Sexual Health in London- achievements and challenges Hong Tan London Sexual Health Programme London Sexual Health Forum 26 November 2010 Hong Tan London Sexual Health Programme London Sexual Health Forum 26 November 2010

London Sexual Health Programme Pan London Procurement Chlamydia Screening Strategic Network London Contraception and Abortion Group Commissioning Network 2012 Planning Group GOL - Teen Pregnancy London Sexual Health forum Pan London HIV Prevention Group Sexual Health Network Subgroups London Sexual Health Commissioning Board- Leading and Strengthening Sexual Health Commissioning in London PCT Directors of Commissioning / SACU MDs London Specialized Commissioning Groups Lead PCT Chief Executive London PCT CEs Group London Sexual Health Commissioning Board London Sexual Health Promotion Framework London Sexual Health Programme. 16th Floor, Portland House, Stag Place. London, SW1E 5RS. London Havens Strategic Board London Sexual Health Strategic Framework FESHproNET Tariffs

1. Structure Context Successes Challenges Future

2. Context Sexual Health remains a Public Health priority for London: Best Performance: Improvements in reducing teenage conceptions- rate of under 18 conceptions fell by 10.0% Q Q Highest increase in primary care LARC uptake Highest performance in Chlamydia screening Services test and diagnose most people with HIV But still more to do: London has the highest rates of sexual ill- health in England:  2 in 5 diagnoses of HIV, infectious syphilis and gonorrhoea  1 in 5 of genital Chlamydia and genital warts  1 in 4 of genital herpes  over 2 in 5 living with diagnosed HIV  over 2 in 5 of people newly diagnosed with HIV  1 in 4 abortion, 1 in 3 under-25 repeat abortion  1 in 7 teenage pregnancy, LB highest TP rate,

2. Context (2) Sexual Health = QIPP= IN YEAR SAVINGS= OPEN ACCESS TO TREATMENT AS PREVENTION In unintended pregnancies cost NHS London £105m £1 in contraception = £11 savings in NHS costs All 9% choose LARC: = c£106m savings ∙ c99k unintended pregnancies avoided ∙c56k abortions avoided ∙c18k repeat abortions avoided All 9% use oral contraceptives: = c£94m savings ∙ c90k unintended pregnancies avoided ∙c51k abortions avoided ∙c17k repeat abortions avoided All 9% use condoms: = c£93m savings ∙ c82k unintended pregnancies avoided ∙c46k abortions avoided ∙c15k repeat abortions avoided

2. Context (3) Sexual Health = QIPP: Reducing late diagnosis of HIV- Prevention pathway Preventing onward Transmission

2. Context (4) Se xual Health = QIPP: Reducing late diagnosis of HIV- Prevention pathway Late diagnosis of HIV = 15 X costs of earlier diagnosis: In , London HIV inpatient costs of c£8m v £0.5m = 7.5m costs avoided = Drug costs for 1070 people with HIV Sexual Health = Public Health, saves lives AND money:  4.5p condom vs £320,000 life time Antiretroviral drug costs Savings can be made in-year: eg TP and abortion rates

3. Achievements- Pioneering Partnerships Implementing London's Sexual Health Strategic Framework: Vision to improve Sexual Health with integrated Sexual Health services: FIRSTS Clinicians, service managers, commissioners, BASHH, Faculty of SRH- Sexual and Reproductive Health Tariffs- costed on 143 best practice care pathways NHS London, PCTs, SRH, GUM, Contraception, Primary care leads- Prevention Framework-> Performance Improvement with a focus on LARC, EC and to reduce repeat abortion Patient advocates, Network, GUM, SRH, Abortion leads, commissioners- Tools for Patient and Public Engagement in Sexual and Reproductive Health London Councils, GLA, Voluntary/Third Sector, Network, Commissioning leads- Olympic and Paralympic Games: Improved Sexual Health Legacy- Annual Forum

3. Achievements- Pioneering Partnerships (2) FIRSTS Metropolitan Police, NHS, Crown Prosecution Service, GLA- Tenth anniversary of the Havens- launch of Have you crossed the line online video-> 100,000 views per day, average age is 23 years old Young people, FE colleges, GLA, NHS, Education, Social services- Further Education Sexual and Reproductive Health Network Young People, Teenage pregnancy, NHS/LA leads- C-card scheme for London Primary Care including General Practice, Voluntary/Third Sector, NHS- London LARC Network Commissioners, Network, NHS leads- Sexual Health Commissioning Network- Tools, Templates, PGDs

4. Challenges- Strengthen Pioneering Partnerships Liberating the NHS, Revised operating framework for NHS- prioritised tariffs, localism, QIPP, New commissioning structures (GP commissioning consortia, Public Health Service, NHS Commissioning Board) Public Health White paper Social Care White paper Others- Policies into the 21 st Century

The London Sexual Health Programme Liberating the NHS: The new Organagram

5. Priorities for London Sexual Health Programme in Strengthening sexual and reproductive health commissioning: Commissioning integrated STI and contraception tariffs Specialist Commissioning of the Havens Supporting Transition into new commissioning structures London framework for abortion services 2. Strengthening LARC, EC access to reduce repeat abortion recruitment of GP champion to improve knowledge signpost to training for doctors and nurses within primary care 3. Pilot programme/s for 2012 Olympic and Paralympics Games

6. Future Sexual Health needs will remain and rise Sexual Health as QIPP- needed more than ever London - pioneering partnerships Seize opportunities, Shape change- " until the lights are switched off" We must make a difference

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