This is the second in a series of three blogs exploring every stage of the sexual health commissioning cycle. It will deal with the primary two levels of the cycle: analysing and planning.
It is important to spend time on the primary levels of the cycle, because it lets you perceive the wants of the inhabitants and successfully plan to satisfy them.
There is a hazard that health wants assessments make generic, strategic ideas to ‘strengthen’ or ‘improve’. However, with out ‘SMART’ measures, we’ll by no means know whether or not we now have achieved what we got down to do. Using these levels to find out the tangible issues that want to vary, and how we plan to make this alteration, is essential to success.
Stage 1: Analysing and understanding inhabitants wants
In the UK, we now have a wealth of knowledge on sexual health service attendance and exercise, epidemiology of STIs, HIV and contraceptive use, and an understanding of the inhabitants’s life and attitudes towards sexual health. The Sexual and Reproductive Health Profile features a information to native and nationwide knowledge, and there may be steering on the best way to undertake a sexual health needs assessment. PHE Centre colleagues, together with sexual health facilitators, discipline epidemiologists, and data and info colleagues, can help in accessing and deciphering these knowledge. However, there are some vital ideas to pay attention to.
Activity and diagnoses don’t equal want
Determining ‘need’ in relation to sexual health is sophisticated, as the extent of service supply will inevitably affect STI analysis charges and contraception take-up. For instance, will increase in service stage often resulting in will increase in STI analysis charges which may very well be misinterpreted as a better stage of want.
Nonetheless, all of us recognise that figuring out extra infections and treating them to forestall onward an infection is sweet for public health. Using exercise and analysis charges alone as measures of want will be inaccurate and deceptive, and there’s a must evaluation each testing charges and the proportion testing optimistic to raised perceive whether or not there continues to be unmet wants.
Whilst the general public health consequence measures are an excellent place to begin to evaluate the effectiveness of native providers, you will need to bear in mind that some measures are impacted by entry to providers and others will not be. For instance, chlamydia detection charges will likely be influenced by service entry, however teenage conception figures are a mix of precise numbers of births and abortions.
With restricted assets, you will need to deal with populations in best want. Looking solely at exercise or analysis charges doesn’t inform us about unmet want locally; not least as a result of it could be that these at best threat of poor sexual health will not be attending providers.
So, how can we perceive want?
It is vital to start with an in depth understanding of the native inhabitants’s demographics, and take into account this alongside what we find out about sexual health wants of various sub-populations. The National Survey of Sexual Attitudes and Lifestyles (NATSAL) supplies knowledge on the traits and wants amongst completely different inhabitants teams, together with the hyperlinks between deprivation and sexual health.
Using current service knowledge
Existing service knowledge present an perception into the present state of affairs, what may have bettering, and the place to dedicate assets.
Comparing the demographic breakdown of service customers to the native inhabitants will present who’s, and is just not, accessing native providers. We may also have a look at which teams are likely to entry which service settings, from specialist providers, to GPs, pharmacies and on-line. This will spotlight how individuals select to entry providers.
Some areas have included of their wants evaluation a consideration of how individuals want to entry and work together with providers. This can result in exploration of modern approaches that guarantee providers are accessible to a variety of populations.
Stage 2: Planning native providers and interventions
With more and more scarce assets, we have to assume innovatively about how greatest to satisfy inhabitants wants. Planning native providers and interventions ought to all the time start with the patient pathway, with the goal of making certain individuals expertise built-in, responsive providers. It is important to work with fellow commissioners to map interdependencies and plan to mitigate any dangers as early as attainable within the course of.
Working with each frontline practitioners and the group is essential at this stage, as it would be sure that the providers and interventions you’re planning will be successfully and effectively delivered, are what the inhabitants want, and are delivered in a means that meets their wants.
The nationwide specialist sexual health service specification template is a wonderful place to start, as this was developed in session with commissioner and supplier representatives, together with the skilled our bodies. It describes the providers any inhabitants would possibly count on to have entry to and their nationwide requirements, and will be amended to mirror native wants.
PHE is usually requested ‘What level of service should I commission?’ This ought to be knowledgeable by the native health wants evaluation, and there are a variety of the way of understanding whether or not there may be ample useful resource to satisfy the necessity, equivalent to waiting times and turnaround occasions for outcomes and therapy.
However, not reaching the mandatory requirements doesn’t all the time imply extra useful resource is required. It might as a substitute be about doing issues in another way, equivalent to a redesign of processes inside a service.
As everyone knows, sexual health providers should be free, confidential and open access, regardless of area of residence. Location of providers is essential to making sure good entry. Talking to the native inhabitants will inform how and the place individuals wish to entry providers, and spotlight unexpected elements that affect entry.
Maintaining good entry to sexual health providers with restricted assets might require taking a look at completely different fashions and supply mechanisms. For instance, fashions of supply that contain better self-management or applicable use of on-line providers, ensuring that those that must see a healthcare practitioner nose to nose are in a position to, and that specialist providers have capability to see these at larger threat as steadily as clinical guidance recommends. These new fashions of supply are beginning to emerge throughout the nation, however it’s nonetheless early days.
Speaking to service suppliers and clinicians
In fascinated by altering fashions of supply, it’s important to be clear on the aim of creating a brand new method. It can be vital that service design is knowledgeable by the present proof base on effectiveness of interventions.
Speaking to service suppliers and clinicians will be helpful as they’ll have invaluable understanding of, and perception into, the best way to successfully and safely alter the care pathway.
Whatever mannequin of supply and configuration of providers is settled on, it’s important to articulate this clearly – each to these organisations who you’ll be asking to ship the interventions, however equally importantly, to the general public so they’re clear on what to anticipate.