BMJ 2015;351:h3798 doi: 10.1136/bmj.h3798 (Published 16 July 2015)
Page 1 of 2
News
NEWS Sexual health services in England lack clear accountability and proper oversight, says report Caroline White Caroline White
The changes to healthcare made under the previous health secretary, Andrew Lansley, have left sexual health and HIV services in England without any clear lines of accountability or proper oversight of the quality and outcomes they deliver, concludes a report by a cross party group of peers and MPs.1
The All Party Parliamentary Group on Sexual and Reproductive Health launched an inquiry last August, prompted by concerns that the new arrangements were fragmenting commissioning and service provision and creating “silos” in previously integrated areas of public health. The reorganisation made local government accountable for the bulk of sexual health services, as part of its new public health remit, with the remainder split between primary care and NHS England (box).
But the report, which drew on written and spoken evidence to the inquiry from a wide range of people and organisations working in sexual and reproductive health, found that although the restructuring had created new national bodies, such as NHS England and Public Health England, lines of accountability had never been clearly set out. “This has led to a lack of proper oversight of the quality and outcomes delivered by commissioners,” said the report, which urged the government to act swiftly to rectify the situation.
“Without this, the APPG [All Party Parliamentary Group] believes there is insufficient national coordination to enable local commissioners to work together in an effective way which meets the needs of service users in their area. This has to be addressed as a matter of urgency,” the report said. “As steward of the system, the Department of Health must monitor and challenge the contribution of each of these national bodies,” the report insisted. And the health department must annually monitor progress on the ambitions set out in its Framework for Sexual Health Improvement in England, which was published just ahead of the implementation of Lansley’s changes.2 Despite promising to publish a progress report last year, the department has so far failed to do this.3
Local health and wellbeing boards and directors of public health need to work together more closely to ensure that services commissioned by the NHS, including general practice and those commissioned by local authorities, are integrated, it said.
For personal use only: See rights and reprints http://www.bmj.com/permissions
Although many local authorities were providing a good range of open access services for sexually transmitted infections and contraception, as they are mandated to do, there was nevertheless evidence that in some areas these were being restricted on the grounds of age or postcode, said the report. Local authorities must be given a more prescriptive mandate, it recommended. The current tariff and block contracts often work to distort provision of, and access to, services, with incentives driving the prioritisation of one service over another, irrespective of patients’ needs, said the report. It added that the tendering process often led to short termism, discouraging training and staff development and hindering innovation.
Service specifications should follow a common national quality and standards framework to ensure a consistent basic standard of care, the report recommended. It expressed concern about the government’s announcement last month that it planned to slash £200m (€280m; $310m) from the public health budget in 2015-16, equivalent to more than 7% of the total.
Compounding the effects of potential cuts was the evidence presented to the inquiry showing that the ringfenced budget was not always being used for public health, said the report, which recommended that Public Health England oversee exactly how public health funds were being spent.
A spokesperson for the Local Government Association said that councils would consider this recommendation carefully but emphasised that local government was “already one of the most transparent parts of the public sector.” Chris Wilkinson, president of the Faculty of Sexual and Reproductive Healthcare, told The BMJ, “Splitting the commissioning of [services] across local authorities and different NHS commissioning bodies has led to some consequences (including the threat of funding cuts that the NHS has been protected from as a whole) that do not bode well for comprehensive, accessible sexual and reproductive health care.” He added, “Like the All Party Parliamentary Group, the faculty believes that only by treating sexual and reproductive health as an ‘exemplar’ of what shared local authority and NHS services could look like—if the political will and accountability is there—will this ‘experiment’ become something that could truly benefit our society.”
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BMJ 2015;351:h3798 doi: 10.1136/bmj.h3798 (Published 16 July 2015)
Page 2 of 2
NEWS
How responsibility for sexual health services is divided Local authorities • Contraception that is primarily delivered in community clinics • Sexually transmitted infection (STI) testing and treatment • Chlamydia screening • HIV testing and prevention, sexual health promotion, and social care • Young people’s sexual health services • Services in schools • Sexual health aspects of psychosexual counselling
Primary care (clinical commissioning groups) • Termination of pregnancy services • Contraception for gynaecological purposes • Non-sexual health elements of psychosexual health services • Sterilisation • HIV testing when required in other services commissioned by CCGs
NHS England • Contraceptive services provided under the GP contract • HIV treatment and care • HIV testing when required in other NHS England commissioned services • STI testing and treatment provided under the GP contract • Cervical cancer screening • Human papillomavirus immunisation programme 1
2
All Parliamentary Group on Sexual and Reproductive Health in the UK. Breaking down the barriers: the need for accountability and integration in sexual health, reproductive health and HIV services in England. 13 Jul 2015. www.fpa.org.uk/all-party-groups-sexualhealth/appg-uk. Department of Health. Framework for sexual health improvement in England. Mar 2013. https://www.gov.uk/government/publications/a-framework-for-sexual-health-improvementin-england.
For personal use only: See rights and reprints http://www.bmj.com/permissions
3
White C. UK government postpones publishing report on sexual health services. BMJ 2015;350:h2279.
Cite this as: BMJ 2015;351:h3798 © BMJ Publishing Group Ltd 2015
Subscribe: http://www.bmj.com/subscribe
Page 1 of 2
News
NEWS Sexual health services in England lack clear accountability and proper oversight, says report Caroline White Caroline White
The changes to healthcare made under the previous health secretary, Andrew Lansley, have left sexual health and HIV services in England without any clear lines of accountability or proper oversight of the quality and outcomes they deliver, concludes a report by a cross party group of peers and MPs.1
The All Party Parliamentary Group on Sexual and Reproductive Health launched an inquiry last August, prompted by concerns that the new arrangements were fragmenting commissioning and service provision and creating “silos” in previously integrated areas of public health. The reorganisation made local government accountable for the bulk of sexual health services, as part of its new public health remit, with the remainder split between primary care and NHS England (box).
But the report, which drew on written and spoken evidence to the inquiry from a wide range of people and organisations working in sexual and reproductive health, found that although the restructuring had created new national bodies, such as NHS England and Public Health England, lines of accountability had never been clearly set out. “This has led to a lack of proper oversight of the quality and outcomes delivered by commissioners,” said the report, which urged the government to act swiftly to rectify the situation.
“Without this, the APPG [All Party Parliamentary Group] believes there is insufficient national coordination to enable local commissioners to work together in an effective way which meets the needs of service users in their area. This has to be addressed as a matter of urgency,” the report said. “As steward of the system, the Department of Health must monitor and challenge the contribution of each of these national bodies,” the report insisted. And the health department must annually monitor progress on the ambitions set out in its Framework for Sexual Health Improvement in England, which was published just ahead of the implementation of Lansley’s changes.2 Despite promising to publish a progress report last year, the department has so far failed to do this.3
Local health and wellbeing boards and directors of public health need to work together more closely to ensure that services commissioned by the NHS, including general practice and those commissioned by local authorities, are integrated, it said.
For personal use only: See rights and reprints http://www.bmj.com/permissions
Although many local authorities were providing a good range of open access services for sexually transmitted infections and contraception, as they are mandated to do, there was nevertheless evidence that in some areas these were being restricted on the grounds of age or postcode, said the report. Local authorities must be given a more prescriptive mandate, it recommended. The current tariff and block contracts often work to distort provision of, and access to, services, with incentives driving the prioritisation of one service over another, irrespective of patients’ needs, said the report. It added that the tendering process often led to short termism, discouraging training and staff development and hindering innovation.
Service specifications should follow a common national quality and standards framework to ensure a consistent basic standard of care, the report recommended. It expressed concern about the government’s announcement last month that it planned to slash £200m (€280m; $310m) from the public health budget in 2015-16, equivalent to more than 7% of the total.
Compounding the effects of potential cuts was the evidence presented to the inquiry showing that the ringfenced budget was not always being used for public health, said the report, which recommended that Public Health England oversee exactly how public health funds were being spent.
A spokesperson for the Local Government Association said that councils would consider this recommendation carefully but emphasised that local government was “already one of the most transparent parts of the public sector.” Chris Wilkinson, president of the Faculty of Sexual and Reproductive Healthcare, told The BMJ, “Splitting the commissioning of [services] across local authorities and different NHS commissioning bodies has led to some consequences (including the threat of funding cuts that the NHS has been protected from as a whole) that do not bode well for comprehensive, accessible sexual and reproductive health care.” He added, “Like the All Party Parliamentary Group, the faculty believes that only by treating sexual and reproductive health as an ‘exemplar’ of what shared local authority and NHS services could look like—if the political will and accountability is there—will this ‘experiment’ become something that could truly benefit our society.”
Subscribe: http://www.bmj.com/subscribe
BMJ 2015;351:h3798 doi: 10.1136/bmj.h3798 (Published 16 July 2015)
Page 2 of 2
NEWS
How responsibility for sexual health services is divided Local authorities • Contraception that is primarily delivered in community clinics • Sexually transmitted infection (STI) testing and treatment • Chlamydia screening • HIV testing and prevention, sexual health promotion, and social care • Young people’s sexual health services • Services in schools • Sexual health aspects of psychosexual counselling
Primary care (clinical commissioning groups) • Termination of pregnancy services • Contraception for gynaecological purposes • Non-sexual health elements of psychosexual health services • Sterilisation • HIV testing when required in other services commissioned by CCGs
NHS England • Contraceptive services provided under the GP contract • HIV treatment and care • HIV testing when required in other NHS England commissioned services • STI testing and treatment provided under the GP contract • Cervical cancer screening • Human papillomavirus immunisation programme 1
2
All Parliamentary Group on Sexual and Reproductive Health in the UK. Breaking down the barriers: the need for accountability and integration in sexual health, reproductive health and HIV services in England. 13 Jul 2015. www.fpa.org.uk/all-party-groups-sexualhealth/appg-uk. Department of Health. Framework for sexual health improvement in England. Mar 2013. https://www.gov.uk/government/publications/a-framework-for-sexual-health-improvementin-england.
For personal use only: See rights and reprints http://www.bmj.com/permissions
3
White C. UK government postpones publishing report on sexual health services. BMJ 2015;350:h2279.
Cite this as: BMJ 2015;351:h3798 © BMJ Publishing Group Ltd 2015
Subscribe: http://www.bmj.com/subscribe
