Wigan Council has developed a pioneering approach to public sector reform known as The Deal. It is a new way of working differently with communities and stakeholders with both sides working collaboratively to improve the borough. When commissioning its sexual health service, this model shaped how the council transformed its approach. This case study forms part of our sexual health resource.
A review of sexual health services between 2015/17 found Wigan had disproportionately high rates of sexual ill health, including between different communities in the borough.
Over the previous 10 years there had been a marked increase in STI diagnoses, particularly among young people, and there was also evidence of risky behaviour.
The borough also had the third highest rate in England of under 16s accessing emergency contraception and a high rate of repeat EHC prescriptions. There was also a downward trend in LARC use and low uptake of HIV testing.
The public health team wanted to explore how the commissioning opportunities enabled by The Deal could be used to support transformation of sexual health within the borough.
The Deal is based on principles of a shared relationship with residents and so it was critical that Wigan’s plans for transforming sexual health in the borough were developed jointly with residents and key stakeholders.
A consultation exercise with stakeholders and residents was therefore initiated to help inform a new start for sexual health services.
The consultation involved questionnaires – filled in by nearly 800 people – and around 60 focus groups. It resulted in seven principles being agreed. They were:
- one organisation to be responsible for care coordination, safe and effective services, and a trained and skilled workforce
- staff to have a ‘different conversation’ with patients focused on their strengths and the things that matter to them
- increased opportunity to access information and advice online, book appointments and order self-sampling kits
- increased outreach into communities, to bring services closer to people into their community
- single point of access to services, helping people to get to the right place at the right time
- using an asset-based approach to support positive sexual behaviours, including working more closely with schools, GPs, pharmacists and community groups
- where possible one service or person to be able to help residents with the things they need.
The development of these principles paved the way for a new delivery model for sexual health services to be developed.
Public Health Lead Officer Paul Jamieson said: “We recognised there needed to be a more integrated system, with delivery closer to people in their own communities, community providers more involved in sexual health and a greater emphasis on prevention.”
In line with the ‘co-production’ nature of The Deal, the council sought to find a partner which could implement the new delivery model as well as leading the transformation needed to improve sexual health outcomes for residents. Spectrum was successfully awarded the contract and delivery commenced in March 2018.
Spectrum has now completed the implementation stage. Staff from three previous providers have been integrated within one staffing model, achieving improvements in consistency, clinical delivery and financial efficiencies.
Spectrum runs two specialist sexual health hubs offering the full range of sexual health provision on both an appointment and walkin basis. The hubs are complemented by a range of nurse-led community clinics.
An integrated website (www.sexual-health. co.uk) was launched in March 2018, removing the need for residents to navigate a variety of provider websites. Campaign information and materials have been distributed across local GPs, pharmacies, schools and leisure facilities.
Meanwhile, Spectrum has also established strong working relationships with most of the secondary schools in the borough and is delivering its relationships and sexual education curriculum to year nine, 10 and 11 pupils.
Over the past year nearly 12,000 pupils attended more than 500 sessions delivered by Spectrum’s RSE team.
Mr Jamieson said it is important to take your time and ensure you have consulted thoroughly when embarking on change.
“One of the most important things for us was the value of seeing really strong support from everyone for what we were doing and securing buy-in across the whole system. “We undertook a really extensive review and re-design process.
The consultation took the best part of the year and really helped influence what the final delivery model looked like.
“We are also already seeing a benefit for how change is being managed as a result of having secured the commitment and buy-in from such a wide range of residents and stakeholders.”
How is the approach being sustained?
Spectrum and the council are now working together with a range of partners and stakeholders to develop and agree specific plans for transformation in a number of areas, including primary care, schools and colleges, digital transformation, HIV and the offer to the most vulnerable and ’at-risk’ residents.
In terms of primary care, this includes exploring opportunities for closer working with the nurseled clinics. Spectrum and a local GP have agreed to pilot the delivery of a community clinic from the GP practice from May 2019.
Director of Public Health Professor Kate Ardern said the future is looking bright. “The innovative approach we have taken to commissioning, based on The Deal, has enabled the recruitment of an excellent partner in Spectrum that shares our vision and ambition to transform how the local health and care system supports residents with their sexual health.”
Public Health Lead Officer. Wigan Council