Agenda item

The Director of Public Health submits a briefing report on Sexual Health Services and HIV Prevention: Service Review.

The Director of Public Health submitted a report providing an overview of the City Council’s Sexual Health services together with a summary analysis of the local need for these services.

A spending review of these services was currently underway with proposals being considered by the Executive this summer. A further report would be submitted to the Commission later in the year following public consultation on the review.

It was noted that:-

a)         Leicester had a higher than average level of under 18 year old conceptions.  The City had a larger proportion of under 18 year olds in the population than the average and there were also high levels of deprivation.

b)         There were more health needs in the west than the east of city and services needed to reflect the needs of the population.  The population in the east of the City preferred to have services provided in central clinics rather than in their own local area.

c)         Leicester had the 5th highest level of HIV outside of London and there are high rates of late diagnosis of HIV.  This resulted in poorer outcomes for patients.  If HIV is diagnosed and treated early there are good life expectancy outcomes for patients.  Ethnic minority populations are more at risk, men having sex with men and those working in the sex industry.

d)         Outreach services were available for each risk area and there was an open access to sexual health services.  Individuals could go anywhere in country for treatment to avoid stigma and the cost would be recharged to the patient’s own area.

e)         The budget for sexual health services had been reduced and the challenge was now to provide services at a suitable level to meet the needs within the available budget.  Providing services digitally or on line were being investigated.

f)          The current service contract ends on 31 December 2018 and the tender process for the new service start at the end of 2017 to enable the new service to be in place by 1 January 2019.

g)         The use of text alerts had been used for many years to advise individuals of negative test results but these did not replace the need to make an appointment where the test was positive and there was a need for a doctor to discuss the result the patient and to discuss their sexual behaviour and the effects if can have on their partners.  It was planned to increase the use of text and e-mails in the future and also increase the use of apps to make access more accessible to young people. Useof texts and e-mails were considered to be more convenient for patients and a more efficient use of staff time.

h)        It was also proposed to enable individuals to requesting testing kits for STIs and HIV on line.  The test kit would then be delivered to the individual’s home for them to take a self-assessment test and return the kit for analysis.  The provision of vending machines to dispense test kits in Universities was also under consideration.

Following questions the following response were received:-

a)         The service also provided training for a wide range of staff from school nurses to teachers and schools who needed a basic level of training to carry out Relationship and Sex Education in schools and colleges.  Not all schools had taken advantage of this training and the service was currently working with 10 schools and 2 colleges.  Officers have raised the issue of providing the service toall 19 schools, as the new Children’s Act would make it mandatory for Relationship and Sex Education (RSE) to be provided in schools.  There were also similar issue of access to schools for flu and other public health initiatives.

b)         The service commissioned Long Acting Reversible Contraception (LARC) from both GPs and from centralise services.  There was a mixed take up of GPs offering this service, partly due to the aging population of GPs and some of the younger GPs not been training in providing the service.  Officers had visited GPs to see how the provision of this service could be increased and how the core competency of undertaking 15 procedures per year could be achieved and maintained.  The dual approach to providing the service both in GP practices and in a central service was based upon preferences express by patients.  There were still issues of how GPs were paid for delivering these services, access to the service and the training of staff to provide them, which were all being addressed.  The possibility of a GP referring a patient to another GP in the locality that offered the service was also being considered.

c)         The provision of cervical screening was the responsibility of NHS England and officers had been working for some time to have this service reinstated in St Peter’s Health Centre.  This had been successful and the service would recommence in the next two months.  The Deputy City Mayor commented that St Peter’s Health Centre was no longer the most suitable location for the service and he looking to re-locate it to a city centre location where to would be more accessible and more affordable for the future budget provision.

d)         On-line services would still offer a triage system and if the person triggered certain criterion they would be asked to make an appointment come to see a health professional.

e)         The service provided 3 male sauna clinics in the city and a clinic at Trade for the LGBT community.  More work would be undertaken with this community in the future and the service was available for both men and women.

f)          Appropriate counselling for sexual health issues which were related to a patient’s mental health were also available.

Members felt that:-

a)         Given the higher use of condoms in City and the high use of Emergency Hormonal Contraception from pharmacies it would be preferable to promote the use of LARC.

b)         The Commission should write to the Strategic Director of Education and Children Services to encourage schools to take up the sexual Health services offer of RSE in schools and well as the other public health initiatives.  It was noted that some schools currently found it difficult to encompass Relationship and Sex Education with the curriculum, but they would need to do so in the future.  It was also suggested that it would also be helpful for Public Health England to raise the issue with Ofsted.

c)         The service should also allow sufficient provision for the older persons’ cohort as well.

AGREED:

1.         That the report be noted and that a further report be submitted to the Commission at the end of the consultation period.

2.         That the Strategic Director of Education and Children’s Services be informed of the Commission’s concerns for the take up of training for Relationship and Sex Education in all schools and that the Commission write to Public Health England suggesting they raise the issue with Ofsted.