Sexual Health: where we are now and our
vision for the future
Dr. Mayada Abu Affan
Presentation Outline
• Dudley’s profile
• Local Authorities responsibilities
• Sexual Health Service Provision in Dudley Borough
• Progress so far
• What we need to improve on
• Our Vision – What we want to achieve
• Finance and contracting
2014 Dudley Population
2015 Index of Multiple Deprivation
Dudley’s demography
• According to 2011 census Dudley has 312,925
residents.
• 24 electoral wards
• Population is more affluent in the periphery
with 25% are over 60 years
• Younger and more deprived population in the
centre of the Borough
• DY1,Dy2and DY5re hot spot areas for sexual
ill-health
Background
As from 1 April 2013, Dudley MBC is now required by regulation to
commission comprehensive sexual health services including:
 Contraception including implants and intrauterine
contraception in primary care.
 STI testing and treatment, including post-exposure
prophylaxis, Chlamydia Screening Programme and HIV
testing, prevention and support
 Sexual health aspects of psychosexual counselling
 Any sexual health specialist services, including young
people's sexual health, and sexual health promotion in
schools, colleges and pharmacies
National Policy and Frameworks
• The Public Health Outcomes Framework sets out
three indictors related to sexual health
• Reducing individuals presenting with HIV at a
late stage
• Reducing numbers of under 18 conceptions
• Reducing Chlamydia diagnosis rate in 15-24
years old
Sexual Health Service Provision in Dudley
Borough
•
The current model has two main providers, provision at primary
care and community pharmacies and third sector
•
Contraception and Sexual Health (CASH) services are based
at Brierley Hill Health and Social Care Centre with two community
clinics at Central Clinic, Dudley town centre and Halesowen
Health Centre.
•
Genito- Urinary Medicine (GUM) service is based at Russells
Hall Hospital
•
Under 25s service is provided by Dudley Brook and is based in
Dudley town centre with outreach clinics in colleges and the
What? Centre, Stourbridge.
Other sexual health services offered in Dudley
Borough
•
•
Chlamydia Screening Programme which is commissioned and delivered
by Brook. Service is offered in mainstream sexual health services, and
some pharmacies and GP practices
Community pharmacies offer the following:
•
EHC
•
Some offer HIV POC testing
•
Chlamydia testing and some offer Chlamydia treatment
•
Primary care offer SDI and IUD fitting and removals and Chlamydia testing
•
Summit House Support: offers support for people living with HIV, HIV point
of care testing (POCT) and is particularly targeted at people who are in “at
risk groups”
Other Sexual health services
•
•
•
•
Condom Distribution Scheme;
• a partnership between a number of partners
working to support young people in Dudley .
Point of Care HIV Testing pilot scheme is offered in
12 pharmacies, Dudley Brook and contraception and
sexual health (CASH) clinics.
Respect Yourself Team provides holistic support to
prevent teenage pregnancy and support teenage
parents.
Abortion services which are commissioned by the
CCG
The current situation
The level of sexual ill-health in some areas is lower across Dudley
Borough when compared to regional and national rates; for example:
•
•
•
Dudley is ranked 195 (out of 326 local authorities in England; first
in the rank has highest rates) for rates of new sexually transmitted
infections (STIs), at a rate of 577.5 per 100,000 residents
(compared to 810.9 per 100,000 in England).
Rates of HIV are low when compared to national rates. In 2014 the
diagnosed HIV prevalence rate was 1.0 per 1,000 population
(compared to 2.1 per 1,000 population in England and 1.5 per
1,000 in West Midlands)
The percentage of HIV diagnoses with CD4 cell count <350 at time
of diagnosis (2011 - 2013) was 38%, (compared to 45% in England
and 55% in West Midlands)
(Source: PHE, 2014)
Achievements to date
•
An increase in the rate of LARC prescribing in primary care: In 2013, the
rate of LARC prescribing was 58.0 per 1,000 women aged 15 to 44 years,
compared to 52.7 in England. (PHE, 2014)
•
Expansion of EHC community pharmacy; 60% of community pharmacies
provide EHC
•
Every clinical provider in mainstream services are able to fit at least one
method of LARC
•
Early access to termination of pregnancy (80% before 10 weeks gestation)
•
48 hour access to GUM services
•
An increase in Chlamydia screening uptake and positivity
•
Year on year reduction in unplanned teenage pregnancy
What we need to improve on: health and
wellbeing outcomes?
•
•
•
Reduce STIs among young people in Dudley:
•
In 2013, 61% of diagnoses of new STIs in Dudley were in young
people aged 15-24 years (compared to 55% in England).
Reduce re-infection and onward transmission of STIs:
•
Between 2009 and 2013 an estimated 8.2% of women and 8.1% of
men presenting with a new STI at a GUM clinic became re-infected
with a new STI within 12 months (compared to 6.9% for women and
8.8% for men in England)
Increase detection of Chlamydia infection:
•
Chlamydia testing levels are lower when compared to national and
regional levels; rate of diagnosis in 2013 per 100,000 young people
aged 15-24 was 1,793 (compared to 1,917 in West Midlands and
2,016 in England)
What we need to improve on: health and
wellbeing outcomes
•
•
Further reduction of teenage pregnancy:
• In 2013, the under 18 conception rate per
1,000 female was 30.7. Despite seeing a
year on year reduction, Dudley is still higher
than the national and regional average (24.3
in England and 28.9 in West Midlands).
Reduce the rate of repeat abortion
• In 2013, the under 25s repeat abortion rate
was 29.7% (compared to 26.9% nationally
and 28.8% regionally)
What young people have told us Service
Model
What the public have told us? One stop
shop
• 52% of young people preferred a one-stop
shop
• 70% of the general public preferred a one
stop shop
• 89% of service users preferred a one-stop
shop
• From this, the consultation supports onestop provision wherever possible.
Our vision – What we want to achieve
To have the best sexual health outcomes for Dudley’s population through:
• Ensuring sexual health is everyone’s business and it is in everyone’s
agenda
• Ensuring we commission according to the evidence base ,needs of
our local communities and long the ethos of Community Council
• Effective partnership and collaborative working
Our objectives:
•
Have efficient, effective and accessible sexual health services that meet
the need of our population, particularly amongst those at highest risk of
sexual ill health
•
Reduction in sexual health inequalities amongst those more at risk of poor
sexual health
•
Increased opportunities for diagnosis and effective management of STIs
OUR OBJECTIVES:
•
•
•
•
•
•
Increased uptake of HIV testing and rapid referral
to HIV care services
Increase uptake of Chlamydia testing, diagnosis
and treatment
Increased uptake of effective methods of
contraception, including access to LARC for all age
groups
Continued reduction in teenage conception rates
Reduction in number of people repeatedly infected
with a STI
Reduction in repeat abortions
Procurement outlines
• Along the whole care pathway:
• Level 1,2&3 integrated sexual health services
• HIV support services in the community
• HIV treatment services
• Wider provision of community based sexual health services
• Welcome collaboration between providers and innovation
• Welcome risk stratification approach to management,
including self testing.
Finance and contracting
 Block contract for GUM , CASH and HIV
community support services:
• Informed by a quality standard framework
• % of the payment is linked to achieving specific
quality standards
• KPIs are evolving to meet the needs of the
population and are agreed annually
• contract value around (?£1.5 million)
 Separate HIV treatment contract with NHS
England
• contract value around (? £2 million)