House of Commons - Health - Minutes of Evidence

Select Committee on Health Minutes of Evidence

Letter from the Parliamentary Clerk, Department of Health to the Clerk of the Committee (SH1A)

You requested some further information on several issues raised at the evidence session of the Parliamentary Under-Secretary of State for Public Health before the Health Committee on 23 January. Taking each item in order:

How the £5 million "injection of cash" was allocated to Genito-urinary medicine services across the country

The allocations to each clinic were based on the data in 2001-02 KC60 returns (2000-01 where these were not available), which is the most recent data available. The KC60 return provides the main source of information for the surveillance of sexually transmitted infections (STIs) in England and Wales. All GUM clinics have a statutory obligation to return data to the Department of Health. However responsibility for collection and analysis of these data rests with the Public Health Laboratory Service.

The data used was new patient workload based on diagnosed caseloads rather than new attenders and follow-up cases. Caseload is greater than new patient numbers because patients often have more than one diagnosis. This workload data was then used to calculate an anticipated 15% capacity increase on the annual total new patient numbers. The £5.3 million was then allocated pro rata according to these numbers. In addition whether the clinic is expected to be a focal point for a local clinical network was also taken into account. The formula was devised by the Medical Society for the Surveillance of Venereal Disease (MSSVD) as the most equitable basis for distributing funds. MSSVD issued guidance to the field and on their web-site, highlighting that money has been distributed in accordance with their representations to DH.

A letter was then sent to each GU clinic informing the lead consultant of their individual allocation on 27 September (specimen copy attached). We also wrote to PCTs with a GUM clinic in their area to notify them of the allocation and asked them to work with the service to ensure that the money is used effectively and in line with the recommendations in the strategy.

What is the timetable for evaluation of the different models of "one-stop shop" services?

The evaluation will last for three years and is expected to start early in the next financial year. Decisions on the researchers to undertake the evaluation and the three services to be evaluated will be announced shortly. A copy of the letter calling for expressions of interest and three specifications is attached.

CLARIFICATION OF INFORMATION ON CONSULTANT EXPANSION

Is the increase of 35 consultants over the next two years supplementary to the number of Specialist Registrars currently in training?

The increase of 35 is not supplementary to Specialist Registrars in training. We anticipate that by 2004 the number of SpRs completing training will be sufficient for there to be an increase of around 35 trained specialists in genito-urinary medicine, after taking into account retirements. These extra staff will be available to take up consultant posts. However, these projections do not take into account the other recruitment measures we are putting in place, such as international recruitment and conversions from other non-consultant grades.

Will these newly qualified consultants have posts to fill?

At local level, it is for NHS trusts to determine how their services are configured and delivered, in the light of local circumstances, in order to provide quality services to patients. They must decide the number and grade mix of staff they need, for only they can judge exactly what is needed to deliver quality services in their location. We are ensuring through the Department's performance management measures that the creation of consultant posts is seen as a high priority.

The NHS is currently working on local delivery plans for a three-year period, which will identify the demand for additional Genito-urinary consultants up until 2005-06.

How will the posts be funded, if not from the £47.5 million to be spent on implementing the Strategy?

Once the SpR has obtained a consultant post, the salary is paid directly by the employer Trust through their general allocations. However it is possible that some areas may fund or part fund new consultant posts from the investment we have made in GU from the £47.5million.

How the Department will investigate the implications of continued use of EIA test for Chlamydia rather than the PCR test?

The decision on which type of test to use is a local one and it is not clear how many clinics still use EIAs. DH is planning to carry out a survey of PCTs and testing laboratories to establish how many still use this type of testing.

The choice of which type of test to use may reflect local funding priorities but other issues such as the availability of trained staff, the necessary equipment and laboratory conditions will also have a major impact on the type of test used.

When DH was selecting the 10 sites to included in the first stage of the Chlamydia screening programme the use of nucleic acid amplification as a test method was one of the most important conditions. All future sites will also be required to use nucleic acid amplification.

How the £47.5 million will be invested—over two, or over three years?

The £47.5 million will be invested over three financial years as was made clear in the Strategy's Implementation Action Plan. £5.5 million was invested in 2001-02 to prepare for implementation, during 2002-03 we have invested a further £14 million and a further £28 million will be invested in 2003-04.

A copy of the results of the sample survey carried out to measure investment in prevention and treatment of HIV/AIDS at local level.

A copy of this survey is attached.

17 February 2003

Annex A

SEXUAL HEALTH AND HIV STRATEGY—IMPROVEMENTS TO GUM SERVICES

As you will know the Sexual Health and HIV Strategy Implementation Action Plan was published on 24 June. The action plan highlights a number of actions we are taking to improve access to GU services including investing an additional £5 million this year to pump-prime these improvements.

We have been in discussion with the professional bodies representing GU consultants about how this money should be allocated across England. A formula has been agreed based on the baseline workload data of individual GUM clinics in England during 2001, or on data for 2000 where data are incomplete. The amount we have agreed to allocate to your clinic is £xxxxxx. We expect this money to be used in line with the priorities highlighted in the strategy to expand service capacity, develop clinical networks and expand the role of health advisors.

CLINICAL NETWORKS

Currently, national standards for HIV care are being developed upon which clinical networks for HIV care will be developed. As GU clinics are the major provider of HIV care in England we believe it is sensible to base future GUM care upon the same principle and arrange similar geographical groupings. We acknowledge that appropriate linkages with teaching hospitals may not be possible in some parts of England, especially in more remote areas. In these cases linkages between adjacent DGH clinics would be acceptable. We therefore expect that any new consultant appointments will normally be shared between adjacent health districts rather than be located entirely within one centre. This will help reduce single-handed consultant practice, assist with clinical governance requirements and raise standards.

HEALTH ADVISORS

The action plan highlights our intention to develop health advisors' role and responsibilities within GUM services, and increase their numbers, informed by the recommendations from the Health Advisors Working Party. Health advisors have an important role to play should there be an influx of the "worried well" to clinics as a result of the national sexual health awareness campaign. This may be particularly relevant for those clinics with small annual caseloads, which are receiving a smaller allocation of money.

Please can you arrange for an invoice to be sent to Phillip Morrison at the above address by Friday 18 October at the latest. We will then arrange to allocate the money to your clinic. Any investment for future years will depend on the outcome of decisions about financial allocations. However any future investment is likely to be targeted around the development of clinical networks and the expansion of satellite services in areas of low prevalence. In addition we will be particularly supporting those areas where there is a track record of effective service delivery.

We will expect Trusts to account for how effectively this funding has been invested and this information will be taken into account when allocating any additional funding next year. In addition PCT sexual health leads and strategic health authorities, will monitor how effectively this funding has been utilised by GU clinics.

Head of Sexual Health and Substance Misuse

Annex B

To: Chief Executives of PCTs [via the C/E bulletin]

PCT Sexual Health Leads

GU medicine consultants

Contraceptive service consultants

Teenage Pregnancy Co-ordinators

GPs [via the GP bulletin]

20 November 2002

Dear Colleague

SEXUAL HEALTH AND HIV STRATEGY: DEVELOPMENT AND EVALUATION OF ONE STOP SHOP SEXUAL HEALTH SERVICES

The National Strategy for Sexual Health and HIV was launched in July 2001. One of the actions in the Strategy's Implementation Action Plan is to develop and evaluate three models for one-stop shop sexual health services. These are services which provide advice, contraceptive and GU services on a single site. The three models are:

— a dedicated young people's integrated GU and contraceptive service;

— a specialist primary care led service; and,

— a specialist service to meet the needs of all age groups.

I am writing to seek expressions of interest from existing services who feel they fit the above descriptions and would welcome being selected as one of the three models of service to be comprehensively evaluated. Attached are specifications detailing the criteria against which services will be selected.

I should make clear that we are looking for expressions of interest from services that have all or most of the elements set out in the specifications already in place and who would welcome comprehensive independent evaluation. We are currently seeking bids from researchers to undertake the evaluation of all three models. The evaluation is expected to run until January 2006, at which time a final report will be produced. Some funding may be made available to each of the three participating services to further develop aspects of their provision.

Expressions of interest should be sent to Andrea Duncan, Sexual Health Team, room 580D Skipton House, 80 London Road, London, SE1 6LH or andrea.duncan@doh.gsi.gov.uk by 31 December 2002.

Yours sincerely

Jane Mezzone

Sexual Health Programme Manager

Annex C

SPECIFICATION FOR "ONE-STOP SHOP"—SPECIALIST SEXUAL HEALTH SERVICE IN PRIMARY CARE MODEL

BACKGROUND

1. The National Strategy for Sexual Health and HIV was launched in July 2001. The strategy proposed a model of sexual health care provision in which the role of primary care is strengthened. Action point 21 of the Strategy Implementation Action Plan outlines the commitment to develop and evaluate the benefits of integrated sexual health services. Specifically the Department of Health (DH) is committed to developing and evaluating three models of "one stop shop" sexual health services. One of the three models is that of a primary care service providing GU and contraceptive care to meet the needs of all age groups.

2. DH is seeking expressions of interest from existing primary care services who feel they fit this description, and the more detailed criteria set out below, and would welcome comprehensive evaluation from an independent research team. Details of the intended evaluation are included here. It is anticipated that this research will make a significant contribution to the evidence base regarding effective sexual health services.

SERVICE CRITERIA

3. Primary care services will be selected for inclusion in the programme based on the extent to which they meet the following criteria:

— a full range of level 1 and some level 2 elements of sexual health care. The level 2 services should include elements of both STI and contraceptive care;

— these services will be open access and will include undertaking sexual health care for patients registered with neighbouring collaborating practices;

— the service is likely to undertake a leadership role in terms of sexual health care work among local practices; and

— the service is expected to have a data system that allows the routine collection of activity information.

4. Consideration will be given to services that do not have all these elements in place but plan to expand to adopt a model similar to that outlined above.

5. Services can be located anywhere across the country. This call is restricted to England only.

THE EVALUATION

6. The researchers commissioned to evaluate the three models will work co-operatively with the services at all stages and make use of existing data collection mechanisms wherever possible. The research team will be required to minimise the workload for services resulting from the evaluation and maximise the potential for providing feedback to them. The services will have the right to see and comment on any materials emerging from the evaluation prior to publication which relate to them. Services can require that identifying details remain confidential.

7. The research team will be required to gain ethics committee approval to undertake the research and adhere to strict ethical guidelines. The evaluation will be overseen by an advisory group made up of experienced practitioners and researchers.

8. The evaluation will address the following key issues across the three models:

— the impact of these models on the range of sexual health impact and outcome indicators;

— the impact of these models on actual and perceived service access;

— how these services have developed /are developing care pathways within local sexual health networks which link primary care and specialist sexual health care services;

— the acceptability of such services to their target client group;

— the acceptability of such services to service staff, commissioners and staff of other services in the local area;

— the training needed to develop and support these models. This should include the development of enhanced primary care nursing roles in sexual health care;

— the expertise and levels of staffing needed to run the services;

— the logistical issues involved with providing care for patients from (neighbouring) general practices and those not registered including funding and other resource issues;

— impact of the service on demand and the impact of any additional workload on the local sexual health network;

— how issues regarding confidentiality and Venereal Diseases regulations are addressed;

— mechanisms for collecting activity data within the service and the collaborating sexual health care network; and

— extent, and success of, the service in building partnerships with agencies outside of health eg youth and social services, education.

9. It is expected that the evaluation will run until January 2006.

SUBMITTING EXPRESSIONS OF INTEREST

10. Expressions of interest describing how the service meets the model described above should be submitted to Andrea Duncan, Sexual Health Team, room 580D Skipton House, 80 London Road, London, SE1 6LH or andrea.duncan@doh.gsi.gov.uk by 31 December 2002.

11. Services will be notified whether they have been selected during January 2003. The evaluation will be expected to begin during March 2003.

"ONE STOP SHOP" PILOT—SPECIALIST YOUNG PEOPLE'S SEXUAL HEALTH SERVICES MODEL

BACKGROUND

1. The National Strategy for Sexual Health and HIV was launched in July 2001. Action point 21 of the Strategy Implementation Action Plan outlines the commitment to develop and evaluate the benefits of integrated sexual health services. Specifically the Department of Health (DH) is committed to developing and evaluating three models of "one stop shop" sexual health services. One of the three models is that of a specialist sexual health service providing GU and contraceptive care for young people.

2. DH is seeking expressions of interest from existing services who feel they fit this description, and the more detailed criteria set out below, and would welcome comprehensive evaluation from an independent research team. Details of the intended evaluation are included here. It is anticipated that this research will make a significant contribution to the evidence base regarding effective sexual health services.

DRAFT SPECIFICATION

3. Services will be selected for inclusion in the programme based on the extent to which they meet the following criteria. The service is expected to be provide an open access service in line with the criteria set out in the Best Practice Guidance on the Provision of Effective Contraception and Advice Services for Young People, published as part of the Teenage Pregnancy Strategy in 2000 (www.teenagepregnancyunit.gov.uk). In brief these criteria include:

— Open to young women and young men with an upper age limit of 25.

— The involvement of young people in planning and evaluation of the service.

— An explicit confidentiality policy highlighting the right of young people, including under 16s, to the same degree of confidentiality as older patients.

— Staff with non-judgmental attitudes, trained in working with young people.

— A non-clinical atmosphere reflecting young people's culture and the diversity of the local community.

— A location which offers young people easy access with sufficient anonymity.

— Opening hours which match young people's availability.

— Service publicity which is actively disseminated to young people in places where they meet.

4. In the one-stop shop model, the minimum level of service on contraceptive and sexual health advice required in the Best Practice Guidance would be extended to include both "level one" and "level two" specialist sexual health services. Elements of level two services include:

— interuterine device insertion;

— contraceptive implant insertion;

— testing and treating sexually transmitted infections, including invasive testing for men; and

— partner notification.

— As a minimum, the service must include elements of both STI and contraceptive care and be open access.

— The service should also undertake a leadership role in terms of sexual health care work among local general practices and other local sexual health services.

— The service is expected to have a data system that allows the routine collection of activity information.

5. Consideration will be given to services that do not have all these elements in place but plan to expand to adopt such a model.

6. Services can be located anywhere across the country. This call is restricted to England only.

THE EVALUATION

7. The researchers commissioned to evaluate the three models will work co-operatively with the services at all stages and make use of existing data collection mechanisms wherever possible. The research team will be required to minimise the workload for services resulting from the evaluation and maximise the potential for providing feedback to them. The services will have the right to see and comment on any materials emerging from the evaluation prior to publication which relate to them. Services can require that identifying details remain confidential.

8. The research team will be required to gain ethics committee approval to undertake the research and adhere to strict ethical guidelines. The evaluation will be overseen by an advisory group made up of experienced practitioners and researchers.

9. The evaluation will address the following key issues across the three models: