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Developing a 5 year Sexual Health Plan for HertfordshirePH & Localism Cabinet Panel Louise SmithDeputy Director, Public Health

23 January 2014

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5 Year Plan

• Needs assessment

• Partnership & commissioning responsibilities

• Vision

• Implementation

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Outcomes

• 3 indicators in Public Health Outcomes Framework:

• Under 18 conceptions

• Chlamydia diagnosis in the 15-24 age group

• Late diagnosis of HIV

• Improving patients’ experience of services

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Commissioning responsibilitiesFigure 1: Sexual Health services commissioning arrangements from April 2013

Local authorities will commission Clinical Commissioning Groups (CCGs) will commission

The NHS Commissioning Board will commission

Comprehensive sexual health services. These include:

Most abortion services (but there will be a further consultation about the best commissioning arrangements in the longer term)

Contraception provided as an additional service under the GP contract HIV treatment and care (including drug costs for post-exposure prophylaxis after sexual exposure)

- contraception, including LESs (implants) and NESs (intra-uterine contraception) and all prescribing costs, but excluding contraception provided as an additional service under the GP contract;

Sterilisation

- sexually transmitted infection (STI) testing and treatment, chlamydia screening as part of the National Chlamydia Screening Programme (NCSP) and HIV testing;

Vasectomy

Promotion of opportunistic testing and treatment for STIs, and patient-requested testing by GPs

Non-sexual health elements of psychosexual health services

- sexual health aspects of psychosexual counselling; and

Gynaecology, including any use of contraception for non-contraceptive purposes. Sexual health elements of prison

health services Sexual Assault Referral

- any sexual health specialist services, including young people’s sexual health and teenage pregnancy services, outreach, HIV prevention and sexual health promotion, services in schools, colleges and pharmacies.

Centres

   

Cervical screening

Specialist fetal medicine services

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Sexually Transmitted Infections

Overall rate of key 5 STIs, Hertfordshire, 2011

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Community data2011

GUMCAD 2011

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Conception rate in women under 18 across Hertfordshire, 1998 - 2011

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101520253035404550

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Overall rate for England

Overall rate for Hertfordshire

Average rate for WestHertfordshire

Average rate of East/NorthHertfordshire

<18 Conception Rates

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HIV Prevalence by Locality

Local Authority

Diagnosed HIV prevalence per

1,000 (2012)% late diagnosis

(2009/11)England 50.00%Broxbourne 1.22 60.00%Dacorum 1.09 55.60%East Hertfordshire 0.82 37.50%Hertsmere 1.64 63.60%North Hertfordshire 1.03 54.50%St. Albans 0.98 61.90%Stevenage 2.14 57.10%Three Rivers 0.91 81.30%Watford 2.84 50.00%Welwyn Hatfield 1.97 44.70%

Sexual Health Clinics

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Vulnerable GroupsInformation concerning vulnerable groups is extremely

limited but some data has been sourced on the following groups:

– Looked after young people– Young People NEET– Commercial sex workers– People with disabilities– Prisoners

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Service User Views

• Accessibility

– Making appointments and contacting services

– Opening times

– Turned away from drop-in

• Environment

– Maintaining confidentiality

• £ Efficiencies

• Centralised booking

• Single point of GUM & FP access across Herts

• Increased testing provision in community clinics

• Better opening times: evenings, weekends

• Improve equity of access East vs West

• Increase HIV testing in wider settings

• Target support for vulnerable groups

Vision

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Recommendations:

1. Re-tender a single integrated sexual health service

2. Establish a provider training network

3. Establish a sexual health partnership across Hertfordshire

4. Commission research into the health needs of groups with high risk sexual health behaviours

5. Develop an integrated strategy for sexual health promotion & harm reduction, targeting vulnerable groups