Sexual Health Commissioning Framework - PowerPoint Presentation

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Sexual Health Commissioning Framework

Facing the Challenges

-

Adopting a Strategic Approach 2014-16

Haringey Council

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WHO

definition of Sexual Health According to the current working definition, Sexual Health is:“…a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.” (WHO, 2006a)  WHO (2006a). Defining sexual health: Report of a technical consultation on sexual health, 28-31 January 2002. Geneva, World Health Organisation.

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1. Sexual

Health in Haringey – Time for a ‘Step-Change’Sexual Health continues to be a major public health issue both nationally and locally. Haringey is faced with several challenges to overcome.These include:High and increasing levels of sexually transmitted infections, including repeat infectionsHigh levels of unintended and unwanted pregnancies, including repeat abortionsThe need to modernise and integrate service provision to meet the increasing demands of Haringey residentsImproving access to better information, advice and early help 2. Scope - ‘Safety & wellbeing for all : a place where everyone feels safe & has a good quality of life.’This three year strategy focuses on the sexual health and wellbeing needs of the whole population of Haringey. The scope of this strategy is

inclusive, and not stand alone, in that it relates to other key strategies and plans, including Haringey Council ’s Corporate Plan.

The

strategy covers the period 2014-16 , and will be reviewed by Haringey Council and its partners on a regular basis through robust engagement and performance management to ensure that it remains relevant, appropriate and is delivered upon.This strategy covers the following key areas:Sexual health promotion including the prevention of sexually transmitted infections, and unintended pregnanciesIntegrated STI testing and contraception services, located within community based sexual health servicesHIV testing, treatment and carePrimary Care, including General Practices and PharmaciesProgrammes for young people, including the prevention of under 18 conceptions

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3. Our Vision & Purpose

‘Outstanding for all : Enabling all Haringey Children & Young People to thrive and achieve their potentialSexual Health in Haringey will be built on the belief that all people have the right to good sexual healthWe shall build a sexual health culture that prioritises prevention and supports behaviour change We will ensure that people are motivated to practise safer sex, including the use of condoms and contraceptionWe shall increase the availability and uptake of testing to reduce transmission of STIsWe shall increase awareness of sexual health among healthcare professionals and relevant non-health practitioners, particularly those working with vulnerable groupsWe shall embrace the principle and approach set out in ‘Every Contact Counts’, whereby safer sex messages and preventative behaviours are integrated into all forms of commissioned service delivery.4. Aims & OutcomesImprove the sexual health of the population of HaringeyThere is reduced harm from sexual ill health and HIVPeople with HIV live long and healthy livesThere are fewer unintended pregnanciesPeople make confident and competent decisions about safer sex4Slide5

5. We shall achieve our aims by:

Improving sexual health promotion and disease prevention interventionsReducing the number of under-18 conceptionsReducing the number of unintended conceptions (all ages)Providing information on, and faster referrals to abortion services Reducing the transmission of Sexually Transmitted Infections (STIs), including HIVReducing the prevalence (total number of infections) of undiagnosed Sexually Transmitted Infections, including HIVImproving diagnosis, treatment and social care for people living with HIVReducing the stigma associated with HIV and Sexually Transmitted InfectionsEnsuring that the workforce can deliver modern, integrated sexual health servicesOur overall approach will aim to develop a local sexual health culture which prioritises prevention and supports behaviour change. While taking direct action to assist people of all ages, but especially young people aged 16-24, to make informed and responsible decisions, by promoting the benefits of stable relationships, and increasing awareness of the risks to their health from of unprotected sex. Improve access to information, advice and guidance on testing and early detection, in order to prevent the

onward

transmission of STIs and HIV

. We shall encourage better understanding of the range of choices of contraception, and where to access them. Publicity, including the marketing of rapid and easy access to appropriate sexual and reproductive health services will be refocused and increased. 5Slide6

6. Principles

– underpinning Sexual Health in HaringeyBuild self-confidence and improve the wellbeing of the local populationEncourage and empower residents to take responsibility for their own sexual health and support them to make healthy choicesReduce sexual ill health and unplanned pregnanciesRespect cultural diversity, by ensuring that sexual orientation, illness, culture, age or disability are taken into account in the design and delivery of key interventions and programmesRespect gender differences – with a focus on women’s health needsGiving every child the best start in lifeInvolve service users in service development and evaluationBe free and confidentialBe easy to access, with services delivered in a variety of clinical and community settings, at times that people need to use them Offer prevention and treatment that is evidence based and consistent across servicesBe cost effectiveCommission services in keeping with the “You’re Welcome” criteria.These underpinning principles for sexual health, fit with Haringey Council’s strategic priorities which aim to ‘reduce health

inequalities and improve wellbeing for all’; which will be achieved by : ‘ensuring that children and young people develop the skills

for healthy living and healthy relationships; and enabling young people and adults to exercise choice in reproductive and sexual

Health’.6Slide7

7. Key

Groups - Age, gender & ethnicityNationally, young people aged 15-24 years, men who have sex with men (MSM) and Black Caribbean ethnic groups have been shown to have higher rates of acute STIs. Overall, of those diagnosed with an STI in Haringey, 53% were male and 45% were female (gender was not known or unspecified for 2% of episodes). For young people in Haringey, 42% of STI diagnoses were aged 15-24 years. Figure 1. Age group and gender of cases of acute STIs in Haringey: 20127Higher rate includes men who have sex with men more

High rates

in

young womenSlide8

7.1 Sexually transmitted infections, including HIV

, remain one of the most important causes of illness due to infectious disease among young people (aged 16 – 24). Young people are also more likely to become re-infected with STIs, contributing to infection persistence and health service workload. In Haringey, an estimated 15.1% of 15-19 year old women and 14.5% of 15-19 year old men presenting with an STI at a GUM clinic during the four year period from 2009 to 2012 became re-infected with an STI within twelve months. Young people, in particular young women may lack the skills and confidence to negotiate safer sex, and young women are biologically more susceptible to STIs. For women aged under 30 years in Haringey, the data in figure 1 is significant, not only in terms of the increase in the rates of STIs, when compared to men, but also in terms of the risks and implications to their long term health and wellbeing. Early identification and testing of Chlamydia is a case in point. Since Chlamydia is most often asymptomatic, a high diagnosis rate is required in order to prevent infections being left untreated, which otherwise could lead to serious reproductive health consequences. Public Health England recommends that local areas achieve a Chlamydia testing rate of at least 2,300 per 100,000 resident 15-24 year olds, a level which is expected to produce a decrease in Chlamydia prevalence. 37% of 15-24 year olds in Haringey were tested for Chlamydia in 2012, with an 11% positivity rate reported. The Chlamydia diagnosis rate in 15-24 year olds in Haringey in 2012 was 3943 per 100,000. Nationally, 26% of 15-24 year olds were tested for Chlamydia with an 8% positivity rate.

In

parallel to the high level of STI’s, the rates of teenage conceptions also remains high (although the trend is falling), with Haringey ranked 5

th across London in 2012, with a rate of 33.1 conceptions per 1000 women under 18 years of age (142 conceptions) compared to 25.9 per 1000 in London and 27.9 per 1000 in England and Wales. In 2012, over 40% of all abortions, (all ages), were classified as repeat abortions in Haringey – compared to 37% in England. The fact remains, having a child at an early age can damage young women’s health and well-being, and limit their education and economic prospects.

7.2 Gay

, Bisexual, and Men who have sex with men (MSM)

Haringey residents have a high prevalence (total number of infections) and a high incidence (new infections) of sexually transmitted infections acquired sexually between men. In Haringey, in 2009 to 2012, for cases in men where sexual orientation was recorded, 22.2% (n=1792) of STIs were

among MSM.

7.3

Ethnicity

, including people from Black and Minority Ethnic Groups

Research has shown that, compared with the population as a whole, people from black and minority ethnic (BME) groups tend to suffer from poorer health and greater levels of socio-economic deprivation. Certain BME groups have been identified

as

bearing a disproportionate burden of sexual ill-health.

Where

recorded, 44.9% of STIs diagnosed in Haringey were in people born overseas. Overall, the UK’s African communities have been affected badly by HIV/AIDS, with high rates among both adults and children.

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Socio-economic deprivation is a known determinant of poor health outcomes and data from GUM clinics show a strong positive correlation between rates of STIs and deprivation across England. The relationship between STIs and deprivation is probably influenced by a range of factors such as the provision of and access to health services, education, substance misuse, health awareness, health-care seeking behaviour and sexual behaviour.

7.4 Diagnosed HIV prevalenceIn 2012, the diagnosed HIV prevalence in Haringey was 6.5 per 1,000 population aged 15-59 years compared to London at 5.5 per1,000 population, and England at 2 per 1,000 population.Late diagnosis is the most important predictor of HIV-related morbidity and short-term mortality. It is a critical component of the Public Health Outcomes Framework and monitoring is essential to evaluate the success of expanded HIV testing. In Haringey between 2009 and 2011, 49% of HIV diagnoses were made at a late stage of infection compared to 50% in England; 39% of men who have sex with men (MSM) and 57% of heterosexuals were diagnosed late in Haringey. Haringey Council is committed to extending the provision of HIV testing by promoting uptake in easy to access locations across the community. In 2012, of the GUM clinic patients from Haringey who were eligible to be tested for HIV, 77% were offered at test – and 71% were actually tested. Nationally, 71% of GUM clinic patients who were eligible to be tested for HIV were tested. In 2011, 68 adult residents (aged 15 years and older) were

newly diagnosed with HIV

in Haringey and, among those who acquired their HIV through sex, 33 new HIV diagnoses were among MSM, 11 among heterosexual men and 15 among heterosexual women

. In 2011, 1221 adult Haringey residents received HIV-related care: 794 males and 427 females. Among these, 38% were white, 41% black African and 8.1% black Caribbean. With regards to exposure, 40% probably acquired their infection through sex between men and 54% through sex between men and women.7.5 Vulnerable groupsSome groups within the population have additional vulnerability. This may be because of the setting or circumstances they live in, e.g. prisoners and asylum seekers, or because of risks related to behaviour, e.g. sex workers and injecting drug users. Additionally, some groups find accessing services more difficult because of concerns regarding stigma or other service limitations, e.g. lesbian, gay, bi-sexual and transgender groups, over 50s, and homeless people. Finally, other people may be at additional risk of exploitation because of life circumstances, e.g. people with mental health difficulties or learning difficulties, victims of

sexual

assault or domestic violence

. Haringey Council is committed to identifying, working with, and supporting vulnerable adults, young people, and children, and has produced a strategic approach aimed at promoting and ensuring the Safeguarding

of vulnerable groups and vulnerable people across the borough.

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8. Service

Modernisation and a New Integrated PathwayHaringey Council is committed to modernising the availability and delivery of sexual health services which are responsive to the needs of the local population, providing a broad range of services in a number of different settings. Our preferred approach is to ensure that services are integrated, using a ‘hub and spoke’, nurse led model.The aims of a modern, integrated sexual health service would be to:maximise the sexual health of individuals and their sexual partners by promoting local sexual health services effectively and facilitating convenient and timely access to integrated sexual health care for Haringey residents.reduce inequalities in sexual health by targeting vulnerable groups and communities with greater sexual health needs and tackling the stigma and discrimination associated with HIV and poor sexual health in partnership with other agencies.reduce rates of STIs and HIV through the provision of integrated services for STI screening, diagnosis and treatment with services for contraception and reproductive health and the provision of targeted sexual health promotion and partner notification.reduce the prevalence of undiagnosed HIV infection and late diagnosis of people with HIV through the effective uptake of HIV testing across a broader range of settings.reduce teenage conceptions - by improving access to contraception services (including LARC) for young people across a broad range of settings and by ensuring that contraception is available as part of all STI and termination of pregnancy care pathways.reduce unintended conceptions and repeat terminations of pregnancy by improving access to long acting reversible contraception (LARC) and ensuring that access to contraception is included in all termination of pregnancy pathways.

develop

increasingly user-focused sexual health services

by involving service users, stakeholders and related services in service design, development and evaluation.ensure maximum effectiveness and the best use of resources by reducing service duplication, ensuring an effective skill mix of staff and sharing good practice, where appropriate, developing services in line with local need with referral and partner agencies.help to reduce out of area activity for Contraception, STI and other sexual health services by improving access to high quality services within area while at the same time maintaining patient choice.improve the sexual health of the local population, especially those at risk of poor sexual health by supporting Haringey Council to provide evidence based behaviour change interventions tailored to meet specific needs of target groups/individuals.improve access to integrated sexual health services by delivering a ‘one stop shop’ approach to sexual health service provision, ensuring that patients have access to a range of prevention and STI treatment, contraception and reproductive health services, within a greater range of community based locations and reducing the number of appointments that patients require to improve their sexual health.Work within resource limits, in order to achieve value for money in the provision of appropriate and effective community focused integrated services .

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9. Focus on Pharmacy

The role of pharmacists as providers of contraception and sexual health advice and services has broadened over the last decade. An increasing number of pharmacies have been commissioned to prescribe emergency hormonal contraception (EHC) and to provide Chlamydia screening. The proportion of women choosing to obtain EHC from pharmacies increased from 20% to 55% between 2002 and 2008 in England.The further development of the role of pharmacists in the provision of sexual health services has been recommended in recentnational policies and guidelines. Pharmacies provide a convenient and less formal environment for people to access health services. The provision of commissioned sexual health services, and the retailing of condoms and pregnancy testing kits, present opportunities for pharmacists and their colleagues to deliver sexual health promotion work. Haringey Council commissions around 25 pharmacies to provide free emergency hormonal contraception, some of which also participate in the Chlamydia screening programme, and C-Card scheme. As part of this three year strategy, it is intended to ‘re-focus and re-energise’ the contribution that pharmacies can play in promoting better sexual health, through better and increased service provision, by setting up a new ‘Healthy Living Pharmacy’ programme across Haringey. This strategic approach will aim and continue: To review level of sexual health service provision in pharmaciesTo further develop sexual health service provision in pharmacies located in the areas of greatest needTo maintain and improve access to emergency hormonal contraception and the C-Card scheme from pharmacies To further promote the provision of sexual health services from pharmacies – especially for those under 25 years of age, and in the long term ALL adults.

To support pharmacies providing sexual health services to achieve You’re Welcome accreditation.

10. Preventing

Sexually Transmitted Infections – through increased Community TestingGiven the high prevalence and incidence of STIs in local population, Haringey Council is looking at ways in which can prevent the levels of infection increasing further by promoting early detection and treatment of asymptomatic infection; reducing onward transmission to sexual partners; and preventing the consequences of untreated infection. Haringey’s approach will be build on the successful roll-out of the Chlamydia screening programme, which continues to offer free, opportunistic screening, treatment,

partner

management and prevention to sexually active young men and women under the age of 25. The community STI testing

programme

will include all age groups, partners

and

asymptomatic individuals who are not requesting investigation of

an STI.

The

main focus of the community based STI prevention programme in Haringey will include:

Tests

for Chlamydia,

Gonorrhoea, Syphilis, and

HIV infection.Testing for Hepatitis B & C, with vaccination for Hepatitis A & B will also be provided. The community testing programme will be integrated with Haringey’s wider safer sex programmes and interventions, ensuring equity in provision across the borough, so that hard to reach groups are targeted effectively.11Slide12

11. Sexual Health Promotion & HIV Prevention

As part of this three year strategy, Haringey Council will continue to commission a number of provider organisations to deliver sexual health promotion and HIV prevention services. Local providers have developed a broad range of prevention and health promotion interventions, at a structural and individual level, to address the needs of each population group. Examples of this activity that will inform part of ‘a universal screening approach’ tends to focus on the following groups:Gay and bisexual men / men who have sex with menBlack and minority ethnic (BME) groupsPeople who are HIV positive, particularly in terms of reducing onward transmissionStreet-based female sex workers (SHOC)In broad terms, most interventions will be based on the following principles:

for behaviour to change, individuals must recognise the problem, be motivated to act, and have the knowledge and skills to perform and sustain the action

to increase the likelihood of action, barriers in the social environment must be removed or overcome and support or reinforcement provided wherever

possibleHaringey Council will continue:to work with providers to ensure that there is a co-ordinated approach to sexual health promotion interventions across the boroughto work with providers to ensure that sexual health promotion and HIV prevention interventions are evidence based, cost effective and designed to meet local needsto review HIV and STI data and ensure that resources are targeted at those groups most likely to contract HIV or STIsto review and ensure that the national prevention frameworks inform sexual health promotion and HIV prevention at the local level12. Sex and Relationships EducationSex and Relationships Education (SRE), delivered as part of Personal, Social and Health Education (PSHE), can allow young people to

develop knowledge

and understanding

about

sex and relationships and the skills and confidence to make positive choices in

relation

to their sexual

health

. Haringey Council will continue to work with and support

local

schools to improve their SRE

provision, in order to ensure that parents and professionals feel confident to discuss sex and relationships with young people.

We will support

the work of Healthy School’s partnerships and the School Nursing service, using the ‘Health Hut’ delivery model, to ensure that SRE work and sexual health services in schools continue to be prioritised. 

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13. Condom distribution

Condoms are essential in the prevention of Sexually Transmitted Infections (STIs) for all sexually active individuals. They also help to prevent unwanted pregnancies, especially those that result in terminations.The refreshed Department of Health strategy on sexual health, entitled: ‘A Framework for Sexual Health Improvement in England’, 2013, sets out the following key objectives, which support Haringey Council’s ‘step-change’ approach, including: the need to ‘ensure that people have access to free condoms and know how to prevent sexually transmitted infections’. the need to sustain/support ‘the fall in the number of unwanted pregnancies, especially those that result in terminations’. the ‘need to provide a comprehensive package of interventions and actions to improve sexual health outcomes’.‘The best way for sexually active people of any age to avoid an STI is to use a condom when they have sex. It is important that people

should be able to access condoms easily and feel confident about carrying and using them.....’ DH, 2013

.

One of the approaches taken by Haringey Council for supplying condoms and sexual health information has been through the introduction of a C-Card scheme. C-Card schemes have been in operation across London for a number of years in various localities, working to specific guidelines and service standards. Haringey Council will improve the co-ordination and operation of the C-Card Scheme on the basis of strengthening partnership working and increasing signposting between services, in order to ensure that free condoms are more accessible to those aged under 25 years of age in the community.

While

Haringey Council will be

responsible

for shaping and developing the new C-Card Scheme, which in the short term, will

include

the

central co-ordination and

maximisation

of the number of outlets for young people to access free condoms across the

borough

; in

the

medium term the intention is to extend the service, to provide a ‘universal scheme’ that will include those aged 25 plus.  Meanwhile, Haringey Council will continue to review the targeted provision of free condoms in the community, building on existing

schemes for black and minority ethnic groups, and gay and bisexual men, whereby condoms and lubricants are distributed

in

safer sex kits which include information on safer and proper condom use and

information on STI and HIV prevention.

You’re Welcome

In keeping with the roll out of the Department of Health’s You’re Welcome quality mark across England, Haringey Council will continue to ensure that all health providers are delivering young person friendly services. The intention being that all young people, wherever they live, will be able to access services that are best suited to their needs. Haringey Council will use the commissioning and contracting processes to require local health providers to work towards achieving You’re Welcome accreditation.

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14. Workforce planning and development

Health professionalsThere has been a considerable expansion of the local sexual health workforce over the last decade. This has seen the broadeningof existing roles to take on new aspects of sexual healthcare, and the development of new roles outside of specialist settings. Local contraception and sexual health services have developed multi-disciplinary teams, to make full and effective use of the skills of all team members. Notable developments include the further development of nurse-led clinics, and an increasing proportion of dual-trained contraception and sexual health nurses. This has allowed contraception services to offer sexual health screening, and has supported sexual health services to meet the 48 hour access targets.The increasing use of Patient Group Directives (PGDs) has allowed healthcare professionals from a broad range of disciplines to offer

some contraception and sexual health services, such as pharmacists providing emergency hormonal contraception, testing

for

Chlamydia, and condoms via the C-Card scheme. Additional training has been made available to allow GPs to develop their clinical competencies to provide Local Enhanced Services (LES) for Sexual Health. Additional training has also been arranged to increase the number of health professionals across Haringey who are trained to fit and remove the contraceptive implants and the coil. Non-health professionals

Non-health professionals have an important role in improving the sexual health of the local population. Haringey Council

commissions

a broad range of sexual health services, from a number of different sources, and it is therefore our intention to review

Current training

programmes provided, to ensure that there are clear and agreed pathways for different staff groups, and that the

training

offer is

validated

, and aligned to local priorities.

By

adopting a strategic approach, Haringey Council will aim to:

support

improvements in clinical competencies in order to provide more effective sexual health services, such as the training for fitting and removing long acting reversible contraception support the development of training on sexual health for non clinical staff scope

the need to develop a comprehensive and integrated training pathway

support

proposals to improve the skill mix of staff working in contraception and sexual health services to

further the

modernisation

and integration of local services.

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15. Communication &

MarketingA significant component of this three year strategy will be the development of an effective communication and marketing planthat will ensure that Haringey residents know how, when and where to access early help and support from local sexual health services.  Using experience gained from developing and promoting previous campaigns, it is envisaged that key strands of any communication and marketing plan will include: promoting the use of condomspromoting contraceptive choiceencouraging testing for sexually transmitted infectionsrelationships and communication skills Haringey Council recognises that some sexual health providers working across the borough have their own media and communication strategies, and publish print and electronic resources, to promote their services and to communicate sexual health promotion and disease prevention messages.

It

is our intention to work closely with local providers to support the implementation of a new integrated sexual health

communications campaign across Haringey. This will help to improve co-ordination of local sexual health and HIV prevention campaigns, to make the best use of resources and avoid duplication. Haringey Council is committed to utilising and developing new interactive technologies to provide the main portal for members of the public seeking information about local contraception, sexual health and abortion services. 

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