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Justine Womack

In this month’s eFeature, Justine Womack, Public Health Specialist at Public Health England (South of England Region), reminds us that leadership, collaborative endeavour, innovation and speed of response are as important as ever as sexual and reproductive health moves into the next phase of its history.  She looks as what local areas can do to ensure they are working collaboratively to effectively tackle the significant challenges that remain, and provides a useful list of tools and resources which underpin and support this work.

Working together to promote good sexual and reproductive health in a new organisational landscape

The 1960s and early 1970s were a critical period in the history of sexual health in England. Oral contraception became available in 1961, the National Health Service (Family Planning) Act and the Abortion Act in 1967 enabled the provision of contraception by the NHS and legalised abortion respectively. Free contraception, the development of sex education and campaigns to promote sexual health followed. At the time, the spread of sexually transmitted infection was causing significant concern, with gonorrhoea increasing by 6.8% in men and 11% in women between 1967 and 1968, as was the increasing number of pregnancies in under-16s and fears of overpopulation.

These historic developments came about because of the combined leadership of politicians, individuals such as Marie Stopes, voluntary and advocacy organisations like the Family Planning Association, BPAS, Brook Advisory Centres, the Birth Control Campaign, members of the medical and nursing professions and local health authorities.

It was the same leadership from politicians, advocacy groups and organisations, health professionals and local services, which led to the swift reaction to the emergence of AIDS in the UK in the 1980s.

As the promotion of sexual health moves into the next phase of its history, leadership, collaborative endeavour, innovation and speed of response remain essential to improving local people’s health.

In England, a number of commissioning organisations are now responsible for organising different aspects of sexual health services. Local government commissions HIV prevention and sexual health promotion, open access genitourinary medicine and contraception services for all age groups, including ‘enhanced’ services from primary care, and chlamydia screening for 16-24 year olds. NHS England commissions HIV treatment and care, health services for prisoners, sexual assault referral centres, cervical screening and the GP contract, which includes some contraception. Clinical Commissioning Groups led by General Practitioners commission community gynaecology, vasectomy and sterilisation and abortion services.

The challenges to sexual health remain considerable and the consequences of inadequate coordination across the new commissioning organisations would be severe. A quarter of all HIV remains undiagnosed and the overall proportion of late diagnoses is high (47% in 2011). People diagnosed late have a tenfold increased risk of dying within a year of diagnosis[i]. Despite the dramatic reduction in teenage pregnancy led by local government, rates remain at higher levels than comparable European countries. The provision of contraception and the uptake of the most effective long acting reversible forms varies across the country and sexually transmitted infections continue to increase, particularly in some important new groups such as the over 45s and among men who have sex with men (MSM) and some black and minority ethnic groups. Relationship and sex education varies in quality yet concerns about the sexualisation of children, the increase in intimate partner violence among young people and their exposure to online pornography and sexual exploitation make it an ever vital foundation for emotional resilience and safe-guarding as well as health.

The latest sexually transmitted infection (STI) figures from Public Health England demonstrate the reason why sexual health remains such an important national priority with STI diagnoses continuing to remain high.  Although improved data collection will have had some impact, the most recent figures show that new STI diagnoses rose by 5% in 2012 (up to 448,422 from 428,255 in 2011), suggesting too many people are still putting themselves at risk through unsafe sex, especially MSM and young heterosexual adults. In 2012, over 1.7 million chlamydia tests were undertaken in England among young people aged 15-24 years old with over 136,000 diagnoses made.  While chlamydia remains the most commonly diagnosed STI (206,912 diagnoses in 2012; 46% of the total), considerable numbers of genital warts (73,893; 16%) and genital herpes (32,021; 7%) cases were also reported last year and new gonorrhoea diagnoses rose 21% overall (from 21,024 in 2011 to 25,525 in 2012), and by 37% in the MSM population (to 10,754)[ii]. The increase in gonorrhoea diagnosis is concerning because of the global threat of antibiotic resistance.

There are three things that can help local areas to be effective in tackling these issues:

  • ensure there is an explicit, joint, multi-disciplinary commitment to improving the sexual health of local young people and women and men of different ethnicity, sexual orientation and age;
  • undertake a robust assessment of sexual health need, including unmet need, which all commissioners, providers and clinicians familiarise themselves with;
  • develop a responsive and adequately funded commissioning strategy to address the health improvement and protection needs of local people, tackle inequalities that exist, and ensure services are in the right places. It will help if all organisations and individuals working in the field understand the strategy, are committed to delivering it and take responsibility for its implementation.

This approach is likely to be useful in developing the wider Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy for a local area.

The kind of collaborative approach required to do this work is at the heart of the South West Directors of Public Health Network’s Office for Sexual Health, which has a multi-disciplinary Board chaired by Torbay Director of Public Health Debbie Stark with representation from commissioners, providers, professional bodies and third sector organisations including Brook and Terrence Higgins Trust. It leads programmes across all areas of sexual health to maximise efficiencies and the sharing of knowledge at a level above the local. The same approach is also behind the joint sexual health commissioning and strategy groups that are continuing or emerging in other parts of the country.

The range of tools and resources available to support local areas with their sexual health needs assessments and strategies are listed in the appendix below. Public Health England provides expert information through its health and wellbeing, health protection, knowledge and intelligence and epidemiological teams. This is a combination of data on local health needs, coupled with evidence-based advice on STI prevention, contraception and sexual health promotion approaches, to improve risk awareness and encourage safer sexual behaviours. PHE Centres provide the way in to this information and should be the first port of call for local government public health teams, NHS England Local Area Teams, Clinical Commissioning Groups and provider organisations.

PDF – List of tools and resources available to support local areas: includes data sources, needs assessment guidance, commissioning support and service standards.

[i] HIV in the United Kingdom 2012 Report, Health Protection Agency

[ii] Sexually Transmitted Infections and Chlamydia screening in England, 2012: Public Health England, HPR 7 (23) June 2013

The content of all eFeatures represents the views and opinions of the authors.  MEDFASH does not necessarily share or endorse the views expressed within them.


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