AGENDA ITEM
REPORT TO CHILDREN AND YOUNG PEOPLE HEALTH AND WELLBEING COMMISSIONING GROUP
19th June 2014
REPORT OF DIRECTOR OF PUBLIC HEALTH, SBC
SEXUAL HEALTH - UPDATE
SUMMARY
This paper presents an update on the sexual health of young people in the borough and outlines the current service arrangements.
RECOMMENDATIONS
1.CYPHWCG is asked to consider the update and discuss the issues for consideration.
DETAIL
Context
1.Improving sexual health is one of the key priorities outlined in the national public health strategy ‘Healthy Lives, Healthy People which pledged to work towards the integration of sexual health services.
2.The 2013 national Sexual Health strategy ‘A Framework for Sexual Health Improvement in England’ aims to improve the sexual health of the whole population, reduce inequalities and improve sexual health outcomes. The strategy acknowledges the importance of building resilience and knowledge in young people to reduce rates and transmission of sexually transmitted infections and unintended pregnancies.
3.The importance of improving sexual health is acknowledged by the inclusion of three indicators in the Public Health Outcomes Framework (PHOF). These indicators have been prioritised as each represents an important area of public health that needs sustained and focused effort in order to improve outcomes. The indicators are:
• under-18 conceptions;
• chlamydia diagnoses (15–24-year-olds); and
• people presenting with HIV at a late stage of infection.
4.In April 2013 the commissioning arrangements for sexual health services changed, with the range of services now commissioned through Local Authorities, Clinical Commissioning Groups and NHS England (see Appendix One).
Local Data
5.In 2012 there were approximately 1500 new diagnoses of acute sexually transmitted infections in Stockton on Tees with the impact of this remaining greatest in heterosexual young people under the age of 25 years.
6.The numbers and rate of chlamydia infection in the borough continues to rise with higher rates found in more deprived areas.
7.In the same year there were 138 teenage conceptions in Stockton on Tees (rate of 40 per 1,000) with 42.8% resulting in termination of pregnancy. This is the first annual rise in under 18 conceptions in the borough since 2006.
8.The five wards with the highest average teenage conceptions rates are: Portrack and Tilery, Victoria, Newtown, Blue Hall and Hardwick. However, the five wards with the highest number of teenage conceptions are: Portrack and Tilery, Newtown, Ingleby Barwick, Blue Hall and Roseworth (based on data from 2009-2011).
Current Service Provision
Integrated Sexual Health Service
9.The integrated sexual health service is commissioned by the Local Authorities and Clinical Commissioning Groups working across Teesside alongside NHS England.This service is provided by Virgin Care Stockton LLP and operates as ‘Sexual Health Teesside’.
10.Sexual Health Teesside provides a fully integrated, community based sexual service and offers full contraception services, STI testing and treatment, chlamydia screening, HIV testing,post exposure prophylaxis for HIV following sexualexposure (PEPSE), termination of pregnancy, sterilisation, vasectomy, prison sexual health outreach, cervical screening and psychosexual counselling.
11.The service is delivered in Stockton on Tees through a service hub (Lawson Street Health Centre), three spoke clinics (Billingham Health Centre, Thornaby Health Centre and University Hospital of North Tees) and subcontracted providers including GP practices, community pharmacies and a voluntary sector organisation.
12.The service is contracted to offer walk-in provision alongside pre-booked appointments with extended opening times on most days at the service hub alongside evening clinics at the spokes.
13.In addition the service offers outreach services in schools, colleges and other settings to provide information and advice on contraception and STIs, emergency hormonal contraception, condoms and chlamydia testing. However, outreach services are currently suspended in Stockton on Tees.
14.In Stockton on Tees 5,528 patients were seen at 9,260 appointments during the course of one year (October 2011-November 2012) with good utilisation of the hub and each of the three spokes. Spoke clinics saw a significantly higher proportion of young people than the hub.
15.The service hub at Lawson Street Health Centre has achieved the ‘You’re Welcome accreditation and is currently working towards accreditation in the three spoke clinics. The accreditation process involves site visits and mystery shopping attendances at clinics carried out by a team of young inspectors.
16.Young people rated their experience of the service positively with particular praise for the staff and their professionalism. Long waiting times and access to planned appointments have been highlighted as areas for improvement.
Sexual Health Promotion and Prevention
Schools
17.The provision of sex and relationships education (SRE) is a statutory requirement for maintained primary and secondary schools. Schools are able to locally determine the content of their SRE programme however all schools must have regard to the Secretary of State for Education’s Sex and Relationship Education Guidance. The guidance aims to ensure that pupils develop positive values and a strong moral framework that will guide their decisions, judgement and behaviour. It also aims to ensure that pupils are taught about the benefits of loving, healthy relationships and delaying sex, and that pupils are aware of how to access confidential sexual health advice and support.
18.Academies do not have to teach sex education, but are required through their funding agreements to provide a broad and balanced curriculum. They are also required to have regard to the Sex and Relationship Education Guidance when providing sex education.
19.All schools delivering sex and relationship education are required to ensure that their pupils receive high-quality information on the importance of good sexual health.
20.In Stockton on Tees the majority of primary schools are using the Lucinda and Godfrey resource to deliver their SRE programme. The themes covered include: friendships, personal hygiene, feelings and emotions, personal safety, peer pressure and growing and changing.
21.A risk taking behaviour approach is taken within the secondary school curriculum which incorporates sex and relationships, drugs and alcohol, domestic abuse and mental health.
22.A risk taking toolkit developed by SBC Public Health and SBC Education Improvement Service is available to support curriculum development within secondary schools. A risk taking roadshow supplements and complements this resource and is delivered by SBC Youth Directions.
23.Ten secondary schools are currently using the risk taking toolkit to develop their curriculum with a further two intending to use this resource within the forthcoming academic year. Ten secondary schools have also supplemented their curriculum delivery with the risk taking behaviour roadshow.
24.The school nursing service has a vital role to play in future delivery of sexual health promotion and prevention with school-aged children and their families. Work is ongoing to embed this within the core functions outlined in the school nursing service specification going forward.
Work with Partners
25.Sexual health promotion and prevention continues to be delivered in informal settings by practitioners from a wide range of professional backgrounds including: youth workers, caseload managers, pharmacy staff and participation advisers.
26.Many service providers incorporate positive sexual health messages into broader programmes of assessing and managing risk.
27.A risk taking behaviour resource has been developed by SBC Youth Directions for use within informal education settings and has been rolled out across both statutory and voluntary sector youth provision. The use and impact of this resource has not been evaluated.
Local Research
28.In September 2013 SBC Public Health commissioned a research project to identify the most effective support, including training and learning opportunities, for the delivery of risk taking behaviour education going forward. This included the delivery of sexual health promotion and prevention.
29.The research project engaged with teaching staff, stakeholders from key agencies and young people.
30.Recommendations from the project were as follows:
- SRE needs to be part of a planned andcoherent curriculum that is age-appropriate and allows students to revisit topics and issues tobuild on their knowledge, understanding and skills to manage those issues.
- A safe and supportive learning environment is a priority for establishing anenvironment conducive to participation and engagement in learning.
- A balanced approach is required that includes knowledge and understanding alongside skilldevelopment and attitudes and values.
Issues for consideration
31.A review of the Integrated Sexual Health Service is scheduled to commence in early Autumn 2014. This will beled by the Tees Valley Public Health Shared Service.
32.The sexual health of young people living in the borough continues to be a key area of concern as evidenced through the increased rates of transmission of STIs and unintended conceptions.
33.There is currently no overarching strategic plan for young people’s sexual health. It is asked that CYPHWCG give consideration to the formation of a co-ordinated approach to improve the sexual health of young people living in Stockton on Tees.
FINANCIAL AND LEGAL IMPLICATIONS
34.There are no direct financial implications within this paper however the Integrated Sexual Health Service will be reviewed in line with the ongoing programme of service reviews within Public Health.
RISK ASSESSMENT
35.Risk will be considered as part of any options for future commissioning or service development.
COMMUNITY STRATEGY IMPLICATIONS
36.Implementation of the work will have a positive impact on both Joint Health and Wellbeing Strategy and Early Help strategy through positive outcomes for the health and wellbeing of children and young people.
CONSULTATION
37.Consultation has been held with young people using the Integrated Sexual Health service and will be ongoing throughout the service review process commencing in early Autumn 2014 .
References
- Healthy Lives, Healthy People : Our Strategy for Public Health in England. HM Government 2011.
- A Framework for Sexual Health Improvement in England. Department of Health, 2013.
- Sexual Health Needs Assessment for Teesside. Tees Public Health Shared Service, 2014.
Name of Contact Officer:Jane Smith, Early Intervention Manager, SBC Public Health
Telephone No:01642 527237
Email Address:
Appendix One
Commissioning Responsibilities for Sexual Health Services from April 2013
Department of Health 2013