Issue 4 : 28 February 2013

Welcome to the February issue of the Sexual Health & HIV Policy eBulletin. This month’s eFeature is by Councillor Jonathan McShane, Portfolio Holder for Health, Social Care & Culture in Hackney and lead on sexual health for the Local Government Association (LGA).  A number of guidance documents and template contracts have been issued this month to support the new planning and commissioning processes and links to these can be found in the round-up section, together with the Sexual Health Commissioning FAQs issued last week by the LGA and Public Health England (PHE).  As the new commissioning structures begin to take shape, the recent Unprotected Nation report from Brook and FPA provides a stark reminder of the need to continue to invest in sexual health services and the high economic and social costs of not doing so.

**stop press**
The Office for National Statistics (ONS) have released 2011 conception data this week showing a further decline in under 18 conception rates and a 34% reduction from the baseline year of the Teenage Pregnancy Strategy. See the 'Data and statistics' section of the eBulletin for more information and links to the 2011 ONS report.

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In this month’s eFeature Councillor Jonathan McShane considers the importance of new partnerships as the local government sector takes on a critical leadership role in local health improvement at a time of growing demand and diminishing resources. He acknowledges that councillors will be key to driving improvements in sexual health, and despite old sensitivities and commissioning complexities, is confident most are more than up to it.
>Jonathan McShane eFeature
 

New Gonorrhoea Resistance Action Plan for England and Wales
The first Gonorrhoea Resistance Action Plan for England and Wales was launched this week, recommending a heightened national response to combat the emerging threat of untreatable gonorrhoea.  The Action Plan, developed by the Gonnococcal Resistance to Antimicrobials Surveillance Programme (GRASP), sets out practical, measurable actions to extend the useful life of the current recommended therapies in England and Wales and advocates comprehensive health promotion programmes to encourage safer sexual behaviour.
>HPA - New action plan launched to combat emerging threat of untreatable gonorrhoea in England and Wales
>GRASP Action Plan Feb 2013

HIV transmission, the law and the work of the clinical team
The British HIV Association (BHIVA) and the British Association for Sexual Health & HIV (BASHH) have produced information and guidance based on current scientific evidence, on managing legal issues related to the sexual transmission of HIV including criminal prosecution. It is primarily aimed at clinicians working in the field of HIV medicine but will also be useful for general practitioners.
>BHIVA - HIV Transmission, the Law and the Work of the Clinical Team
>Guidance

Position statement on use of antiretroviral therapy (ART) to reduce HIV transmission
The Expert Advisory Group on AIDS (EAGA) and the British HIV Association (BHIVA) issued a position statement at the end of last month on the use of ART to reduce HIV transmission. The statement will help clinicians and those engaged in health promotion translate the evidence on treatment as prevention and support patients to make an informed decision about starting treatment.
>BHIVA and EAGA position statement January 2013 | Department of Health
>Position statement

Payment by Results (PbR): reference costs guidance for 2012-13
Following NHS feedback, this final guidance sets out requirements for the collection of 2012-13 reference costs from Trusts between June and July 2013. Guidance costs on HIV testing and partner notification have been amended and should now be reported against the sexual health service currency and not the HIV and AIDS currency. It also includes guidance on costs relating to outpatient services for patients diagnosed with HIV or AIDS.
>Reference costs guidance for 2012-13 | Department of Health
>2012-13 Guidance

HIV outpatient pathway guidance updated
Further guidance is available to support the implementation of the mandatory adult HIV outpatient and Payment by Results currency. This includes an HIV outpatient guide; HIV outpatient clinical care pathway; HIV currency general factsheet and an HIV adult outpatients pathway clinical factsheet. This documentation replaces previously published guidance.
>HIV outpatient pathway updated guidance available | Department of Health
>HIV-Outpatients-A-Simple-Guide.pdf
>HIV-Outpatient-Clinical-Care-Pathway.pdf
>HIV-Currency-General-Factsheet.pdf
>HIV-Adult-Outpatients-Pathway-Clincial-Factsheet.pdf

New national pledge to improve children and young people’s health
A new pledge about making improvements to the health of children and young people was launched this month as part of the government’s response to the Children and Young People’s Health Forum.  A myriad of organisations – including Public Health England (PHE), Society of Local Authority Chief Executives (SOLACE) and Royal College of General Practitioners (RCGP) – have signed the pledge committing themselves to improving every aspect of health services for children and young people from pregnancy through to adolescence and beyond.
>New national pledge to improve children’s health and reduce child deaths | Department of Health
>Pledge
 

Unprotected Nation: the financial and economic impact of restricted sexual health services
This new report, commissioned by Brook and FPA (Family Planning Association), projects the economic and social impacts from reduced or restricted access to contraceptive and sexual health services. It demonstrates how service cuts and restrictions could lead to a significant rise in sexually transmitted infections and unintended pregnancies, with the potential to add an additional £612million to NHS costs by 2020.
>Press and media centre - XES - We Can't Go Backwards
>Executive Summary
>Full report

PGD authorisation in new organisational structures
The Medicines and Healthcare products Regulatory Agency (MHRA) and the Department of Health (DH) are amending medicines legislation to enable Clinical Commissioning Groups (CCGs), Local Authorities and the NHS Commissioning Board to authorise Patient Group Directions (PGDs) from April 2013 and to ensure that existing PGDs with an expiry date after 31 March 2013 will continue to be legal until the PGD expires or is replaced. See links below for DH update and more information
>PGD authorisation in new organisational structures – DH update - NeLM
>What happens to PGDs when NHS organisations merge or cease to exist? UPDATED JANUARY 2013 - NeLM

Collaboration between PHE and NICE
Public Health England (PHE) and the National Institute for Health and Clinical Excellence (NICE) have produced an agreement on five areas of collaboration, including reviewing evidence, providing evidenced based guidance and providing support to put guidance into practice.
>Interim statement of collaboration between Public Health England and NICE | Modernisation of health and care
>Statement

The health and care system from April 2013
This interactive diagram gives an overview of the new health and social care system from April 2013.
>The health and care system from April 2013 | Modernisation of health and care

PHE's organisational structure, National Executive, Centres & Regions
Public Health England’s final organisational structure and National Executive are now in place in readiness for its full range of responsibilities from 1 April 2013. Duncan Selbie also explains the regional structures of PHE, and how it will interact with other organisations on a local level. Click links to view.
>PHE Organisational Structure 
>PHE National Executive
>Public Health England’s Centres and Regions | Modernisation of health and care

Health and Wellbeing Boards regional map
The Local Government Association (LGA) has created a map showing the health and wellbeing boards in each of the nine local authority regions, and listing the names of Chairs and key contacts.  Click on the link below to access the map.
>Health and Wellbeing Boards regional map | Local Government Association
 

Sexual Health Commissioning: Frequently Asked Questions
These frequently asked questions have been produced by the Local Government Association (LGA) and Public Health England (PHE) to address a number of issues relating to the transfer of responsibility for commissioning sexual health services to local government.
>Publications | Local Government Association
>FAQs document

Public Health Services Contract
A non-mandatory public health services contract is now available for use by local authorities when commissioning services to deliver their new public health functions - including the provision of comprehensive sexual health services – from April 2013. The contract has been developed by the Department of Health (DH) working closely with local government and public health professionals. The contract is available via the DH website, along with further guidance.
>Public health services non mandatory contracts and guidance published | Department of Health
>Guidance

NHS Standard Contract and launch of eContract portal
The NHS Commissioning Board (NHS CB) has published the 2013/14 NHS Standard Contract for use by commissioners when commissioning healthcare services (except those commissioned under primary care contracts).  The Standard Contract has been issued as an eContract with a newly launched portal to support it. Click on the links below to access the contract and supporting documents.
>2013/14 NHS Standard Contract published | NHS Commissioning Board
>2013/14 NHS Standard Contract & contract support documents
>NHS Standard eContract portal

Direct Commissioning planning guidance
The NHS Commissioning Board (NHS CB) has published a document which describes the processes that will be used to support planning for 2013/14 Direct Commissioning in area teams. The appendices include key activities, deliverables and deadlines across primary care, public health and specialised commissioning.
>Direct Commissioning: planning guidance document published | NHS Commissioning Board
>Planning document

Influencing local commissioning guidance for voluntary and community sector
Regional Voices has published a policy briefing to help the voluntary sector influence health and wellbeing boards.  The briefing is part of a suite of resources to support the voluntary sector in working with the new health and care commissioning structures.
>Guidance published to support voluntary sector understand and influence health and wellbeing boards | Regional Voices
>Briefing
 

Updated NICE guidelines for fertility problems
The National Institute for Health and Clinical Excellence (NICE) has recently published updated clinical guidelines revising treatment recommendations for people with fertility problems, including those for couples with HIV (section 1.3.10).
>Updated NICE guidelines revise treatment recommendations for people with fertility problems
>Fertility treatment guideline CG156

NICE briefing for local government on health-related behaviour change
The National Institute for Health and Clinical Excellence (NICE) has produced a new briefing for local government advising on the general principles that should be used when commissioning initiatives to change health behaviours.
>Behaviour change Introduction PHB7

Equity of access to chlamydia screening survey
Recommendations to help commissioners and providers improve future equity of access to the chlamydia screening programme are included in the latest National Chlamydia Screening Programme (NCSP) quality assurance survey report.
>NCSP: Equity of Access
>Report

Guidance on text message results notification
The National Chlamydia Screening Programme (NCSP) has developed new guidance on text messaging for chlamydia test results communication.  The guidance was based on feedback from chlamydia screening teams and on a survey of service user attitudes.
>Chlamydia Test Result Notifications: NCSP recommendations

No reduction in HIV levels in MSM in England & Wales
Recently reported results of a modelling study by the Medical Research Council (MRC) and the Health Protection Agency (HPA) show that the number of new HIV infections in men who have sex with men (MSM) has remained unchanged over the last ten years despite a significant increase in HIV testing and treatment. Read more about the study in Lancet Infectious Diseases by clicking the link below.
>Health Protection Report |  1 February 2013

New research explores driving force behind HIV epidemic in MSM in UK
The rise in new infections in men who have sex with men (MSM) has been driven by an increase in condomless sex, according to a second modelling study by the Health Protection Agency (HPA) and University College London (UCL). The findings also suggest that the increase would have been much greater without the introduction of antiretroviral therapy (ART) or if condom use had ceased entirely, supporting current public health recommendations for expanded testing, higher levels of ART coverage and sustained condom education.
>HPA - New research explores driving forces behind HIV epidemic in men who have sex with men in the UK
>Published paper in PLOS ONE

Pilot project on HIV home sampling kits
The Health Protection Agency (HPA) and Terrence Higgins Trust (THT) have launched a pilot project to offer postal HIV home sampling kits to men who have sex with men and Africans living in England.  Postal HIV home sampling kits can be requested from the THT website.
>Health Protection Report | 1 February
>Pilot scheme allows gay men to test for HIV by post | Terrence Higgins Trust
>Pilot scheme allows Africans in England to test for HIV by post | Terrence Higgins Trust

NAT Policy Briefing: HIV and post mortems: best practice for pathologists
This briefing from National AIDS Trust (NAT) has been developed in response to a number of reports of pathologists denying post-mortems on the basis of a person’s HIV status. It draws on Royal College of Pathology (RCPath) guidelines on autopsy practice and recommends that all pathology professionals should conduct post mortems on HIV-positive individuals if requested. Click the links below for the full briefing and RCPath guidelines.
>NAT Best practice for pathologists briefing
>RCPath Guidelines

Evaluation studies of Family Nurse Partnership
The Family Nurse Partnership (FNP) is an evidenced based early intervention and preventative programme for young first time mothers and their families. Two independent evaluation studies on delivering the FNP programme have been recently published: the first covers FNP workforce issues to help plan the future expansion and sustainability of the programme; the second study determines the cost of delivering a typical FNP team and an FNP place so as to inform future national and local commissioning of the FNP programme.
>Evaluation studies of Family Nurse Partnership programme published | Department of Health
>The FNP workforce study
>The FNP costs study

Guide for safer online relationships
Safer Internet Day (SID) is organised by the UK Safer Internet Centre in February each year. To mark the event in 2013, the Sex Education Forum (SEF) and Anti-Bullying Alliance have produced a guide for parents and carers to promote safe use of online and mobile technology and help young people enjoy safer online relationships.
>SEF: Lets talk about online relationships
>Guide
 

ONS release 2011 conception data
The Office for National Statistics (ONS) released annual conception data earlier this week. The number of conceptions to women under 18 and to girls under 16 both fell by 10% compared to 2010.  The under 18 conception rate for 2011 is the lowest since 1969 at 30.9 conceptions per thousand women aged 15-17.  Conception rates in 2011 increased for women aged 30 years and over, stayed the same for women aged 25-29 and decreased for women aged under 25.
>Conceptions in England and Wales, 2011
>ONS 2011 conceptions statistical bulletin

ONS Analysis of U18 conceptions and their links to measures of deprivation, 2008-10
This release from the Office for National Statistics (ONS) explores annual under 18 conceptions using three year aggregates and averages.  Published earlier this month, it explores the link between teenage conceptions and measures of deprivation at national and regional level, using the new ONS Conception-Deprivation Analysis Toolkit.
>Area Based Analysis, Conceptions and Deprivation Analysis, England and Wales, 2008-10
>Abstract
>Conceptions deprivation analysis toolkit

Public Health Outcomes Framework (PHOF): new baseline data on HIV
New baseline data have been added to the PHOF data tool on the indicator for people presenting with HIV at a late stage of infection (Indicator 3.04).  The interactive data tool allows local authorities to benchmark against the England average and to make comparisons with neighbouring authorities.
>Statistical Press Notice – Public Health Outcomes Framework data update, February 2013
>Public Health Outcomes Framework

Chlamydia screening data for July-Sept 2012
The latest quarter chlamydia screening data for England have been published and the full tables are available on the National Chlamydia Screening Programme (NCSP) website.  Diagnosis rates nationally and in many areas remain below the > 2,400 per 100,000 population aged 15-24 level recommended in the Public Health Outcomes Framework.
>NCSP : The Data

Maternity and Children’s data set bulletin
This bulletin provides information about the roll-out of the Maternity and Children’s data set and identifies what commissioners and providers need to do in relation to this.  Click link to access the January bulletin and to sign up for future issues.
>Maternity and Children's data set bulletin
 

Parliamentary Questions on Sexual Health Policy
Anna Soubry, Parliamentary Under-Secretary of State for Health, answered a number of questions about the timing and content of the forthcoming Sexual Health Policy document in parliament earlier this week and confirmed that she anticipated the Sexual Health Policy document would be published in March.  Click the link below to read more.
>House of Commons Hansard Debates for 26 Feb 2013 (pt 0001)

NHS Constitution and sexual health services after April 2013
In response to a recent PQ from Baroness Gould, Earl Howe, Parliamentary Under-Secretary of State for the Department of Health (DH), confirmed that all those bodies (LA’s, CCG’s & NHS CB) commissioning sexual health services from April 2013 will be required by law to have regard to the NHS constitution in their decisions and actions, including those in relation to sexual health services (eg, 48 hour genito-urinary medicine (GUM) access pledge contained in Handbook to the NHS Constitution).
>Lords Hansard text for 12 Feb 201312 Feb 2013 (pt 0001)
>Handbook to the NHS Constitution

Select Committee Inquiry into the role of local authorities in health issues
Anna Soubry MP, and Baroness Hanham, Parliamentary Under-Secretary of State in the Department for Communities and Local Government gave evidence to the Communities and Local Government Committee on the role of local authorities in health issues at the end of last month.  Uncorrected transcripts of the oral session are available on the parliamentary website.
>House of Commons - Uncorrected Evidence - HC 694-v

Cross-party parliamentary inquiry into asylum support for children and young people
The parliamentary inquiry into asylum support for children and young people, with support from the Children’s Society, has published its final report. The inquiry took evidence from a wide range of organisations including the Children’s HIV Association (CHIVA) and the National AIDS Trust (NAT). Click the links below to read the report or access written evidence.
>Parliamentary inquiry into asylum support for children and young people | The Children's Society
>Executive Summary
>Full report

Backbench debate on violence against women and girls
Fiona Mactaggart MP introduced a debate this month on violence against women and girls and called on the government to introduce statutory PSHE in schools.  Click the link to read more.
>House of Commons Hansard Debates for 14 Feb 2013 (pt 0002)
 

Consultation on future social care topics for NICE guidance and standards
The Department of Health (DH) has launched a 12 week web-based consultation to seek ideas on future topics for standards and guidance for social care. Future topics listed include sexuality, sexual identity and intimacy within the context of social care.
>Department seeks views on NICE standards to improve quality of social care | Department of Health
>Consultation document
>Online survey
 
Starting a National Conversation on Child Sexual Exploitation
The Local Government Association (LGA) has launched an eight week ‘national  conversation’ to gather views, ideas and existing practice on child sexual exploitation.  The link below will take you to the LGA website where you can download the feedback form.  Deadline for feedback is 10 April.
>Safeguarding children | Local Government Association

Alcohol, drugs, sexual health and teenage pregnancy briefing
This prevention briefing from Mentor explores the close links between alcohol, drugs, sexual health and teenage pregnancy. It is part of a series of briefings on public health issues that affect young people.
>Mentor Public Health briefings
>Teenage pregnancy briefing

Abortion Education in the UK: Failing our young people?
A report was released this month by Education for Choice which looks at the current state of abortion education in our schools.  The report finds that education on abortion is often of poor quality and that some of the teaching materials used by teachers and visiting speakers were inaccurate and stigmatising, rather than impartial, factual and non-judgemental. Click the links below to read the full report and to access EFC’s best practice toolkit.
>Education For Choice: EFC report into abortion education in UK schools
>Executive Summary
>Full report
>EFC: Best Practice Toolkit

Gender-based violence and HIV in England
This report from the Sophia Forum highlights the experiences of women living with HIV and gender-based violence and explores the potential for a national investigation into violence as a cause or consequence of HIV for women in England.
>Sophia Forum - Launch of Report on GBV and HIV in England
>Full report
 

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The Sexual Health and HIV Policy eBulletin is compiled and edited for MEDFASH by Helen Christophers (HChristophers@medfash.bma.org.uk)

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