Show Menu


Ruth Lowbury, Chief Executive, MEDFASH

MEDFASH’s Chief Executive, Ruth Lowbury, looks at some of the opportunities and challenges that lie ahead for those commissioning and providing sexual health and HIV services

Welcome to the first issue of the MEDFASH Sexual Health & HIV Policy eBulletin. Its launch could not be more timely.

Responding to the change agenda

The NHS, local government and the voluntary sector are all facing radical change in the way services are to be commissioned and delivered. Policy is evolving rapidly, with new guidance and information about its implementation being constantly generated. For busy professionals at the frontline of commissioning and providing sexual health and HIV services, it can be hard to keep on top of all this information and to sift it for its relevance to our areas of work.

This eBulletin is designed with local sexual health and HIV commissioners and providers in mind. It will give a concise and regular round-up of emerging policy developments, relevant evidence updates and available tools and resources across the field of sexual and reproductive health and HIV. It will also consider the impact the change agenda is having on this area of healthcare through a series of eFeature articles and interviews with those working at both national and local levels.

The challenges ahead

From April 2013 the world of healthcare and public health will not be as we have ever known it before. MEDFASH shares the anxieties of many colleagues about the risks arising from potential fragmentation of commissioning in our sector – HIV treatment and care to be commissioned by the NHS Commissioning Board which will also be responsible for the GP contract including contraception in general practice; sexually transmitted infection and contraceptive services to be commissioned by local authorities as part of their new public health remit alongside sexual health promotion and HIV prevention; abortion and sterilisation to be commissioned by Clinical Commissioning Groups (CCGs). But, what may fall through the gaps?

On the provider side there will be increasing diversity under the Any Qualified Provider policy, while the drive for efficiency savings will focus minds on the potential for innovation and service re-design. Here again there are risks of fragmentation and more patchy service provision.

The transition process will put different people in different places, with new individuals taking up key roles in public health and commissioning. Fresh relationships will need to be forged and we face a potential loss of expertise as some of those previously responsible for sexual health and HIV move on.


On the positive side, the new world also presents opportunities for us to ensure that sexual health and HIV remain high on the list of public health priorities.

Every local authority will have a mandated responsibility to commission comprehensive, open access sexual health services. Meanwhile, the coordination of HIV commissioning at national level offers scope for better value for money on drug costs and a mechanism for ensuring consistency in the quality of treatment and care around the country.

Local priorities will be guided by Health and Wellbeing Boards where local authorities will come together with Clinical Commissioning Groups to assess needs and agree strategies to improve the health of their local population.

Informing those strategies will be the Public Health Outcomes Framework, which offers the overarching national vision for public health and defines the outcomes to be achieved and the indicators that will help measure success. The Framework includes three specific indicators for sexual health and HIV (under 18 conceptions, chlamydia diagnoses in 15–24 year olds and people presenting with HIV at a late stage of infection) as well as others which are also very relevant (such as infectious disease testing in pregnancy and violent crime including sexual violence).

Building on progress

Despite all the changes, we are not starting from scratch. We have a strong evidence base for sexual health (including teenage pregnancy). We have widely recognised clinical guidelines and standards plus NICE public health guidance. There is a broad range of existing tools and resources available for use in assessing sexual health need and commissioning comprehensive, high quality services. Great strides have been taken in recent years in modernising services and improving access, and we need to protect this progress.

We look forward to the Government’s forthcoming sexual health policy document which should set the framework for local action on sexual health and HIV.

Last but not least, people with HIV and other sexual health needs benefit from the commitment of the many dedicated professionals who believe passionately in the importance of what they do, despite (or perhaps because of) the stigma that can still rear its ugly head in this area of healthcare.

The eBulletin

We hope our new eBulletin will serve as a support to all those professionals, both those who have been working in the field of sexual health and HIV for many years and those who are coming new to it in 2012 and beyond.

We are grateful to the colleagues who gave us feedback on eBulletin at different stages in its development and to ViiV for financial support which has enabled the eBulletin to see the light of day. 

With the current pace of change at local level, we are relying on those of you receiving this first bulletin to forward it on colleagues who may find it of interest and want to subscribe to receive the eBulletin on a regular basis. So, please pass it on, and let us know what you think of it and what issues you would like it to cover in future. 

Please note that this first issue is a ‘bumper’ edition to ensure important items from the last few months are included. Subsequent eBulletins will carry fewer items and be much shorter!

Sign up to receive the MEDFASH eBulletin

MEDFASH closure

MEDFASH closed in December 2016. This website is not being updated. For details of where our current publications and resources have been transferred to, click here