Review of the National Strategy for Sexual Health and HIV SSHA, Newcastle 26 September 2008

SHHA Newcastle 26 September  Desk research: on the progress of implementation of the Strategy; the changing landscape and epidemiology  Expert Review Groups: services; commissioning; prevention & inequalities; indicators  Meetings: on strategy; with stakeholders; and with sexual health service users. NATIONAL STRATEGY REVIEW METHODOLOGY

SHHA Newcastle 26 September  Changing context for sexual health  Progress in improving sexual health and implementing the Strategy  Key barriers to implementation  Action to drive forward the Strategy  Measuring further progress REVIEW CONTENTS

SHHA Newcastle 26 September CHANGING CONTEXT FOR SEXUAL HEALTH[I]  Policy developments Devolved decision making Local authority role and partnerships Public health and tackling inequalities Patient and public involvement Darzi review – quality, health improvement/prevention  Organisational change and NHS reforms Restructuring – PCTs, SHAs, RDPH role Commissioning reform Market reform and patient choice Financial reform – PbR, GMS contract

SHHA Newcastle 26 September  Clinical and service delivery developments Service modernisation Multidisciplinary teams, new roles (nurses, health trainers) Self-management  Technological changes Prevention, testing and treatment technology - rapid testing, HPV vaccination Communications technology – internet, text messaging CHANGING CONTEXT FOR SEXUAL HEALTH[II]

SHHA Newcastle 26 September PROGRESS IN IMPROVING SEXUAL HEALTH AND IMPLEMENTING THE STRATEGY  Sexual health in 2008 HIV, STIs, unintended pregnancy, psychosexual problems, sexual assault Inequalities - BME, gay men, young people and older people  Implementing the strategy - achievements national priority, targets and support - GUM access, abortion <10 weeks publication of standards and best practice guidance service modernisation and integration, innovation implementation action plan – most actions delivered (national level)

SHHA Newcastle 26 September KEY BARRIERS TO IMPLEMENTATION  Barriers Prioritisation, targets and investment Commissioning Evidence base Integration and workforce development Funding mechanisms Engaging GPs Lack of strong voice, stigma  Locally variable implementation

SHHA Newcastle 26 September  improve access to the full range of contraceptive methods  reduce unintended pregnancy rates  improve care for women seeking abortion  reduce transmission of HIV and STIs  reduce prevalence of undiagnosed HIV and STIs  improve health and social care  reduce stigma [HIV and other aspects of sexual health]  improve sexual health and wellbeing  recognise psychosexual health as an integral part of sexual health  improve access to good quality services and care STRATEGY AIMS Focus for further action

SHHA Newcastle 26 September PRIORITY AREAS FOR ACTION: PRIORITY ACTION 1 Prioritise sexual health as a public health issue. Sustain high-level leadership locally, regionally and nationally. Designate accountability for sexual health improvement at PCT/LA level Strong public health base with regular sexual health needs assessment Dedicated regional function to ‘support and challenge’ backed by sound leadership and performance management Continued national support for local delivery via NST More effective mechanisms to foster evidence building and knowledge transfer Build infrastructure and training

SHHA Newcastle 26 September PRIORITY AREAS FOR ACTION PRIORITY ACTION 2 Build strategic partnerships Active engagement in joint planning mechanisms to ensure sexual health and HIV are prioritised Ensure sexual health is represented in related health improvement plans (eg alcohol, staying healthy, mental health) Acknowledge third sector as an equal partner and include in needs assessment and strategic planning Closer working between SHAs and GOs More integrated cross-government approach to address inequalities and wider determinants of sexual heath Fully engage professional bodies representing sexual health

SHHA Newcastle 26 September PRIORITY AREAS FOR ACTION PRIORITY ACTION 3 Commission for improved sexual health Holistic commissioning model Commissioning at an appropriate level to ensure fair, effective best- value provision Link service networks to the commissioning process and business agenda Skill up sexual health commissioners to meet WCC requirements Accelerate development of tariffs which allow for different service models and reflect the real cost of services Develop strong multi-disciplinary teams

SHHA Newcastle 26 September PRIORITY AREAS FOR ACTION PRIORITY ACTION 4 Invest in prevention Ensure effective sexual health promotion and HIV prevention is commissioned according to local need and is adequately resourced Make prevention an integral part of all sexual health service provision Develop a national prevention framework for a more coordinated approach across government departments Improve synergy between national and local prevention initiatives Improve dissemination about what works and what is cost effective, particularly in relation to African communities, gay men and young people Intensify efforts to tackle stigma Make PSHE Education and all elements of SRE a statutory subject

SHHA Newcastle 26 September PRIORITY AREAS FOR ACTION PRIORITY ACTION 5 Deliver modern sexual health services Specify local quality standards and ensure performance of all those providing sexual health services is monitored Establish and further develop sexual health and HIV networks to cover all areas of the country Label services more clearly and maintain open access at all times Increase level and quality of services provided by general practice and include sexual health in future development of QOF Ensure sexual health and HIV services are included in local reconfiguration work (eg primary care centres/polyclinics) Improve workforce planning and training at all levels and link to service development and changing models of care

SHHA Newcastle 26 September A HIGH QUALITY WORKFORCE

SHHA Newcastle 26 September KEY MESSAGES  Transmissible infections have no regard for geographical boundaries  There are potential dangers in leaving public health control of STIs and HIV to competing services without quality standards or a requirement for collaboration.  High quality and timely surveillance data are vital to identify need, determine the value of prevention programmes and optimise service configuration.  There has to be a shared understanding about why improving sexual health is priority why it matters to life outcomes and the wider community.

Review of the National Strategy for Sexual Health and HIV