Policy responses and statements
- Name of organisation:
- NHS Quality Improvement Scotland (NHS QIS
- Name of policy document:
- Draft Standards - Sexual Health Services
- Deadline for response:
- 12 October 2007
Background: This document introduces the NHS Quality Improvement Scotland (NHS QIS) draft standards for sexual health services.
These draft standards cover key elements of sexual health services:
Access to specialist sexual health service
Comprehensive provision of specialist sexual health services
Information provision
Termination of pregnancy
Partner notification
Sexual healthcare for people living with HIV
Male and female sterilisation
Chlamydia testing
Hepatitis B vaccination for men who have sex with men
Intrauterine and implantable methods of contraception
Appropriately trained staff providing sexual health services
Service delivery consistent with national guidelines
When finalised, these standards will be used by NHS QIS to assess performance in the NHS boards throughout Scotland.
COMMENTS ON
NHS QUALITY IMPROVEMENT SCOTLAND (NHS QIS)
DRAFT STANDARDS - SEXUAL HEALTH SERVICES
The Royal College of Physicians of Edinburgh welcomes this consultative document on sexual health services. It is a sensible and practical document that will act as a driver for change. It will also be helpful as a guide to expectations for NHS patients seeking sexual health services. We raise some questions over the quality of evidence for some of the firmer recommendations that will have important resource consequences. We recommend that the Steering Group address this issue before important investment decisions result.
A second question on the document generally is its use as a force for better cohesion between genito-urinary and family planning/reproductive health services. Incentives for effective collaborative working and better results for service users would be an additional asset of this document in final form.
Turning to the individual recommendations:
Section 1: we support the proposal.
Section 2: recommendation 2.2 relates to the balance between access and immediacy of specialist services. This may be an example of a recommendation with implicit and major resource consequences that is short of evidence. Also, the document does not examine the role of intermediate care - those staff located nearer to smaller populations with specialist interests who may be able to supply competence and greater capacity from first line services.
Section 3: we welcome this statement, and wish to underline the importance of information in readable format. The most marginalised groups, in terms of sexual health services as in other areas, are least likely to be able to absorb or interpret complex messages. The text of any information should be crystal clear and in accessible format.
Section 4: is outside the field of specialist interest for this College. In general, the statement is reasonable, based on public health grounds.
Section 5: on partner notification, is appropriate. Particular sensitivity will be required for NHS Boards seeking to implement the statement in amongst small populations and groups where confidentiality and its implications are likely to have adverse consequences if breached.
Section 6: in general, we support the area of interest, but the text confines itself to a narrow field within the range of HIV related issues. We would welcome a general widening of the focus to reflect the many issues faced by HIV positive patients. We support the general recommendation towards syphilis serology assessment, especially for MSM groups. We suggest a revision of that text to read "90% of sexually active MSM patients receiving on-going HIV care etc". We also wish the Working Group to consider an additional criterion around the provision of PEPSE - such as "good practice would routinely include the provision of post-exposure prophylaxis for sexual exposure to HIV (PEPSE) to the sero discordant partners of patients under care. This should be discussed with and offered to all patients."
Section 7: we have no comment to make.
Section 8: chlamydia screening is a matter of great debate at the moment. It is still a matter, also, of marginal cost effectiveness analysis. We agree that the age range 16-24 should be the focus, and that there should be planned and structured expansion of testing from specialist to generalist settings. However, we would advise caution, waiting for further effectiveness data, and the outcome of evidence review in preparing a revision of SIGN 42 on this subject.
Section 9: on Hepatitis B, focuses again on MSM groups. While the evidence may point to this specific client group, it would be beneficial to state that "all established groups of transmission" should be offered this protection, and offer broader strategies for Hepatitis B prevention across all at risk groups, especially in the sexual health area.
Section 10: is appropriate, and we support it.
Section 11: on training, is reasonable but, again, there would be merit in specifying that the role of staff in specialist centres would be to agree a strategy for appropriate training of clinical professionals in a number of settings, so that the quality of non-specialist practice and referral continues to rise.
Section 12: is appropriate. In common with statement 11, it would be useful for there to be a specific challenge for leadership from specialist services to other agencies, settings and non-specialist services in assuring the quality of work carried out everywhere in the area of sexual health care.
Referring to both Sections 11 and 12, is there a role to challenge NHS Boards in establishing and sustaining network leadership and co-ordination for the broader benefit of sexual health services?
We hope these comments are helpful.
Copies of this response are available from:
Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.
Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939
[11 October 2007] |
