Public Health Commissioning,
Sexual Health Procurement &
Sexual Violence
Jak Lynch
Senior Public Health Commissioner
3rd November 2014 Chester Campus
The Commissioning Cycle and
Public Health Values and Skills
• Long term and iterative engagement with
the subject
• Casting Light and generating proper heat
• Synthesis of evidence and focus on
outcome
FGM and Sexual Health Services
•
•
•
•
Demographic
Universal and Targeted Services
UK HIV Prevalence 0.2%
UK FGM prevalence?
Country
HIV Prevalence
%
FGM prevalence % Country
HIV Prevalence FGM
%
prevalence %
Somalia
0.7
97.9
Yemen
0.1
38.2
Guinea
1.3
95.6
Cote d'Ivoire
3.4
36.4
Sierra Leone
1.6
94
Nigeria
3.6
29.6
Djibouti
2.5
93.1
Senegal
0.9
28.2
Egypt
0.1
91.1
Kenya
6.3
27.1
0.8
88.7
Central African
Republic
4.7
25.7
Mali
1
85.2
Tanzania
5.6
14.6
Gambia
2
78.3
Benin
1.2
12.9
Burkina Faso
1.2
72.5
Togo
3.2
5.8
Mauritania
0.7
72.2
Ghana
1.8
3.8
Liberia
1.5
58.2
Niger
0.8
2.2
Chad
3.4
44.9
Cameroon
5.3
1.4
Guinea-Bissau
2.5
44.5
Uganda
6.5
0.8
Eritrea
Engagement
• Engagement was broad and included public,
service providers and specialist national and
local perspectives
• Started with a clear idea about what we were
proposing and used engagement to refine the
proposal
• Used engagement to generate significant issues
that had not been adequately considered
before- e.g. Sexual Violence
Health & well being outcomes
1. Reducing under 18 conceptions
2. Increasing chlamydia diagnosis in the 15-24 age groups
3. Reducing the late diagnosis of HIV
4. Improved support for people vulnerable to, and victims of, sexual
coercion, sexual violence and exploitation
5. Providing better access to services for high risk communities
6. Ensuring prompt access for earlier diagnosis and treatment
7. Increasing the use of effective good quality contraception
8. Reducing the number of people repeatedly treated for STIs
9. Reducing the number of abortions and repeat abortions
10. Reducing the transmission of HIV, STIs and blood borne viruses
Priority Groups
• Support the needs of the most vulnerable groups, their
families, friends and communities, in particular:
–
–
–
–
Substance misusers
Children in need
Care leavers
People with mental
health problems
– Offenders
– LGBT people
–
–
–
–
–
–
–
Men who have sex with men (MSM)
People with learning disabilities
Homeless people
Sex workers
Gypsies and travellers
Trafficked people
New arrivals from abroad
Consultation
• Very focussed on changes to be proposed
and supporting information
• Made use of 3rd sector organisation to
access hard to reach groups
• Sought national and local comment
• Sought the views of frontline staff and
professional bodies and trades unions
Consultation December 2013
Improved support for people vulnerable to, and victims of,
sexual coercion, sexual violence and exploitation
2500
2194
2000
1500
1000
500
41
63
41
No
Don't Know
Not Answered
0
Yes
Improved support for people vulnerable to, and
victims of, sexual coercion, sexual violence and
exploitation
• Our consultation found overwhelming
support that Sexual Health Services should
address this outcome
• The challenge for providers is to co-produce
with users, commissioners and other services
what should be done to address the outcome
Procurement
• Co produce service specifications
• Competitive dialogue- dedicated session on
Sexual violence based on outline
solutions/method statements
• Role of Young People in evaluation- 63
over 2 days to generate scores
#2ndcitysex
Tested in Procurement
• Subject of a detailed method statement in
the competitive dialogue
• Question relates to mandated services- core
specification- a proper service response
• Question relates to non mandated servicestargeted non clinical outreach and capacity
building
#2ndcitysex
Aims and Objectives
• Bring prospective providers together
• Orientate providers on the Violence Against
Women and Children (VAWC) topic
• Improve the Sexual Health Performance
Framework in relation to VAWC
• Improve the Service Specification in relation to
VAWC
Opportunities for the new sexual health
‘System’
•Opportunity to ask the right questions
•
Systematic identification of victims and those at
risk of sexual exploitation, coercion and violence
in our mandated services
•Opportunity to contribute to our city wide
response
•
•
•
Through developing local policies
Contributing to safeguarding children and adults
Support capacity building in associated 3rd sector
and primary care
#2ndcitysex
Laying the Track
•
•
•
•
•
•
•
•
Strategic Outcome
Policy and Practice
Procurement
Service users experience and views
ISVA’s
SARC
CYP SARC
Care Pathway
#2ndcitysex
Qualitative
•
•
•
•
•
Service users views
Use of qualitative Research
Local action learning
Focus on users experience
Extensive use of grey literature and
soundings from those who know the subject
#2ndcitysex
Birmingham Sexual Health Outcomes
Framework
The Objective
“The size of these provisional figures
underlines the urgent need for a robust plan
for services to support women who have
undergone FGM and to safeguard their
daughters from undergoing it.”
Female Genital Mutilation in England and Wales: Updated statistical estimates of the
numbers of affected women living in England and Wales and girls at risk Interim
report on provisional estimates
University of London (2014)
Thankyou