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eFeature

Ruth Lowbury

In this month’s eFeature, Ruth Lowbury, Chief Executive of MEDFASH, shares the top line findings from the 2015 eBulletin survey conducted by MEDFASH during the summer. As well as presenting respondents’ views on the eBulletin itself, she reflects on the stark feedback we received on perceived improvements in sexual health and HIV services locally and on the overriding concerns respondents still have in relation to the commissioning and provision of these services. With funding of services and prevention work topping the list of concerns, Ruth looks at the wider challenges facing those working locally, including the public health budget savings that local authorities will be grappling with this year.

In November 2012, as implementation of the Health and Social Care Act approached, MEDFASH launched this eBulletin to give a concise and regular round-up of emerging policy developments across the field of sexual health, reproductive health and HIV. We also wanted to give voice to different perspectives, local and national, on the impact of the changes as we moved through the transition. Almost three years on, we wondered if there was still such a need for the eBulletin. The response from the 245 of you who completed our recent reader survey was a resounding ‘yes’. More about this below.

Our survey also asked about your views on the context you are working in. Worryingly, over two fifths (42%) said you think the local provision of sexual health services ‘has got worse’ since local authorities took on responsibility for commissioning these services, with a further 24% indicating that there has been ‘no change’ and only 13% that local provision has improved. 

These are challenging times, and there could be a number of reasons for these perceptions. We listed the key issues of concern relating to sexual health commissioning and service provision that were identified in our last reader survey two years ago, and asked you to rate your current level of concern about these. The issues about which you rated the highest level of concern (5 on a scale of 1-5) were as follows:

>funding of services (61% of respondents were ‘very concerned’)

>funding of prevention work (59%)

>fragmented commissioning (49%)

>investment in training (44%)

>potential loss of integrated services (42%)

>procurement process (31%)

>accountability at local level (25%)

Funding is clearly an overriding concern. Over half of survey responders were working either in local authorities (LAs) or in LA-commissioned services. The Department of Health’s (England) announcement in June 2015 of an in-year cut of £200m to LAs’ public health budgets no doubt exacerbated anxiety in this sector which is already grappling with the massive savings required across local government. LA-commissioned sexual and reproductive health services are untouched by the funding protection afforded to the NHS, despite the clinical nature of many of them. Responses from sexual health and HIV organisations to the Government’s consultation on the public health funding cut have highlighted the financial short-sightedness of disinvesting in preventive services.

Not surprisingly, given the localisation of decision-making, your responses to our survey also highlighted large local variation – some areas have seen improvements in sexual health services, others not. In some areas, specific elements of services have improved, while other parts have suffered. The need for networks was mentioned, to avoid service silos and promote best practice and patient-centred care.

Our findings chime with those of the recent inquiry by the All Party Parliamentary Group (APPG) on Sexual and Reproductive Health in the UK, on which I had the privilege of being a panel member. The inquiry heard from stakeholders that the changes established through the Health and Social Care Act were leading to fragmentation in commissioning and service provision, creating silos in previously integrated areas of public health. The APPG’s report, Breaking down the barriers: The need for accountability and integration in sexual health, reproductive health and HIV services in England concludes that lines of accountability under the new arrangements have never been clearly set out, and that this has led to a lack of proper oversight of the quality and outcomes delivered by commissioners. It calls for urgent action by the DH to clarify national accountability, in order to enable commissioners in local government, clinical commissioning groups and NHS England to work together effectively to meet the needs of service users in their areas.

The report also urges directors of public health and local health and wellbeing boards to improve integration between services commissioned by the NHS (including general practice) and those commissioned by public health, and to promote partnership and joint working between local providers to ensure that services are organised around patients’ needs. This echoes the messages of Making it work: a guide to whole system commissioning for sexual and reproductive health and HIV, prepared by MEDFASH on behalf of Public Health England (PHE) and published by PHE in 2014 - a recommended read for any commissioner struggling in a silo.

On funding, the APPG decried the £200m public health budget cut, highlighting the inevitable knock-on costs for the NHS. It also urged the DH to extend the ring-fence on public health funding in the coming government Spending Review, and recommended a role for Public Health England in overseeing whether ring-fenced monies are actually being spent on public health.

On a more positive note, it seems that the confusion prevalent during transition is abating somewhat. Nearly two-thirds (62%) of respondents to our eBulletin survey this year said they feel ‘very well informed or as informed as they need to be’ about the commissioning and provision of sexual health and HIV services in their local area (up from 56% in 2013). But still, nearly a quarter feel ‘only partially informed’ and a further 11% ‘not very well informed or not informed at all’.

On the eBulletin itself, 94% strongly agree or agree that the eBulletin is a reliable source of information on policy relevant to sexual health and HIV, with 73% stating that it is one of their main sources of information for national policy developments in this area, and 84% strongly agreeing or agreeing that the eBulletin has been a useful reference point for their sexual health work during the last 12 months. Rather than being less needed as we’d hypothesised, it seems the eBulletin has become more established and more valued, all these figures having risen slightly since our 2013 survey. As one of you wrote: “It is a vital resource as previous communication channels for disseminating this information have broken down since PCTs were disbanded”.

We are delighted with this incredibly positive feedback and reassured to know that we are still meeting a need. Many thanks to those of you who completed the survey. A full summary of the results will be on the MEDFASH website soon.  

In response to the readers who asked for the eBulletin to be made more inclusive of Scotland, I have to express regret that this is currently beyond our capacity. We launched the eBulletin in response to the significant structural changes in England and our primary focus remains on policy, which can be very different across the four nations of the UK. We would not be able to do it justice within this eBulletin. However, we will try to highlight developments in the devolved nations that seem to us to be particularly important or to have significant relevance for the whole of the UK.

We also hope colleagues in the devolved nations as well as England will be interested in the new MEDFASH Sexual Health & HIV EUROBulletin, launched in July. The EUROBulletin provides a quarterly round-up of selected pan-European policy developments, evidence updates and resources across the field of HIV and sexual and reproductive health. Each issue also has an eFeature opinion piece offering up-to-date commentary on policy issues of relevance and interest to the wider European community.

Subscribers to the English eBulletin received the first issue and we hope you found it interesting. We would be very interested to know what you think of it, and we would also welcome any further comments on this eBulletin. Please send your feedback to the editor of both eBulletins, Helen Christophers, at hchristophers@medfash.bma.org.uk.

In the light of your views outlined above, I am confident you will want to join me in thanking Helen, the MEDFASH team and our web developers, Fresh Lemon, for producing such a consistently professional eBulletin. I would also like to thank our eBulletin funders, ViiV Healthcare Ltd and M.A.C AIDS Fund, who have made it possible.

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