Ruth Lowbury, Chief Executive, MEDFASH
Posted 25th Sep 2013
When we launched this eBulletin, almost a year ago, we were facing unprecedented change in the commissioning and provision of sexual health and HIV services. Uncertainty and anxiety were widespread as the transition gathered pace. The reforms introduced in April by the Health & Social Care Act 2012 are now in full swing and local areas are grappling with how best to work together to reduce inequalities and improve the sexual health of their populations.
Since November 2012, we have issued monthly eBulletins to keep you abreast of emerging policy and other significant developments as well as to help assess the potential impact of the changes. The regular factual round-up has been complemented by a series of eFeatures written by key players across parliament, the new national NHS and public health bodies, local government and clinical service providers in primary and secondary care.
Last month we conducted a survey among our readers and asked for feedback on the usefulness of the eBulletin and for ideas on how we can ensure it continues to be relevant to your work. We also asked specific questions about how well informed you feel about the commissioning and provision of sexual health services in your local area and whether there are any issues that continue to concern you in relation to this.
Many thanks to all of those who responded to the survey (over 280 of you, in the main from clinical services, public health and commissioning). We will be looking more closely at your responses over the next few weeks, but the top line results I have seen are very encouraging:
• 93% of respondents strongly agree or agree that the eBulletin is a reliable source of information on policy relevant to sexual health and HIV, with 69% stating that it is one of their main sources of information for national policy developments in this area.
• Three quarters of respondents strongly agree or agree that the eBulletin has been a useful reference point for sexual health work during transition in the NHS and local government.
We are delighted that the eBulletin seems to be meeting the needs of different audiences:
"a comprehensive digest of policy news and developments relevant for public health and commissioning leads operating in the New World Order"
“an excellent resource that provides a single point of up to date, accurate and timely information’
"a useful summary…often covering topics that workers who have little contact with management would not be aware of but are very relevant"
"so important at such a vulnerable time for services"
Not surprisingly, when asked about issues of concern in relation to the commissioning and provision of sexual health and HIV services, respondents raised a number of general change management issues, such as lack of clarity, uncertainty and accountability. Barely more than half of all respondents said they feel ‘very well informed or as informed as they need to be’ about how the commissioning and provision of sexual health and HIV services in their local area is shaping up since the changes came into effect.
Three issues dominated the feedback. Firstly, the fragmentation of commissioning and care was a major concern, including the separation of responsibilities for sexual health and HIV, for contraception and abortion, and for commissioning different services in primary care. The importance of local authorities, CCGs and NHS England meeting the challenges of working together to provide integrated care pathways was highlighted.
Secondly, a number of anxieties about the tendering process were expressed, including the risk of quality standards being compromised, the complications of clinical governance under local authority commissioning, the loss of HIV services in GUM clinics, and the need to ensure clinical expertise in public health commissioning.
The third main area of concern was the financial environment, with fears about reduced investment in sexual health and the loss of services, as well as complexities relating to pricing and cross-charging under the new arrangements.
Such a major programme of reform inevitably takes time to bed in. A year on from now we will, I hope, see a more positive picture, with greater clarity and confidence among respondents from all sectors about their roles and the context within which they are working. However, the financial pressures will continue to bite. We must ensure the public health value of sexual health services is recognised. If we allow sexual health to be de-prioritised we can expect to see a range of outcomes worsening - more new HIV infections, more late diagnoses, more transmission of STIs, more unintended pregnancies - all of which will ultimately prove more costly than investment in rapid open access sexual health services for all who need them.
The eBulletin is clearly still meeting a need for up-to date information and comment on sexual health and HIV policy. We will continue to review and develop it in response to the survey and any further feedback you give us. A full summary of the survey findings will be available on the MEDFASH website in due course.
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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