Sexual Health Strategy

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A decision made (26.01.07) to endorse the Sexual Health Strategy for Jersey.

Subject:	Sexual Health Strategy for Jersey
Decision Reference:	MD-H SS-2007-0011		Exempt clause(s):	-
Type of Report: (oral or written)	Written		Person Giving Report (if oral):	-
Telephone or e-mail Meeting?	-		Report File ref:	-
Written report – Title	Sexual Health Strategy for Jersey
Written report – Author (name and job title)	Andrew Heaven Assistant Director Public Health (Health Promotion)
Decision(s): The Minister of Health & Social Services has endorsed the Sexual Health Strategy for Jersey
Reason(s) for decision: Many of the sexual health challenges we face are preventable and treatable. Improving the population’s sexual health requires co-ordinated and integrated approaches, with key services working together and ongoing monitoring to measure progress. In doing so we will make sure that States expenditure on improving sexual health is focused on agreed actions and achieving value-for-money.
Action required: To disseminate the strategy to key stakeholders and establish the planned structure for implementation.
Signature: (Minister for Health and Social Services)		Date of Decision:

Sexual Health Strategy

Sexual Health Strategy for Jersey

January 2006

Health and Social Services Department

1 Introduction

The aim of this strategy is to improve the sexual health of the residents of Jersey. This means we must prevent sexual ill health and provide excellent sexual and reproductive health services. In doing so we will make sure that Sates expenditure on improving sexual health is focused on agreed actions and achieving value-for-money.

This strategy seeks to:

· Reduce sexually transmitted infections

· Reduce unintended pregnancies

· Enhance the provision of sexual health services

· Promote a broad understanding of sexual health

· Develop partnership working

· Improve data collection

It will do this by:

· Setting clear priorities

· Providing local leadership

· Maximising existing resources

· Investing in new services

· Monitoring progress to ensure delivery

Protecting, supporting and restoring sexual health is important to people’s physical and emotional health, and is central to many close relationships. Successfully improving sexual health means we have to:

· Work together to deliver agreed objectives

· Be clear about how different services interlink

· Provide accessible services

· Focus services on local needs

· Give staff the education and training they need

· Give the public better information about local services

· Improve our understanding about the sexual health characteristics of the local community

· Update the strategy regularly to reflect changing needs

Many of the sexual health challenges we face are preventable and treatable. Improving the populations’ sexual health requires an understanding of what we know about sexual health; staff and services that are fit for purpose; agreement on the actions needed to improve sexual health; appropriate resources; co-ordinated and integrated approaches, with everyone working together and ongoing monitoring to measure progress. This document explores these issues.

Sexual health can be an emotive subject. This strategy is not about moral judgements. It is about realistic responses, to real issues, that affect us all. This strategy recommends a number of immediate priorities and objectives for the future.

2 Sexual health in Jersey

2.1 What is going well?

In a number of areas Jersey is doing well, for example:

· Conception rates for the under 20s in Jersey have gone down slightly over the past 2 years and are lower than the UK

· Overall conception rates have also decreased slightly across most age groups since 2000

· Since 1997 there has been a gradual reduction in the number of terminations performed in Jersey

· The number of new cases of human immunodeficiency virus (HIV) in Jersey each year is relatively low

2.2 What are our challenges?

The main challenges are:

· Rates of some sexually transmitted infections have risen steadily over recent years, particularly among young people, in Jersey and elsewhere.

· Chlamydia is the most common sexually transmitted infection in women in Jersey, especially those aged between 16 and 19

GUM – Genito-urinary medicine (the branch of medicine that concerns the male and female sex organs and the urinary system)

· Increasing use of emergency contraception, among under 20 year olds, suggests that many are not using barrier methods of contraception. In 2002, Brook in Jersey provided 647 prescriptions for emergency contraception for those under 20, by 2005, this increased to 903.

· While the number of terminations of pregnancies performed in Jersey has reduced over recent years, (there were 326 terminations in 1998; in 2005 this had reduced to 212). The fact that there are more than 200 terminations per year indicates that unintended pregnancy is still an issue

· Although the number of new cases of HIV in Jersey each year is relatively low, the number of cases of HIV has increased and the majority of new infections are now from heterosexual intercourse (currently 70% compared with 8% in the early 1990s) at home and abroad (see chart overleaf)

Risk groups for HIV infections (where known)

Where Jersey patients acquired HIV

2.3 What does this mean?

It is time for a unified sexual health strategy in Jersey that will prevent poor sexual health as well as treating sexual health problems once they arise.

Jersey faces serious challenges. There are an increasing number of people living with HIV, the rates of some sexually transmitted infections have increased significantly in recent years and every year there are unintended pregnancies. The level of sexual health knowledge remains a major issue. Evidence suggests that many people lack the information they need to make informed choices about their sexual health. All of this places increasing costs and demands on local services.

Simply put, doing nothing is not an option. If we fail to address these challenges, then the significant costs to individuals, the States of Jersey and our community will increase.

Many sexual infections have long-term effects on health. For an individual the consequences of poor sexual health include:

· Pelvic inflammatory disease, which can cause ectopic pregnancies and infertility

· HIV

· Cervical and other genital cancers

· Hepatitis, chronic liver disease and liver cancer

· Recurrent genital herpes

· Bacterial vaginosis and premature delivery

· Psycho sexual problems

Addressing problems using an invest-to-save approach will require investment in health promotion, screening and sexual and reproductive health services.

The costs and consequences of poor sexual health emphasise the benefit of early intervention and prevention. For example the average life time treatment cost of an individual who is HIV positive is currently around £150,000 and preventing one pregnant woman from passing HIV on to her baby is estimated to save somewhere between half a million and one million pounds. The annual cost of Chlamydia and its consequences is of the order of £100 million in the UK and approximately £175,000 locally.

Early diagnosis, screening and appropriate management (treatment, contact tracing and education) are the principal proven activities necessary to control STI. Comprehensive delivery of primary prevention is also essential.

The consequences of poor sexual health have important implications for both individuals and society. Unintended pregnancies may have a long-lasting impact on the quality of life for both mother and child. It is estimated that their prevention saves the National Health Service (NHS) over £2.5 billion a year.

Information from the UK has shown that for every £1 spent on contraceptive services the NHS saves £11. This illustrates the substantial impact of investment in universal high-quality contraceptive services.

Sexual health is not just about disease. Ignorance and risky behaviour can also have profound social consequences.

For our community, the consequences of poor sexual health include:

· Increased States expenditure on treatment and care

· Increased demands on sexual health services

· Unintended pregnancies and abortions

· Health, social, economic and educational problems for young parents

3 Strategic principles

Effectively preventing poor sexual health and treating sexual health problems once they arise will depend on following principles of good practice, these are:

3.1 Partnerships and integration

Agencies working well together will achieve the progress and change needed to improve sexual health. A collaborative approach ensures that energy and resources tackle areas of greatest local concern. Partnership working, with relevant stakeholders, will be the foundation of this strategy. To secure these relationships there will be service level agreements (SLAs) between Health and Social Services and key partners funded by Health and Social Services.

3.2 Evidence based practice

There is a growing base of evidence and good practice in the field of sexual health, covering approaches to prevention, effective interventions and treatments. Those responsible for the implementation of this strategy will continue to keep abreast of global evidence and research in order to make sure resources are allocated in the most cost-effective and appropriate way.

3.3 Reaching everyone and particular at-risk groups

An accessible, comprehensive, confidential and well-networked service for all is the goal. This means shaping services around peoples’ needs. There are two complementary approaches to effectively reaching people in order to improve their sexual health. The first is providing appropriate and timely information, advice and services to the population. The other involves more targeted approaches, designed to reach people who are at greater risk of poor sexual health (particularly at-risk groups).

3.4 Resources

Adequate investment in prevention, services, staff, equipment and premises is required to ensure that all are fit for purpose. Phased bids, to the Health and Social Services Department, will be made to secure funding for agreed areas for action.

3.5 Information

Good quality data needs to be gathered, shared and used. This is fundamental to the strategy as it allows progress to be monitored and evaluated. Local data also ensures that emerging trends and changing needs are identified and quickly acted on.

3.6 Continuous improvement

Remaining dynamic and responsive to change will help ensure continuous improvements in the quality of all local sexual health services.

4 Strategic priorities

There are five strategic priorities, which collectively will improve sexual health in Jersey. They are:

4.1 Involving everyone in improving sexual health

Excellent partnership working is central to the strategy’s success. Although local organisations sometimes work together this is not always the case.

This strategy aims to engage, unify and support everyone with a part to play in achieving improvements in sexual health in Jersey. Views on the strategy have been invited from a number of organisations, including ACET Jersey, Brook in Jersey, GPs, Education, Sport and Culture and Family Nursing and Home Care.

A number of professional groups and agencies need to work well together to achieve a comprehensive approach to improving sexual health. This includes, amongst others, teachers, care workers, charities, school nurses, youth and community workers, social workers, prison staff, health visitors, voluntary organisations with a specific role in sexual health, midwives, psychologists and GPs.

Joined-up working, which tackles agreed local priorities, leads to focused work and avoids duplication of effort. The diagram below reflects an integrated approach and illustrates the inter-relationship between various elements of this strategy.

Integrated approaches to improving sexual health

4.2 Enhancing prevention

The level of sexual health knowledge remains a major issue because many people lack the information they need to make informed choices about their sexual health.

We will direct information about safer sex to the general population with particular emphasis given to reaching young people and at-risk groups including those with sexually transmitted infection, men who have sex with men (MSM) and people travelling abroad to high risk countries.

Given their inexperience, it is crucially important to reach young people. The evidence base demonstrates that the quality of personal, social and health education (PSHE) in schools improves when taught by specialist teachers who are knowledgeable and who enjoy teaching it. Consequently, schools have an important part to play in developing the PSHE curriculum. The working relationship between teachers responsible for sex education and other local agencies is vital.

4.3 Providing excellent sexual and reproductive health services

The key elements of contemporary, comprehensive sexual and reproductive health services are:

 Contraceptive care and termination of pregnancy

 Diagnosis and treatment of sexually transmitted infections and HIV

 Prevention of sexually transmitted infections and HIV

 Services that address psychological and sexual problems

People have choices about where they go for sexual and reproductive health services, as these are provided in a variety of settings throughout Jersey. These include clinics within genito-urinary medicine, general practice (patient funded with co-payments via Social Security), community family planning, and clinics aimed at specific groups such as young people (for example, services provided by Jersey Brook for young people). Other agencies including ACET Jersey, Family Nursing and Home Care and other States departments such as Education, Sport and Culture are key stakeholders.

At their best, these services provide comprehensive, accessible, confidential advice and care, and play a big part in promoting public health through prevention and information. The strategy will ensure greater co-ordination between agencies providing these services. The use of standard advice and protocols will avoid any inconsistent advice or fragmentation of care.

Quick, easy and confidential access is especially important for those requiring sexual health services. As well as ensuring that premises are fit for purpose, service providers will review their location and opening hours in light of local needs. They will also ensure that all staff are appropriately trained and updated and promote and advertise services to potential service users.

4.4 Developing sexual health data

To be able to monitor changes in sexual health all agencies will need to collect and share relevant data. Developing local data collection, and protocols that strengthen data collection and sharing are important, as is the use of existing surveys (such as the Health-Related Behaviour Survey and the Jersey Social Survey) to provide on-going feedback on sexual health in Jersey.

Currently there is variation in the availability and quality of local sexual health data. The strategy will ensure that all agencies work closely together to make sure that relevant and accurate data is collected and used.

4.5 Achieving co-ordination, clear leadership and accountability

Local co-ordination in delivering the strategy is central. A chair will be chosen from the members who will lead and be accountable for the co-ordinating group which will include managers from the Department of Health and Social services.

Structure for strategy delivery

Co-ordinating Group (3 Heads of Clinical GUM, Community Gynaecology, and Health Promotion)

Community Gynaecology

Clinical GUM

Health Promotion

All partners in delivering the strategy e.g. Brook in Jersey, GPs, FN&HC, teachers, etc

The co-ordinating group will be responsible for the ongoing monitoring of the outcomes of this strategy. They will report to the Chief Executive of Health and Social Services on a regular basis and publish an annual report detailing progress against objectives.

5 Improving sexual health - areas for action

A phased approach is proposed to secure the changes needed; this will allow realistic and achievable objectives to be set.

5.1 Phase one - what we will do immediately

There are a number of immediate actions required, these are:

· Establish the coordinating group and engage with key partners

The coordinating group will ensure that health and social care agencies, States departments, the prison, voluntary organisations, the private sector, patients and the community at large all play their part in improving sexual health in Jersey.

· Deliver an education programme to nurses, teachers, youth workers and social workers, covering subjects such as contraception, pregnancy, Chlamydia, local support and services, relationships and sexuality

A range of professional groups will receive local training covering core skills and issues relevant to improving sexual health.

· Increase the number of teachers who hold the Personal and Social Health Education (PSHE) Certificate

The delivery of effective sex education, as part of the personal and social health education curriculum in school, remains important. Working with colleagues in Education, Sport and Culture will ensure that more teachers receive appropriate training and support to enable them to effectively deliver and evaluate sex education

· Review and improve the overall provision of contraceptive services and ensure that condoms are easily accessible and widely available (through a condom distribution scheme) this will include increasing young peoples’ understanding of and access to condoms

Barrier methods of contraception play a critical part in preventing sexually transmitted infections and unintended pregnancies. Condoms remain an important aspect of safer sex. Improving the overall availability and accessibility of condoms and ensuring that young people, in particular, understand the principles of safer sex remains a clear priority.

· Further the role-out of Chlamydia screening to achieve full target coverage

Chlamydia is a serious problem. Health and Social Services are committed to improving and extending the Chlamydia screening programme.

· Ensure all clinics providing sexual health advice and services are appropriately staffed by suitably trained individuals with relevant qualifications

All staff working in sexual health services will provide confidential, respectful and non-discriminatory care. Training and support to do this will be provided.

· Ensure all premises that provide sexual health services are of suitable standard and fit for purpose

· Develop information technology (IT) in order to improve data collection and to incorporate Chlamydia screening

The ongoing monitoring of local sexual health trends will be an important indicator of the strategy’s success. All sexual health service providers will ensure that they can efficiently gather and share relevant data. Information systems will:

- Maintain patient confidentiality

- Improve the co-ordination of data collection

- Capture information from new services such as extended Chlamydia

Screening

- Improve information on sexual health behaviours and attitudes

· Take forward unlinked anonymous testing

To gain information about the prevalence of HIV, Acquired Immune Deficiency Syndrome (AIDS) and Hepatitis C in Jersey the Health and Social Services Department is proposing to introduce unlinked anonymous testing. It is suggested that unlinked anonymous testing (the anonymous testing of blood for HIV and other diseases) will take place when a patient gives a blood sample, after completion of all the tests, a small amount of blood will be separated and this will then be tested for HIV/AIDS and Hepatitis C.

This separated blood is completely and irreversibly divorced from donor identification. In other words, it is not possible to link the result of the test back to the donor. Thus, the sample is ‘unlinked’ and is ‘anonymous’. A consultation exercise will canvas views on this proposal.

· Develop a service level agreement with Brook in Jersey

Brook in Jersey is the main provider of information, advice and sexual health services for young people. A service level agreement with the Health and Social Services Department will ensure cost effective and appropriate services for users.

5. 2 Phase two - future priorities - 2008 onwards

The co-ordinating group will need to agree an action plan for the next phase of the strategy. New areas for action will be considered and added year-on-year. The action plan will build on phase one actions through:

 Building a better infrastructure for sexual health services which joins up services with common, high quality care protocols for all services

 Expanding prevention through new and better health education programmes and professional development for health staff and teachers.

 Providing excellent sexual and reproductive health services which are likely to include:

- A further extension of Chlamydia screening

- Tailored GUM services for young people

- Preventing HIV transmission after exposure

- Introducing a new vaccine to help protect against cancer of the cervix and genital warts

- Encouraging routine contraception to be done through primary care with improved training for primary care staff

- Improving services for termination, psychosexual counselling and menopausal symptoms.

 Developing sexual health data: establishing unlinked anonymous testing, unifying service data for audit and monitoring and collecting more data on sexual health behaviours particularly among at-risk groups.

6 Costing the strategy

Staffing and other resource levels have not been set out in detail in this strategy. However, additional resources will be required to deliver on some aspects of this strategy. The annual business planning process, within Health and Social Services and other departments, will be the mechanism for identify ongoing and new priorities and detailing elements of the strategy that require funding.

The co-ordinating group will develop the detail needed to secure appropriate funding and will prepare phased bids, to the Health and Social Services Department, to pursue the resources needed for the immediate actions in phase one for which funding is required.

7 Measuring progress

The ultimate success of this strategy will only be evident in the longer term. There are, however, short and medium-term indicators that will demonstrate improvements. By collecting and monitoring local data, we will be able to track changes in areas such as:

· Improved access to services and information

· Fewer undiagnosed sexual transmitted infections

· Lower rates of unintended pregnancies

· A reduction in the number of newly acquired HIV infections

· Improved availability and uptake of testing, screening and vaccination

· More people trained to a recognised standard

· Improved levels of sexual health knowledge and understanding