1. Sexual and Reproductive Health in Wirral Wednesday 2nd March 2016 Julie Webster: Head of Service & Consultant in PH juliewebster@wirral.gov.uk Deborah Williams: PH Manager deborahwilliams@wirral.gov.uk

2. Agenda Discuss the further development of our integrated sexual health service To present the findings of the sexual health needs assessment undertaken in 2015 Look at the opportunities and challenges with regard to the further development of integrated sexual health services

3. Principles We want to set the tone for the morning with these principles: We are open to ideas We welcome challenge We want to have an open conversation with you We’d like to hear examples of good practice and market innovation We will share our thinking as best we can, but we may not have definitive answers with you at this early stage of the process

4. Our values Prevention is better than cure A culture of positivity about sexual health De-stigmatisation and normalisation of sexual health services A reflexive approach centred around service user feedback Recognition of the interrelationship between sexual health and wider wellbeing

5. Aims and Objectives Aim Our aim is to improve the sexual health of the population of Wirral by ensuring high quality prevention through an integrated system to reduce the consequences of sexual ill health Objectives To meet the sexual health needs of the people of Wirral through Making every contact count Increasing prevention and self managed care Improving the broader wellbeing of service users Reducing demand for specialist and termination services

6. Improve the sexual health of the whole population -Reduce inequalities and improve sexual health outcomes -Build an open and honest culture where everyone is able to make informed and responsible choices about relationships and sex -Recognise that sexual ill health can affect all parts of society, often when it is least expected Build knowledge and resilience among young people Rapid access to high quality services People remain healthy as they age Prioritise prevention Reduce rates of STIs among people of all ages Reduce onward transmission of HIV and avoidable deaths from it Reduce unintended pregnancies among all women of fertile age Continue to reduce the rate of under 16 and under 18 conceptions A Framework for Sexual Health Improvement in England DH, 2013, P10

8. What does the data tell us?

9. Wirral Population Pyramid, 2011

11. Population aged 18-30 by ward

12. Proportion of new STIs by age group and gender in Wirral:2014

13. Rates of new STIs and deprivation by LSOA in Wirral (GU diagnoses only): 2014

14. Prevalence of HIV aged 15-59 (per 1,000 pop.) by MSOA:2014

15. Rate of new HIV diagnosis per 100,000 population among people aged 15 or above in Wirral compared to rates in areas of NWPHEC and England:2014

16. <18 conception rates per 1000 females aged 15-17 years 1998-2013

17. Proportion of LARC, injectable and UDM prescribed by age group among residents of Wirral and England

18. Current Wirral Council commission Integrated level 1-3 sexual and reproductive health service: 5 community based clinics HIV prevention and Point of Care testing service: community base, outreach and in-reach HIV+ non-clinical therapeutic care service: community base and outreach Free emergency contraception in pharmacy service HIV self sampling by post 0-19 drop-in health services in Wirral secondary schools

19. Sexual Health Needs Assessment

20. Voices.. ‘ This is what we do, it’s normal..up for a shag, had a skinful, a good night and up for it.’ ‘.. yeah a spliff, a few drinks,- warms things up.’ ‘The clinic gets me sorted.’ ‘ My brother’s girlfriend got pregnant on the injection and the implant.’ ‘ I got the rod put in and me an’ me mum were play- fighting and it snapped. So I had to get it taken out.’ ‘It’s our parents and carers who need help.’

21. …voices ‘ So they ( SRH service users) take it for granted – that we will sort them out, and we do.’ ‘Is there any sex education in schools any more? ( Laughs) ‘..Of course nobody has sex in Wirral, that’s part of the problem- there is a reluctance…or is it time……to discuss SH as part of wellbeing, lifestyle and strategy, …there are other overwhelming priorities across the system.’ ‘We get it, our women get it, you know, how important knowledge about contraception is, but it takes time to build trust.’ ‘It’s not joined up though we all know each other, it could be so much better, but people are protective of their patch aren’t they?’ ‘ The voluntary sector wants this (staff training for SH)–we can work together to deliver information and support to our clients-we have safe spaces and are trusted.’

22. Key findings People who attend any sexual health service receive a friendly and non- judgemental welcome and are made to feel at ease The current PH commissioned services are accessible, valued and responsive to the public Poor sexual health co-occurs with other disadvantages or vulnerabilities at individual and community level –there is SH inequality Voluntary sector clear articulation of an unmet need for psycho-social- sexual pathways for populations with vulnerabilities Disempowerment and passivity are common but not inevitable However a huge appetite for better information (SRE for grown-ups) and delivered in new and traditional formats Outcomes to improve: HIV late diagnosis; <18 conceptions and repeat ToP (indicative of under-developed contraception pathways) Data demonstrates increasing demand on services, and increases in risk- behaviours including the new and novel Need to understand the use of technology better

23. Planning for the future

25. Outcomes 1 A reduction in unintended pregnancies in all ages as evidenced by: Under 18 conceptions Abortion rates (including reduced numbers of repeat abortions) Increased use of effective, good quality contraception, including increase and retention of IUD/Implant/IUS uptake in the most vulnerable groups

26. Outcomes 2 Early diagnosis and effective management of STIs as evidenced by: A reduction in late diagnoses of HIV An increase in Chlamydia diagnoses in 15-24 yr olds Better access to services for all, especially high risk and vulnerable communities Reduced inequalities amongst high risk and vulnerable communities Lower rates of transmission

27. Outcomes 3 A reduction in sexual risk taking behaviours, especially amongst high risk and vulnerable communities as evidenced by: A high level of age appropriate knowledge about sexual health and relationships Good understanding about access to and availability of services Referral and support for wider health and wellbeing needs Improved support for people vulnerable to, and victims of sexual coercion, violence and exploitation

28. Our aspirations Improving knowledge of contraception choices for both women and men Making every contact count is critical in a system of reduced capacity and increasing need Attendance at a clinic is ‘last resort’ not default destination Seamless service provision – people pathways have a clear interface with clinical pathways –junction boxes (hubs?) offer improved patient experience and appropriate choice Improved opportunities to address the wider determinants through collaborative working Improved clinical outcomes Digital offer

29. Group work What are the opportunities and challenges for delivering our aspirations? What innovations do you envisage over the next five years that will impact on the delivery of sexual health services? Which services can we safely offer out of a clinic setting? Should we be offering an all age service or split adult and young people provision?

30. Next Steps Feedback via The CHEST Ongoing discussion about our future plans