1. Sexual Health in South Tyneside Paula Phillips Public Health Strategic Manager

2. Aims of today’s session To provide select committee with an update on the sexual health review Implementation of recommendations Timeline for the competitive tender

3. 2014 : South Tyneside’s Sexual Health Needs Assessment (HNA) key findings: The burden of STIs within the North East remains high In 2013 South Tyneside ranked 62 (out of 326 local authorities; first in the rank has the highest rates of STIs). Chlamydia remains the most common STI Teenage pregnancy has reduced in under 18s, but under 16s has seen an increase 5,700 South Tyneside residents accessed the STFT sexual health service 21,900 separate attendances Highest rates of access 15-24 age group 5 new HIV diagnoses in South Tyneside GUM in 2013

4. Issues identified through the needs assessment: 1.Gaps in access to sexual health services in areas of deprivation 2.Low uptake of services by men who have sex with men (MSM) and some other key vulnerable groups 3.GUM (genitourinary medicine) services should focus on complex cases only, but currently they are dealing with less complex ones too. 4.Primary Care (GP/Pharmacy) provision needs be improved to deal with less complex cases 5.Low access from the ‘older’ younger population aged 20-24 for Chlamydia screening. 6.Need to improve the uptake of LARC in primary care

5. What People told us – Barriers to access

6. Select Committee Recommendations The services locally need to be commissioned against national specification and outcomes for an integrated service. This will include Level 3 Genitourinary medicine service. A clear vision of sexual health service provision should be developed within South Tyneside Services to be advertised both to the general public and practitioners, particularly the hard to reach groups. Targeted awareness-raising to be provided across the life course but particularly in at risk groups such as men who have sex with men, black and ethnic minority groups, and young people. Build on progress in reducing teenage pregnancy by increasing the proportion of Long Acting Reversible Contraception used While accepting the need for discretion within these services and hence the open access nature of the provision, we need to find out more detail of why people are travelling outside of the borough for services, encourage treatment closer where possible, and increase the accessibility of local services

7. Contd. To explore and simplify current pathways with consideration given to collaborative commissioning arrangements across the Sexual Health system. This would enable efficiencies in specific areas of care that could be reinvested elsewhere within the sexual health system HIV support to be aligned within sexual health services Providers to increase training for pharmacies with regard to emergency hormonal contraception, condom provision, and sign-posting to services, and in conjunction with the chlamydia screening service, provide training to increase chlamydia and gonorrhea screening uptake. Incorporate key wider determinants of health into sexual health consultations such as brief alcohol or drug interventions and sign-posting to services as needed Continued support for the training and development of staff who work within the sexual health services and for those who carry out education and provide access to sexual health services

8. Implementing the recommendations In order to effectively incorporate the recommendations a decision was made to tender for a new integrated sexual health service. This would allow a new model of sexual health services in South Tyneside to be implemented. The tender exercise would also allow cost savings to be applied in the new model by creating efficiencies in service delivery. The new model will ensure sexual health services are in place which meet the current and future needs of our population.

9. Redesigning an integrated sexual health service for South Tyneside There must be a greater emphasis on prevention in the new model GPs and Pharmacies to provide more Sexual Health services in primary care Stronger links between services, including voluntary sector organisations, schools and NHS commissioned services. Will also provide the opportunity to test: New approaches to providing quality services in a different way Different location of services Better use of information about people’s experience to improve their overall care

10. What do we have to commission? Mandatory Mandatory services prevent and treat sexually transmitted diseases and provide sexual and reproductive health services- predominantly contraception- these are open access. Three specific sexual health outcomes in the Public Health Outcomes Framework: –Proportion of persons presenting with HIV at a late stage of infection –Under 18 conception rate –Chlamydia diagnosis rates per 100,000 young adults aged 15-24

11. Commissioning Scope In scope Genitourinary Medicine (GUM) services: Investigation, diagnosis, treatment, screening and testing for sexually transmitted infections (STIs). Reproductive sexual health - RSH (formerly family planning): All methods of contraception. Targeted sexual health promotion. Out of scope Abortion, vasectomy and sterilisation services – CCGs HIV treatment and care services - NHS England Sexual Assault Referral Centres (SARCs) - NHS England Sexual Health services as part of GP core contract – NHS England Sex and relationship education in schools - Schools

12. Local Authority Commissioner Sexual Health Service Specialist Hub LEVEL 3 Focus on delivering complex level 3 services Psychosocial counselling Training wider workforce to deliver Levels 0-2 Quality Assure Level 0-2 Outreach Focussed in areas of greatest sexual ill health Specialist service for at risk groups. Level 2 Long Acting Reversible Contraception Chlamydia Screening Programme C-Card STI and HIV testing Level 1 Emergency Hormonal Contraception C-Card Chlamydia Screening Programme Pregnancy testing Laboratory Chlamydia Screening Programme (dual test – Chlamydia & Gonorrhoea) Level 0 – Prevention and self-care Online Sexual Health Support Resource You’re Welcome You’re Welcome You’re Welcome Contract & Specification Sub-contract with Specification Sub-contract with Specification and PGD Sub-contract with Specification Non – contracted Provide resources and equipment to relevant organisations Provide training and support to services Sub-contract with specification Hub and Spoke Model

13. Tender Timeline – Open Tender Process Consultation on Service Model Nov – Dec 15 Out to Tender w/c 21 Dec 15 – Feb 16 Tender Evaluation Feb 16 Select Winning Tenderer Feb 16 Cabinet Approval March 16 Contract Award April 16 Service Transition April – June 16 Contract Start July 16