Sexual health and HIV services at breaking point, claims Terrence Higgins Trust

NHS sexual health and HIV services are at “breaking point”, an Aids charity has claimed after an official report highlighted problems with commissioning.

The Terrence Higgins Trust spoke out after a Public Health England (PHE) report found evidence the service was “fragmented”, with a lack of expert staff and under “financial pressures due to reductions in budgets”.

The report, released on Wednesday, recommended a series of changes but warned they were not a “panacea” if implemented on their own.

Ian Green (pictured), chief executive of the Terrence Higgins Trust, said the report “confirms the fears that we, and many others, have highlighted – these vital services are at breaking point”.

He said: “Demand is rising, while budgets are shrinking; HIV and sexual health services are reeling from a combination of national government funding cuts to local authorities, a lack of prioritisation by some local councils, and lasting damage from the Health and Social Care Act, which led to fragmented and uncoordinated commissioning.

“This cannot go on. We welcome the actions set out in this report, however, this action plan does not commit to new funding, and does not address the shortfall left by the damaging cuts made to public health budgets.

“Without additional investment in HIV and sexual health services, it is unclear how a sexual health crisis can be avoided.”

The report, Sexual Health, Reproductive Health and HIV: A Review of Commissioning, followed a 2016 survey of local authorities, NHS England and Clinical Commissioning Groups (CCGs), carried out with the Association of Directors of Public Health (ADPH).

It found “fragmentation of commissioning”; issues with accessing services, particularly by those at most risk; “contracting problems” including double charging some patients who also used services in other geographical areas; “workforce concerns”, increased demands and financial pressures “particularly in local authorities”.

It noted: “PHE has seen some excellent work in improving services, recasting service specifications to meet assessed needs and examples of collaborative approaches – particularly in London.

“However it has also found evidence of structural concerns which have the potential to impede effective commissioning.”

It also noted while the 2016 survey had “excellent response rates from local authorities, and a good rate from NHS England”, those from CCGs were “extremely low and required further work to obtain analysable data”.

It recommended five actions, including to “ensure that sexual health, reproductive health and HIV commissioning is explicitly considered within the development of the new funding mechanisms for public health over the next three years”.

But it warned: “Improving the commissioning process is not a panacea, it will only go so far in improving clinical outcomes.

“There is a need to look carefully at a wide range of issues, including how to affect behavioural change, targeted use of marketing, tackling skills shortages in clinical staff and ongoing education.

“Leadership across the system – within clinical communities and nationally, within local authorities, NHS England, CCGs and providers – is essential.

“Without improvement in this wider environment, changes in commissioning will not deliver the step-change that is required to alter some of the negative trends and to accelerate those that are going in the right direction but have not reached the levels we would like when compared with international comparators.”

A PHE spokeswoman said: “This report shows that while effective commissioning of sexual health services does occur, challenges are faced across the system.

“An action plan has been developed which is designed to support and improve how services are made available, together with partners across the system – including Directors of Public Health, local authorities, NHS England and CCGs.

“This includes piloting two cross-system collaborations, improving guidance, developing a model of integration and developing a framework for improvement.”

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