Welcome
19 April 2018 (Issue 46)
Welcome to the April issue of the Sexual Health & HIV Policy eBulletin. As many loyal readers will know, this eBulletin was first launched in 2012 as a short-term resource to keep those working locally up to date with key policy developments that followed changes introduced by the Health and Social Care (HSC) Act and to provide regular national and local stakeholder perspectives on the impact of these changes. Six years on, the sexual and reproductive health (SRH) sector continues to grapple with the consequences of such radical change alongside increasing service demands and ongoing funding pressures. Earlier this week, key national SRH and public health stakeholders, sent an open letter to Jeremy Hunt, Secretary of State for Health & Social Care, calling for a strengthened SRH mandate at local authority level and enhanced accountability mechanisms to ensure public health regulations, made under the HSC Act in 2012, work more effectively now and in the future.
The eFeature this month covers the detail of the letter to Jeremy Hunt, but other items to look out for in the round-up include: the recent BMA report showing that sexual and reproductive health services have been amongst the worst-hit by cuts to public health funding; the new Prioritisation Framework tool from Public Health England (PHE) to support evidenced-based spending decisions across public health programmes; the new NHS England commissioning advice and training standards for healthcare professionals for Female Genital Mutilation (FGM); the Invisible No Longer report from the Sophia Forum and THT on what action is needed to ensure women living with HIV are no longer left behind in the progress made around HIV and the ground-breaking news that Ealing Council is to introduce the first UK ‘safe’ zone around one of its local abortion clinics from the end of this month.
Finally, the intention of the eBulletin has always been to cover the whole system of sexual health, reproductive health and HIV, bringing together various professional interests to help to promote further integration and build consensus. So, to that end, we are delighted to announce that a coalition of key national organisations, professional bodies and charities working in this sector have joined forces with the Faculty of Sexual and Reproductive Healthcare (FSRH) to formally support the eBulletin. The coalition – currently comprising of FSRH, British Association for Sexual Health & HIV (BASHH), British Medical Journal (BMJ), Faculty of Public Health (FPH), Family Planning Association (FPA), Brook, National AIDS Trust (NAT), Terrence Higgins Trust (THT), NAM aidsmap and the Sex Education Forum (SEF) – will work together to ensure the eBulletin not only remains a ‘go-to’ source of reliable policy information, but also continues to give a voice to those working in the sector.
Please forward the eBulletin to colleagues and networks who may find it useful and may want to subscribe to it on a regular basis
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eFeature
The Government’s call for evidence on the impact of current regulations for local authority public health activity closed on 17 April 2018. Key SRH and public health stakeholders, including FSRH, BASHH, BHIVA, FPH, NAT, THT, FPA and Brook, have joined forces to highlight the challenges in the current system and to put forward a series of recommendations. This includes a call for a strengthened SRH mandate at local authority level and enhanced accountability mechanisms to ensure public health regulations, made under the HSC Act in 2012, work more effectively now and in the future. Click the eFeature link to see the open letter to Jeremy Hunt.
>A joint call for a strengthened SRH mandate
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Policy development and guidance
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Feeling the squeeze: The local impact of cuts to public health budgets in England
This recent report from the BMA highlights the impact that public health funding changes are having on the ability to deliver services locally as well as the potential consequences of reduced service provision on the health of local populations. It looks at areas that have been particularly affected, including sexual and reproductive health services. The report makes a series of recommendations and calls on government to look urgently at funding levels and future protections for public health budgets.
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Financial sustainability of local authorities 2018
This report from the National Audit Office (NAO) finds that local authorities are struggling to juggle higher demands and cost pressures against central government funding cuts of 49% since 2010-11. It points to the uncertainty over future funding and calls on the Government to address growing funding gaps facing local services.
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PHE Annual Business Plan 2018-19
PHE has recently published its annual business plan for 2018/19, describing where it will concentrate efforts over the next year. The areas of focus for sexual and reproductive health will be to support the commissioning and delivery of services, helping delivery organisations reduce the variation in outcomes for reproductive, STIs and HIV services across England and to support NHS England in their PrEP Impact Trial.
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New Prioritisation Framework
PHE has published a Prioritisation Framework to support local authorities in making transparent, evidence-based spending decisions across public health programmes. The framework can be used to build consensus so when investment decisions are made, they are based on a clear set of criteria.
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SRH workforce challenges and solutions
FSRH has outlined the main issues affecting the sexual and reproductive health (SRH) workforce as part of its response to Health Education England’s (HEE) consultation on Facing the Facts, Shaping the Future: a draft health and care workforce strategy for England to 2027. Its response covers the need for fully funded Community Sexual and Reproductive Healthcare (CSRH) training posts and consultant posts as well as training for health professionals in Primary Care. FSRH has also issued a joint statement with leaders from eight Royal Colleges and Faculties outlining priority areas for the government and its partners to consider in finalising the new strategy.
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Review into NHS Overseas Visitor Charges: call for submissions
The Department for Health & Social Care (DHSC) is reviewing the impact of changes to regulations on recovering the cost of health treatments provided to overseas visitors. As part of this, it is now seeking submissions of evidence on the impact of the new regulations on vulnerable groups and how any negative effects that are identified can be addressed. Evidence submissions will be accepted until 1 June 2018.
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Strategic direction for sexual assault and abuse services (2018-2023)
This document from NHS England sets out the strategic direction and shared vision for sexual assault and abuse services. It focuses on six core priorities for delivery across England, including strengthening prevention, reducing fragmentation and introducing consistent quality standards.
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Ealing Council introduces first UK safe zone outside local abortion clinic
Ealing Council has recently agreed to implement a Public Spaces Protection Order (PSPO) around a local abortion clinic to protect those women attending the clinic from facing harassment and intimidation from anti-choice protesters. This follows a recent public local consultation and engagement exercise. The PSPO will come into force by the 23 April. It is the first time such a measure is being used in relation to anti-choice activity in the UK. Similar proposals are under consideration in other local councils and a nationwide government review is underway.
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HPV vaccination programme for MSM
On 5 April PHE published clinical and operational guidance to facilitate the safe and effective delivery of the national human papillomavirus (HPV) vaccination programme for men who have sex with men (MSM). The aim of the programme is to extend protection against HPV infection, HPV associated cancers and genital warts to the MSM population up to and including the age of 45 years through opportunistic vaccination at Specialist Sexual Health Services (SSHS) and HIV clinics. New promotional materials are also available.
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First UK case of multi-drug resistant gonorrhoea
PHE is currently investigating a UK case of gonorrhoea which was acquired abroad and is resistant to the first line treatment of azithromycin and ceftriaxone. This is the first time a case has displayed such high-level resistance to both of these drugs and to most other commonly used antibiotics. PHE has formed an incident management team to coordinate the ongoing investigation and to help contain the spread.
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A Review of Sexual Health in Wales
This report from Public Health Wales provides an overview of sexual health service provision across Wales and makes a series of recommendations for Health Boards, including addressing current inequities in service provision, improving services to vulnerable groups and extending the role of primary care and pharmacies in sexual health provision.
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Memorandum of Understanding (MOU) on data-sharing between NHS Digital and the Home Office
On 15 April the Health & Social Care (HSC) Committee released its report into the Memorandum of Understanding (MOU) on data-sharing between the Home Office and NHS Digital in support of immigration enforcement work. The report raises serious concerns about NHS Digital’s ability to protect patient data and repeats the call for data-sharing arrangements to cease pending a fuller review. In February NHS Digital confirmed its intention to continue with the MOU arrangement despite earlier challenges from the HSC Committee and key public health and sexual health organisations. PHE is currently seeking further evidence on the impact of the data-sharing arrangements on the health and health-care seeking behaviour of migrant populations (see the evidence section for more details).
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Call for full abortion access in Northern Ireland
An open letter signed by 135 MPs and Peers has been sent to Amber Rudd, Minister for Women and Equalities, urging her to legislate for equal access to abortion for all citizens in Northern Ireland. The letter, coordinated by Stella Creasy MP, comes after a recent report by the UN’s Committee on the Elimination of Discrimination against Women (CEDAW) declared that the current abortion law in Northern Ireland constituted a grave violation of women’s rights. A group of abortion care providers and campaigners - including FPA, BPAS and Marie Stopes UK – have also called on government to take action.
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Home use of misoprostol
The Women’s Equality Party (WEP) has launched a campaign to call on government to allow the home use of misoprostol for medical abortions in the early stages of pregnancy. Scotland already allows home use of misoprostol and the Welsh government has made recent signs that it will push ahead with plans to enable home use in Wales. Home use of misoprostol is standard practice in most countries where early medical abortion is available, and it is recommended by the World Health Organisation as a safe option for women.
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WHO DECIDES? Abortion in the developing world and the UK
This report was recently published by the UK All-Party Parliamentary Group on Population, Development and Reproductive Health. It covers a wide range of topics including abortion law reform, safe abortion care and future developments. It makes a series of recommendations on action the UK can take both domestically and internationally to support change in other countries.
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Inquiry into sexual harassment of women and girls in public places
The Women and Equalities Committee is preparing for oral evidence sessions as part of its inquiry into sexual harassment of women and girls in public places. A national survey published by YouGov in 2016 revealed that 85% of women aged 18–24 had experienced unwanted sexual attention in public places and 45% have experienced unwanted sexual touching. Written evidence from interested parties has already been submitted.
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Inquiry into the impact of social media and screen-use on young people’s health
The Science and Technology Committee has launched an inquiry into the impact of social media and screen-use on young people’s health. The deadline for written submissions was 6 April but later submissions will be accepted. The first oral evidence hearing is yet to be announced.
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Service standards & guidelines
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Commissioning services to meet the needs of women and girls with FGM
NHS England has published a set of ten recommendations to ensure commissioners provide services in their area which best meet the needs of women and girls who have had female genital mutilation (FGM) and safeguard those at risk. The top ten recommendations include each organisation having a nominated FGM lead and suitably trained workforce. New standards for training healthcare professionals in this area have also been published (see below).
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FGM: Standards for training healthcare professionals
These training standards from NHS England build on the existing safeguarding curriculum and identify what skills and competences are required by healthcare professionals in relation to FGM.
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High level guidance to support a shared view of quality in general practice
The 11 national organisations who together are responsible for the regulation and oversight of general practice in England have published a joint view of the principles that define quality in general practice. The principles set out a common vision of the compassionate and patient-centred care all general practices should provide and that all patients, including those seeking sexual and reproductive health care, are entitled to expect.
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The Standards for employers of public health teams in England
These new Standards from the Local Government Association (LGA) are designed to help ensure the public health workforce is fit to practice and to enable and sustain high quality public health outcomes for the local population and communities. They are relevant to employers and workers with a role in the commissioning or delivery of public health functions.
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Public health nursing workforce: guidance for employers
This guidance has been developed by PHE in partnership with the LGA and other stakeholders. It is for all employers of health visiting and school nursing teams to help support recruitment and retention of health visitors and school nurses, to sustain the quality and consistency of local services. It should be read in conjunction with the Standards for Employers of Public Health Teams in England (above).
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Service Standards for Medicines Management in SRH Services
The FSRH Clinical Standards Committee is consulting on an updated version of the Service Standards for Medicines Management in Sexual and Reproductive Health (SRH) Services. The consultation is open until 10 May 2018.
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New guidance on heavy menstrual bleeding
The National Institute of Health & Care Excellence (NICE) has recently updated its guidance on heavy menstrual bleeding. The update makes new recommendations for diagnosing and treating the condition, which is estimated to affect around a quarter of women of reproductive age. The heavy menstrual bleeding quality standard has also been amended to align with the updated clinical guideline.
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‘Quick’ guide for children and young people who have experienced abuse
NICE has published a new ‘Quick’ guide, written by young people who have all experienced abuse or neglect, to help those with similar experiences understand what support they can expect and are entitled to. Practitioners are encouraged to share it with the young people come into contact with.
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Evidence, data & research
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Conceptions in England 2016
Annual 2016 conception data released on 27 March by the Office for National Statistics (ONS) show that in England 18.8 per 1,000 young women under-18 became pregnant, a reduction of 9.6% from 2015, with numbers dropping from 19,080 to 17,014. The rate of under-16s conceptions has fallen by 18.9% with numbers down from 3,261 to 2,646. Both rates are at the lowest level since records began, with conception rates among under 18s now 59.7% lower than in 1998, the baseline year of the Teenage Pregnancy Strategy. All top tier local authorities have seen declines since 1998, but with significant differences in progress and rates between areas. Reductions range from 38% to over 70% and there is an almost 6-fold variation in the rate between local authorities. Further details on progress by local areas between 1998 and 2016 is available from the Teenage Pregnancy Knowledge Exchange (TPKE).
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PHE call for evidence: public health impact of data-sharing between NHS Digital and Home Office
PHE is continuing to seek evidence on the public health impact of data-sharing arrangements under the memorandum of understanding (MOU) between NHS Digital and the Home Office on the health and healthcare seeking behaviour of migrant populations. The deadline for evidence submissions is 30 April 2018. See the related item in the policy section above.
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National HIV self-sampling service: two-year service report
This report from PHE shares data and learning from the national HIV self-sampling service, summarising who is using the service, the proportions of people testing positive and the costs of the service. It concludes that the national self-sampling service continues to be successful at engaging most at-risk populations for HIV acquisition including those who have never tested for HIV before and that the service offers a low-cost HIV testing service that can complement current service provision to key populations.
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New national standards on public involvement in research
The National Institute of Health Research (NIHR) together with other UK partners have published a set of national standards designed to improve the quality and consistency of public involvement in research.
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Reports & other resources
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Commissioning local HIV sexual and reproductive health services
PHE has updated the tools and resources available to commissioners of HIV, sexual and reproductive health services to help plan and commission regional and local services.
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Economic case for investing in public health
This PHE blog considers the question of whether public health interventions are cost-saving and points to the available tools setting out the economic evidence that exists in in relation to different areas of the public health grant, including sexual health.
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Public health transformation five years on
This report from the LGA uses a series of case studies to illustrate the ways in which public health is transforming since moving to local government in 2013. It includes local examples of sexual health service recommissioning as well as the growing use of technology as part of sexual health service provision.
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Commissioner perspectives on working with the VCSE sector
This King’s Fund report, commissioned by DHSC, explores how and why clinical commissioning groups (CCGs) and local authorities chose to engage with the voluntary, community and social enterprise (VCSE) sector. Commissioners’ perceptions of their own strategic role as well as their views on what role the VCSE sector plays in the local area appear to exert a strong influence on commissioning decisions.
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Women and HIV: Invisible No Longer
Invisible No Longer is a joint report from the Sophia Forum and THT. It provides a comprehensive overview of the situation for women in the UK living with or vulnerable to acquiring HIV and makes a series of recommendations for action in the areas of HIV prevention, care, support, research and data.
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Women with medical complexities and abortion care
BPAS has published a briefing on women with medical complexities and abortion care. The briefing is based on 2,900 women whom BPAS helped to find abortion care during 2016 and 2017. Key points include the need for a nationwide pathway to ensure access to abortion services for women with medical complexities and the availability of high quality specialist contraceptive services to help them avoid and plan pregnancy.
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Talk to Us leaflets
The Royal College of General Practitioners (RCGP) has produced two new leaflets – one for young people and the other for parents and carers. The leaflets explain that young people can come to the GP on their own, or with a friend, and that the GP will keep that information confidential, similar to any other patient. Both leaflets are free to download and there is space for practice details.
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LGBT ABC Handout
Brook has produced a new handout to support LGBT-inclusive relationships and sex education (RSE) lessons. It is free to download from the Brook website.
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Member survey on decriminalisation of abortion
The Royal College of Nursing (RCN) has undertaken a UK-wide survey of its members on the principle of removing criminal sanctions from termination of pregnancy (decriminalisation of abortion). The RCN does not currently have a position on this and it is envisaged that the results of the all-member survey will inform a future position statement on this issue.
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It Starts with Me campaign briefing
The spring phase of the It Starts with Me campaign from HIV Prevention England (HPE) was launched on 16 April 2018. The campaign provides targeted HIV health promotion to MSM and black African people, the two groups that continue to be disproportionately affected by HIV in England. The focus on this phase of the campaign will be on the impact of HIV medication on prevention.
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Me.Him.Us. campaign
GMFA , a charity dedicated to gay men’s health, has recently launched a new campaign created by Black, Asian and Minority Ethnic (BAME) gay and bisexual men. The aim of the campaign is to increase testing among BAME gay and bisexual men but also to increase representation of BAME gay and bisexual men in public health campaigns. The new posters will appear on high streets in South London as well as LGBT+ venues across the capital and online.
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2018 BMA MEDFASH prize
A reminder that the 2018 BMA MEDFASH prize for improving the quality of HIV and/ or sexual healthcare is still open for applications. The £1,000 prize is open to any health or social care professional or organisation actively involved in the delivery of HIV and/ or sexual healthcare in the UK. Applicants do not have to be a doctor or BMA member to apply. The deadline for applications is 8 June 2018.
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Conference news
The 25th Conference on Retroviruses and Opportunistic Infections (CROI) was held in Boston, USA, from 4 to 7 March 2018. NAM aidsmap reported from the conference, published news online and sent out conference news summary bulletins. All of NAM aidsmap’s news stories and bulletins can be found on its CROI 2018 webpages.
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The Sexual Health & HIV Policy eBulletin was originally developed and published by MEDFASH.
It continues to be compiled and edited by Helen Christophers on behalf of FSRH and coalition partners. If you have any comments on the eBulletin or eFeature or suggestions for topics you would like to see covered in future eFeatures please get in touch (ebulletineditor@fsrh.org).
You can access previous eBulletins and eFeatures via the links below:
> eBulletin archive (MEDFASH) > eFeature archive (MEDFASH/FSRH)
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FSRH and coalition partners do not accept responsibility for the content of linked websites/items included in this eBulletin and do not necessarily endorse the views expressed within them.
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