Sexual Health: where we are now and our vision for the future Dr. Mayada Abu Affan

Dudley’s profile Local Authorities responsibilities Sexual Health Service Provision in Dudley Borough Progress so far What we need to improve on Our Vision – What we want to achieve Finance and contracting Presentation Outline

Dudley’s demography According to 2011 census Dudley has 312,925 residents. 24 electoral wards Population is more affluent in the periphery with 25% are over 60 years Younger and more deprived population in the centre of the Borough DY1,Dy2and DY5re hot spot areas for sexual ill-health

Background As from 1 April 2013, Dudley MBC is now required by regulation to commission comprehensive sexual health services including:  Contraception including implants and intrauterine contraception in primary care.  STI testing and treatment, including post-exposure prophylaxis, Chlamydia Screening Programme and HIV testing, prevention and support  Sexual health aspects of psychosexual counselling  Any sexual health specialist services, including young people's sexual health, and sexual health promotion in schools, colleges and pharmacies

National Policy and Frameworks The Public Health Outcomes Framework sets out three indictors related to sexual health Reducing individuals presenting with HIV at a late stage Reducing numbers of under 18 conceptions Reducing Chlamydia diagnosis rate in years old

Sexual Health Service Provision in Dudley Borough The current model has two main providers, provision at primary care and community pharmacies and third sector Contraception and Sexual Health (CASH) services are based at Brierley Hill Health and Social Care Centre with two community clinics at Central Clinic, Dudley town centre and Halesowen Health Centre. Genito- Urinary Medicine (GUM) service is based at Russells Hall Hospital Under 25s service is provided by Dudley Brook and is based in Dudley town centre with outreach clinics in colleges and the What? Centre, Stourbridge.

Other sexual health services offered in Dudley Borough Chlamydia Screening Programme which is commissioned and delivered by Brook. Service is offered in mainstream sexual health services, and some pharmacies and GP practices Community pharmacies offer the following: EHC Some offer HIV POC testing Chlamydia testing and some offer Chlamydia treatment Primary care offer SDI and IUD fitting and removals and Chlamydia testing Summit House Support: offers support for people living with HIV, HIV point of care testing (POCT) and is particularly targeted at people who are in “at risk groups”

Other Sexual health services Condom Distribution Scheme; a partnership between a number of partners working to support young people in Dudley. Point of Care HIV Testing pilot scheme is offered in 12 pharmacies, Dudley Brook and contraception and sexual health (CASH) clinics. Respect Yourself Team provides holistic support to prevent teenage pregnancy and support teenage parents. Abortion services which are commissioned by the CCG

The current situation The level of sexual ill-health in some areas is lower across Dudley Borough when compared to regional and national rates; for example: Dudley is ranked 195 (out of 326 local authorities in England; first in the rank has highest rates) for rates of new sexually transmitted infections (STIs), at a rate of per 100,000 residents (compared to per 100,000 in England). Rates of HIV are low when compared to national rates. In 2014 the diagnosed HIV prevalence rate was 1.0 per 1,000 population (compared to 2.1 per 1,000 population in England and 1.5 per 1,000 in West Midlands) The percentage of HIV diagnoses with CD4 cell count <350 at time of diagnosis ( ) was 38%, (compared to 45% in England and 55% in West Midlands) (Source: PHE, 2014)

Achievements to date An increase in the rate of LARC prescribing in primary care: In 2013, the rate of LARC prescribing was 58.0 per 1,000 women aged 15 to 44 years, compared to 52.7 in England. (PHE, 2014) Expansion of EHC community pharmacy; 60% of community pharmacies provide EHC Every clinical provider in mainstream services are able to fit at least one method of LARC Early access to termination of pregnancy (80% before 10 weeks gestation) 48 hour access to GUM services An increase in Chlamydia screening uptake and positivity Year on year reduction in unplanned teenage pregnancy

What we need to improve on: health and wellbeing outcomes? Reduce STIs among young people in Dudley: In 2013, 61% of diagnoses of new STIs in Dudley were in young people aged years (compared to 55% in England). Reduce re-infection and onward transmission of STIs: Between 2009 and 2013 an estimated 8.2% of women and 8.1% of men presenting with a new STI at a GUM clinic became re-infected with a new STI within 12 months (compared to 6.9% for women and 8.8% for men in England) Increase detection of Chlamydia infection: Chlamydia testing levels are lower when compared to national and regional levels; rate of diagnosis in 2013 per 100,000 young people aged was 1,793 (compared to 1,917 in West Midlands and 2,016 in England)

What we need to improve on: health and wellbeing outcomes Further reduction of teenage pregnancy: In 2013, the under 18 conception rate per 1,000 female was Despite seeing a year on year reduction, Dudley is still higher than the national and regional average (24.3 in England and 28.9 in West Midlands). Reduce the rate of repeat abortion In 2013, the under 25s repeat abortion rate was 29.7% (compared to 26.9% nationally and 28.8% regionally)

What young people have told us Service Model

What the public have told us? One stop shop 52% of young people preferred a one-stop shop 70% of the general public preferred a one stop shop 89% of service users preferred a one-stop shop From this, the consultation supports one- stop provision wherever possible.

Our vision – What we want to achieve To have the best sexual health outcomes for Dudley’s population through: Ensuring sexual health is everyone’s business and it is in everyone’s agenda Ensuring we commission according to the evidence base,needs of our local communities and long the ethos of Community Council Effective partnership and collaborative working

Our objectives: Our objectives: Have efficient, effective and accessible sexual health services that meet the need of our population, particularly amongst those at highest risk of sexual ill health Reduction in sexual health inequalities amongst those more at risk of poor sexual health Increased opportunities for diagnosis and effective management of STIs

OUR OBJECTIVES: Increased uptake of HIV testing and rapid referral to HIV care services Increase uptake of Chlamydia testing, diagnosis and treatment Increased uptake of effective methods of contraception, including access to LARC for all age groups Continued reduction in teenage conception rates Reduction in number of people repeatedly infected with a STI Reduction in repeat abortions

Procurement outlines Along the whole care pathway: Level 1,2&3 integrated sexual health services HIV support services in the community HIV treatment services Wider provision of community based sexual health services Welcome collaboration between providers and innovation Welcome risk stratification approach to management, including self testing.

Finance and contracting  Block contract for GUM, CASH and HIV community support services: Informed by a quality standard framework % of the payment is linked to achieving specific quality standards KPIs are evolving to meet the needs of the population and are agreed annually contract value around (?£1.5 million)  Separate HIV treatment contract with NHS England contract value around (? £2 million)