Posted 31st Oct 2013
I have worked in the field of sexual health for over 20 years, starting as a nurse and spending the last 7 years or so as a commissioner. We are all (providers and commissioners) in the midst of changes to the NHS that are unprecedented and here is my brief reflection from the ‘shop floor’.
So, there was a time (the halcyon days?) before all the changes, when sexual health was commissioned largely from a single organisation. Primary Care Trusts (PCTs) were the responsible commissioners for all sexual health services, including importantly HIV care and treatment.
It took 23 months from the announcement of the proposed change to the transition from the NHS (where most Public Health staff had spent their careers) to Local Government. Individuals from the now abolished PCTs were dispersed across a number of new organisations: NHS England (who even had time for a name change), Public Health England, Clinical Commissioning Groups (they had time for a name change too!) and finally Local Authorities.
The feared fragmentation of the commissioning responsibility for sexual health is now a reality and my biggest concern, which no doubt others share, is the commissioning of HIV. HIV commissioners have been given a huge portfolio that includes cancer and a large geography to cover. Where they are new to HIV, they are often being met not by an orderly handover and induction, but by requests for support about sexual health procurements that are not including HIV and by questions about a subject area they are trying to get to grips with.
Locally, we continue to work with our providers and do our best to support the HIV commissioner and flag up and offer to work through solutions. Public Health England is proving to be an excellent champion for and supporter of good HIV care. My hope is that between PHE, LA commissioners and most importantly HIV consultants and specialist nurses, we will ensure that those living with HIV continue to get excellent care and are oblivious to all the changes. If we do that then we have achieved success, despite all the frustrations.
Public Health, within LAs, has been given the responsibility for commissioning 'comprehensive open access sexual health services'. It is a huge advantage for sexual health that it is one of only five mandated services. Arguably this focus will ensure sexual health remains a continued priority. This is marred slightly by the future challenge to make cost efficiencies (I know it means savings), but I believe that if we had stayed in PCTs we would have been charged with the same challenge.
Not all public health directorates in PCTs were responsible for commissioning sexual health, so in the transition of public health staff, we have lost some of the organisational memory and gained shiny new commissioners that in some cases are picking up new skills in both commissioning and sexual health. But I have found working with new people really refreshing; they pose questions that make you question, they have ideas from other areas of work that challenge the preconceived ideas. I have to say I like working with others - in my experience people always bring different things to the 'party'.
Personally, I have found the shift from being a member of staff to 'Officer' a little odd and confess that I still shed a silent tear when I see an NHS badge and have to resist the temptation to snatch it off the wearer! But assimilation to the local authority is swifter than I thought and fears about sexual health services being slashed are unfounded. We have a councillor lead and an organisation that has embraced the public health staff. I have been impressed by the systems, though navigating them has been a little tricky. The changes have led to a staggering amount of work, with new organisations having to sort out a whole new infrastructure. Not everyone has landed safely - a number of people are still dazed by the huge change in everything that was previously familiar. Overall, however, I am happy and just starting to be excited about the future. We are undertaking a joint strategic needs assessment (JSNA) for sexual health and intend to procure our services with our neighbouring LA and include HIV.
Those of us who have worked in sexual health for a number of years share a sense of community, filled with both providers and commissioners, and this community is and remains passionate about maintaining and promoting good sexual health. That passion has not been dimmed by the reforms that have been forced upon us and I remain proud to be a member. Ever the optimist, I firmly believe we will work through all the noise created by the changes. Even dare I say it, engage in procurement that challenges the status quo, provides new ways of thinking, new approaches and improves the already good service delivery. It's certainly my intention. So there's my reflection, with no mention of cross charging - a refreshing change I hope!
Public Health Specialist/Commissioner for Lancashire County Council & Co-chair of the HIV and Sexual Health Commissioners Group for England
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