Posted 11th Jun 2014
The progress in sexual and reproductive health and HIV (SRHH) that has occurred in the thirty years since I qualified as a doctor is phenomenal.
HIV, once universally fatal, killing people in the prime of their lives now has the potential to be a long term, manageable condition. Rapid and open access to high quality integrated genitourinary medicine and sexual health services, together with improved choices for people’s reproductive health, have had an enormous impact on individual and population health and wellbeing.
Yet there is absolutely no room for complacency - securing these gains whilst accelerating interventions to address the ongoing extensive challenges requires prioritisation of SSRH across the entire health and social care economy.
The past year has been a transformative time, as the Health and Social Care Act 2012 moved from the statute book into the real world. Responsibility for public health has moved to local government, NHS England’s specialised commissioning role was established and clinical commissioning groups were set up. Commissioning for SRHH services has undergone a complete change, with the ambition of securing locally relevant responses to improve the sexual and reproductive health of people and populations, whilst simultaneously increasing equity for high cost prescribed HIV services nationally.
Everyone working within the system has had to evolve their thinking and approach in this unfamiliar world. New partnerships need to be forged between commissioning organisations, providers and communities. Securing channels that enable new conversations with new partners is crucial if population and individual patient outcomes are to be not just maintained but improved.
Public Health England (PHE), newly established in April 2013, is an operationally autonomous executive agency of the Department of Health. PHE’s remit is to protect and improve the nation’s health and to address inequalities, working with national and local government, the NHS, industry, academia, the public and the voluntary and community sector to deliver through expertise, evidence and intelligence.
Reflecting this, the PHE SRHH team vision is to produce appropriate and relevant data, guidance, evidence and intelligence, combined with robust national and local support. PHE works at national, regional and local level, with fifteen Centres across the country and it is these Centres that are PHE’s “front door”. You can find out more about your Centre here.
We have prioritised building effective partnerships – working closely with colleagues across the country. It has been a sharp learning curve and we will continue to focus on how best we can work with partners to identify priorities and deliver on them together.
Comprehensive and reliable data underpins local decision making, service planning and progress monitoring. This year PHE launched the Sexual and Reproductive Health Profiles to provide robust intelligence on topics including contraception, teenage pregnancy, HIV and health equity, presented in user friendly interactive maps, charts and tables.
HIV diagnosis, prevention and care are a vital aspect of PHE's work. In April, we published a report summarising the latest evidence underpinning the crucial role of expanded HIV testing and, with the change in legislation, a FAQ guide on HIV self-testing. PHE collaborates with the HIV Prevention England programme, giving significant input into National HIV Testing week and support for HIV home sampling. PHE is working closely with NHS England's Clinical Reference Group for HIV as well as clinical colleagues, providing extensive data and intelligence to inform and monitor approaches to best practice across the country.
Supporting and building resilience amongst key populations is a PHE priority. A new report setting out the evidence that underpins chlamydia screening for sexually active young adults was published in April. Teenage pregnancy in the UK is at a forty year low, following intensive efforts across the sector. PHE working with Brook, is supporting the publication of new C-card guidance this month, setting out a comprehensive strategy for how the condom card scheme can help improve the sexual health of young adults. Working with key stakeholders, we are developing a Strategic Framework to enhance health and wellbeing amongst men who have sex with men (MSM), with the ambition of improved HIV prevention and sexual health.
The establishment of PHE, coupled with links forged within local government, gives new opportunities to go beyond traditional boundaries and address the wider determinants of good sexual and reproductive health. For example, there are new opportunities to make stronger links between alcohol and drug misuse, mental health and sexual health. A recent study in south London, exploring the issues of “chemsex” in the MSM population flags the need for joined up commissioning and services that address both safer sex and drug use.
With the changes in commissioning arrangements for SRHH, a fresh approach is required. A guide to whole system SRHH commissioning is in production, led by PHE and supported by the Department of Health, Local Government Association, NHS England and Association of Directors of Public Health with MEDFASH as project delivery agent. The guide reviews the interfaces and boundaries of all the bodies involved in commissioning SRHH services and explores flexible and adaptable approaches to collaborative working, with the aim of securing best outcomes for people and populations. It will support local teams to achieve the effective partnership working required to develop and maintain high quality services via seamless, integrated care pathways. It is intended to focus on how to pull the whole system together and be complementary to other, existing guidance. Currently open for comment (here), the final guidance is due to be released in July.
It has been a very busy and often challenging first year for SRHH in England, with new opportunities as well as potential for new risks. Organisational transition is essentially complete and now the need is for operational translation. This will require an understanding of and respect for the roles, responsibilities, expertise and constraints for all those working across the sexual and reproductive health and HIV pathway. As new approaches consolidate, partnerships strengthen and priorities become clearer, we look forward to continued collaborative working, for best outcomes for individuals, families, communities and the wider population. There is much to do.
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