Sexual Health 103 options to young women. She also uses the opportunity to advise non-pregnant friends about safe sex and refers them for appropriate screening and contraception.
104 Essential Midwifery Practice: Public Health
•
To halve the under-18 conception rate in England by 2010•
The participation of 60% of teenage parents in education, train- ing or employment, to reduce the risk of their long-term social exclusion.Every local authority has developed its own teenage pregnancy strategy, setting out how it will address the key areas for action, and contribute to the targets set out by the government.
The most recent key policy driver for change in relation to sexual health can be found in the government public health White Paper,Choosing Health: Making Healthy Choices Easier (2004) where it is cited as one of the top six priority areas for action. The White Paper reinforces previous strategic messages about sexual health improvement and also provides a focus for improving sexual health treatment and care through modernising services and improving access to them.
Choosing Health also came with an accompanying delivery plan, Delivering Choosing Health: Making Healthy Choices Easier (DoH 2004a). This document identified performance monitor- ing lines that primary care trusts (PCTs) would be measured against in their local delivery plans, which set out how a PCT will deliver on improving health. The monitoring lines are as follows:
•
A reduction in the under-18 conception rate by 50% by 2010 as part of a broader strategy to improve sexual health•
100% of patients’ contacts in GUM clinics to be offered an appointment within 48 hours by 2008•
A decrease in the rates of new diagnoses of gonorrhoea by 2008•
An increase in the percentage of people aged 15 to 24 accepting chlamydia screening.All of the above specifically refer to improving sexual health.
There are also broader policy documents that impact on attempts to improve sexual health. They include:
•
Every Child Matters: Change for Children (DfES 2004) – the key policy document for improving outcomes for children and young people which focuses on being healthy, staying safe, enjoying and achieving, making a positive contribution and achieving economic well-being•
Our Health, Our Care, Our Say(DoH 2006b) – the key policy document for the provision of integrated services in the com- munity, which refers explicitly to sexual health servicesSexual Health 105
•
Creating a Patient-led NHS: Delivering the NHS Improvement Plan (DoH 2005a) – which focuses on encouraging informed choice and on NHS organisations becoming more focused and better at understanding the needs of their patients and commission- ing services that more effectively meet the needs of the local population.While a national commitment to improving sexual health in key policy documents is welcomed, it is important that these policies are a real lever for change at the local level, which in turn will lead to improvements in sexual health outcomes for our populations.
Real changes are happening. While England still has one of the highest teenage conception rates in western Europe, UK teenage pregnancy rates are at their lowest for twenty years. Waiting times at GUM clinics have improved from 38% of patients seen within 48 hours in May 2004, to 57% in August 2006. There has been an increase in uptake of HIV testing in GUM clinics among gay and bisexual men from 64% in 2003 to 79% in 2004 and in hetero- sexuals, an increase in testing uptake from 54% in 2003 to at least 75% in 2004 (DoH 2006b).
Many areas now have chlamydia screening programmes in place and, if not, are well on their way to having opportunistic screening programmes for all under-25-year-old men and women in the community by April 2007. The National Chlamydia Screen- ing Programme was set up following the recommendations inChoosing Health. This service has a community focus and con- centrates on opportunistic screening of asymptomatic sexually active men and women under age of 25 who would not normally access, or be offered a chlamydia test, and focuses on screening in non-traditional sites (youth services, military bases, universities, contraception services, primary care) (DoH 2005b).
While there are real improvements being made in improving sexual health and sexual health services, a long-term commitment is required if we are to really improve sexual health and more importantly ensure that these improvements are sustainable.
A major modernisation of the whole range of NHS sexual health services is needed with emphasis on offering more locally based, accessible services for testing and screening for STIs and targeting young people, vulnerable people and those who are hard to reach or at significant risk, such as black and minority ethnic groups.
We hope that Choosing Health will drive the modernisation of sexual health services. So far, £130 million has been promised to modernise GUM clinics, with an additional £80 million to com- plete the national rollout of the chlamydia screening programme.
106 Essential Midwifery Practice: Public Health
There is also a commitment to spending £50 million on a sexual health advertising campaign for under-25s and further financial support to upgrade prevention services including contraceptive services.
If this strategy is adequately supported, it will go some way to halting the worryingly high levels of poor sexual health; but the financial and political commitment by the government and the commitment to implement at the local level must be real. Already some PCTs are being accused of not allocating Choosing Health monies towards improvements in sexual health and instead are using the monies to maintain financial balance at year-end. A recent report in Public Health News (2006) reported that 64 GUM providers have had difficulty in getting any of their Choosing Healthfunds allocated to develop services and in other areas, plans to develop chlamydia screening programmes have been halted.