Comprehensive Sexual Heath Needs Assessment Wakefield 2007 By Design Options for NHS Wakefield District/YHSHA

Evidence for the Report Key documents and strategies Interviews with key informants (commissioners, providers, patients, service users, etc) Stakeholder workshop (September 2007) Workshops with high risk groups Service mapping exercise (availability and configuration) Local epidemiology

Local epidemiology (1) STI infection rates increased by 41% between 2000 and 2005 STIs in under 19s accounted for 27% of the diagnoses in 2005 Chlamydia infection rates increased by 116% between 2000 and 2005 Gonorrhoea infection rates increased by 56% in women between 2000 and 2005 Syphilis infection rates increased gradually in MSM between 2004 and 2006

Local epidemiology (2) Herpes Simplex Virus (Herpes) infection rates are increasing significantly in under 19s, under 25s and men over 45 Human Papilloma Virus (Genital warts) infection rates increased by 67% in women between 2000 and 2007 and by 60% for men over 35 HIV diagnoses increased by 234% between 2002 and 2006 Wakefield was not meeting the local targets for teenage pregnancy rates (Under 16s and 18s)

Service demand The GUM Clinic had met the “offered within 48 hours” target but not the “seen within 48 hours” target (by the time of printing the report) Data collection in contraception services did not reflect the full range of work (e.g. training, STI diagnosis and treatment, tertiary referrals etc) No abortion or termination of pregnancy services in the district. Services are available only at Marie Stoopes (Leeds) and BPAS (Doncaster)

Vulnerable/At Risk Groups (1) Geographical inequality and access (physical isolation, absolute/relative poverty, cultural factors, stigma around sexual health and identity in the older mining communities, etc) Young people Looked after children Asylum seekers and failed asylum seekers Non-asylum seeking immigrants Other black and ethnic minority communities

Vulnerable/At Risk Groups (2) Prisoners Men who have sex with men (MSM) Sex workers Substance users Mental health

Sexual health services in Wakefield (1) One single consultant GUM Clinic at Clayton Hospital (Josephine Butler Centre for Sexual Health) and no GUM Clinic in Pontefract A limited number and variety of venues for the Chlamydia Screening Programme Uneven distribution of contraceptive and sexual health services was a major barrier for access No local termination of pregnancy service

Sexual health services in Wakefield (2) No dedicated services for sex workers Little sexual health service provision by school nurses/health services Inadequate provision of sexual health services in primary care and community pharmacies Terrence Higgins Trust (THT)/Brook and other local agencies provided community based sexual health advice and testing services

Gaps and needs (1) Summary of sexual health needs –Rising rates of STIs (excluding HIV) –Relatively high numbers of individuals presenting with late diagnoses of HIV Strategic issues –Service integration at strategic and operational levels –User engagement in service development –Information Management –Service specifications –Human resources and skill mix –Innovation in service development

Gaps and needs (2) Service Model –Integration of contraception, GUM, general practice and other primary care services –Geographical distribution of community contraception services and GUM services –Sexual health provision within general practice –Community contraception services (CASH) –Information technology (IT) development –Pharmacy venues –Specialist services –School nursing and community health services

Operational issues (1) Awareness raising –Health promotion (limited advice and information, etc) –Sexual and Relationship Education (SRE) Strategy Access –Opening hours and Walk-in services (limited) –Booking system (no centralized booking system, etc) Service experience –Service experience (transport, parking, location, etc) –Targeted services (high risk groups) –Barriers to access for young people (including disengaged young people)

Operational issues (2) Service experience (Cont’d) –MSM (bisexuals) –Service provision for sex workers (no dedicated service) –Barriers to access for ethnic minorities (attitudes, cultural values, obstructive gate keeping, etc) –Barriers to access for refugees and asylum seekers (attitude, cultural values, language, etc0) –Sexual health in prisons –Care pathways for victims of sexual assault –Local services that are easily accessed by drugs and substance users