Posted 30th Jul 2014
Brook first opened its doors to women almost 50 years to the day that this eFeature lands in your inbox. At that time the NHS did not provide contraception, homosexuality and abortion were illegal and sex before marriage was generally frowned upon. Thankfully, in large part owing to small groups of brave women and men who campaigned for change, our society has progressed and there is now a broad consensus in support of people’s sexual and reproductive rights and freedoms.
Brook is now the country’s largest young people’s charity specialising in sexual health and wellbeing. In 2013/14 we worked with approximately 280,000 young people under the age of 25, providing them with sexual health services, support and advice. Brook has three key activities - clinical and support services, education and training and advocacy and campaigning.
Until the end of March last year Brook’s clinical services were generally commissioned by Primary Care Trusts (PCTs) with some joint commissioning. Local authorities largely funded our education and early intervention work. During this time the Teenage Pregnancy Strategy, Sexual Health and HIV Strategy and the National Chlamydia Screening Programme all drove improvements in policy, priority and resources available. These strategies produced results and facilitated significant learning. We continue to see a downward trend in teenage conception rates. Importantly we have also seen significant and positive changes in our culture over the last decades, with a stronger consensus developing in support of the age of consent, young people’s rights to confidential services and to personal, social, health and economic (PSHE) education in schools.
Since 1 April 2013 Brook’s clinical services and education/early intervention are largely funded by local authorities through a range of funding pots including the (currently ring fenced) public health grant. The shift to local authorities has brought with it some teething troubles: for example, there was a lack of understanding about the roles and responsibilities of commissioner and provider in ratifying and implementing Patient Group Directions within some local authorities, and it would be fair to say the speed at which we were paid for services in the first six months varied considerably!
Surprisingly, in the immediate period after the transfer of public health to local government we experienced much less commissioning activity than we had anticipated. By contrast in recent months we have seen an increasing number of tenders for both sexual health (at all levels) and wider health and wellbeing provision. Some of these contracts have been for young people specifically, and some for all age provision. Brook like the rest of the voluntary and public sector has had to invest significantly more resources than previously to build the specialist skill and expertise to bid for and win contracts for services.
The commissioning environment is changing fast and so is our understanding. From our experience and perspective the below are some of the issues that will need further thinking:
1. How can we help commissioners and providers feel confident and able to collaborate using their respective expertise to inform the development and improvement of cost effective services that meet the needs of communities?
2. How do we ensure the young people’s specialist requirements are built into commissioning, procurement, key performance indicators (KPI) and monitoring processes?
3. How do we ensure contracts are not too big for very expert (and often by their nature smaller) providers so they are not squeezed out of the market, expertise lost and outcomes worsened?
4. How can we maintain a relentless focus on value and quality when pressure is on costs?
5. How will we protect the training and development of the current and future workforce?
When it comes to young people’s sexual and reproductive health we know so much about what works – sex and relationships education, confidential services, open culture and high aspirations – and we must ensure investment in all of these and we must do them well. It is simply unacceptable that PSHE education continues to be patchy and left to individual schools to decide what to do. But it is not enough to simply do more of what we know works. We also require a culture of innovation.
For young people this includes finding ways to develop joined up services for joined up lives - young people told Brook they really trusted us to talk to them about sex and relationships and that they would like us to provide more services in one place. We are piloting and evaluating a wider approach to health and wellbeing for young people, including the development of digital services. This is already providing us with interesting information about what the future of Brook services could look like for young people.
We know at Brook that young people are both moral and fallible. It is our job to help them navigate their way through adolescence and into adulthood by ensuring all children and young people get the education, services and support they need. We must have exceptionally high expectations for young people and their relationships, so they in turn have high expectations for themselves. If we work in partnership with young people to develop, deliver and evaluate services whichever the government, whoever the commissioners and providers, we will have the best chance of getting it right.
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