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PHE acknowledges damaging sexual health services fragmentation

Its action plan aims to plug accountability gaps and boost commissioning capacity

Caroline White

Friday, 01 September 2017

Public Health England (PHE) has acknowledged* the damaging fragmentation of sexual health services brought about by the 2012 Health and Social Care Act.

It has pledged to revise its commissioning guidance for sexual and reproductive health to surmount some of the current problems and ensure that commissioning arrangements are explicitly considered as plans evolve for local authorities to fund public health themselves from retained business rates.

The move follows the results of a survey of the responsible bodies — local authorities, NHS England, and clinical commissioning groups — and a slew of reports from MPs, clinicians, think tanks and charities, voicing concerns about the current lack of clear accountability and its impact on service provision.

The survey responses show that since local authorities took over responsibility for the bulk of sexual health services in 2013, commissioning has become fragmented, and it has become difficult to ensure that those at the greatest risk can access the services they need.

Other issues that emerged from among the responses included the challenges posed by charging for patients attending services out of area and insufficient capacity in the workforce, not only for commissioning but also for service delivery.

These have been coupled with increasing demand and financial pressures as a result of reductions in budgets, particularly in local authorities.  

There are no plans to change the current set up as this would require primary legislation. But PHE has promised to work with the Department of Health and commissioners to strengthen local commissioning to reduce fragmentation and contracting barriers and help commissioners do their job more effectively, by providing evidence and data to support it, monitoring outcomes, and boosting capacity.

The Faculty of Sexual and Reproductive Healthcare (FSRH) described the report as “timely” and said that it confirmed the experience of its members.

It said that one of the most concerning findings was that local authorities, who commission contraception services, have said that cuts to the public health grant are making it impossible to maintain the current levels of provision.

Gaps in the workforce highlight an absence of investment in training healthcare professionals, including in the provision of the most effective forms of contraception – long-acting reversible contraceptives (LARCs), it said. 

Dr Asha Kasliwal, FSRH president, commented: “The survey highlights what FSRH members have been reporting to the Faculty for several years: deep cuts to specialist SRH services and fragmented commissioning are resulting in reduced access to contraception and other SRH services.”

She added: “There is also evidence from our membership that many SRH consultants will be retiring in the near future. Safe and effective SRH care requires combined leadership from Public Health, commissioners and consultants who are trained to develop and lead services that support all aspects of care.”

HIV charity, Terrence Higgins Trust also welcomed the “honest reflections” outlined in the report but warned that it confirmed fears that sexual health services are "at breaking point".

Ian Green, CEO of Terrence Higgins Trust, commented: "Demand is rising while budgets are shrinking; HIV and sexual health services are reeling from a combination of national government funding cuts to local authorities, a lack of prioritisation by some local councils, and lasting damage from the Health and Social Care Act, which led to fragmented and uncoordinated commissioning.

"This cannot go on. We welcome the actions set out in this report, but this action plan does not commit to new funding and does not address the shortfall left by the damaging cuts made to public health budgets. Without additional investment in HIV and sexual health services, it is unclear how a sexual health crisis can be avoided.”

* Sexual health, reproductive health and HIV: a review of commissioning. Public Health England, 2017

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