funding - a suggestion that was made by one respondent.
The mere publication of an Action Plan on Hepatitis C indicates a clear commitment by the Scottish Executive to tackle this problem. However, this commitment is undermined by the lack of funding attached to the Action Plan. The Scottish Executive will need to consider carefully what specific actions can be undertaken in the next few years to address the Hepatitis C epidemic in the absence of additional resources. To some extent, it will be possible for work in relation to Hepatitis C to piggy-back on existing actions in the areas of harm reduction, drug treatment and rehabilitation, sexual health and HIV. But, the results of this consultation would indicate that without a massive injection of targeted funding, the problems associated with Hepatitis C are only likely to get worse.