London Sexual Health Transformation Programme

1. London Sexual Health Transformation Programme Cllr Jonathan McShane London Borough of Hackney

2. VD clinics were established under the control of local authorities in 1916 by the Public Health (Venereal Diseases) Regulations 1916. In April 2013 we got them back…

3. London SH services catchment area 1.348 millionNumber of sexual health attendances in London in 2015/16. Over 400,000 students study in London each year 8.4 million people are resident in London Over 1.1 million people commute into London each day There were 15.4 million visits from overseas visitors in 2012 who spent on average 6 nights in London • Source: ONS 2013 Population estimates, Transport for London 2009, London Datastore 2013, HESA 2010

5. Changing patterns of need and demand • 7.6% increase in new sexually transmitted infections in London since 2012, compared with -1% reduction nationally. • London STI rate is double the national rate • 33.5% Late diagnosis of HIV In London has improved by 13.5% from 47% in 2009-11 • Very different patterns of service provision across London • Significant use of non-local, often central London clinics • 50+% of those in GUM waiting rooms across London are symptom free

7. Finance context • Long term trend of increasing cost of sexual health services in London • Significant reductions in public health budgets, e.g., -4.7% for each of 17/18 and 18/19 • Clinician led work towards using the integrated sexual health tariff stopped in 2012 with the anticipated changes • Use of First/Follow-Up tariffs did not reflect cost of activity • Significant use of London clinics by non London residents - not all give home postcode • Variable quality of activity data across London

8. The London Model Aim • to provide high quality services to all London residents • To explore new modalities for testing, e.g., an eService or self testing kits • To implement the integrated sexual health tariff (ISHT) across integrated sexual health services

9. Three levels • London wide • eService • HIV testing promotion campaign – DO IT LONDON • Sector based • Terrestrial integrated sexual health services • Local • Sexual and reproductive health services

10. Structure • London Sexual Health Transformation Programme Strategic Board – chaired by London LA Chief Executive • Clinical Advisory Group • Analytical and Costing support • London wide HIV Testing Programme • Channel Shift Group • Implementation Group

11. What went well • Large number of councils working together - Grew from small number of boroughs • Early wins • Senior level engagement • Use of Clinical Advisory Group • Managed to get final outcome • Clinical buy-in • Kept a reasonable pace • Identified the right people • Made savings • Clear brand

12. What could have gone better • A lot of time spent managing relationships • Authorities not staying with the programme • Reliant on a handful of people • Forming Clinical Advisory Group took longer than expected • Success allowed advisers/sponsors to disengage • Un-even “in kind” contributions • More engagement from providers • Concerns about timing of programme closure • Underestimated resource needed • Political and constitutional engagement time consuming

13. Surprises • A robust and constantly evolving governance system is needed • Massive investment in relationships required • Difficulty with getting people on board • Bad behaviour • Have kept +/- all of the local authorities on board • Receiving questions about the programme cost • Internal mechanisms • Short term and tactical decision making

14. How well were these issues resolved • Good to have senior ownership of the risk log • Have to recognise there is a level of compromise • What do you do when people sign up and don’t play by the rules? • We did not have a formal dispute resolution process • Need to commission to be sure that clinics and e-services are going to work together • The approach/style has changed over time- it has become more abrupt and forceful

15. 3 key lessons learned • Collaboration takes real commitment from all partners • Time, preparation and planning are key to success • A robust and constantly evolving governance system is needed

16. Recommendations • Senior ownership- chief executive level • Service users at the heart • Push the case for change - clear overall strategic vision • Keep stakeholders on board at all stages • Get the right people into meetings • Don’t underestimate programme management skills that are needed • Explicit articulation of risk really helpful • Strong and direct leadership • Commissioners need to be thinking of the long term

17. …..however, this programme won the MJ (cf HSJ) award for Reinventing Public Services two weeks ago.

20. London wide • HIV testing programme • commissioned by team in Lambeth Council • eService • Specification developed and agreed by the Clinical Advisory Group • Competitive procurement • Service to “soft start” next month • Service to be managed on behalf of London by City of London

21. GUM clinics • Five sectors, each negotiating on behalf of all participating London boroughs • +/- a common specification for the services • Integrated sexual health tariff • Different approaches to procurement

22. Sexual and Reproductive Health Services • Local procurement • Equity of access for all to the full range of contraception options. • Different inherited services • Different models – local solutions for local issues