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Sexual Health Programme

Details of saving proposals

Background

The aspiration of the sexual health programme is to:

  • promote good sexual health in the population
  • promote safe sex practices
  • identify sexually transmitted infections and HIV in the population as early as possible
  • provide high quality access to contraception and widen access in primary care
  • improve access to online and other testing facilities e.g. community pharmacies, primary care and to target acute services at complex patients requiring treatment

Current investment

  • Acute Genito-Urinary Medicine (GUM) Provision of contraceptive services, STI screening & treatment & psychosexual counselling, chlamydia screening £5.5m
  • Integrated sexual health (Contraception and Sexual Health Services - CASH) Provision of contraceptive services STI screening & treatment, chlamydia screening co-ordination, psychosexual counselling and work with high need groups £1.4m
  • Integrated sexual health young people - Provision of contraceptive services, STI screening & treatment, chlamydia screening co-ordination, SRE and targeted prevention work with young people  £601k
  • Sexual health services in general practice - Provision of contraceptive services, STI screening & uncomplicated treatment, chlamydia screening £280k
  • Sexual health services in pharmacies Provision of Emergency Contraception, Chlamydia and Gonorrhoea screening & uncomplicated treatment, condom distribution - £190k
  • Peer education sexual health – sex and relationship education programmes that are offered in schools and youth centres  £178k
  • Enhanced sexual health promotion in high risk groups - Targeted outreach, community mobilisation and resource development to support testing, treatment and behaviour change to reduce STIs, HIV transmission and increase sexual health £170k
  • Commissioning support for sexual health – specialist commissioning support for GUM services £50k
  • Sexual health promotion in commercial sex workers - through outreach, community mobilisation and health promotion to encourage street based commercial sex workers to test, treat and vaccinate to reduce sexually transmitted infections and blood bourne viruses £50k
  • Living well with HIV - health promotions with people living with HIV to encourage treatment uptake, behaviour change and adoption of healthy lifestyles £50k
  • Pan London sexual health -

London wide HIV prevention programme targeting MSM and people from African Communities £47k

  • Health promotion in undiagnosed HIV - through outreach, community mobilisation and health promotion to encourage people from high need communities to test for HIV £40k
  • London DPH programme - £22k
  • North East London Sexual Health Network (NELNET) - provision of a clinical commissioners network for HIV and sexual health services across North East London £10k

Proposed budget reductions 16/17 and 17/18

  • Acute GUM (£5.5m) reduce by £200k
  • TH CASH (£1.4m) reduce by £250k in 16/17 and a further reduction of £250k in 17/18
  • Integrated sexual health young people (£601k) reduce by £15k
  • Peer education sexual health (£178k) reduce by £108k and further reduction of £70k in 17/18
  • Enhanced sexual health promotion for high risk (£170k) reduce by £6k
  • Sexual health promotion in commercial sex workers (£50k) reduce by £25k and further reduction of £25k 17/18
  • Living well with HIV (£50k) reduce by £3k
  • Health promotion in undiagnosed HIV (£40k) reduce by £3k
  • North East London Sexual Health Network (NELNET) (£10k) reduce by £10k

Summary

From a base budget of £3,077,529 we are proposing a saving of £619,336 in 2016/17 and a full year savings of £964,336 in 2017/18.

Implications

Improving sexual health is a high priority for public health in Tower Hamlets and there is an ambition to shift the focus of the investment towards prevention rather than the treatment of infections. To that end there is a strong commitment to protecting the prevention services as far as possible. There is also commitment to ensuring that wherever possible services are provided at the appropriate level, for example, making better use of the primary care services that are provided rather than a continued increase in take up of high cost services in hospital-based clinics. Services such as the Young People`s Service and the prevention services working with the high risk groups are seen as important to maintain.

At the same time the cost of meeting the needs of local residents sexual health needs has significantly increased over the last two years. A major initiative is being made through the London and East London Sexual Health transformation programme to ease and reduce the cost of accessing services by greater use of technology, on line services, enhanced partner notification services and replace the current national payment structures for providers with a more appropriate integrated sexual health tariff. The transformation programmes will start to commission services in 2017 and 2018.

Acute GUM (£5.5m) reduce by £200k and in 16/17

GUM services that can be accessed anywhere by Tower Hamlets residents are one of the major costs for the public health grant and in recent years the growth in expenditure has been very significant. There are a number of initiatives to control cost levels in this area and in the interim a reduced cost of £200k per year is anticipated.

The implications of this are that some users of acute sexual health services would be encouraged to attend at primary care settings and in borough acute services where the requirement is a straightforward contraception requirement, testing or simple treatment rather than a more  acute need. This would result in a better use of the available resources without having an adverse impact on any sexual health service user.

TH CASH (£1.4m) reduce by £250k and further reduction of £250k in 17/18

In advance of the transformation programme we will work with the current providers of services to reduce duplication of services provided by the current configuration of sexual health services provided by the TH CASH service at Mile End Hospital and the Ambrose King Centre at the Royal London Hospital by co-locating the level 3 services (CASH and GUM) at Ambrose King. This will improve the efficiency of the services by reducing overheads, enabling less complex activity to be provided by community based services and encourage lower urgency resident access (e.g. supply of condoms only) to access services in a lower cost setting or change how services are provided to reduce the costs of delivery.

The implication would be a reduction in the duplication of services and the referral of users to more appropriate service levels. No significant impact on the accessibility of services is anticipated as needs can be met from other services such as those offered in primary care.

Integrated sexual health young people (£601k) reduce by £15k

The Young People Services provides a high quality, accessible, comprehensive contraception and sexual health service for young people aged 24 years and under with a particular focus on those aged 19 years and under. Clinic based clinical services and community outreach services offer information, advice and guidance, provision of contraception, diagnosis and treatment of sexually transmitted infections including partner notification as set out in this service specification and onward referral where appropriate.
This is a high priority service to maintain and the small reduction in the budget is likely to be achievable through reducing duplication of services between primary care and this service so there will be no or very limited impact on the numbers of young people supported.

Peer education sexual health (£178k) reduce by £108k and further reduction of £70k in 17/18

The aim of this programme is to work with adolescents and young adults in schools and community settings to deliver targeted Sex and Relationship Education. This is an important area of pastoral education but is also supported through other sources of funding such as school PHSE programmes. In addition it has frequently proved difficult to engage schools positively and the programme has struggled to reach the numbers anticipated.

The review of the Youth Service has highlighted this as an area that will be prioritised for development as part of a health-promoting Youth Service, including sexual health as one of its core themes.

Enhanced sexual health promotion for high risk groups (£170k) reduce by £6k

This service provides enhanced sexual health promotion and HIV prevention, targeting high need communities in the London Borough of Tower Hamlets. This work is in addition and builds on the general population sexual health promotions undertaken by both public health and other providers. The small reduction in the budget can be absorbed without significant impact on the levels of engagement.

Sexual health promotion in commercial sex workers (£50k) reduce by £25k and further reduction of £25k 17/18

The commercial sex workers health promotion project targets street-based sex workers to encourage regular testing and take up of treatment services for sexually transmitted infections. However, the project has not engaged the numbers anticipated and will be brought in house and provided through a Drugs Intervention Programme (DIP) project that already works with this client group.

The implications are minimal as the service is failing to add value and there is duplication of services that will still be provided through the DIP project.

Living well with HIV (£50k) reduce by £3k

This project aims to improve the health and well-being of people with HIV using a peer led and peer-supported approach. A small reduction in the budget is proposed and this should be absorbed without significant impact on the numbers engaged.

Health promotion in undiagnosed HIV (£40k) reduce by £3k

The service delivers enhanced health promotions to reduce undiagnosed HIV, targeting high need communities in Tower Hamlets – men who have sex with men, some ethnic minority groups and at risk young people under age 35. A small reduction in the budget is proposed and this should be absorbed without significant impact on the numbers engaged.

North East London Sexual Health Network (NELNET) – (£10k) – reduce by £10k

This is a support group for clinical commissioners which will continue with other funding through the sexual health service providers.

Impact on key local or national targets

The changes proposed are not anticipated to have a detrimental impact on local or national sexual health indicators which include teenage pregnancy rates, chlamydia screening and late HIV diagnosis. Services will remain open access and access points have increased following the extension of sexual health services to nearly all community pharmacists for provision of Emergency Contraception, HIV testing and chlamydia and gonorrhoea screening. The savings proposed are based on increasing efficiency, reducing duplication and directing users to lower cost services where appropriate to their needs.

Health promotions and health improvement programmes targeted to the most at risk groups for sexual ill health will continue and work will continue to mainstream the promotion of good sexual health throughout the wider education, youth, and social care and NHS services.

You can review the sexual health programme equalities screening.

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