Public Health Commissioning Sexual Health Procurement Sexual Violence

Public Health Commissioning, Sexual Health Procurement & Sexual Violence Jak Lynch Senior Public Health Commissioner 3 rd November 2014 Chester Campus

The Commissioning Cycle and Public Health Values and Skills • Long term and iterative engagement with the subject • Casting Light and generating proper heat • Synthesis of evidence and focus on outcome

FGM and Sexual Health Services • • Demographic Universal and Targeted Services UK HIV Prevalence 0. 2% UK FGM prevalence?

Country HIV Prevalence % FGM prevalence % Country HIV Prevalence FGM % prevalence % Somalia 0. 7 97. 9 Yemen 0. 1 38. 2 Guinea 1. 3 95. 6 Cote d'Ivoire 3. 4 36. 4 Sierra Leone 1. 6 94 Nigeria 3. 6 29. 6 Djibouti 2. 5 93. 1 Senegal 0. 9 28. 2 Egypt 0. 1 91. 1 Kenya 6. 3 27. 1 0. 8 88. 7 Central African Republic 4. 7 25. 7 Mali 1 85. 2 Tanzania 5. 6 14. 6 Gambia 2 78. 3 Benin 1. 2 12. 9 Burkina Faso 1. 2 72. 5 Togo 3. 2 5. 8 Mauritania 0. 7 72. 2 Ghana 1. 8 3. 8 Liberia 1. 5 58. 2 Niger 0. 8 2. 2 Chad 3. 4 44. 9 Cameroon 5. 3 1. 4 Guinea-Bissau 2. 5 44. 5 Uganda 6. 5 0. 8 Eritrea

Engagement • Engagement was broad and included public, service providers and specialist national and local perspectives • Started with a clear idea about what we were proposing and used engagement to refine the proposal • Used engagement to generate significant issues that had not been adequately considered before - e. g. Sexual Violence

Health & well being outcomes 1. 2. 3. 4. Reducing under 18 conceptions Increasing chlamydia diagnosis in the 15 -24 age groups Reducing the late diagnosis of HIV Improved support for people vulnerable to, and victims of, sexual coercion, sexual violence and exploitation 5. Providing better access to services for high risk communities 6. Ensuring prompt access for earlier diagnosis and treatment 7. Increasing the use of effective good quality contraception 8. Reducing the number of people repeatedly treated for STIs 9. Reducing the number of abortions and repeat abortions 10. Reducing the transmission of HIV, STIs and blood borne viruses

Priority Groups • Support the needs of the most vulnerable groups, their families, friends and communities, in particular: – – Substance misusers Children in need Care leavers People with mental health problems – Offenders – LGBT people – – – – Men who have sex with men (MSM) People with learning disabilities Homeless people Sex workers Gypsies and travellers Trafficked people New arrivals from abroad

Consultation • Very focussed on changes to be proposed and supporting information • Made use of 3 rd sector organisation to access hard to reach groups • Sought national and local comment • Sought the views of frontline staff and professional bodies and trades unions

Consultation December 2013 Improved support for people vulnerable to, and victims of, sexual coercion, sexual violence and exploitation 2500 2194 2000 1500 1000 500 41 63 41 No Don't Know Not Answered 0 Yes

Improved support for people vulnerable to, and victims of, sexual coercion, sexual violence and exploitation • Our consultation found overwhelming support that Sexual Health Services should address this outcome • The challenge for providers is to co-produce with users, commissioners and other services what should be done to address the outcome

Procurement • Co produce service specifications • Competitive dialogue- dedicated session on Sexual violence based on outline solutions/method statements • Role of Young People in evaluation- 63 over 2 days to generate scores

#2 ndcitysex Tested in Procurement • Subject of a detailed method statement in the competitive dialogue • Question relates to mandated services- core specification- a proper service response • Question relates to non mandated services- targeted non clinical outreach and capacity building

#2 ndcitysex Aims and Objectives • Bring prospective providers together • Orientate providers on the Violence Against Women and Children (VAWC) topic • Improve the Sexual Health Performance Framework in relation to VAWC • Improve the Service Specification in relation to VAWC

Opportunities for the new sexual health ‘System’ • Opportunity to ask the right questions • Systematic identification of victims and those at risk of sexual exploitation, coercion and violence in our mandated services • Opportunity to contribute to our city wide response • • • Through developing local policies Contributing to safeguarding children and adults Support capacity building in associated 3 rd sector and primary care

#2 ndcitysex Laying the Track • • Strategic Outcome Policy and Practice Procurement Service users experience and views ISVA’s SARC CYP SARC Care Pathway

#2 ndcitysex Qualitative • • • Service users views Use of qualitative Research Local action learning Focus on users experience Extensive use of grey literature and soundings from those who know the subject

#2 ndcitysex Birmingham Sexual Health Outcomes Framework

The Objective “The size of these provisional figures underlines the urgent need for a robust plan for services to support women who have undergone FGM and to safeguard their daughters from undergoing it. ” Female Genital Mutilation in England Wales: Updated statistical estimates of the numbers of affected women living in England Wales and girls at risk Interim report on provisional estimates University of London (2014)

Thankyou