Sexual health services have suffered from ‘fragmentation’ since being put under the responsibility of local authorities, according to a Public Health England review.
Since April 2013, councils commission the majority of services relating to sexual health, reproductive health and HIV, although some of the responsibility sits with NHS England and CCGs.
But PHE’s report said that since the overhaul, which came with the Health and Social Care Act 2012 replacement of Primary Care Trusts (PCTs), there have been issues with fragmentation of commissioning.
It said this had led to problems with ‘ensuring access to services, particularly for those at greatest risk’ as well as ‘contracting problems including cross-charging for patients attending services outside of area’.
PHE’s report, which was based on responses from local authorities, NHS England and CCGs, also unveiled workforce concerns including ‘clinical expertise both in service delivery but also in commissioning’; ‘increasing demand for some services’; and ‘financial pressures due to reductions in budgets – particularly in local authorities’.
Among workforce concerns, the report highlighted ‘vacancy levels in general practice, genitourinary medicine, and sexual and reproductive health’.
PHE also said the competitive tendering environment in England since the 2012 Act had led to sexual health services providers facing ‘constant uncertainty and regular rounds of re-tendering’.
In response to the concerns highlighted, PHE said fragmentation and ‘contracting barriers’ should be reduced, while outcomes should be monitored. It also called for sexual health, reproductive health and HIV commissioning to be ‘explicitly considered’ when new funding mechanisms for public health are developed over the next three years.
But leading UK sexual health charity the Terrence Higgins Trust said the report showed that vital services were on the brink of collapse.
Chief executive Ian Green said: ‘Sadly this confirms the fears that we, and many others, have highlighted – these vital services are at breaking point.
‘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.
‘Without additional investment in HIV and sexual health services, it is unclear how a sexual health crisis can be avoided.’
