Posted 21st Jan 2014
I recently moved to a new post after 10 years as the Network Director for Greater Manchester Sexual Health Services and found myself reflecting and reminiscing on the journey taken. It is hardly ‘Lord of the Rings’ but none the less a journey full of personal enrichment and learning.
Many of you will recall the years preceding 2003 and it is fair to say that sexual health services were seen as a poor relation; the Cinderella of services. Many years of limited investment resulted in poor access for patients, ever increasing waiting times and the additional bureaucratic burden of managing this spiralling situation. These issues began to surface on a national stage and by mid-2003 the House of Commons Health Select Committee Chairman commented “the picture in many parts of the UK is extremely worrying… I do not use the word lightly, but during the course of the inquiry, it has become plain that with sexual health we are looking at a public health crisis”.
The then Labour government invested £47 million nationally; effectively about £0.80 per head of population. In Greater Manchester, across 10 local authority areas, we received £2.9m and from that funded a Network for £120k to work across the economy.
I think it fair to say, the ‘Network’ as a concept wasn’t initially well received. Instead of appeasing these disconsolate staff, it only reasserted many of the underlying fears: does this mean we will lose local power, control and autonomy? Was a Network needed? Is this another NHS fad? Another waste of time and money?
Early conversations were understandably tense. These new monies were welcomed but would only touch the surface of need considering the long-term neglect in the services, so would have to be used judicially.
Thankfully we had a number of people nationally championing the needs of all sexual health services, together with promoting the concept of networks. Locally we had a strategic health authority which had seen networks develop for cancer and cardiac services and saw great value in people coming together in partnership to develop services. Key to our local success was Dr Ash Sukthankar who stepped forward to take the Clinical Lead role for the Network.
This support from all levels gave us the momentum locally to seek further engagement and involvement. We talked of having collective strength, coherent and concerted approaches to issues; effectively the whole would be greater than the sum of the parts.
We talked long and hard about the ‘how?’. We wanted to build engagement, trust and respect across the professional areas, grow a sharing and innovation culture and exploit the personalities and positive characteristics of people, their skills and expertise, to best advantage for services in Greater Manchester. We wanted to make the best use of existing resources and modernise services, as well as enabling barriers to be broken down between sectors, focusing solutions on patient care pathways, rather than on organisations.
We began through one to one and group conversations to describe a structure for how the Network could function. A board, sector groups and working groups emerged including primary, secondary, tertiary and third sector partners. The Network team’s role would be to facilitate the opportunity for key people to work together. At the last count we had over 150 members from all stakeholder organisations (statutory, community, voluntary and private sectors) working collaboratively together on issues such as service delivery, clinical governance, quality assurance and workforce development to improve services.
Of course, as evidence shows, when people feel empowered they deliver; they deal with complex and difficult issues constructively, sensitively and professionally. The tensions are mitigated by co-operative behaviours. We found we could deal collaboratively with the challenges of change, employer organisations, communications and policy shifts.
As with many parts of the country, we saw the genitourinary medicine (GUM) ‘offered and seen’ targets met and maintained. New-to-follow-up ratios reduced from 1:2 to 1:0.4 and missed appointments significantly reduced from 32% to less than 5%. We now see 30% more patients through integrated sexual health services. All provide a full range of contraceptive services, with dedicated young people’s services including chlamydia and gonorrhoea screening through the Greater Manchester RU Clear Programme. A Greater Manchester-wide centralised booking service for abortion has ensured 80% of people are seen in under 10 weeks, saving £4.5m by redesigning pathways. Further patient benefits and savings (£3m) have also been made in the home delivery of HIV drugs. We have seen significant and evidenced improvements in the standards and quality of prevention, treatment and care of patients. A culture of continuous improvement is embedded within all the services. All of this has been driven by local professionals working together, through shared leadership with a commitment to deliver their best for patients.
We have successfully navigated the transition of the Network arrangements and team to a host local authority (one local authority on behalf of all 10) and have ensured all successor commissioning bodies (local authority partners, clinical commissioning group partners and NHS England) have access to the best clinical and managerial advice for decision making. The Network members have supported events and meetings to help confirm and clarify these new responsibilities to commissioners and providers, ensuring a continued appreciation of the added value of integrated sexual health services. Locally, commissioners are looking to develop a shared commissioning model that builds on existing collaboratively commissioned services and good practice. This model will secure the economies of scale whilst retaining local relationships.
I am very proud to have been part of the sexual health services in Greater Manchester, to witness such achievements and to work with people who are passionate about the way they deliver services. I am reassured that with new and dynamic leadership from Sarah Doran the Network will continue to flourish. The latest hospital scandals allow a negative media to question all who work in the NHS but we all know patients get excellent services when you have good dedicated and respected staff. Thankfully in Greater Manchester Sexual Health Services we have been blessed with those people!
For more information on the GM Sexual Health Network, including advice on setting up a network, click on the linked document below:
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