Local Government

We urge governments, to support us in shaping our service for implementing the recommended measures as follows:

• DHSC to review the funding allocations given to each part of the sexual and reproductive health sector in line with current demand and future population. Funding allocations to include pay uplifts and reflect the cost of living.
• DHSC should work with local commissioners to build the case for sustained investment in sexual and reproductive health - based on a deeper understanding of the cost of not addressing the harms - to ensure that the strategy is appropriately prioritised at the next spending review.
• To improve certainty around funding for sexual health services. DHSC should provide multi-year and timely settlements for councils to allow them to plan and make meaningful financial decisions.
• DHSC to review the HIV pre-exposure prophylaxis (PrEP) allocations in line with the needs of all groups, including underserved groups (e.g. women) following the increasing demand for this prevention and impact on sexual services capacity and testing required.
• DHSC to investigate the introduction of national tariffs for some elements of sexual and reproductive health services to ensure equity, and ensuring annually the tariff is reviewed to reflect the current and future cost of living costs. This will allow for local authorities to improve their efficiency, and reduce the administration and monitoring of sexual and reproductive health budgets.
• DHSC should undertake the work necessary to improve its understanding of the up-to-date costs of poor sexual health to the NHS and wider society.

Quality standards

Develop and implement joint quality and performance management standards of all sexual and reproductive health-related commissioned services.

Recommendations

• DHSC, in partnership with EHSHCG, NHSE and ICBs to undertake a whole system review to develop joint national quality and performance standards, in line with a new strategy.
• DHSC to improve data standards and data sharing to enable capture of the whole system at a local authority level (inclusive of sexual and reproductive health services commissioned by local authorities, NHSE and ICBs).
• For each local area to develop and implement a multi-stakeholder sexual and reproductive health strategy and to report on measurable activity and publish.

Background

For progress against the strategy to be consistently applied and measured, it should include clear and defined shared targets. A refreshed national quality and performance framework should be released that provides regular publicly available progress updates. This should include progress compared to any national targets – including progress within communities most affected by poor sexual and reproductive health.

In addition to these targets, we also support the recommendation from the Health Select Committee Report 2019 for the strategy to set clear national quality standards for commissioners to adhere to.

 

There must be collaboration and integration between a broad range of organisations and stakeholders, including commissioning organisations, to achieve the desired outcomes and reduce fragmentation in care. Alongside this integration, service users should be involved in co-designing services and be part of continuous feedback to and from service providers and commissioners.

 

There are already some standards and public health outcomes already established for integrated sexual health services however these are not reflected across other sexual and reproductive health services. For example, there is a national target for the Chlamydia screening programme (aged 15 – 24) but this is not currently a shared target across all sexual and reproductive health services.

 

Office for Health Improvement & Disparities (OHID) data collects and reports nationally (Fingertips) on some aspects of reproductive health and STIs, however, it is challenging nationally and locally to fully view aspects of provision and therefore unable to accurately identify gaps. We acknowledge the improvements over the years of data collection and would welcome further improvements across all sexual and reproductive health services to align data to give an overall aspect of provision and to support intelligence-led strategic decision-making for all partners and providers.

 

For example, emergency contraception is available from specialist sexual health services, GPs, pharmacies, Accident and Emergency departments and online. There is currently no definitive data across all these to be able to look at demand and inequalities of access.

 

Further improvement tools and training should be developed to improve the quality and consistency of commissioning approaches with the support of DHSC, NHSE, LGA and other stakeholders.