Agenda item

Consideration was given to the report introduced by Councillor Roche, Cabinet Member, which detailed how the Strategy, previously approved by the Health and Wellbeing Board, had since been refreshed and an action plan agreed ready for consultation.

 

Gill Harrison, Public Health Specialist, was welcomed to the meeting who presented the 2019-2021 refresh of the Sexual Health Strategy for Rotherham.

 

The Strategy set out the priorities for the next three years for improving sexual health outcomes for the local population.  It provided a framework for planning and delivering commissioned services and interventions (within existing resources) aimed at improving sexual health outcomes across the life course.

 

It aimed to address the sexual health needs reflected by the Public Health England sexual and Reproductive Health Epidemiology report 2017 which highlighted areas of concern.  The following were identified as concerns to identify actions for 2019-2021:-

 

·           Sexually Transmitted Infection diagnosis in young people.

·           Sexual health within vulnerable groups.

·           Under 18 conception rate.

·           Pelvic Inflammatory Disease admission rate.

·           Abortions under 10 weeks.

 

The refreshed Strategy also reflected concerns expressed in the Rotherham Voice of the Child Lifestyle Survey 2018 which showed increased numbers who said that they did not use any contraception and a significant increase in those reporting that they had had sex after drinking alcohol and/or taking drugs.

 

Sexual Health had since moved on and it was timely to look at new changes and new priorities.

 

A PowerPoint presentation highlighted:-

 

·           Definition – sexual health.

·           Strategic Ambitions.

·           Improving sexual health.

·           Rates of gonorrhoea (2013-2017) – success stories – public awareness and good contact tracing and working with partners.

·           Priorities STI.

·           Improving Reproductive Health – downward trend reduced the rate of under 18 conceptions by 60% between 2008 and 2017 higher, but started off a lot higher.  A range of factors contributed – access to clinics, contraception, good reputation good relationship and sex education – range of other interventions self- esteem and aspirations.

·           Priorities – under 18 conception rate, access to contraception and timely access to abortion services.

·           Focusing on vulnerable groups – showing young people affected.

·           Priorities – diagnosis of new STIs, prevention, treatment and care.

·           Building on successful service planning and commissioning.

·           Priorities – provision of integrated services and building on success.

·           Key indicators for success.

·           Implementation and monitoring – action plan.

 

Discussion ensued with the following issues explored:-

 

-        What had been successful in the 2015-19 Strategy, what had not been  delivered on and why was the focus on repeat abortions?

 

       It was not just repeat abortions but it was important to focus on problems with ongoing care and with relationships.  The Pause Programme dealt with repeated pregnancies, identified problems and how issues could be dealt with.

 

       The refresh of the Strategy looked further as it had not previously had a fully integrated service delivery model which was viewed as a priority and was now in place.

 

-        The statistics appeared to be incorrect, especially in relation to Chlamydia.

 

       The populations were different as the figures for Chlamydia focused on 15-24 year olds so they were correct.

 

-        How did the national graph or local graph compare with other areas and were specific areas of concern targeted.

 

       Public Health England had a fingertip tool that showed the national figures and individual areas and allowed an individual to manipulate and compare across the country.  The Services were keeping an eye on trends around the country and would target specific areas if there appeared to be an issue.  If there was a specific issue or an increase of STI’s in Rotherham then Public Health England would be in touch.

 

-        It would appear that one of the diseases was identified as borderline untreatable.

 

       Certain strains were resistant which required a combination of antibiotics to treat. So far the Service had not found one that was not treatable.  However, a watching brief would continue and any particular issues were plotted for the area.  There were, however, a couple of highly resistant strains in the country that had hit the national news, but this was being closely monitored.

 

-        There had been a marked improvement in Gonorrhoea so what intervention had been effective.

 

       There had been no specific interventions put in place, but awareness raising in populations with increased contact tracing ha probably had an impact.

 

-        What was the cost of this awareness raising and could the Service pick the next worse one and do the same thing.

 

       Awareness raising had all been within existing resources so there had been no extra funding.  Some partner organisations would have had extra workloads that had the cost of staff time.  Commissioned services worked within a financial envelope and some infections would require more work than others and national campaigns would be used.

 

-        There had been a reported rise in men who have sex with men contracting STI’s, but were there any indications this was happening in Rotherham.

 

       The proportion of reported new STIs from men having sex with men was a relatively small number, but there had been seen a significant increase within that small population.  Specific work had been undertaken and they had identified as one of the vulnerable groups to work with.

 

-        Was there a profile of groups most likely to present with PID?

 

       There were no profile as such.  One of the things planned as a group was to unpick this by looking at the data with partner organisations such as the Foundation Trust to find more about it, see if there was a profile and identify what partners should be doing.

 

-        Often a different story was heard around this including changes in sexual practices of young people and young women’s confidence and esteem  Information earlier said this was more than about infection control which was what we seemed to measure success by.  Was there any evidence to document this?

 

       From work that was taking place with various people there were models of good practice in relation to young people and attitudes to sexual health.  The latest voice and influence survey raised a few concerns around risk taking behaviour in relation to alcohol, drug use and anti-barrier contraception, which appeared to be at odds with other surveys when risk taking tended to be lower than it used to be. This needed to be unpicked.  Traditional interventions needed to change and move on. Whilst some concerns were shared, from experience there was some good practice taking place.

 

-        There were lots of different experiences targeting vulnerable groups and issues.  Around healthy relationships and education in schools, what percentage of schools were taking this up and what was happening in primary and secondary schools including how many schools were not doing it?  It was disappointing in that there was more information on infection control and a focus on this in the measures rather than on consent, sexual abuse, reduction of CSE, reduction of rape and sexual assault healthy relationships.

 

       All information had come from the Sexual Health Strategy Group.  An annual update from the Schools’ Effectiveness Services highlighted what information was provided to primary and secondary schools in relation to sex and relationship education.  Overall a good number of schools were providing good sex and relationship education.  There were some pockets where this was not happening, but this would happen more widely when it became a statutory duty to do so.  The Strategy Group would look at this as to how partners could assist schools to maintain that level of education.

 

-        The numbers of participating schools and information from schools needed to be shared on how this would be delivered and whether this had an impact on young people if the data was sophisticated enough to show that.

 

       This would be taken back to the Strategy Group to discuss, but it was noted that the data was provided by schools and questions about education should be addressed to Children and Young People’s Services.  Data about Child Sexual Exploitation fell under the remit of the Safer Rotherham Partnership.

 

-        Was the Strategy made up a variety of partners and multi-agency?

 

       The Strategy was signed up to by range of partners originally from the Health and Wellbeing Board as a Sub-Group and was multi-agency.

 

-        With regards to the media coverage of a faith school talking about gay relationships, did this have a knock-on effect with regard to about healthy sexual relationships?

 

       Rotherham had laid out its policy on sexual health and PSE and all schools should adopt it.

 

-        Teenagers socialised more in a virtual world so to what extent did this have an influence?

 

       There was no research available.

 

-        Data access to contraception was concerning as it had been good up to 2017, but then contracts were terminated for LARC (long-acting reversible contraception) to be supplied through GP services.  The Strategy did not seem to recognise or mitigate for that.  There appeared to be a bottleneck for LARC for non-contraceptive services which had been effective and very safe for debilitating conditions such as fibroids or endometriosis.  Recent information from the Pause Project indicated that people were having trouble accessing appointments for LARC so what could be done to resolve this to give patients better access?

 

       Contracts with GP’s were terminated, but not completely as the Integrated Sexual Health Service sub-contracted these after the first year.  There had been issues with regard to clinical governance and maintaining GP competency, but it was important to have a main provider and training.  Performance meetings had taken place with services and information provided on the GPs who provided the range of different LARC services to all ages.

 

       In terms of endometritis the LARC IUCD (COIL) tended not to be used for young women other than for regulating menstrual difficulties or gynaecology issues rather than contraception.  Long waiting lists had not been reported so this information would be taken back to the partnerships within the Strategy Group.

 

-        Gynaecological issues were intertwined as these conditions affected fertility.

 

       There had to be a cut-off point for the Sexual Health Strategy.  The Group had had discussions on a whole range of issues, but was it universal and, if so, why had the Service chosen to go down that path?

 

-        Young people had a particular vulnerability, especially those who were Looked After.  Had there been any targeting of resources or reversal as to why the Service had chosen to go down that path.

 

       Younger people were likely to be more disadvantaged by STI’s and Looked After Children were a vulnerable group.  One of the things the Group was looking at was how to target and get information out to young people and tease this out.  An action plan was being re-introduced with targets to see how this could be done better.

 

-        Could data be drilled down further as part of an EIA?

 

       This was recognised and more details would be provided on the EIA as part of the Strategy.

 

-        Did we know what the origins of the gender imbalance were as it appeared to affect more females than males at an early age?

 

       It was not apparent, but this would be looked into further about what was happening in other areas and to be able to see the difference.

 

-        Some of the priorities in the action plan were contracted to other people; how was this monitored, were there any issues and if there were was there consideration to bring this back in-house to give some reassurance how the contract was managed?

 

       There were some direct contracts in relation to the Integrated Sexual Health Service at the hospital. There were regular performance monitoring meetings to discuss and monitor the Service specification.  Actions in the action plan were assigned to specific partners.

 

-        Delivering awareness - quality was important with young and vulnerable people so how did the Service ensure the quality was good?

 

       Yorkshire Mesmac were contracted to provide this service and were successful following a tender process.  Evaluation had taken place to drill down using nationally accredited information and techniques with quality assurance built in.

 

-        What measures were being taken to make access to Sexual Health Services more accessible in circumstances where vulnerable teenagers lived with prudish parents who were against pre-marital sex?

 

       Information was easily accessible.  The Voice and Influence survey asked where did teenagers go for sexual health information and the vast majority identified peers, but this information needed to be culturally acceptable with the young people themselves to ensure the right messages and information were passed on.  A presentation had been made on ten week abortions at one of the Strategy Group meetings by two providers and consideration given as to how this information was easily accessible to people and who young people could talk to.

 

-      Some of the indicators were a bit woolly and it would be better to have smarter targets and indicators so that hard information could be interpreted in measuring the impact for good sexual health.  If social issues around consent and safe, healthy relationships were not going to be measures within the Strategy should they be left out?

 

This would be taken on board.

 

Resolved:-  (1)  That the refreshed Sexual Health Strategy and the associated action plan be noted.

 

(2)  That school data questions be sent to Children and Young People’s Services for a response to be scheduled into the work programme for future discussion. 

 

(3)  That the EIA be submitted to Health Select Commission for this Strategy and for any new or refreshed strategies.

 

(4)  That consideration be given by the Sexual Intervention Group to developing a broader and SMART range of performance indicators to measure success.