A Personal Take on the New Sexual Health Data Release
Governnment released at 0930 today the latest figures on Sexually transmitted infections (STIs) and public health for England. You can find the press release here https://www.gov.uk/government/news/new-data-reveals-420000-cases-of-stis-diagnosed-in-2017 and the data report here https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/713429/hpr2018_AA_STIs_v2.pdf
I suspect over the next few days this will be the subject of much argument, and some spin. For what it’s worth, this is my personal take on the national picture. I don’t claim it represents any views other than my own:
The headlines are the numbers of diagnoses of STIs are broadly similar to last year with a small decrease in chlamydia, an increase in gonorrhea and syphilis and a sharp increase in attendances at clinics. My take on this is more people are getting tested and more people are taking their sexual health seriously.
- Compared to 2016, the total number of new STIs diagnosed in 2017 remained relatively stable (0.3% decrease from 423,352 to 422,147).
- Of these, the most commonly diagnosed STIs were chlamydia (203,116; 48% of all new STI diagnoses), first episode genital warts (59,119; 14%), gonorrhoea (44,676; 11%), and non-specific genital infections ([NSGI] 33,473; 8%).
- The total number of attendances at Sexual Health services nationally increased 3% between 2016 and 2017 (from 3,227,254 to 3,323,275), continuing the increasing trend over the past five years: between 2013 and 2017, there was a 13% increase in the number of attendances (from 2,940,779).
- Total number of new attendances at SHS nationally increased again to 2,217,387 up from 2,151,905 last year and up significantly up from 1,889,143 in 2013 – 328,244 more new attendances than in 2013
- Genital warts are down – attributed by government to the uptake of HPV Vaccine. (Great for girls but this still leaves gay and bisexual young men unprotected https://www.theguardian.com/society/2018/mar/31/hpv-vaccine-boys-cancer-rates)
- There is an in increase in the last year in gonorrhea and syphilis
- The increase in syphilis follows a ten year trend (before anyone starts blaming the increase on the transfer of sexual health to local government commissioning). We need to get a grip on it but given this is a ten year trend, nobody can cover themselves in glory. 78% of these diagnoses are in gay and bisexual men. Some key points here:
- Before people start blaming this on the transfer to local government, while there was a reduction in some of these last year, this trend started well before transfer of sexual health from the NHS to local government in 2013.
- I imagine we will cue another debate on whether PrEP for HIV is seeing a massive increase in syphilis and ghonorrhea among gay and bisexual men….which means we risk ignoring some of the thoughtful work about what sexual health in the age of PrEP means from folk like Matthew Hodson. (https://www.gmfa.org.uk/fs161-stis-in-a-post-condoms-world). Now is NOT the time to have an argy-bargy about PrEP. Now is the time to consider again why we see this trend continuing, what we can do about it, and a balanced assessment of PrEP within that issue.
- For my money, that also means the Local Government Association and Association of Directors of Public Health shared view that full roll out of PrEP needs to wait for the results of the trial and its discussion is the right tactic.
- Chlamydia testing in some settings has decreased. In my view this is a sign that the deliberate strategy of Directors of Public Health to concentrate chlamydia testing resources on people more likely to be positive, rather than blanket testing whole populations, was the right judgement.
My take on the key points arising from this:
- The data shows a rising demand for sexual health services at the same time as public health funding is being cut by £531million YET overall, outcomes are still good
- Directors of Public Health are trying to manage this, and the fact we’ve managed rising demand and maintaining outcomes despite cuts is a sign that the programmes of work we’re trying to deliver with providers and professionals is having an impact.
- But let’s be clear, there are not endless opportunities to do this. If budgets continue to reduce while demand continues to increase, we won’t be able to maintain the same level of service.
The Association of Directors of Public Health UK is calling on the Governent to reverse the cuts. In its press release, I said
“The figures published by PHE today demonstrate the continuing strain that sexual health services are under.
At this time of rising demand, public health funding is being cut substantially. Directors of Public Health are currently trying to manage this through modernising services and introducing innovative online services for people who don’t need to attend face to face consultations but we have reached the limit. Cuts to the public health budget must be reversed to enable us to protect and improve the health of our residents.
It’s good to see that STIs are continuing to fall but the persistent inequalities in sexual health outcomes, particularly among young people and gay men, are unacceptable. We need to see whole system action to urgently address these inequalities.
We are continuing to monitor chlamydia screening activity and, while overall screening rates have fallen, the increase in positive tests suggests that the more targeted approach is working.
Ultimately sexual health is about wellbeing not just services: education, personal capacity and resilience, good relationships and preventative actions as just as important as the provision of high quality sexual health services.”
False Friends and wrong turnings
I would have hoped that we would have some degree of consensus across all stakeholders that the best way out of this would be for government to reverse the cuts to public health. All of the sector and system bodies need, in my view, to call on government to change this in a single and unified way. I’m not sure we’re there yet.
This means we need to think whether some of the tactics being used at present are beginning to do more damage than good. And I mention two particular issues here:
First, what seems to be a growing industry of interest groups asking Freedom of Information requests on local authority spending – data which is already public – seeking to know how much spend has changed. If all we do is repeat that while a united and focused campaign from all sides to call on government to reverse these cuts languishes with little impact, local authorities bear the brunt of opprobrium while Government gets off the hook for once again prioritising NHS acute services over public health, a tactic as short sighted as it is harmful to the population’s health overall.
Second, the counsel of despair that “it would be better back in the NHS.” No, it wouldn’t. This is a triumph of hope over experience. There are numerous opportunities where sexual health services in the NHS were passed over for financial growth to prioritise other acute services. And anyone looking deep inside the NHS finances at present will see very clearly that this will continue. Transfer of services from local authorities would probably mean transfer of the – reduced – sexual health budget back into the NHS. I regularly ask CCG and STP system leaders from across the country when I meet them what this would mean. The answer “spend what transfers and no more in this climate.” We need to stop wishing for something that won’t make anything better. I’ll blog in more detail about this soon.
So, where next?
Well, we need to set aside these false friends, and work together as a system to make the system work as best we can, and call on government to reverse these cuts.
Don’t expect me to give you anything other than short shrift if all you want to do from today is criticise local government. If you think you can do better, let’s talk.