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Etty Martin

Etty Martin is Sexual Health Commissioning Manager at Warwickshire County Council.  She was appointed jointly by the council and NHS Warwickshire over four years ago, way ahead of the transfer of public health to local authorities. In this month’s eFeature Etty uses the example of Warwickshire’s Respect Yourself  campaign to show how a sex positive approach to public health was successfully navigated and commissioned within the local authority setting.

A commitment to jointly fund and commission sexual health services at a time of change and uncertainty was a real demonstration of the partnership working that had developed between NHS Warwickshire and Warwickshire County Council. Almost three years before the transfer of public health to local authorities, this foresight provided an opportunity for the commissioning of sexual health services to take centre stage across the county and nationally.

A key part of the sexual health commissioner role was to take responsibility for the Respect Yourself campaign, which included commissioning programmes to promote sexual health and wellbeing for 13-25 year olds. The motto ‘Feel the Fear and Go for it Anyway!’ not only described the Respect Yourself  team and public health leaders, but included senior managers within Warwickshire County Council, who were required to support a controversial campaign that would place them under the spotlight.

In 2011 the Respect Yourself team and 20 frontline workers took a study tour to the Netherlands, where we witnessed the benefits of adopting the evidence based sex positive approach that worked so well in Holland. Gaining support for a sex positive vision, with values that reflected the Dutch success story, was helped by the existing working relationships between the health service and local authority. This was especially possible given our familiarity with processes for decision making and governance, and opportunities to disseminate ideas with the senior management teams in each organisation. Although a joint commissioning role, being employed by the local authority provided access to key committees and elected members in a way that may not have otherwise occurred.

A conference was held locally, entitled ‘Speaking Double Dutch’ to reflect the confusion around sexual health messages, and showcase the Dutch method of providing both condoms and a supply of oral contraception routinely with emergency hormonal contraception.  The aim of the conference was to engage with strategic leaders across key directorates of both the local authority and the NHS, in an innovative way. This enabled us to gain commitment to the new approach whilst understanding that it may be perceived as controversial by some. Attendance was excellent as was the commitment to support the change in ethos – and indeed to embrace our ‘Feel the Fear and Go for it Anyway!’ motto.

Given the green light to move forward with an innovative programme, the Respect Yourself  team set to work on redesigning and refreshing the way that we communicated with young people. We started with a refresh of the www.respectyourself.info website to ensure that it reflected the sex positive features that had enabled our Dutch partners, Rutgers WPF, the national Dutch Sexuality Programme, help achieve impressively low rates of sexually transmitted infections (STIs) and teenage pregnancies.

We conducted sex positive relationship and sexual health master classes for two students from each year in one Warwickshire school (24 in total), helping to inform the development of the website. Using a range of approaches with a focus on electronic media, the new website was designed and the launch planned for summer 2012 – six months before full transfer of public health into local authorities. An evaluation of the website and accompanying mobile app using a behaviour change model to measure access to sexual health services was commissioned from Coventry University and took place after the launch.

This sex positive website was the first to be launched with a licence for use by Warwickshire County Council from our Dutch partners. It includes features developed and designed by the students such as:

•    Sextionary – a description of sexual terms used by the target age group 13-25 years.

•    Pleasure Zones – sex positive descriptions of erogenous zones for pleasure.

•    FAQs – honest, factual and humorous answers to all questions posted to the website.

•    Gallery - pictures of male and female genitalia with a full range of shapes and sizes that reflect normal bodies and not those depicted in pornographic images.

•    Mobile App – mobile application to download service finder and ability to rate the experience of attending a particular clinic/ service.

An extensive briefing programme was developed prior to the launch. This included meeting with the Chief Executive, Leader and Portfolio Holders for Children’s Services and Public Health, and the Chair of the Shadow Health and Wellbeing Board to remind leaders and elected members about the change in ethos and reiterate the sex positive approach.

The launch took place over the summer months, with interest from the national press in early autumn. During the media frenzy that followed the launch, the website and the sex positive philosophy underpinning it continued to be supported and endorsed by Warwickshire County Council at all times despite aggressive and emotive headlines.

The debates and headlines, although often controversial, resulted in a wave of negative and positive coverage with a resounding increase in website hits from 600 a month to 6000.  This increase in website hits has been sustained to date (with 175,000 hits in the last year)

The website is now endorsed by the UK Safer Internet Centre (South West Grid for Learning) and has been sold to local authorities wishing to replicate this success. It was also shortlisted for the national Sexual Health Awards in 2014.

It is important to note that Public Health Warwickshire moved physically to the Communities Directorate of Warwickshire County Council in December 2012 and transition was well under way organisationally and operationally by the launch of the website event. Two years of routine briefing and familiarisation across the county council and inclusion of the director of Public Health in the leadership team proved vital to the success of the campaign.

Support has continued throughout the first year within the Communities Directorate with the added bonus of working alongside our Community Safety colleagues. This has resulted in additional Police Crime Commissioner funding to add new features to the website, which will address issues such as pornography, consent, child sexual exploitation and domestic abuse.

The Respect Yourself  campaign has enabled sexual health commissioning to generate a high profile in Warwickshire County Council, and the evaluation of the website and mobile app by Coventry University has shown an increase in the use of sexual health services across the county. The route this campaign has taken and the impact it has had locally demonstrates how sexual health commissioning within the local authority setting can be effective. Much of the success of this campaign is due to the early decision to employ a sexual health commissioner and by doing so embed public health messages across the council. Such an approach lends itself well to other health and wellbeing interventions that require joint working in order to succeed.

For further information on the Respect Yourself campaign contact Etty Martin (ettymartin@warwickshire.gov.uk)

 

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