NHS GRAMPIAN
SEXUAL HEALTH STRATEGY
ANNUAL REPORT 2005 - 2006
INTRODUCTION
The Grampian strategy ‘Improving Sexual Health in Grampian – an inter-agency strategy’ was launched in early March 2006, following a three month consultation with a range of organisations including local and national voluntary agencies, pharmacists, Community Health Partnerships, service providers and public health. The strategy was developed by a partnership of the NHS, local authorities, voluntary sector and Aberdeen University. Further to a diversity impact assessment in line with the Scottish Executive ‘Diversity and Impact Assessment Toolkit’ (2005), the strategy was further consulted upon with local ethnic communities and disability groups. The voluntary sector were approached for consultation on an individual basis where their services were sexual health orientated such as PHACE Scotland Grampian, and Drugs Action, in addition to inclusion in the consultation process via mechanisms such as the Drug, Alcohol and HIV Forums, the Aberdeen Council of Voluntary Sector Organisations, Moray Council of Voluntary Sector Organisations, Kincardine and Deeside Voice, B-Bridge and Gordon Rural Action. The local strategy is the Grampian response to the national strategy, translated to meet local needs. Implementation has begun and Community Health Partnerships are progressing activity within the three local authority areas.
It should be noted that NHS Grampian is pleased to report on considerable development in the sexual health arena during 2005/2006. However, it is worth highlighting that as with any change process, the development of services/initiatives, including staff recruitment, which will see improved outcomes reflected by clinical data, is taking some time, as is indicated in the reports below.
OVERVIEW OF CLINICAL SERVICES
Genitourinary Medicine
- The Department of Genitourinary Medicine (GUM), which runs clinics in Aberdeen and Elgin, is NHS Grampian’s specialist service for the prevention and management of sexually transmitted infections (STIs) and related conditions.
- Many people are seen from minority or disadvantaged groups such as gay men, immigrants, and sex industry workers.
- Fast track appointments are offered to those under 18 years of age and men who have sex with men.
- The department works closely with primary care to improve management of STIs in the community, particularly with regard to partner notification and advice on treatment.
- GUM nursing staff support Drugs Action in the provision of hepatitis A & B immunisation and general sexual health advice on a weekly basis. In addition, GUM provides clinical support to Drugs Action via the sex industry workers’ drop in ‘The Quay’ and associated street outreach work.
Sexual & Reproductive Health (family planning)
- Sexual & Reproductive Health (family planning) services are provided via Dr Grays Hospital, Elgin (2 evenings per week), fortnightly outreach clinics of 2 hours duration each, held in Peterhead and Fraserburgh, and via Square 13, the main, Aberdeen City centre base of the community sexual and reproductive health service for Grampian, which offers a mixture of booked and walk–in sessions. The service offers general and complex contraception, vasectomy and female sterilisation counselling, pregnancy advice and chlamydia testing, with dedicated young people’s sessions also provided. A dedicated pregnancy advisory service provides consultations across Square 13 and gynaecology for unplanned pregnancy (single booking system), directly linked to termination of pregnancy provision. Specialist Psychosexual medicine clinics are provided. It provides medical gynaecology services including ultrasound scanning and hysteroscopy in support of the core services. The nursing staff provides a telephone advice service to clients. The medical and nursing staff provides professional advice, support and a referral service for other healthcare professionals.
- Grampian is unique within Scotland’s Health Boards in that its Clinical Lead also has responsibility for overseeing the provision of the abortion service, which is an additional responsibility.
- The established consultant posts are also different from others in Scotland in that the consultants deliver some services from within gynaecology, which has advantages from a seamless care point of view.
Moray SMS Young People’s ‘Drop In’
- The SMS young people’s drop in, established in 2002, operates on a Saturday between 2 - 4pm, and was developed by young people, for young people and is accessed by service users from 13 – 19 years of age.
- Young people across Moray use the drop in, including a large proportion of young males who do not currently access traditional family planning services.
- The service offers support from one to one and group advice on lifestyle topics, and provides an adapted family planning service comprising pregnancy testing, various types of contraception including emergency contraception, and chlamydia testing. A family planning physician, specialist nurse, and health information assistant staff the service.
- Due to the rural inequalities experienced by young people in Moray, engagement with the service has been encouraged by the development of a text messaging help service with a 24-hour response deadline, where possible.
CLINICAL ACTIVITY DATA
Following the receipt of funds to the sum of £407,454 from the Scottish Executive in May 2005, a local application process was designed to which front line clinical services in Grampian applied. Successful applicants were awarded in October 2005 as per appendix iii.
The relatively small initial increase in tests conducted, outlined below, is reflective of the time required to appoint staff across clinical services and subsequently increase capacity, which will have a ‘knock on’ effect as it were at laboratory services. We anticipate greater throughput during 2006/2007 and thereafter.
Genitourinary Medicine
GUM have appointed a part time G Grade Health Adviser who commenced in post on 1st May 2006 to progress the Shared Care Partner Notification Service, which is currently being consulted upon, therefore this service has not yet progressed. A Foundation Year 2 Doctor took up post as of 2nd August 2006. In addition, two (Elgin and Aberdeen) part time Out Patient Assistants came into post on 1st August 2006.
Sexual & Reproductive Health (family planning)
Square 13 are in the process of appointing to the Consultant in Sexual and Reproductive Health post. Unfortunately, we were unable to appoint to Nurse Consultant post. However, we are aware that this has been a problem nationally, and measures are afoot to further develop the skills of senior nurses, some of whom may become suitable for appointment to Consultant level in the future.
Moray SMS Young People’s Drop In
The Moray SMSutilised Health Improvement Fund under-spend to support the service during 2005/2006. NHS Grampian have therefore carried forward ring fenced sexual health funds and will be in a position to support this service from 2006 –2009.
The Moray SMS continues to expand its reach to young people and since opening in 2002, the number of young people accessing the service has increased from 597 to 1272. The majority of enquiries are around sexual health issues and over half of those using the service are aged 13-15 years. The numbers of males accessing the service, pregnancy and Chlamydia testing have all increased by 50%. To provide equitable access to sexual health services for all young people across Moray, outreach services are now being planned for Forres and Keith. The SMS texting service is now being used to provide Chlamydia test results with appropriate measures in place in line with NHS Grampian GUM confidentiality protocols.
Laboratory Services
A part time A+C grade and a part time Medical Laboratory Assistant took up post on 1st March 2006.
A full time trainee Biomedical Scientist (BMS) took up post on 3rd April 2006 and a second full time trainee BMS commenced on 2nd May 2006.
Trainees were appointed instead of BMS1 staff as there were no suitable applicants from BMS1 group (who are in very short supply). This will result in lower rates of pay initially until they become registered and move on to BMS1 rates.
The total number of tests undertaken by the medical Microbiology Laboratory increased (by 774) from 7342 in October 2006 to 8116 in June 2006.
DEVELOPMENTS/ACHIEVEMENTS IN 2005 – 2006 (see table)Although we have attempted to align recommendations from the national strategy against local activity both planned and undertaken, it should be noted that some recommendations are relevant across sectors and in various guises of activity such as recommendation 40, ensuring that resources for health promotion are identified, and recommendation 46, progress made in implementing the HIV strategy. It must also be acknowledged that activity such as the training needs audit will have a ‘knock on effect’ as it were, on other recommendations over time such as 47, professional development of school nurses.
PRIORITIES FOR 2006 – 2007(see table)
In addition to the priorities outlined below, given that we are in the early stages of implementation, much current activity will be further developed during 2006/2007.
KEY CHALLENGES
The key challenges experienced locally include:
- The time involved in recruitment to new posts
- Problems experienced in recruitment (vacancy control restrictions)
- Delays in having the training needs audit approved locally which has a knock on effect on the actual undertaking of the audit, and subsequently on the development and delivery of future training
- Early stages of implementation vs. deadline for annual reporting.
- Ensuring appropriate organisational representation on the strategy group and the associated two way flow of information throughout the community and to and from the overarching group.
EFFECT ON AVERAGE SERVICE USER
The average service user will be better informed and able to make appropriate choices around their sexual health. They will be more aware of the risks of unsafe sex including STIs and unintended pregnancy, how to protect themselves and how to access a choice of sexual health services, and will face reduced waiting times when presenting to services, and overall improved access to a wider range of services across the network.
COMMUNICATION
A communication plan was developed prior to launch to support the strategy and is attached as appendix iv for information.
Janet Bruce
Sexual Health Improvement Co-ordinator
NHS Grampian
October 2006
APPENDIX I: STRUCTURE CHART
Susan Jappy
Acting Director of Public Health & Executive Director for Sexual Health
Dr Gillian Flett
Consultant & Head of Service Sexual & Reproductive Health (family planning Square 13)
& Clinical Lead for Sexual Health / Janet Bruce
Sexual Health Improvement
Co-ordinator
Grampian Sexual Health Strategy Group
Aberdeen City
Implementation Group/Structure
To be established /
Aberdeenshire
Implementation Group/StructureAlthough a sexual health group operates in the central area LHCP an overarching Aberdeenshire group is to be established.
CHP and Local Authority leads have highlighted vacancy and lack of capacity issues which may hinder implementation. They have agreed to identify potential membership of local group followed by establishment of same. Priorities are mapping of sexual health services and extent of service provision, multi-agency training and awareness raising. Initially mapping in the central area is planned. / Moray
Implementation Group/Structure
A sexual health group has been operation in Moray for some time. Membership has recently been reviewed and is being expanded to incorporate non NHS partners, to ensure greater implementation of local (and therefore national) strategy.
APPENDIX II: MEMBERSHIP OF INTER-AGENCY SEXUAL HEALTH
STRATEGY GROUP
Chair: Susan Jappy, Acting Director Public Health and Executive
Director for Sexual Health, NHS Grampian.
Secretary:Diane McGregor, Administrative Assistant, NHS Grampian.
Terry Ashton, Adviser for Guidance and Careers, Aberdeen City Council.
Dr Steve Baguley/Dr Gordon McKenna (Head of Service), Consultant Physicians, Genito-Urinary Medicine Clinic, NHS Grampian.
Janet Bruce,Sexual Health Improvement Co-ordinator, Public Health Unit, NHS Grampian.
Dr Gillian Flett (Head of Service), Consultant, Department of Sexual and Reproductive Health, Square 13, and Sexual Health Clinical Lead, NHS Grampian.
Heather Kelman, General Manager, Aberdeen City Community Health Partnership, NHS Grampian.
Denise Mair, Depute General Manager, Drugs Action.
Dr Janet Tucker, Senior Researcher, Dugald Baird Centre for Research on Women’s Health.
Sandy Riddell, Director of Community Services, The Moray Council.
Professor Allan Templeton, Head of Department - Obstetrics and Gynaecology, Aberdeen University Medical School. President Royal College of Obstetricians and Gynaecologists.
Dr Sarah Wallage (Moray Lead), Consultant, Department of Sexual and Reproductive Health, Square 13, NHS Grampian.
Emma Wink, Branch Co-ordinator, Caledonia Youth - Grampian Branch.
Helen Robbins, Lead System Manager (Nursing), Moray Community Health & Social Care Partnership, NHS Grampian.
Jennifer Hall,Public Health Lead, Aberdeenshire Community health Partnership, NHS Grampian.
Liz Taylor/Linda Morrison, Strategic Development Managers, Social Work Department, Aberdeenshire Council. (now Val Milne & Barbara Foad)
Alan Parker, Senior Worker, PHACE Grampian.
APPENDIX III: FINANCIAL REPORT DETAILING ACTUAL EXPENDITURE FOR 2005- 06
Please see accompanying excel spread sheet
APPENDIX IV: IMPROVING SEXUAL HEALTH IN GRAMPIAN – AN INTER-AGENCY STRATEGY COMMUNICATION PLAN
NHS Grampian Corporate Communications Lead:
Jodie Dawson
t 01224 558815
Aim of communication plan:
To support the strategy by:
Raising awareness of its existence
Raising awareness of the reasons for its development
Preparing to respond to any criticism
Raising awareness of its planned implementation
Objectives of communication plan:
- Identify suitable vehicles to raise awareness of the strategy among partner
organisations represented on strategy group and via their networks to partners across
Grampian - Deliver a programme of communication activities
- Monitor and track communication for evaluation purposes
Strategy Group Members / Role / Partner Organisation Represented
Susan Jappy
t 01224 558478 / Acting Director of Public Health/Sexual Health Chief Executive / Public Health Unit
NHS Grampian
Dr Gillian Flett
t 01224 555120
/ Consultant & Head of Service/Sexual Health Clinical Lead / Department of Sexual & Reproductive Health Square 13NHS Grampian
Janet Bruce
t 01224 558592 / Sexual Health Improvement Co-ordinator / Public Health Unit
NHS Grampian
Dr Mayada AbuAffan
(currently on secondment to ISD) / Specialist Registrar / Public Health Unit
NHS Grampian
Terry Ashton
t 01224 522000 / Adviser for Guidance and Careers / Aberdeen City Council
Dr Gordon McKenna
or
Dr Steve Baguley
t 01224 555555 / Consultant & Head of Service
Consultant / Department of Genito-Urinary Medicine (GUM)
NHS Grampian
Heather Kelman
t 01224 558714 / General Manager / Aberdeen City CHP
NHS Grampian
Senga MacDonald/Denise Mair
01224 577120 / General Manager
Depute General Manager / Drugs Action
Dr Janet Tucker
/ Senior Researcher / Dugald Baird Centre for Research on Women’s Health/Aberdeen University
Sandy Riddell
t 01343 563531
Carol Kirkwood (back-up)
t 01343 563375 / Director of Community Services
Health Improvement Officer (Strategy) /
The Moray Council
Helen Robbinst 01343 567947 / Lead System Manager (Nursing) / Moray Community Health & Social Care Partnership
Professor Allan Templeton
t 01224 552456 / Head of Department
Obstetrics & Gynaecology / Aberdeen University Medical School
Emma Wink
t 01224 658773 / Branch Co-ordinator /
Caledonia Youth
Jennifer Hall01467 672844 / Public Health Lead / Aberdeenshire CHP
NHS Grampian
Liz Taylor (adult services)
t 01476 620981
Linda Morrison (children’s services)
t 01476 620981 / Strategic Development Manager (Community Care) Social Work Dept
Strategic Development Manager(Children’s Services) Social Work Dept / Aberdeenshire Council
Alan Parker
t 0845 2412151 / Senior Worker / PHACE Grampian
Dr Sarah Wallage
t 01225 555120 / Consultant & Moray Lead / Department of Sexual & Reproductive Health Square 13
NHS Grampian
Preparation of final strategy document:
Janet Bruce to prepare strategy which will go to group for final approval, and to Jodie Dawson at Corporate Communications NHS Grampian for proof checking. Must be ready to go out to NHS Grampian Board Members by 27th February 2006. Strategy (in word format) will be placed on internet, intranet etc on launch date. Thereafter desktop publishing by Graphics Team will be undertaken and will replace word version once ready – Jodie arranging this.
Launch Date:
7th March 2006 – after NHS Grampian Board Meeting
Strategy Information:
The need for a Strategy
Sexual health affects our physical and mental well-being and is central to some of the most important and lasting relationships of our lives. Sexual activity is increasing amongst young people and for some at a young age. Society is changing, many middle aged and older people who have spent time in stable relationships are now single again and there is greater societal acceptance of cohabitation of non-married partners and of homosexuality. Sexually active individuals are at risk of a range of sexually transmitted infections (STIs). Almost all STIs are becoming more common but the rate of infection of Chlamydia in Scotland and in Grampian has been rising steadily. Nationally an increase in Chlamydia of 39% in people aged under 25 and 36% in the over 25’s between 2002 and 2003 has been reported1. Teenage (13-19 yrs) conceptions in Scotland are amongst the highest in Western Europe. Young women living in the most disadvantaged communities are more likely to become pregnant than their counterparts in more affluent areas. Poor sexual health is commonly associated with poverty and social exclusion.
National Strategy
Promoting positive sexual health is therefore a major public health challenge. In recognition of these concerns, Respect and Responsibility: a Strategy and Action Plan for Improving Sexual Health was published by the Scottish Executive in 2005.
Grampian Strategy
Improving Sexual Health In Grampian - an inter-agency strategy has been developed on a multi-agency basis with the aim of improving the sexual health and well being of the Grampian population and reducing inequalities in sexual health. The strategy informs planning and budgetary decisions in relation to sexual health education & prevention, screening & testing, and treatment provision throughout Grampian, mirroring the national strategy.