See information about proposals for the future of Sexual Health Services in North Yorkshire and have your say on them.

Background

North Yorkshire covers 3,000 square miles ranging from isolated rural settlements and farms to market towns and larger urban conurbations such as Harrogate and Scarborough. Whilst North Yorkshire is in overall terms more affluent than a typical local authority in England, there are nevertheless areas of profound deprivation, including some parts of the County ranked within the 20% most deprived areas in England.

Sexual and reproductive health is not just about preventing disease or infection. It also means promoting good sexual health in a wider context, including relationships, sexuality and sexual rights. 

Most adults are sexually active and good sexual health matters to individuals and communities. Sexual health needs vary according to factors such as age, gender, sexual orientation and ethnicity. However, there are certain core needs common to everyone, including high-quality information and education enabling people to make informed decisions, and access to high-quality services, treatment and interventions. However, poor sexual health outcomes fall disproportionately on certain groups. Sexual health is therefore an important component of public health.

The impact of STI's remains greatest in:

  • young heterosexuals ages 15 to 24 years
  • black minority ethnic population
  • gay, bisexual and other men who have sex with men (MSM)
  • people in the most deprived deciles

Young people experience the highest diagnosis rate of the most common STI's

Since 1 April 2013, local authorities have been mandated to ensure that comprehensive, open access, confidential sexual health services are available to all people who are present in their area (whether resident in that area or not). The requirement for Genito-Urinary Medicine (GUM) and Contraception and Sexual Health (CaSH) services to be provided on an open access basis is stipulated in the Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) Regulations 2013.

We recognise that the specialist sexual health service operates as part of a wider sexual health system across North Yorkshire; including Primary Care, NHS Clinical Commissioning Groups and NHS England. This service will not work in isolation from the wider range of services and workforces, but services commissioned by other organisations such as the NHS England are out of scope from this consultation.

North Yorkshire ranks 26th out of 149 Local Authorities across England for sexual and reproductive health outcomes. In comparison to our 16 nearest comparator councils (Chartered Institute of Public Finance and Accountancy (CIPFA)) North Yorkshire ranks 2nd for sexual and reproductive health outcomes.

Sexual and reproductive health summary rank (2017/18)

  • Best: Devon - 1
  • North Yorkshire - 2
  • Worst: Staffordshire - 16

(PHE Fingertips).

The existing service, for the last seven years (branded YorSexualHealth) delivered by York and Scarborough Teaching Hospitals NHS Foundation has a proven record of accomplishment and is a well-regarded specialist sexual health service across North Yorkshire. The service delivers high quality, free, confidential and friendly sexual health provision across the county accessed via face-to-face clinics, online and telephone.

As COVID-19 continues and infection rates remain high we want to ensure that everyone who needs contraception, and other types of sexual and reproductive healthcare, stays informed about changes to services and that they can continue to access services  when they are needed.

North Yorkshire County Council in partnership with York and Scarborough Teaching Hospitals NHS Foundation Trust, is proposing to change some aspects of the sexual health service. In a national and local context of reducing Public Health budgets, as well as the learning from COVID-19, we need to ensure that the service is affordable, continues to provide value for money and evolves to meet the needs of our residents.

We want to hear your views about these proposed changes and how best to implement them.

The new partnership agreement between North Yorkshire County Council and York and Scarborough Teaching Hospitals NHS Foundation Trust is due to commence on 1 April 2022 for a further 4 year period.

We previously consulted on North Yorkshire County Council and York and Scarborough Teaching Hospitals NHS Foundation Trust entering into a partnership agreement (known as a S75 Agreement) under section 75 of the National Health Service Act 2006. The Parties intended for the partnership arrangements to commence 1 April 2020 however due to Covid 19 this has been delayed. The partners are consulting on a potential change to sexual health services (this consultation). The partners intend to consult later in the year on the final proposals for the partnership arrangement including content of the S75 Agreement between the partners.

Proposal summary

We (the council and York and Scarborough Teaching Hospitals NHS Foundation Trust) propose to maintain open access (this means that everyone irrespective of age or location or residence or GP registration can access the service directly without referral) to sexual health services with an enhanced targeted approach to those who need it most.  

Under the new proposals, the service will further develop its online offer with more services available remotely; the service will continue face-to-face clinics with a reduction or removal of some community clinics, based on need and footfall. The service will continue to offer the full range of contraception; however, those over 19 years old will be required to access routine repeat contraception from their GP unless emergency contraception is issued. An improved training offer with blended options including interactive webinars, e learning and face-to-face will be available for frontline professionals. Finally, the service will further integrate the counselling and HIV services and the clinical and community development teams to provide a holistic offer to those in greatest need.

The current sexual health service works well and we want to continue what works, within the funding available and to work together with one of our leading, local NHS organisations, to invest in services for the future.

We want to learn from the emergency changes made to the current service during the response to the Covid-19 pandemic.

In putting these proposals forward, we are making clear pledges to you.

Our commitments

  • We will ensure the service prioritises prevention and early intervention with a focus on young people and most at risk populations.
  • We will ensure a skilled and competent sexual health workforce (providing person centred care) delivers the service.
  • We will ensure strong clinical leadership within the service that works closely with partners across the local sexual health system.
  • We will ensure the service complies with evidence-based practice, but also applies innovative practice, which is evaluated. 
  • We will ensure there is rapid and easy access to the Service including in rural areas, delivering services in accessible and appropriate settings.
  • We will ensure all contraceptive, Sexually Transmitted Infection (STI) diagnosis and treatment provided is delivered in one location as far as is practicably possible.
  • We will ensure available resources are focussed on delivering the best possible sexual health outcomes for all people in North Yorkshire. We will keep investment in North Yorkshire, ensuring that people get the service they need within the county.

What is a Sexual Health Service?

An integrated sexual health service provides people of all ages, open access, confidential, non-judgemental services including sexually transmitted infections (STI’s) and Blood Borne Viruses (BBV) testing, treatment and management; the full range of contraception provision; health promotion and prevention.

The service currently comprises of the following key elements:

Sexual health promotion and information

Provide evidence based sexual health information including but not limited to information on: pregnancy and abortion, full range of contraception, STI’s and safe sex messages, sexual assault, child sexual exploitation (CSE) and female genital mutilation (FGM).

Contraceptive services

Provide full range of contraceptives including pregnancy testing and counselling about pregnancy choices, supply of condoms, emergency contraception, first prescription and  continuing supply of all contraceptive methods (excluding gynaecological reasons), all follow up appointments, advice about family planning, advice and support experiencing difficulties with choice of contraceptive methods, management of complex contraceptive problems.

STI services

Provide STI services following assessment of need and risk. Tests for Chlamydia, Gonorrhoea, Syphilis and HIV. Hepatitis A and B immunisations. Diagnostics processed and results conveyed quickly and acted upon appropriately. Management of complex and non-complex STIs. Partner notification. Post exposure prophylaxis (PEP, PEPSE) and Pre-exposure prophylaxis (PrEP) provision.

Clinical outreach service (under 25’s and those of greatest need)

Clinical outreach provision to those most in need and complex, advice, information, contraception, STI/HIV testing and treatment.

Sexual health counselling

Six 1-hour sessions for people living in North Yorkshire who wish to seek support around different aspects of sex or sexual health.

Community outreach service (targeted most at risk groups)

Community development approaches providing sexual health promotion and prevention to high-risk groups, improve access to HIV/STI diagnostic and treatment interventions. 

Positive support service for people living with HIV and their carers

Support for people living with HIV, self-management, prevention of onward transmission, improve quality of life and independence.

Training

Coordinate and deliver an annual sexual health training programme, tailored to meet the needs of a range of frontline professional staff.

Why are we proposing to make changes to the service?

  1. The national Public Health Grant has reduced and is reducing further.

    The Central Government grant funding has reduced, this means that North Yorkshire will have less money for the Local Authority to spend on its local public health services, which includes sexual health services.

  1. We have learnt from how we have had to respond to COVID-19.

    The pandemic has changed how we deliver the current service for the long-term. The profound impact of the virus on society and on public services means that people have been using services differently and staff have developed new roles and skills. As national lockdown is easing, the current service is recovering but it will never return to the pre-pandemic status. This consultation is proposing to implement the learning from our COVID-19 response.

  1. Seven years have passed since the Integrated Sexual Health Service first launched.

    Although the service has adapted and changed to meet individual and communities needs over the last seven years, it offers an opportunity to review the full service with all the different elements of provision and continue to make improvements.

What difference will the proposed changes make to the current service?

The sexual health service will continue to provide an all age, open access, free confidential service across the county.

However, the proposal is that the service will further develop its current on-line offer with more services available remotely (dependant on risk). These will include:

  • An on-line booking system where individuals will be able to book their appointments, create their own confidential individual record where they can track test results and next steps if treatment is required.
  • A telephone triage system will continue to operate via highly skilled clinical staff, which will ensure that people reach the right place at the right time. A mobile number for young people will continue to operate for access into the service in a discrete and confidential manner.
  • The website will be developed to include more information and advice on self-care. Individuals will be able to self-refer for counselling, access clinical triage and order appropriate STI tests.
  • In terms of ordering appropriate on-line STI tests in the new service, STI tests will be personalised specifically to individual risk taking and sexual health history (i.e. HIV & Syphilis).  All tests will only be made available to individuals once every 3 months, unless there is a demonstrated risk. These changes will mean people get the right test for their individual history and risks taken.

There will continue to be an offer of face-to-face clinics across a range of locations five days a week for those who need it. There will be a reduction or removal of some community clinics as the enhanced online and virtual provision takes effect. However, as a minimum the four main hubs across North Yorkshire will remain, these are Harrogate, Northallerton, Scarborough and Selby.

Decisions on which community clinics will continue will be made using the latest available data and demand to ensure service offer reflects the needs of the local population. As a minimum, clinics will remain in Skipton and Catterick Garrison, additional community clinics will continue to evolve and flex over the life of the partnership.

The full range of contraception will remain in place, however if individuals are over 19 years old under the proposed changes, they will no longer be able to access repeat basic contraception (pills, patches, rings) and will be directed to their GP for continuation. One exception to these changes would be if an individual has received emergency contraception within the last 14 days. In this instance, they would still be supported to identify the most appropriate method of contraception for themselves and provided with 3 months’ supply of the chosen method of contraception. The service would then contact the individual’s GP to ensure follow-up, providing a full rationale for the contraceptive choice. Further prescribing would then supplied by the GP. The service will work closely with General Practice and residents to ensure seamless continuity of care.

Under the new proposals front-line professionals within the wider sexual health system, would see an improved training offer. This will include a range of blended training options including interactive webinars, e learning and condensed face-to-face training for clinicians who wish to complete the COIL fitting and removal competencies. This will reduce travel and staff time across the county for training and should increase the uptake of the training on offer.

The service will continue to deliver a counselling and HIV support service. Under the proposed changes, the counselling and HIV services will further integrate to enable a more coordinated approach between professionals to improve the pathways of care for individuals and their carers accessing those services. This multi-disciplinary team will help people manage and reduce risks, ensure access to the full range of integrated sexual and contraceptive health services, support for physical and mental health and wellbeing and structured interventions and support to people living with HIV and their carers.

The service will continue to deliver a clinical and community development offer for high-risk groups. In the new service, practitioners from different disciplines (nurses and community development workers) will work more closely together and use innovative practice to improve reach for those in high-risk groups.  These include for example, drug and alcohol users, sex workers, BAME, LGBTQ+ and homeless communities.

What does our Equality Impact Assessment say?

We have carried out an equality impact assessment (EIA) available here.

Equality impact assessments ensure that our policies, services and legislation do not discriminate against anyone and that we promote equality of opportunity.

We will update the EIA following comments received during the consultation and our Executive and the York and Scarborough Teaching Hospitals NHS Foundation Trust Board will consider it again before a final decision on implementing the re-configured service.

The EIA has identified at this stage that there will not be an impact on individual’s sexual health.

We anticipate that, if the proposals are implemented, the service will have a positive impact on sexual and reproductive health outcomes, with a more responsive service for all. However we will continue to monitor and review the data to address early any adverse impacts.

Take part and tell us your views.

We want to hear your views on the proposals and, in particular on the following questions:

  1. We have learned from how we had to adapt during the Covid-19 pandemic, and in future, we want to further the online and telephone remote offer as part of the sexual health service. Do you support a more enhanced online and telephone service to complement face-to-face delivery?
  2. Do you support a more personalised offer to sexually transmitted infections (STI) testing across North Yorkshire based on an individual’s level risk and history?
  3. Free contraception and advice will continue to be available from the sexual health service. The sexual health service will be able to start an individual on a new contraception method where appropriate; however, people aged over 19 years old will not be offered basic repeat prescriptions. Instead, individuals will be signposted to their GP. What do you feel we need to consider as part of this change?
  4. Do you support a more coordinated approach between the sexual health counselling and HIV support services?
  5. Do you support a more responsive joined up clinical and community approach to engaging with those with greater levels of risk or need in relation to sexual and reproductive health?
  6. Finally, what are the most important issues for you and your sexual and reproductive health?  

You can tell us your views and give us your suggestions in the following ways:

Complete the online survey 

Please do not include any personal identifiable information in any of your answers that could identify yourself or another individual.

An easy read version of this survey is available on request.

If you would like to request any paper copies of the survey, or require information about the consultation in a different language or a more accessible format please contact nypublichealth@northyorks.gov.uk

Or call our customer service centre on 01609 780780.

You can also send your views on the proposals by email to nypublichealth@northyorks.gov.uk

Or write to us at:

Sexual Health Service Consultation
Central Admin Team
North Yorkshire County Council
County Hall
Northallerton
North Yorkshire
DL7 8AE

How long is the consultation?

This will be a 60-day consultation starting on 4 August 2021 and ending on 4 October 2021.

The consultation and related feedback will enable formal agreements to be in place by 1 April 2022.

What happens after the consultation closes?

The responses received during this public consultation will be considered by North Yorkshire County Council’s Executive, and by York and Scarborough Teaching Hospitals NHS Foundation Trust Board, before any final decision is made.

Subject to the outcome of this consultation and due consideration, it is proposed that the new service will begin on 1 April 2022.