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Review of the National Strategy for Sexual Health and HIV SSHA, Newcastle 26 September 2008. NATIONAL STRATEGY REVIEW METHODOLOGY. Desk research: on the progress of implementation of the Strategy; the changing landscape and epidemiology Expert Review Groups:
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Review of the National Strategy for Sexual Health and HIV SSHA, Newcastle 26 September 2008
NATIONAL STRATEGY REVIEW METHODOLOGY • Desk research: on the progress of implementation of the Strategy; the changing landscape and epidemiology • Expert Review Groups: services; commissioning; prevention & inequalities; indicators • Meetings: on strategy; with stakeholders; and with sexual health service users. SHHA Newcastle 26 September 2008
REVIEW CONTENTS • Changing context for sexual health • Progress in improving sexual health and implementing the Strategy • Key barriers to implementation • Action to drive forward the Strategy • Measuring further progress SHHA Newcastle 26 September 2008
CHANGING CONTEXT FOR SEXUAL HEALTH [I] • Policy developments • Devolved decision making • Local authority role and partnerships • Public health and tackling inequalities • Patient and public involvement • Darzi review – quality, health improvement/prevention • Organisational change and NHS reforms • Restructuring – PCTs, SHAs, RDPH role • Commissioning reform • Market reform and patient choice • Financial reform – PbR, GMS contract SHHA Newcastle 26 September 2008
CHANGING CONTEXT FOR SEXUAL HEALTH [II] • Clinical and service delivery developments • Service modernisation • Multidisciplinary teams, new roles (nurses, health trainers) • Self-management • Technological changes • Prevention, testing and treatment technology - rapid testing, HPV vaccination • Communications technology – internet, text messaging SHHA Newcastle 26 September 2008
PROGRESS IN IMPROVING SEXUAL HEALTH AND IMPLEMENTING THE STRATEGY • Sexual health in 2008 • HIV, STIs, unintended pregnancy, psychosexual problems, sexual assault • Inequalities - BME, gay men, young people and older people • Implementing the strategy - achievements • national priority, targets and support - GUM access, abortion <10 weeks • publication of standards and best practice guidance • service modernisation and integration, innovation • implementation action plan – most actions delivered (national level) SHHA Newcastle 26 September 2008
KEY BARRIERS TO IMPLEMENTATION • Barriers • Prioritisation, targets and investment • Commissioning • Evidence base • Integration and workforce development • Funding mechanisms • Engaging GPs • Lack of strong voice, stigma • Locally variable implementation SHHA Newcastle 26 September 2008
STRATEGY AIMSFocus for further action • improve access to the full range of contraceptive methods • reduce unintended pregnancy rates • improve care for women seeking abortion • reduce transmission of HIV and STIs • reduce prevalence of undiagnosed HIV and STIs • improve health and social care • reduce stigma [HIV and other aspects of sexual health] • improve sexual health and wellbeing • recognise psychosexual health as an integral part of sexual health • improve access to good quality services and care SHHA Newcastle 26 September 2008
5 PRIORITY AREAS FOR ACTION:PRIORITY ACTION 1 Prioritise sexual health as a public health issue. Sustain high-level leadership locally, regionally and nationally. • Designate accountability for sexual health improvement at PCT/LA level • Strong public health base with regular sexual health needs assessment • Dedicated regional function to ‘support and challenge’ backed by sound leadership and performance management • Continued national support for local delivery via NST • More effective mechanisms to foster evidence building and knowledge transfer • Build infrastructure and training SHHA Newcastle 26 September 2008
PRIORITY AREAS FOR ACTIONPRIORITY ACTION 2 Build strategic partnerships • Active engagement in joint planning mechanisms to ensure sexual health and HIV are prioritised • Ensure sexual health is represented in related health improvement plans (eg alcohol, staying healthy, mental health) • Acknowledge third sector as an equal partner and include in needs assessment and strategic planning • Closer working between SHAs and GOs • More integrated cross-government approach to address inequalities and wider determinants of sexual heath • Fully engage professional bodies representing sexual health SHHA Newcastle 26 September 2008
PRIORITY AREAS FOR ACTIONPRIORITY ACTION 3 Commission for improved sexual health • Holistic commissioning model • Commissioning at an appropriate level to ensure fair, effective best- value provision • Link service networks to the commissioning process and business agenda • Skill up sexual health commissioners to meet WCC requirements • Accelerate development of tariffs which allow for different service models and reflect the real cost of services • Develop strong multi-disciplinary teams SHHA Newcastle 26 September 2008
PRIORITY AREAS FOR ACTIONPRIORITY ACTION 4 Invest in prevention • Ensure effective sexual health promotion and HIV prevention is commissioned according to local need and is adequately resourced • Make prevention an integral part of all sexual health service provision • Develop a national prevention framework for a more coordinated approach across government departments • Improve synergy between national and local prevention initiatives • Improve dissemination about what works and what is cost effective, particularly in relation to African communities, gay men and young people • Intensify efforts to tackle stigma • Make PSHE Education and all elements of SRE a statutory subject SHHA Newcastle 26 September 2008
PRIORITY AREAS FOR ACTIONPRIORITY ACTION 5 Deliver modern sexual health services • Specify local quality standards and ensure performance of all those providing sexual health services is monitored • Establish and further develop sexual health and HIV networks to cover all areas of the country • Label services more clearly and maintain open access at all times • Increase level and quality of services provided by general practice and include sexual health in future development of QOF • Ensure sexual health and HIV services are included in local reconfiguration work (eg primary care centres/polyclinics) • Improve workforce planning and training at all levels and link to service development and changing models of care SHHA Newcastle 26 September 2008
A HIGH QUALITY WORKFORCE SHHA Newcastle 26 September 2008
KEY MESSAGES • Transmissible infections have no regard for geographical boundaries • There are potential dangers in leaving public health control of STIs and HIV to competing services without quality standards or a requirement for collaboration. • High quality and timely surveillance data are vital to identify need, determine the value of prevention programmes and optimise service configuration. • There has to be a shared understanding about why improving sexual health is priority why it matters to life outcomes and the wider community. SHHA Newcastle 26 September 2008