Agenda item

Gill Harrison (Public Health) to present

Gill Harrison, Public Health Specialist, presented a progress report on the multi-agency Sexual Health Strategy and action plan.

In May 2013 the Health and Wellbeing Board had recommended the reconvening of a multi-agency Sexual Health Strategy Group to produce an updated comprehensive Strategy for Rotherham.  The final Strategy was agreed in December, 2014.

One year into the delivery phase of the Strategy the following had been achieved:-

-          The mapping of the provision of Sex and Relationship Education across Rotherham

An audit by the School Effectiveness Team had revealed that the provision varied but the majority of schools felt that it was an improving picture regarding time on the curriculum for Personal, Sexual and Health Education which was where relationships and Sexual Health Education would be taught

-          CSE Theatre in Education (TiE)

The TiE ‘Chelsea’s Choice’ had been funded by the Clinical Commissioning Group and Public Health and aimed at Y8 or Y9 pupils.  All secondary and special schools and Pupil Referral Units engaged and there were a further two evening sessions for vulnerable young people (60 capacity) and parents/carers and siblings of vulnerable young people (126 booked, 117 attended).  All performances received excellent evaluations

-          Review of Sexual Health for Looked After Children (LAC) and Children Leaving Care

The multi-agency LAC Physical and Emotional Health Group now had a regular focus on sexual health with new training for carers being considered.  A review of pathways into services was being undertaken

-          Review of Youth Clinic Provision

The Rotherham Foundation Trust and Early Help and Family Engagement had undertaken a comprehensive review of all youth clinic provision and there had been a realignment of services to provide consistent delivery of services to young people on sites that were accessible by all within the community/locality and extended beyond the restrictions of term time only.  Staffing provision had improved in each clinic and the partners were marketing the services and had developed stronger links and pathways between other areas such as family Nurse Partnership and School Nursing.  Where footfall was poor and the more vulnerable were not engaging with the services, plans had been put into place for outreach work.  Embedded into the core of the clinics were robust assessments for CSE and Safeguard and partner notification or sexually transmitted infections such as Chlamydia

-          Review of delivery of Emergency Hormonal Contraception in the Community

Following a review, the CSE referral pathways had been updated and all pharmacists were undergoing extra training.  An audit of activity had been undertaken and provision across Rotherham mapped. Data showed that the majority of women accessing this service were over the age of 20; this information would now help in the future commissioning processes

-          Development of the Integrated Sexual Health Services

In line with national recommendations, the Council had commissioned an Integrated Sexual Health Service from the Foundation Trust to provide a full range of STI testing, HIV testing (not treatment) and comprehensive contraceptive services.  At present, NHS England also commissioned HIV treatment from the Trust.  The Trust had been working to an integration plan and developing their services.  CSE referral pathways had been strengthened and the Service would be going out to tender during 2016 which would further strengthen the process of integration to offer Rotherham residents a comprehensive sexual health offer

-          Review of Primary Care Sexual Health Services

Existing provision had been mapped.  Public Health and GP providers had been working towards ensuring that competencies were maintained and that there was a good service in place for all users.  Audit of the Services had shown that they were mainly used by women over the age of 20

-          New Service for HIV Prevention and Support

+Me had been commissioned to provide HIV education, awareness raising and prevention in the community as well as support with a regular drop-in service for people living with HIV.  The third sector was actively promoting HIV testing and working closely with the Trust to help people access services.  Although Rotherham did not score well on the Public Health Outcomes Framework measure for late diagnosis of HIV, it did score highly on uptake of testing within the Sexual Health Services.  The newly commissioned Service should help improve diagnosis by promoting the Services and HIV testing

Proposed future activity was:-

·           Although the audit of schools was positive, it was felt that the promotion of good practice should be continued.  Many schools were providing excellent Relationship and Sex Education and this should be the ‘gold standard’ for all Rotherham schools

·           The audit of primary care contraception provision showed that a few young people were accessing these services.  More work needs to be done to ensure that our young people had the best possible access to contraception.  This is especially important as, there was an increase in teenage conception rate in 2014 taking Rotherham once again above the rate for England.  However,  Rotherham still has the lowest rate among its closest statistical neighbours and the last two quarters of 2014 had rates well below those in England

·           Among NHS funded abortions in Rotherham, the proportion of those under 10 weeks gestation was considerably lower than in England.  The earlier abortions were performed the lower the risk of complications.  Prompt access to abortion, enabling provision earlier in pregnancy, was also cost effective and an indicator of service quality and increased choices around procedure.  There was considerable room for improvement in earlier access to terminations in Rotherham.  The commissioners (CCG), abortion providers and all referrers into the service needed to work to ensure earlier access

·           Because of the complexity of the commissioning of Sexual Health Services, more work needed to be done to ensure that services provided were effective and provided services that were relevant to the needs of the population

Discussion ensued with the following issues raised/clarified:-

-          The Group had felt there was a need to develop a specialist service to work with hard to reach vulnerable groups such as the Roma community and young people in care and adopt specific, evidence based targeted interventions but not necessarilyto introduce a new service. 

-          Linking in with the locality theme work would be a good way of finding out what work was already taking place and ascertaining if there were any gaps

-          There was a clearly defined action plan which was a living document used by the Strategy Group to monitor progress.  This report was a summary of the things that had been achieved over the past year

-          Teenage pregnancies had considerably decreased; the numbers had been slightly up at the beginning of last year but had reduced again and measured quite well with statistical neighbours.  There were certain aspects of STI infection reports which were higher. However, the Chlamydia detection rate was good and providers of service were able to identify infection within the community

-          In comparison with its statistical neighbours, Rotherham was the 3^rd highest in Yorkshire and Humber with a tremendous difference between Rotherham and Wakefield and Doncaster

-          How did diversity fit into the picture particularly in relation to commissioning? 

-          How was the work linked to deprivation particularly the effect of the Welfare Reforms?

-          The Team participated in the work of the Health Protection Committee and did “deep dive” into infection.  The Team tried to  look at it from a Health Protection point of view of what was working well and how to address some of the issues

-          The main provider of Sexual Health Services (Specialist Service) were required to report how many referrals they had made to the MASH

-          Public Health England was looking at the early monitoring and early detection of STIs as a much earlier indication was required against what would normally be expected 

-          The report showed that there was progress of early testing of HIV but a high number of late diagnosis.  HIV figures came out retrospectively so this was what had happened previously.   Once patients were into the service, it was very good at offering the test and it being accepted.  There was a need to get potential patients into the service and be tested earlier and was the reason why there was a group promoting HIV testing.  A recent meeting had revealed that the measure of late diagnosis was reducing but more awareness raising was needed

Resolved:-  (1)  That the progress made against the suggested actions within the Sexual Health Strategy be endorsed.

(2)  That the proposed future activity be endorsed.