Decision details

Committee to receive a report from Public Health (Barnet and Harrow) on sexual health commissioning. 

The Chairman invited Audrey Salmon, Head of Public Health Commissioning, Harrow and Barnet Councils Public Health, to the table alongside Dr. Howe and Councillor Helena Hart.

At the invitation of the Chairman, Councillor Hart introduced the report which provided an update on the collaboration between London Boroughs on Genitourinary Medicine (GUM) and set out the main findings of the market engagement developed by the pan London Sexual Health Transformation Project.  Councillor Hart noted that the Council spends approximately a third of its Public Health budget on sexual health, which equates to about £3.5 million per year.  Councillor Hart noted the importance of early diagnosis in respect of sexual health provision. 

Ms. Salmon informed the Committee that sexual health had become a statutory part of Local Authority provision approximately two years ago.  The Committee noted that the Boroughs involved in the project would be working together to contain costs, renegotiate tariffs and achieve efficiencies.  The Committee were informed that some provision would be through a web based system where the internet could be used as a “front door” to see what services are available across London.  For example, this would allow residents to order a sexual health self-testing kit which is a cost effective option.

The Committee noted that the project would lead to integrated sexual health services which would encourage the use of local community-based services rather than high cost acute services.  Ms. Salmon informed the Committee that a service specification is being developed for London as part of the Sexual Health Transformation Programme; this would be tweaked to ensure that it meets the needs of local residents. 

The Vice Chairman commented that the project for a pan London system seemed sensible.  Responding to a question from the Vice Chairman, Dr. Howe commented that a pan London system would mean that all Boroughs would sign a binding document which consisted of two main parts.  Firstly it would require the Boroughs to buy the same electronic services and, secondly, that Boroughs pay the same rate to providers to the best of their ability.  The Vice Chairman noted the interaction between the Boroughs of Harrow and Barnet and questioned if it would be possible to create a London system of provision that broke London into sub regions.  Dr. Howe commented that a lot of patients attend clinics from all over London and that clinics in Westminster and Camden had particularly high attendance.

A Member commented on the importance of confidentiality for patients, particularly for young people and for people being tested for HIV.  Dr. Howe noted that confidentiality was key for patients, particularly with sexual health services.  Dr. Howe also commented on the need for patients to be able to be seen anywhere in order to be treated quickly. 

A Member questioned where test kits for  young people would be sent to.  Ms. Salmon advised that the project would consider a range of options including sending test kits to a pharmacy or to their home. 

Referring to the report, a Member noted that commissioners had agreed a tariff for 2013-2014 which cost £133 for a first appointment at a GUM (Genito-Urinary Medicine) or CaSH (Contraceptive and Sexual Health) clinic and £82 for a follow up appointment.  Ms. Salmon informed the Committee that Officers would look to have a more reasonable tariff. 

A Member noted that the report stated that a survey of service users had shown that only 30% had received sex education at school.  Ms. Salmon commented that this was a surprising statistic.  Councillor Hart noted that certain faith schools can opt out of sex education.  A Committee member commented that parents can also ask for their children to opt out of sex education lessons.

A Member questioned if there were any risks of young people being deterred from accessing services because they couldn’t access a drop in or face to face clinic.  Dr. Howe informed the Committee that it wouldn’t be the case that everybody had to use online systems but that there would be a “front door” online which would take people through a number of steps which would include them being able to book an appointment online.  Dr. Howe noted that there would still be open access and face to face appointments.   Dr. Howe commented on the need to make better use of resources.  The Committee noted that service users had been asked what they thought would make a better model of provision. 

A Member commented that he thought that whilst teenagers wouldn’t have as much freedom of movement, the main way that they would access information is via the internet.  The Member questioned if offering access to services online was a good first port of call.  Dr. Howe advised that he thought it would be.  Dr. Howe commented that the project would be a lengthy procurement and noted that there was a risk that services were used too much and that people think that they can be tested whenever they want.  The Committee noted the need to make sure that patients still took appropriate steps to protect their sexual health.  Dr. Howe commented that a behaviour marketing campaign was also needed.  Ms. Salmon noted that commissioners were aware that there are some parts of the community, for example where English is not their first language, where there will be a need to target support to remove barriers through outreach. 

A Member expressed concern that if someone had ordered a testing kit online and that the result came back positive, then the patient would need someone to talk to and questioned if it would be better for pharmacists to keep the kits.  Ms. Salmon advised the Committee that they were currently trialling HIV kits with the Terrence Higgins Trust and that, whilst it had only been running for a few months, the initial results had been successful. 

A Member commented that many Committee Members were School Governors and that they could ask questions as Governors as to how education programmes were working.  Ms. Salmon welcomed the suggestions and advised that she would come back to Committee Members outside of the meeting with further information on the idea. 

Responding to a question from a Member, Dr. Howe informed the Committee that Public Health are able to leave health information leaflets in local schools. 

A Member commented that the cost of a chlamydia test was approximately £7 and questioned if students could go to the school nurse to access the test.  Ms. Salmon advised the Committee that in Harrow there was a service where the CaSH went into schools and were able to provide advice, condoms and refer young people to the service if they required it.  The Committee noted that Public Health were considering an outreach offer in Barnet which would include schools and youth clubs.

RESOLVED that:-

1.     The Committee notes Barnet and Harrow Joint Public Health Services' plans to participate in:

a.     A pan-London procurement for a web-based system to include a ‘front-end’ portal, joined up partner notification and home/self-sampling.

b.     The North Central London (NCL) sub-regional arrangements with the London Boroughs of Camden, Islington, Haringey, Enfield, Hackney and City of London, for the procurement of Genitourinary Medicine (GUM) and Contraception and Sexual Health (CaSH) Services (including primary care sexual health services, outreach and prevention).