HIV And Sexual Health Services

The UK wide rise in rates of sexually transmitted infections and HIV in Wales continue to affect us. In October 2003, a Project Board was set up to Review the state of our HIV and Sexual Health Services. As a result of the Review I have decided to strengthen the infrastructure for delivery of these services across Wales. I would like to take this opportunity to outline the action I propose.

First, the Review identified the need to set clear standards for these services. These are being delivered by the  National Public Health Service for consultation early in the new year. Standards will be set in relation to all aspects of sexual health services including: sexual health service networks; sexual health promotion; sexually transmitted infections; contraceptive care;  abortion services; HIV and AIDS treatment and care; and psychosexual services.

Modernisation of current services was identified as a necessary precondition to ensuring an efficient service that  meets the needs of its patients. I propose to integrate existing family planning and genitourinary medicine services into a single sexual health service which will maximise the opportunity for preventative health checks, diagnosis of infections such as chlamydia, and provide a more acceptable service for patients and staff.

Expanding the role of nurses working within a sexual health service is key to these developments. Studies have shown that comprehensive patient care can be provided by trained sexual health nurses, working to agreed guidelines and protocols. We have seen the benefits of developing the nurse role here in Wales. In the Cardiff Royal Infirmary genitourinary medicine clinic two existing nursing staff have been trained to work as nurse practitioners. This has allowed the clinic to change its booking system from ‘appointment only’ clinics to a combination of appointment clinics and open access ‘sit and wait’ clinics on 5 mornings per week. During the first four months of this new system there was a 27 per cent increase in the number of patients seen and most importantly, patients now have the choice to be seen immediately or by appointment. The waiting times for appointments have been greatly reduced from 14 weeks to two weeks.

I want to see this success replicated across the country. I am therefore announcing today a new SAFF target for  2005-06 in which LHBs and Trusts must ensure access to testing for sexually transmitted infections within 2 working days. I expect this target to be achieved through modernisation of services. Spending for these services will be protected.  The £7.1 million that is ring fenced for genitourinary medicine will be integrated with current £7 million spend for family planning services to create a single sexual health service ring fenced budget.  In addition to these ring-fenced funds, I will make a further £0.5 million available to support the modernisation process.

To spearhead these new developments Dr Marion Lyons, Consultant in Communicable Disease Control in the National Public Health Service will be seconded to the Assembly as Director of the HIV and Sexual Health Services Modernisation Project. Dr Lyons has already played a central role in taking this Review forward and will champion the modernisation agenda. Under her direction, the Assembly will advise on and agree local HIV and sexual health modernisation plans with LHBs and Trusts, allocate the additional monies in line with need and the modernisation agenda, and ensure the appropriate training for nurses is put in place across Wales. A multi-disciplinary HIV and Sexual Health Advisory Board will support Dr Lyons and inform the Assembly’s work.

The Review also highlighted the important contribution primary care makes to providing sexual health services. General practitioners are currently the main providers of oral contraception and many already undertake testing for sexually transmitted infections. Some pharmacists already supply emergency hormonal contraception in Wales and the majority supply it for sale over the counter. As testing kit technology develops we must not underestimate the potential role pharmacists could play in providing future diagnostic and treatment services. The new Community Pharmacy Contract which is due to be implemented next year will help us obtain the best possible use of pharmacists’ skills in this field.

I have spoken mainly about clinical services as timely access to testing, diagnosis, and treatment of infection underpins our response to what is a developing public health crisis.  However, to make real sustainable progress we must ensure a multi-agency response that  promotes safer sexual behaviour in the population. Much progress has already been made already.  Indeed, figures published last month show a decrease of over 15 percent in our underage conceptions. We have a number of excellent examples of sexual health promotion work in Wales including: sex and relationships education based in school and community settings; schemes that provide free condoms for young people; relationship advice drop-in centres; national and local HIV and sexually transmitted infection prevention campaigns, and outreach work with vulnerable groups. These services are provided across a range of sectors including, health and social services, education, youth and voluntary. I would like to pay tribute to the sexual health charities,  Terence Higgins Trust  and fpa Cymru,  as partners in this work.

Providers of sexual health services currently come together through a range informal local networks.  I want to see these local networks strengthened to meet the forthcoming standard on HIV and sexual health service networks.  Multi-agency and multi-disciplinary partners will work together within service networks to plan and deliver HIV and sexual services in their locality. It is important that effective local practice is shared across Wales. The existing all-Wales sexual health network will be re-aligned to provide a national forum for the sharing of information and best practice from local sexual health service networks.

To conclude, this package of national and local leadership, modernisation, and partnership at all levels, will provide the key to improvement and contribute to significant sexual health gain in Wales. I look forward to the support of the whole Assembly in putting forward these recommendations.