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Andrea Duncan

Andrea Duncan is Programme Manager for Sexual Health & HIV at the Department of Health (DH) in England.  She and her team are responsible for policy on all aspects of sexual and reproductive health, including contraception, abortion, sexually transmitted infections and HIV.  In this month’s eFeature Andrea touches on the new ‘system steward’ role of the DH and the current focus of its work in supporting the implementation of the Framework for Sexual Health Improvement as well as reviewing progress towards meeting the Government ambitions set out in it. She also considers the implications of the NHS Five Year Forward View for the delivery of sexual health services in the future.

Since the Framework for Sexual Health Improvement in England was published in March 2013, we have seen significant changes to the commissioning landscape and a range of new bodies, including Public Health England and NHS England, established. The role of the Department of Health has also changed.  Our new role is to act as ‘system steward’ with oversight over the whole health and care system, and work to ensure the health and care system operates effectively to meet the needs of people and their communities. DH also retains responsibility for policy and legislation and overall accountability for the health and care system to Parliament.

This changing role is reflected both in the way the Framework was drafted and in the responsibility for implementation. The Framework:

  • sets out the Government’s ambitions for sexual health and HIV
  • provides a comprehensive package of evidence, interventions and actions to improve sexual health outcomes.

The Framework committed us to an annual review of progress to identify success and failure. We know it is still early days to identify significant changes and we also know that there are no quick fixes and sustained effort will be needed to achieve our ambitions.

In particular, we know there are specific challenges in changing behaviour and reducing risk taking. We also need to see a shift in attitudes so there is less embarrassment around sexual health issues, including a fear of being judged. Reducing deprivation and inequalities is also crucial to improving sexual health outcomes and we need high quality services and interventions in place that meet the needs of both the general population and high risk groups.

The first progress report will be published shortly and will include 2013 data to make it as timely as possible.  The report will comprise a short overview, a set of indicators and examples of local and national case studies which support the Framework’s key objectives. We are also including relevant findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal 3).

Top line indicators suggest progress continues to be made in many areas. This is very welcome as we know that 2013 was the transition year for the new system, new commissioning arrangements and a time of considerable change. We know that colleagues working in all parts of the system worked very hard to ensure that these changes did not impact on patient care. As someone who has worked in the sexual health team at DH for some years I know the dedication and passion of so many of you working (both commissioners and providers) in sexual health and HIV and your commitment to providing the best quality service to patients.

Implementation of the Framework is locally led. Therefore progress in achieving our ambitions is dependent on local organisations working together to ensure services and interventions are high quality, responsive and accessible.  We know that the changes to commissioning have brought challenges as well as opportunities. PHE’s guide to whole system commissioning Making it Work promotes effective collaboration and cooperation to achieve the best outcomes and value for money. Working together collaboratively across the commissioning landscape is crucial if we are to make the new arrangements and relationships work effectively.  Change also brings an opportunity to consider what service models are needed in today’s world and how these can best be delivered in an environment of limited resources. This involves both building on learning about what has been effective to date and challenging ourselves around working differently.

There is also a need to consider the implications of the NHS Five Year Forward View for delivery of sexual health services in the future, in particular:

  • how to manage increasing demand for services at a time of financial constraint
  • the need to prioritise prevention to reduce demand for services upstream
  • the need to break down barriers between hospital care and primary and community services and social care.
  • how to harness new technology to meet patient need – particularly pertinent to sexual health given the age of many at higher risk.

There have already been some major changes in the way that sexual health services are provided to the millions of people who use them each year, including service integration and innovation and access to on-line and digital services.  There is great potential to maximise the use of technology and social media to deliver best value outcomes which are convenient to patients. Both commissioners and providers need to be able to work together and respond appropriately to these pressures and opportunities.

Technology has already transformed how people access information about sexual health, including where and how to access services and introduced new ways of testing through the internet. However, technology is also a crucial way of obtaining information for those in communities where discussion of sexual health remains taboo and where there may also be cultural and language barriers.  Young people in these communities may also be at risk of exploitation, including for young women, female genital mutilation (FGM).  Meeting the needs of these very hard to reach and often vulnerable people continues to be essential.  

Our key challenge going forward is to work with a range of organisations to consider how the issues raised in the Forward View can be translated into a vision for sexual health and HIV which is bold and creative. This will inevitably mean further changes to the way services are designed and commissioned which presents opportunities too. If we are to embrace the changes set out in the Forward View and ensure that sexual health services are fit for purpose to meet future needs, working together flexibly and openly is critical to success.

The content of all eFeatures represents the views and opinions of the authors.  MEDFASH does not necessarily share or endorse the views expressed within them