London Sexual Health
Transformation Programme
Cllr Jonathan McShane
London Borough of Hackney
VD clinics were established under the
control of local authorities in 1916 by
the Public Health (Venereal Diseases)
Regulations 1916.
In April 2013 we got them back…
London SH services catchment area
1.348 million
Number of
sexual health attendances in
London in 2015/16.
Over 400,000
students study in
London each year
8.4 million
people are
resident in
London
There were 15.4
million visits from
overseas visitors in
2012 who spent on
average 6 nights in
London
Over 1.1 million
people commute
into London each
day
Source: ONS 2013 Population estimates, Transport for London 2009, London Datastore 2013, HESA 2010
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Changing patterns of need and demand
• 7.6% increase in new sexually
transmitted infections in London since
2012, compared with -1% reduction
nationally.
• London STI rate is double the national
rate
• 33.5% Late diagnosis of HIV In London
has improved by 13.5% from 47% in
2009-11
• Very different patterns of service provision
across London
• Significant use of non-local, often central
London clinics
• 50+% of those in GUM waiting rooms
across London are symptom free
Finance context
• Long term trend of increasing cost of sexual health services in
London
• Significant reductions in public health budgets, e.g., -4.7% for
each of 17/18 and 18/19
• Clinician led work towards using the integrated sexual health
tariff stopped in 2012 with the anticipated changes
• Use of First/Follow-Up tariffs did not reflect cost of activity
• Significant use of London clinics by non London residents - not
all give home postcode
• Variable quality of activity data across London
The London Model
Aim
• to provide high quality services to all London residents
• To explore new modalities for testing, e.g., an eService
or self testing kits
• To implement the integrated sexual health tariff (ISHT)
across integrated sexual health services
Three levels
• London wide
• eService
• HIV testing promotion campaign – DO IT LONDON
• Sector based
• Terrestrial integrated sexual health services
• Local
• Sexual and reproductive health services
Structure
• London Sexual Health Transformation Programme Strategic
Board – chaired by London LA Chief Executive
• Clinical Advisory Group
• Analytical and Costing support
• London wide HIV Testing Programme
• Channel Shift Group
• Implementation Group
What went well
• Large number of councils working together - Grew from small
number of boroughs
• Early wins
• Senior level engagement
• Use of Clinical Advisory Group
• Managed to get final outcome
• Clinical buy-in
• Kept a reasonable pace
• Identified the right people
• Made savings
• Clear brand
What could have gone better
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A lot of time spent managing relationships
Authorities not staying with the programme
Reliant on a handful of people
Forming Clinical Advisory Group took longer than expected
Success allowed advisers/sponsors to disengage
Un-even “in kind” contributions
More engagement from providers
Concerns about timing of programme closure
Underestimated resource needed
Political and constitutional engagement time consuming
Surprises
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A robust and constantly evolving governance system is needed
Massive investment in relationships required
Difficulty with getting people on board
Bad behaviour
Have kept +/- all of the local authorities on board
Receiving questions about the programme cost
Internal mechanisms
Short term and tactical decision making
How well were these issues resolved
• Good to have senior ownership of the risk log
• Have to recognise there is a level of compromise
• What do you do when people sign up and don’t play by the
rules?
• We did not have a formal dispute resolution process
• Need to commission to be sure that clinics and e-services are
going to work together
• The approach/style has changed over time- it has become more
abrupt and forceful
3 key lessons learned
• Collaboration takes real commitment from all partners
• Time, preparation and planning are key to success
• A robust and constantly evolving governance system is needed
Recommendations
• Senior ownership- chief executive level
• Service users at the heart
• Push the case for change - clear overall strategic
vision
• Keep stakeholders on board at all stages
• Get the right people into meetings
• Don’t underestimate programme management skills
that are needed
• Explicit articulation of risk really helpful
• Strong and direct leadership
• Commissioners need to be thinking of the long term
…..however, this programme won
the MJ (cf HSJ) award for
Reinventing Public Services two
weeks ago.
London wide
• HIV testing programme
• commissioned by team in Lambeth Council
• eService
• Specification developed and agreed by the Clinical Advisory
Group
• Competitive procurement
• Service to “soft start” next month
• Service to be managed on behalf of London by City of
London
GUM clinics
• Five sectors, each negotiating on behalf of all participating
London boroughs
• +/- a common specification for the services
• Integrated sexual health tariff
• Different approaches to procurement
Sexual and Reproductive Health Services
• Local procurement
• Equity of access for all to the full range of contraception options.
• Different inherited services
• Different models – local solutions for local issues