Progress on sexual health threatened by spending cuts

Against a worrying backdrop of funding cuts and rising incidence of some sexually transmitted infections, nurses are extending their training so they can integrate contraception and genito-urinary medicine services

Cuts to public health budgets have left local authorities struggling to keep up with a 25% increase in demand for sexual health services over the past five years, according to the Local Government Association, which warns that services are now at a tipping point.

Last year there were 420,000 newly diagnosed cases of sexually transmitted infections (STIs) in England, with the greatest impact among heterosexuals aged 15-24, black and minority ethnic groups and men who have sex with men, according to Public Health England (PHE).

Incidence of syphilis is at its highest level since 1949, and PHE also cites strains of drug-resistant gonorrhoea as being of concern.

‘We’ll be turning the clock back, as pressures build and patients wait longer to get the treatment they need’

Helen Donovan

‘These worrying figures show how the government is undermining decades of progress in sexual health,’ says RCN lead for public health Helen Donovan. ‘We’ll be turning the clock back, as pressures build and patients wait longer to get the treatment they need. Delayed appointments risk further infection transmission – turning individual cases into a wider public health issue.’

Jason Warriner, clinical services director at The Sussex Beacon, an organisation that provides specialist care and support for people with HIV, agrees. ‘Generally, STI numbers remain too high, so cutting public health service budgets at a time when sexual health services need sustained investment is my biggest worry. The real impact of today’s cuts won’t become apparent for a few years, when we’ll see further rises in STIs and unplanned pregnancies.’

Lost posts

STI testing and treatment is protected by legislation dating back to 1916, points out the King’s Fund. But despite this, the health think tank says STI clinics are being closed, moved to less convenient locations or offering reduced opening hours. Sexual health adviser posts and outreach services such as those providing health advice and treatment to sex workers have also been lost, it says.

The Family Planning Association is also concerned. Despite welcoming a recent drop in teenage pregnancies, it warns that a 10% cut in public health funding could result in costs of £8.3 billion in unintended pregnancies over the next five years.

But there is some good news: there has been a slight overall decrease in STIs, which may be attributable to a number of factors including a reduction in the incidence of genital warts since the national HPV vaccination programme for adolescent girls was introduced.

One-stop shops

And a new, PHE-supported three-year HIV pre-exposure prophylaxis (HIV-PrEP) trial is likely to have a significant impact on HIV infection.

Mr Warriner is also encouraged by the integration of contraception and sexual health services (CASH) and genito-urinary medicine services (GUM), introduced in 2013.

‘Merging these contrasting services into a “one-stop shop” is an excellent idea as it reduces stigma for patients visiting a GUM clinic. It also provides sexual health nursing teams with an opportunity to innovate services and extend their training – for example by allowing nurses to continue their professional development through supervised workplace learning, at a time when universities are cutting back on sexual health courses,’ he says.

Gaining new skills

Belinda Loftus is the newly appointed head of integrated sexual health services with Spectrum Community Health in Yorkshire’s Wakefield and Barnsley districts. She was clinical nurse lead with Bradford NHS sexual health services before supervising the integration of the district’s CASH and GUM nursing teams under its current contracted service.

Ms Loftus says integration and merging hospital and community sexual health nursing teams into a main clinical hub for district clinics has not been easy.

‘Some nursing staff initially felt unsettled and anxious about how working for an organisation outside the NHS within a new environment would affect their professional role, employment conditions and their patients’ service provision. This resulted in some staff stress and increased sick leave for a while.’

She adds that some GUM and CASH nurses found gaining new skills and adapting to a new working environment challenging.

Integrated service

‘CASH nurses were used to treating predominantly well, female clients with sexual health needs like contraceptive advice, while GUM nurses were, for example, more used to victims of sexual assault or male patients seeking advice on serious STIs.’

By early next year Ms Loftus anticipates that all Spectrum’s sexual health clinic nurses will have completed and gained their dual British Association for Sexual Health and HIV or Faculty of Sexual and Reproductive Healthcare skills and qualifications, enabling them to work as specialist, independent nurse practitioners with GUM and CASH patients in a fully integrated service.

‘Having gained new skills under the supervision of on-site nurse trainers during their working day, our highly skilled nurses now see all patients through from initial clinical history taking, testing, diagnosis, treatment prescription and follow-up. This ensures our patients need tell their often embarrassing story just once,’ she says.

Close partnership

Each new district clinic also employs at least one nurse health adviser, who can provide counselling after a distressing diagnosis or make risk assessments of patients aged under 18 who may be experiencing sexual exploitation or others at risk of sexual violence.

Becky Bailey is a former GUM hospital clinic nurse adviser who recently transferred to a community clinic in Barnsley where she has gained further contraception qualifications and brushed up her computer skills. She says: ‘I prefer working in a smaller sexual health clinic which is more accessible and convenient for patients, who I can support whatever their condition.

‘Working in close partnership with the clinical nursing team, under one roof, also means they can easily refer a newly diagnosed STI patient to me for partner notification in just one appointment.

‘I also feel lucky to have been encouraged and enabled to extend my training.’

Positive trends

Ms Loftus and Ms Bailey are aware of national concerns about STI increases, but against this worrying background they can also see more positive trends.

‘Fortunately, today’s young people seem interested in finding out how they can look after their sexual health and are keen to get regular STI tests,’ says Ms Bailey.

Ms Loftus echoes this: ‘All our patients are offered STI testing. And our newly launched website providing detailed information on STI symptoms, testing and how to obtain free condoms and online tests are already very popular. Any patient who does not want to wait for an appointment can visit our walk-in clinic and be seen immediately.’

She adds: ‘Embarrassment and stigma have always been major patient barriers to the use of sexual health services, so hopefully providing merged contraception and genito-urinary medicine services, staffed by dual-qualified nurse specialists and health advisers, will bring down barriers to seeking treatment.’

Catharine Sadler is a freelance health writer