Agenda item

Gill Harrison, Public Health Specialist, presented a report on the progress made in relation to the All Service Review (ASR) savings 2019/20 from the Integrated Sexual Health Services budget as agreed at the 28^th February 2018 Council meeting (Minute No. 157 refers) which resulted in a 2.6% reduction from the overall contract value for the commissioned Integrated Sexual Health Service (ISHS).

Since 1^st April, 2013, every local authority had a legal duty to protect the public’s health with the Regulations stating that the Director of Public Health was responsible for ensuring that there were effective arrangements in place for preparing, planning and responding to health protection concerns.  Following a tendering exercise in 2016, the contract was awarded to Rotherham NHS Foundation Trust (TRFT) with the new service, providing a broad range of contraceptive services and a comprehensive STI prevention, testing and treatment, starting on 1^st April, 2017.

The savings had been profiled for 2019/20 due to the service only having recently been out to tender with a budget reduction from the original value and also due to them taking on the responsibility for the provision of contraceptive services in primary care (GPs and Pharmacy).

As part of the original tender TRFT were commissioned to provide clinics at a range of times and locations to give more opportunities to members of the public to attend clinic sessions.  TRFT proposed to stop providing the newly opened Sunday clinic as it was not as well utilised as other clinics and was more expensive to run.  This would result in a saving of £26,000 and the TRFT had also undertaken an equality analysis to consider the impact of the Sunday clinic cessation.

Local authorities were mandated by the Health and Social Care Act (2012) to prevent the spread of STIs including HIV prevention.  Public Health had a budget of £30,000 for this work and the current contract had now come to an end.  TRFT sub-contracted with a third sector organisation, Yorkshire MESMAC, who were already providing awareness raising, prevention and testing for all STIs including HIV.  A contract variation had, therefore, been agreed between Public Health and TRFT to include specific HIV prevention work within their existing service.  This resulted in a £30,000 saving.

The ISHS was a good service that achieved good results and had worked well with survivors of CSE.

Discussion ensued and Dr. Nadi Gupta, Lead Clinician, and colleagues, Natalie Gibbons (Lead Nurse) and Julie Bentley (Service Manager)responded on:-

·             Demographics of people using the service on a Sunday.

The service was for Under 25’s, a high risk group for STIs and a targeted service.  Over the past year there had been 400 attendances to the Sunday clinic, which began on 1^st April, 2017 and was open to males and females.  Further demographic information was not available.

·             Concerns about a reduction in the service. 

Data from the Police website indicated 138 active CSE ongoing investigations and the service had active cases every month.

·             Service impact of cutting out the Sunday clinic. 

The service was currently available 7 days a week Monday to Friday up to 8.00 p.m. with clinics on Saturdays and Sundays plus outreach services in various locations.  The joint integrated service saw the closure of the Sunday clinic as an option having the least impact on a broad sexual health service. 

·             Funding arrangements moving forward, including for PrEP (pre-exposure prophylaxis) and MESMAC. 

PrEP was an anti-viral drug funded by NHS England and was currently undergoing a three year trial to see it if worked as a preventative measure.  ISHS were involved in the national trial.

MESMAC were already providing services to vulnerable people and would work in collaboration to avoid duplication to deliver those essential services of additional HIV prevention, testing and outreach to vulnerable groups. 

·             Was there confidence and appropriate coverage in the free emergency hormonal contraception provided by pharmacies? 

Take up had been good and work was taking place with 29 pharmacies across the borough which provided a good geographical spread.

·             The new service must have identified a gap in provision which had led to the creation of the Sunday service and would there be an impact on Accident and Emergency (A&E)?  

Closure of the Sunday service would be closely monitored, but it had not been set up for a targeted need in a specific demographic.  Footfall and demographics for all the clinics would be closely monitored.  It was noted that no other Local Authority in the Yorkshire and Humber region had a sexual health service operating on a Sunday and Public Health England did not advise doing so.  However, the value of the Sunday service was recognised at a time when many people required it.  There would need to be an evaluation of the impact on A & E following cessation of the Sunday service.

·             Was the Sunday service picking up any CSE cases over and above the Monday to Saturday service and were there links with CYPS to meet the needs of those young people?  What systems were in place regarding repeat users of EHC who were young or vulnerable people? 

Young people in the under 16 cohort were always seen by a health adviser with a detailed assessment with information shared for any pathways of concern. 

The Cabinet Member for Adult Social Care and Health pointed out that the decision to reduce the funding for this service was not taken lightly and was taken in the context of the savings required by the Council.  £1 million had already been cut from the Public Health Grant overall for next year on top of further savings required by the Council.

The TRFT pointed out that the sexual health service in general received on average 350 calls per day, but would ensure with the reduced contract and robust management arrangements in place treatment would continue to be delivered at an early stage. 

The TRFT were keen to point out that in Rotherham CSE remained high on the agenda and was a town where these kind of services required appropriate funding.  The service remained concerned about the reduction in the contract, but the closure on a Sunday would help to make maximum savings with minimum impact on young people.

Resolved:-  (1)  That the impact assessment and progress made in relation to the ASR PH3 savings from the Integrated Sexual Health Service budget be noted.

(2)  That an update be received on service user evaluation once collated and an evaluation provided on the impact on Accident and Emergency following cessation of the Sunday service.