Agenda item

Purpose of report:To update the Adults and Health Select Committee on the Continuous Improvement Plan for the Surrey Integrated Sexual Health and HIV service and to provide information on key sexual health indicators.

Witnesses:

Kate Crockatt, Acting Senior Public Health Lead

Ruth Hutchinson, Director of Public Health

Jonathan Lewney, Consultant in Public Health

Fiona Mackison, Service Specialist – Specialised Commissioning, NHS England South

Mark Maguire, Service Director of Sexual Health, HIV & Hepatitis Services, Central and North West London NHS Foundation Trust (CNWL)

Sinead Mooney, Cabinet Member for Adults and Public Health

Kate Scribbins, Chief Executive, Healthwatch Surrey

Alasdair Tudhope, Deputy Service Director of Sexual Health, CNWL

Key points raised during the discussion:

1. A Member asked whether there was a correlation between a decrease in testing for Sexually Transmitted Infections (STIs) and an increase in STI treatment, as shown in Table 2 in the report. The Consultant in PH explained that the reason testing rates had decreased was that the table referred only to face-to-face appointments, which had decreased because online testing had become more popular. Patients were encouraged to use the online service for testing, and only use a face-to-face appointment for treatment or complex issues. Table 4 in the report demonstrated a corresponding increase in online testing.
2. A Member remarked that in Epsom there was not a wide awareness of sexual health services amongst residents and even some councillors. The university and some deprived areas in Epsom might lead to an increased need of sexual health services. She queried what was being done to raise the profile of services in Epsom. The Director of PH said that work was being done on the website of the service, and that tests could now be ordered online. However, the Council wished to continue to do more to promote the service in ‘coldspots’ such as Epsom. The Consultant added that some of the services offered in ‘spoke’ clinics (smaller, more localised clinics), like the clinic in Epsom, were not as extensive as those offered at the ‘hub’ clinics (larger clinics).

Vicki Macleod left at 1:35pm.

3. A Member emphasised concerns about confidentiality at the Buryfields clinic in Guildford. The Deputy Service Director of Sexual Health for CNWL reminded Members that as well as a screen that would shortly be installed in the clinic’s reception, a TV had been installed to create background noise, and patients were now simply asked verbally if they had a booked appointment or required a walk-in appointment at reception, in order to improve confidentiality. In patient engagement, the issue of confidentiality had come up with a few people but it was not a major issue.
4. A Member recalled that when the contract had first been granted, references had been made to young people being able to go to the school nurse, an idea that had been met with some scepticism. The Director of PH replied that while school nurses (who were commissioned by the PH team) were not always the first port of call, they were important nonetheless. School nurses should be kept up-to-date and should feed back to other PH services (for example, GPs) on students’ cases.
5. A Member was of the opinion that communications had not been good at publicising the sexual health service, and suggested that easy-to-read, succinct posters detailing time and place of events or services should be put on doctors’ notice boards. The Director of PH responded that currently the service was working closely with a communications lead in a commissioning group, including a weekly bulletin to GPs. More publicity of this sort could easily be put on notice boards. In the meantime, the main source of information for all services was the Healthy Surrey website.
6. A Member stated that online bookings system should be streamlined and easy to access. The Service Director of Sexual Health, HIV & Hepatitis Services for CNWL responded that many appointments were booked online, showing that there were already many patients who were able to access the system successfully. The bookings website could easily be found using internet search engines.
7. A Member requested to obtain pathways and flow charts provided to GPs as guidance on sexual health protocol. The Director of PH agreed to provide these.
8. The Director of PH noted that the sexual health outreach group mentioned in the report had existed for some time but had evolved. It was one of a number of mechanisms used to engage with patients, including also quarterly patient engagement events to obtain feedback. The Deputy Service Director of Sexual Health for CNWL said that patients were engaged through comments cards in clinics, quarterly events held at hub clinics and quarterly patient surveys. The feedback received had been largely positive. Issues raised in feedback included confidentiality, on which action was being taken. Also, patients wanted to be able to book asymptomatic appointments; this had previously been offered as a walk-in service, but after patient feedback bookable appointments were now also available at hubs. Also, patient engagement had revealed a lack of awareness about online services and STI testing, and this was now being better publicised.
9. The Chief Executive of Healthwatch stated that ongoing engagement with people who were not accessing services was particularly important, and asked what issues had been encountered in patient engagement and whether adjustments had been made. Also, she enquired whether people with LD; black, Asian and minority ethnic (BAME) people; refugee teenagers; and excluded children who would not be attending PSHE lessons – groups that could be hard to engage with on sexual health – had been consulted for feedback. The Consultant responded that early indications were that there were no obvious ‘coldspots’ (areas where the number of people accessing sexual health services was much lower than expected) throughout Surrey. While research was ongoing, work had begun identifying people with LD, BAME people and vulnerable teenagers for more targeted engagement. These were all groups with whom it could be difficult to engage regarding personal issues such as sexual health. People with LD were a particularly difficult group to engage, in some cases due to how parents of people with LD reacted to the idea that their children were sexually active. Also, BAME people were at a higher risk of developing STIs but may be less likely to seek or access preventative services or treatment. To tackle this issue, the Council had been working closely with Healthwatch and the universities in Surrey, as there was a larger proportion of university students in Surrey who were BAME than the proportion of people in the general Surrey population who were BAME.
10. The Chief Executive of Healthwatch praised feedback on the booking system for people with HIV, included in the report. The Service Specialist – Specialised Commissioning for NHS England South remarked that residents with HIV still sometimes felt a sense of stigma because of the illness. The service had worked with Healthwatch for patient engagement and feedback.
11. The Chief Executive of Healthwatch stated that users sometimes accessed services outside of Surrey, which could have a cost on services. She asked whether there was a plan to engage with Surrey residents to understand why they used services outside the county. The Director of PH replied that accessing services ‘out of area’ was normal, and that some people who did not live in Surrey also used Surrey services. The Council’s aim was to make Surrey’s sexual health services the services of choice.
12. The Chief Executive of Healthwatch asked on behalf of the Co-Chair of the Surrey Coalition of Disabled People whether analysis had been done about people not getting through on the phone when trying to access services. The Deputy Service Director of Sexual Health for CNWL said that the phone line was prone to becoming very busy, but additional operators were being trained for booking services. Moreover, operators had been given training to improve their knowledge of the geography of Surrey specifically.
13. A Member stated that she had heard of a lack of availability of appointments on occasion, and enquired whether vacancies played a part in this. The Deputy Service Director of Sexual Health for CNWL replied that there were multiple facets of appointment availability. Partly, appointments were released every week for two weeks ahead, so that the cancellation rate did not become too high. This meant, however, that patients could not book appointments for more than two weeks ahead. Vacancies were also a factor; largely due to a lack of specialised workforce available, there were vacancies at the moment. Furthermore, the service had largely inherited staff who had been trained in sexual health or contraception, but not both. A significant amount of training had been provided in the last few years, and had been successful. The Service Director of Sexual Health, HIV & Hepatitis Services for CNWL added that at times recruiters had had to change requirements; for example, a specialist junior doctor role had been advertised three times with no success, so it was decided that a consultant would be recruited instead, and this was successful.

Actions/further information required:

1.    For the Director of PH to circulate pathways and flow charts provided to GPs as guidance on sexual health protocol.

Fiona White left at 2:25pm.

A short video on the Cabinet Member for Adults and Public Health’s recent visit to supported living housing for people with LD was shown.