Sexual Health
Performance
improvement – The Story
So Far!
1
Public health outcomes in London
London has some of the worst health outcomes in the country in some
key areas (including SH), and poor performance in prevention activity.
Gross inequalities exist across the capital, both in the quality of
preventive services and in health outcomes.
NHS London prevention strategy, June 09
• Five public health priorities identified for focused improvement:
- Childhood immunisations
- Tobacco control and smoking cessation
- Screening
- Sexual health
- Vascular Health
Sexual Health
Sexual health is a particularly demanding public
health and financial challenge for London. It
affects the majority of the population, is linked
increasingly with poverty and inequality, and is
still associated with stigma. In London, we face
the highest rates of sexual ill-health in the
country.
London Sex & Our City report 2008
4
London Sexual Health Improvement programme 2010/11
• Prioritise the delivery of Standard 5:
Sexual health providers will develop integrated services across
primary, community and secondary care using London Sexual Health
tariffs to enable equity of access to integrated Sexual Health services.
This will be under a Clinical Director providing leadership to the network
of service providers, and with particular responsibility for clinical
governance and training.
• Focus on :
- Improving access to and awareness of Long Acting Reversible
Contraception (LARC)
- Improving access to and awareness of Emergency Hormonal
Contraception (EHC)
- Reducing repeat terminations
- Aim for universal minimum standard of: the offer of a
comprehensive and accessible contraceptive service to
Londoners.
5
Jun-09
Nov-08
Apr-08
Sep-07
Feb-07
30
Jul-06
Dec-05
May-05
Oct-04
Mar-04
Aug-03
Jan-03
Jun-02
Nov-01
Apr-01
Sep-00
Feb-00
Jul-99
Dec-98
Rate per 1000 women
50
45
40
35
England
25
London
Rate per 1000 registered female population aged 15-44
Teenage Conception rates for women
under 18,
1998- Q3 2009
Rate of GP prescribed LARC 2007-2009
60
55
50
40
30
England
London
South West
20
10
20
0
2007/8
2008/9
6
Percentage of abortions that are repeat abortions by quarter in London and England,
2008 to April - June 2010
45
40
% Repeat abortion
35
30
25
20
15
10
5
0
Q1 2008 Q2 2008 Q3 2008 Q4 2008 Q1 2009 Q2 2009 Q3 2009 Q4 2009 Q1 2010 Q2 2010
England
London
7
Performance Improvement
Approach
Tried and
tested
approach
Self assessment
developed with the
LSHP, clinicians and
commissioners
Robust review
of sexual health
commissioning
in your PCT
through self
assessment
with partners
•Action plans to meet any gaps identified
•Challenge meetings to review draft action plans
•Finalised action plans signed off by PCT CE
8
Benefits of approach
•
•
•
•
Secures senior level buy-in for sexual health.
QIPP Quick Win
Maintains focus during period of transition
Galvanises expert support from sexual health
clinicians, commissioners and academics.
• Pan London funding to support themes identified.
9
Key themes and challenges
• Good examples of progress on service integration
and delivery
• Lack of trained LARC fitters, especially in PC
• Young people focused
• Fragmented commissioning
• Informal referral pathways
• Reducing commissioning capacity
• Varied levels of engagement with PC
• Wealth of good practice examples
• Enthusiasm and can-do, will do and inspirational
attitude
10
What next
• Dashboard development
• Programme of support to include:
– LARC train the trainer programme to include exploring
the role of practice nursing and pharmacists
– LARC champions
– Showcase good practice/case studies
• Sexual Health and QIPP
• Explore options for pan-London commissioning and
standardisation
• Next Steps workshop this afternoon
11
12
Workshop – Sustaining
Improvements in Sexual
Health
– What can we do at Borough, Sector and Pan London
levels to:
– Sustain sexual health improvements through the
organisational changes in the NHS?
– Maximise opportunities of QIPP to improve Sexual
Health?
13