FANCY A THREESOME?

Politicisation, Prioritisation and Postcodes, that is.

This month the responsibility for sexual health commissioning has been transferred over to local authorities. This is a big coup for councils since they relinquished public health in the 1970s and it is also an open opportunity to reduce health inequality through integrated and localised care.

The choices about the different types of sexual health care councils will commission will depend on a combination of local need and statutory responsibility. However, despite the commissioning guidelines released by the DoH, there is still uncertainty within local authorities on how to handle these new clinical responsibilities. There are three main challenges we believe local authorities will face: sexual health is politically contentious, population needs and priorities are variable, and current sexual health services are a ‘mixed bag’ of quality.

Politically, some sexual health responsibilities are statutory and will be protected with a ring fenced grant. However other services are preventative, for example, targeted sexual health awareness campaigns. These services are arguably of equal importance when reducing long term health inequalities however their fate will now be dependent on stretched public health budgets and political opinion. DoH Guidance recognises that a number of factors affect people’s relationship to sexual health including social norms, peers and religious beliefs. If Councillors feel that certain elements of sexual health services provision are antithetical to their core beliefs or the beliefs of their party, they might chose to campaign on promises to reduce public funding for these services. This will place Health and Wellbeing Boards under strain to maintain good sexual health.

Another key variable will be the priorities of local Health & Wellbeing Boards. The Boards have responsibility for prioritising sexual health among other public health outcomes for their population. DoH guidance repeatedly states they “will play a key role in ensuring that the services and care their communities receive is seamless”. However if sexual health does not make the cut amongst other public health concerns such as smoking and alcohol abuse then this complex service will not be given the time or resource it will need to be commissioned successfully.

On top of this, councils are inheriting a sexual health service which is already flawed. The public are currently subject to a ‘postcode lottery’ when accessing available sexual health services in their area. A recent review of contraceptive services the All Party Parliamentary Group on Sexual and Reproductive Health found nearly a third of women aged 15-44 do not have access to a fully comprehensive contraceptive service. Consequently Local Authorities may inherit a service that does not meet the needs of their local population. This could mean that inherited bad practice continues, on the assumption the NHS had it right in the first place when sadly they did not. Those Local Authorities who do assess their sexual health services may realise an entire service rehaul is required to adequately meet the needs of the local population.

There is a clear link between social inequalities and poor sexual health. We believe that the return of public health into local government control represents a real opportunity to provide an integrated service which deals with these inequalities. Local Authorities will have to be critical when evaluating the quality of local sexual health services and be bold in considering new models for future service delivery.

Annette Jack is an Executive in BDO’s Healthcare Advisory Team and Antonia Jeans is an Executive in BDO’s Local Government Advisory Team.

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