A blueprint for the future: Sexual and reproductive health and HIV services in England

Sexual health is a complex public health challenge and can generate wide-ranging health, social and economic impacts. Sexual health inequalities are unfair and avoidable differences in sexual health across the population, and between different groups within society.

These inequalities arise and impact opportunities for good sexual health in the most affected groups. Groups that are disproportionately affected include young people under 25, gay and bisexual men and men who have sex with men (GBMSM) and black and minority ethnic (BME) groups, and targeted interventions are often required.

Sexual health is influenced by a myriad of social factors including social and cultural norms, education level and health literacy, economic status, sex, gender identity, and sexual orientation and behaviours which impact on people’s health.

This ‘call to action’ frames the current pressures and demand faced by our sexual and reproductive health services nationally. Crucially, it then presents the priorities and bold approach we believe is required to improve the sexual health and wellbeing of our population.

The effects of sexual ill-health are far reaching, and for those affected, the impacts can be compounded by ongoing stigma and lack of understanding and support. Therefore, it is of paramount importance that we ensure there is a comprehensive offer that rightly allows all citizens and communities requiring access, to do just that.

Over the last 10 years we have seen significant successes and innovation in sexual and reproductive health services, but we also need to look at where further improvements can and must be made. We continue to see dramatic increases in syphilis and gonorrhoea diagnoses, the continued spread of antibiotic-resistant sexual infections and challenges accessing contraception equitably up and down the country.

This report has been shaped by the Local Government Association (LGA), Association Directors of Public Health (ADPH) and English HIV and Sexual Health Commissioners Group (EHSHCG), with input from partners across the system, and shows our ambitious shared intent in improving the sexual health and wellbeing of all residents.

We look forward to working with the new Government and stakeholders to improve the sexual health and reproductive health of the whole population.

Our shared vision over the next 10 years is to improve outcomes, and reduce inequalities, in sexual health, reproductive health and HIV for all of our communities across the country.

This will be achieved by strengthening a coordinated system-wide approach to reducing the adverse consequences of poor sexual and reproductive health, including sexually transmitted infections and unplanned pregnancies, and to reduce stigma and discrimination.

It is absolutely critical that prevention focused activity sits at the core of this work, in order to provide the knowledge and information for individuals and communities, to make informed choices and to develop safe, healthy, enjoyable and consensual sexual relationships.

Despite the best efforts of local government and their system partners to knit together provision to make it more than the sum of its parts, far more can be done to create pathways to help people get the help and services they need. The sector is united in its view that designing, commissioning, and crucially funding of sexual and reproductive health services needs to change.

This report builds on our report ‘Breaking Point: securing the future of sexual health services’ and comes at a time of growing need. We have been making repeated calls to the government to address the funding and capacity challenges, and to provide a clear long-term workforce plan in relation to these services.

Our asks

• We are calling on the Government to work with local government to commit and deliver, a sustainable, national 10 year sexual and reproductive (SRH) strategy that sets out bold ambitions to prioritise prevention, tackle sexually transmitted infections (STIs) and improve access to reproductive health. 
• A commitment to deliver an increase in funding and investment to meet current and future demand.
• A nationally and centrally funded SRH and HIV workforce development plan needs taking forward as part of the recently released NHS workforce plan.
• Ensure that local areas have the resources required to consistently deliver and expand outreach, education, prevention and behaviour change programmes.
• Local and central government should develop a clear set of mutually agreed ambitions for sexual and reproductive health, as well as goals for reducing the unacceptable and widening levels of inequality.
• Work with commissioners and providers to review where technology and innovation can further be utilised, including the potential use of AI in understanding current and future need.

Setting the scene

Sexual Health Services are meeting more need and demand than ever, whilst continuing to innovate

• The UK is ranked the top performing country in sexual and reproductive health and rights policies according to the European Sexual and Reproductive Health and Rights Ranking Atlas 2020–23.
• Access to services (including testing services) has significantly improved by promoting rapid access to accessible services (increase of 36 per cent in consultations).
• Teenage pregnancy rates have fallen to their lowest levels since records began.
• As a result of the national HPV vaccination programme, genital warts diagnoses among young women aged between 15 and 17 years old attending sexual health services were 67.9 per cent lower than in 2018.
• The use of more effective long-acting methods of contraception by females has increased from 28 per cent in 2011/12 to 56 per cent in 2021/22.
• Service access has been improved through the expansion and integration of service delivery outside of specialist services, particularly in the community and general practice.
• Developments in diagnostic tests for STIs and HIV have increased screening levels in settings outside of specialist services and moved into outreach/community.
• There have been concerted partnership efforts and improvements over the last 10 years in relation to HIV prevention methods, testing and treatment and care that have led to enormous progress on the HIV care continuum (i.e. have met the 90:90:90 target).

Despite the above statistics, there are significant challenges faced by services and we can go further and faster to meet need and reduce inequity:

• In 2021, the percentage of conceptions leading to legal abortion reached a record high of 26.5 per cent. This percentage has generally been increasing across all age groups since 2015. These have a major impact on individuals, families and wider society.
• In England during 2022, 3,805 people were newly diagnosed with HIV (this is a 22 per cent increase on 2021).
• Almost 45 per cent of adults newly diagnosed with HIV were diagnosed after the point at which they should have started treatment (late stage).
• Rates of infectious syphilis diagnoses increased 9.4 per cent from 8,693 diagnoses in 2022 to 9,513 diagnoses in 2023.
• Rates of gonorrhoea are at their highest since records began. Gonorrhoea diagnoses increased 7.5 per cent from 79,268 diagnoses in 2022 to 85,223 diagnoses in 2023.
• Equally, gonorrhoea is becoming more difficult to treat, as it can quickly develop resistance to antibiotics.
• In 2022, there were over 400 diagnoses of STIs made each day among young people. The impact of STIs remains greatest in young people aged 15 to 24 years; GBMSM; and some minority ethnic groups.
• In 2022, just over half of women having an abortion had previously had a live or stillbirth, indicating that better support is needed to access contraception following childbirth.
• Almost half (45 per cent) of pregnancies nationally are unplanned or ambivalent, again indicating that better and more equitable access to contraception is vital (in all settings).

Demographic challenges over the next 10 years

Over the next 10 years, the effects of demographic change, such as declining birth rates and increasing individual life expectancy, require system adjustments offering age and needs-based care.

Development of the national 10 year sexual and reproductive health strategy

There has not been a comprehensive national sexual and reproductive health strategy since 2001.

The Government published a framework for sexual health improvement in England (2013), which set out its ambitions to improve sexual health outcomes across the population.

This is a call to action for the government to work with local government and other system partners to develop a new overarching system-wide and funded strategy.

This strategy should address the issue of the increasing volume and complexity of demands on services, and crucially allows us to shift the dial and approach.

Appropriately investing in prevention and upstream initiatives to empower people to look after their own sexual health and wellbeing and prevent STIs or unplanned pregnancy in the first place are key.

Our proposed priorities for any national sexual and reproductive strategy are:

• Reducing the prevalence and onward transmission of STIs.
• Improving access to reproductive health services across all settings and reduce unintended pregnancies in all women of fertile age.
• End all new HIV transmissions by 2030 and reduce HIV associated stigma.
• Prioritise prevention and health promotion interventions (which support informed choices) – this should include quality assured, statutory RSHE delivery in schools and other educational settings.
• Reduce inequalities in sexual health outcomes by better understanding our more under-served communities.

The above priorities should be backed by an ambitious series of metrics and outcomes by which to jointly ensure progress is being made.

Building blocks

This report outlines the following building blocks for strategic direction and development of the sexual and reproductive health strategy together with a set of practical recommendations and innovative ideas to take forward.

1. Funding review
2. Commissioning framework refresh
3. Quality standards and performance management of all sexual and reproductive health services
4. Sexual and reproductive health workforce development strategy
5. Prevention and outreach
6. Technology and innovation.

Strategy development – key principles

Take a whole-systems approach – which reaches beyond NHS clinical services and in which local government, schools, parents, the voluntary sector and the community itself are key partners in creating communities that promote good sexual and reproductive health. The strategy will need a collaborative and whole system approach to commissioning and delivery to make a difference. This requires a commitment to meticulous joint planning to ensure that those people accessing services receive seamless, high-quality care and support and that we engage those who are in need that are not utilising provision.

Join up national government planning and action – in the same way that integrated care systems are beginning to collaborate at system level and the way that health and wellbeing boards and other place-based partnerships have adopted at place level. The strategy will recognise that good sexual and reproductive health does not happen in isolation and is therefore complementary and embracing of other national policies and strategies. This includes but is not limited to the, Women’s Health Strategy, HIV Action Plan, Hatfield Vision, 10 year drug strategy, Children and Young People (Best Start in Life) and maternity strategies.

A life-course approach is vital – starting from pre-conception, continuing through childhood, adulthood and older age whether focusing on prevention, early identification, or effective treatment and support. The strategy must recognise that sexual and reproductive health is important throughout life, and that people’s needs for information and demands for services vary according to their age, lifestyle, sexual orientation and wider social determinants

A shared framework for action - the strategy will be required to provide a framework for system partners to work together to plan and take appropriate actions to improve the sexual and reproductive health of the population and to enhance existing pathways to high-quality, open and accessible services. The framework will provide support to planning, core standards, commissioning and delivery of services to improve outcomes.

The person must be at the centre of sexual and reproductive health – the strategy should focus services more closely on people and their experience. People can find it difficult to navigate a fragmented system and that our present services are not always well placed to support people with multiple needs. This means that support and care can be disjointed, waits are longer than they need to be and individuals can lack the ongoing help they need.

Prevention and early intervention must be the basis of the strategy - Prevention is central to achieving good sexual and reproductive health outcomes and entails changes that reduce the risk of poor sexual health outcomes and activities that encourage healthy behaviours. Education, condom use, diagnosis and treatment are key interventions for their prevention and control.

Evidence based- the strategy should be using the latest national evidence and standards including those developed by National Institute of Clinical Excellence (NICE), British HIV Association (BHIVA) and British Association of Sexual Health and HIV (BASHH).

Recommendations

• Local and central government to develop a clear set of mutually agreed ambitions for sexual and reproductive health, as well as ambitions for reducing the unacceptable and widening levels of inequality.
• UKHSA and DHSC, in collaboration with a national sexual health strategy group of representatives drawn from commissioners and providers of sexual health services, should develop a new sexual health strategy.
• As part of the work, the national sexual health strategy group should set out the minimum levels of funding that will be required to ensure that all local areas are able to deliver high quality services and meet cost pressures and pre-existing challenges.
• Political leadership and accountability will be needed to bring decision-makers together with a shared mandate to improve the sexual and reproductive health needs of the population. Whilst leadership at national level is important, it should also be reflected and driven at local level.
• DHSC working in collaboration with the national sexual health co-design group to ensure the 16 goals within the Hatfield Vision, HIV Action Plan outcomes and Women’s Health Strategy outcomes are aligned to the outcomes and strategic direction in the new sexual and reproductive health strategy.

Long term sustainable investment in sexual and reproductive health is required by government to meet service demand, reduce inequalities and to keep pace with technology and potential changing sexual behaviours.

Recommendations

Poor sexual and reproductive health outcomes are unlikely to improve unless a sustained investment is achieved. Primary and secondary clinical services are highly likely to be unable to maintain current or future demands without investment in workforce, service delivery and a clear strategy to support the recommendations in this paper.

Failure to make an explicit investment in public health will continue to weaken systems, subsequent service delivery and health outcomes for the population. An example of this is that as local systems are unlikely to be able to manage and respond to any future significant STI outbreaks.

In order to mitigate this, we call upon the government to implement the following actions:

• DHSC to review the funding allocations given to each part of the sexual and reproductive health sector in line with current demand and future population. Funding allocations to include pay uplifts and reflect the cost of living.
• DHSC should work with local commissioners to build the case for sustained investment in sexual and reproductive health—based on a deeper understanding of the cost of not addressing the harms — to ensure that the strategy is appropriately prioritised at the next spending review.
• To improve certainty around funding for sexual health services. DHSC should provide multi-year and timely settlements for councils to allow them to plan and make meaningful financial decisions.
• DHSC to review the HIV Pre-Exposure Prophylaxis (PrEP) allocations in line with need of all groups, including underserved groups (e.g. women) following the increasing demand for this prevention and impact on sexual services capacity and testing required.
• DHSC to investigate the introduction of national tariffs for some elements of sexual and reproductive health services to ensure equity, and ensuring annually the tariff is reviewed to reflect current and future cost of living costs. This will allow for local authorities to improve their efficiency, reduce administration and monitoring of sexual and reproductive health budgets.
• DHSC should undertake the work necessary to improve its understanding of the up-to-date costs of poor sexual health to the NHS and wider society.

Background

Since 2013, local councils have successfully commissioned high quality integrated sexual and reproductive health services. In many places they have modernised settings and transformed services. These services have incorporated innovations which have seen significant modernisations with a rapid shift to online consultations, apps, home testing and home sampling.

Only with adequate long-term funding – to cover increased cost pressures and invest in local services – and the right powers, can councils deliver for our communities, and protect the health and wellbeing of residents.

Reduced funding has made it a significant challenge for them to respond at the scale needed. Government cuts to councils’ public health budgets has left local authorities struggling to meet increased demand for sexual health services.

Greater investment is required to restore parity as demand for sexual and reproductive health services has significantly increased and funding has decreased.

LGA analysis has found that, between 2015 and 2024, the public health grant received by councils has been reduced in real terms by £880 million (based on 2022/23 prices). This has resulted in a reduction in councils’ ability to spend on STI testing, contraception, and treatment.

Across England, spending on STI testing, contraception and treatment decreased by almost £200 million between 2014/15 and 2022/23.

The next Spending Review is an opportunity for the Government to provide significant additional funding for all councils that can be wisely invested in stabilising the current system to ensure strong foundations on which to build future reform.

Investment in sexual health remains one of the public health “Best Buys”, it significantly improves peoples’ physical and mental health, impacting on a range of direct and indirect health and social care outcomes. Reductions to spending on sexual health, as with other areas of public health expenditure, are a false economy because they lead to higher financial costs for the wider health and social care systems.

SRH intervention of contraception has been evaluated to show an investment of £1 is estimated to return £9 of cost savings to the government."

Investing in sexual and reproductive health and HIV services makes sense. They have demonstrated value for money and excellent return on investment via a range of studies. There are a number of Return-on-Investment tools available to illustrate the cost impact of prevention and intervention. These include Health Economics Evidence Resource and Sexual & Reproductive Health: Spend and Outcome Tool (SPOT).

Data shows that 52 per cent and 12 per cent of unplanned pregnancies end in abortion and miscarriage respectively. If we avert or reduce unplanned pregnancies (by providing robust access to contraception), we would not only improve outcomes for the patient involved, but this could lead to a saving of £1,663 for each conception averted (in direct healthcare costs).

Each new case of HIV infection is estimated to represent between £73,000 and £404,000 in lifetime treatment costs), with median lifetime costs found to be £296,022."

Create a positive, enabling ‘culture of collaborative commissioning’. This should assume a shared approach to risk, responsibility and resources to deliver improved outcomes for our population.

Recommendations

• DHSC working with key partners, to review and refresh the Making it Work PHE commissioning guidance to ensure it provides more clarity, clear steps/guidance and allows for shared responsibility for sexual and reproductive health across the health system.
• DHSC to enable and lead the review all national sexual health service specifications to ensure they are up to date and reflect changes in treatment, social care and national priorities (i.e.. across the whole system, and for all responsible commissioners).
• Working with NHS partners we need public health commissioned services and NHS commissioned services to work better together. Integrated commissioning for better outcomes (ICBO) developed for use in social care is designed to support continuous improvement in integrated commissioning and service re-design. It builds on its predecessor, ‘Commissioning for better outcomes’ (2015), whilst widening its reach to address commissioners from both councils and the NHS at a time when closer collaborative working between the two is becoming the norm.
• Introduce a new development programme for commissioners from across LA and NHS organisations where they can come together to help shape commissioning outcomes, support transformational and cultural change across services/projects and develop their skills and experience on commissioning effectively.
• Working with the LGA and ADPH, DHSC should develop a new Sector Led Improvement programme for sexual and reproductive health. Sector-led improvement has proven to be a success in other areas of local government services such as child safeguarding, adult social care, planning and building control.

Background

The Health and Social Care Act 2012 places a duty on local authorities to provide open access services for contraception and for prevention, testing and treatment of sexually transmitted infections (STIs) for their residents.

One of the biggest challenges for sexual and reproductive health is working collaboratively across commissioning and provider colleagues. Nationally and locally the sexual health system is diverse, fragmented and, at times, complex.

For example, local authorities have responsibility for STI testing and treatment, and HIV prevention, including PrEP, whilst HIV treatment rests with NHS England. Meanwhile, Integrated Care Boards run abortion, vasectomy and gynaecology services.

Fragmentation was a feature of the system long before the transfer of services in 2013. This was pointed out by a number of reports and it has probably become more visible over recent years. The fragmented nature of the system, coupled with the cuts to the public health grant, has created challenges.

Service users, of course, do not think of sexual health in terms of who commissions it and why. They expect to have accessible, confidential and integrated services. Councils have had to work hard to maintain these and build on them in this commissioning landscape.

There has never been a greater need for organisations to work together, pooling expertise and resources in a collaborative, whole systems approach. In doing so the interrelated needs of service users – across primary and secondary care, and between secondary care specialties – are recognised and put at the heart of the commissioning process.

A whole system approach needs to be ta ken at both the local and national levels, covering prevention, improvement, promotion and protection, and spanning the three areas of sexual health, HIV and reproductive health including contraception. Attempts to tackle these issues in isolation will lead to silo working and will not be representative of people’s experiences of sexual health, which are not divided into the three neat categories.

Sexual and reproductive Health and HIV services: Commissioning arrangements from April 2024

Recognising the potential for fragmentation of service provision arising from the new arrangements, Public Health England published Making it Work: a guide to whole system commissioning for sexual health, reproductive health and HIV in 2014.

Whole system commissioning requires a commitment to meticulous collaboration, an alignment of values and principles, agreement on processes, and mechanisms with the willingness to work differently. It is vital for commissioners to work together to ensure care and treatment people receive is of a high quality and not fragmented. Service users to be involved in co-designing services and be part of continuous feedback to and from service providers.

The commissioning, planning and delivery of services should focus on reducing inequalities and delivering better sexual health outcomes covering effectiveness, safety and individual experience of care. It is important that services cater for the needs of people of all genders and sexual orientation and at all life stages.

Develop and implement joint quality and performance management standards of all sexual and reproductive health related commissioned services.

Recommendations

• DHSC, in partnership with EHSHCG, NHSE and ICBs to undertake a whole system review to develop joint national quality and performance standards, in line with a new strategy.
• DHSC to improve data standards and data sharing to enable capture of whole system at a local authority level (inclusive of sexual and reproductive health services commissioned by local authorities, NHSE and ICBs).
• For each local area to develop and implement a multi-stakeholder sexual and reproductive health strategy and to report on measurable activity and publish.

Background

For progress against the strategy to be consistently applied and measured, it should include clear and defined shared targets. A refreshed national quality and performance framework should be released that provides regular publicly available progress updates. This should include progress against any national targets – including progress within communities most affected by poor sexual and reproductive health.

In addition to these targets we also support the recommendation from the Health Select Committee Report 2019 for the strategy to set clear national quality standards for commissioners to adhere to.

It is essential that there is collaboration and integration between a broad range of organisations and stakeholders, including commissioning organisations, in order to achieve the desired outcomes and reduce fragmentation in care. Alongside this integration, service users should be involved in co-designing services and be part of continuous feedback to and from service providers and commissioners.

There are already some standards and public health outcomes already established for integrated sexual health services however these are not reflected across other sexual and reproductive health services. For example, there is a national target for Chlamydia screening programme (aged 15 – 24) but this is not currently a shared target across all sexual and reproductive health services.

Office for Health Improvement & Disparities (OHID) data collects and reports nationally (Fingertips) on some aspects of reproductive health and STIs, however it is challenging nationally and locally to fully view aspects of provision and therefore unable to accurately identify gaps. We acknowledge the improvements over the years of data collection and would welcome further improvements across all sexual and reproductive health services to align data to give an overall aspect of provision and to support intelligence led strategic decision making for all partners and providers.

For example, emergency contraception is available from specialist sexual health services, GPs, pharmacies, Accident and Emergency departments and online. There is currently no definitive data across all these to be able to look at demand, and inequalities of access.

Further improvement tools and training should be developed to improve the quality and consistency of commissioning approaches with support of DHSC, NHSE, LGA and other stakeholders.

Any new national sexual and reproductive health strategy to include a well-defined priority action to sustain and improve training and development for both the current and future sexual and reproductive health workforces.

Recommendations

• Commit to inclusion of a fully funded long term national sexual and reproductive health clinical workforce within the NHS Long term Workforce Plan.
• A new national strategy should explicitly support training and development of the allied professional non-clinical workforce to deliver Sexual and Reproductive Health interventions.

Background

Securing a safe, well trained, supply of staff is imperative to the delivery of good sexual and reproductive health services. The sexual and reproductive health workforce is varied and includes a broad range of medical and non- medical and non-specialist staff providing services from hospital, primary care, and community settings.

The demand on services continue to increase which is impacting on staffing with elevated levels of sickness and staff being exhausted. In some cases, this has led to low morale and contributed to challenges with retention and recruitment. Pressures within the sexual and reproductive health sector have led to working in sexual and reproductive health less attractive to both new and existing staff. Current workforces are retiring and leaving. A diminishing pipeline of staff is making this situation particularly challenging, and services are reporting that it is difficult to recruit appropriate staff.

Retention and recruitment difficulties are exacerbated by diminished training opportunities: limited learning and development opportunities feed into the decreasing attractiveness of working in sexual and reproductive health.

Training across multi-disciplinary teams is vital but is falling through the gaps. It has been challenging for services to prioritise training to build capacity and develop the clinical and wider workforce due to budget cuts and the service being overstretched.

By ensuring that Community Sexual and Reproductive Health and Genito-Urinary Medicine specialty training posts are fully funded, this directly supports and improves leadership, training and governance to the sexual and reproductive health systems locally and nationally.

The workforce beyond the clinical teams extends widely. This includes education staff delivering relationships and sex education, social workers, outreach staff, substance misuse staff, health psychologists, counsellors, youth workers, community workers and therapists to name just a few. The skills and professionalism of this staff group enable quality primary prevention interventions, behavioural change interventions and ongoing engagement with individuals and communities. They can support areas of sexual and reproductive health such as working with sex workers, migrant health and engaging with the hardest to hear of all groups at risk of poor sexual health in our communities.

The Faculty of Sexual Reproductive Health (FSRH) workforce report 2023 highlighted key findings and recommendations outlining the critical factors evidencing the ‘staffing crisis’.

These include:

• Retirement with one third of the qualified workforce heading towards retirement in the next five years.
• SRH ‘deserts’ with few or no qualified SRH workforce – with areas struggling to meet patient need.
• Recruitment and wellbeing.

There has been a significant drop in the number of GPs training to develop and maintain competency in LARC (Long-Acting Reversible Contraception) fittings. This has been attributed to reduced provision in primary care due to the impact from the pandemic and issues with training, commissioning, and funding.

Since the pandemic there remain some areas with long waiting lists for women to have their LARC fitted or removed. Evidence shows that marginalised groups have been particularly affected with services reporting a specific drop in access amongst young people, Black women as well as women and girls from Asian and ethnic minority groups.

Effectively value and fund provision and delivery of outreach, sexual health education and prevention services alongside the clinical service.

Recommendations

• Ensure that the distinct barriers to good sexual and reproductive health faced by people are understood and that local public health teams have adequate resources to prioritise prevention of poor sexual and reproductive health outcomes.
• Prevention strategies which respond to changing behaviours and norms are made a priority within future sexual and reproductive health strategies.
• Sexual and reproductive health promotion strategies take an empowering, co-produced and evidence-based best practice approach to support individuals and communities to look after their sexual health and wellbeing.
• Ensure an evidence-based approach to deliver the statutory relationships, sex and health education guidance in education settings. Education must be age-appropriate, culturally competent, inclusive, and up to date.

Background

We are aware that councils have had to prioritise clinical activity over prevention in many areas. Unlike STI testing and treatment and contraception, they are not services which councils are mandated by law to provide. The funding for prevention services has reduced as a result of cuts to the public health grant, meaning that outreach services for groups such as sex workers, rough sleepers, known to have poorer sexual health outcomes have been stripped back. Cuts to these services leave these vulnerable populations increasingly exposed to poorer sexual health outcomes.

We must continue to work across society to tackle HIV through prevention, education, awareness, and increased access to testing, enabling early diagnosis and treatment. There is a need to ensure equitable access to prevention interventions, from condoms to HIV PrEP so that it benefits all groups at greater risk of HIV. Prevention is a key strand of the National HIV Action Plan[iv], and directly contributes to its targets and ambitions.

Social media platforms and online interventions provide opportunities for sexual health promotion. Public health campaigns can leverage social media to disseminate accurate information, raise awareness about STI prevention, and encourage individuals to seek testing and treatment. Campaigns are a useful tool to potentially counter misinformation.

Addressing teenage pregnancy can save money, with £4 saved in benefit costs for every £1 spent. Furthermore, every young parent returning to education, employment and training saves agencies £4,500 a year. For every child prevented from going into care, social services would save on average £65,000 a year."

We welcome the national Women’s Health Strategy launched in July 2022. The strategy indicates an approach to reduce inequalities and disparities in health outcomes affecting women. We fully support taking a life course preventative approach to improving access and care for women, who represent 51 per cent of the population. We call for the continuation of the Women’s Health Strategy which we hope will align with a new sexual and reproductive health strategy.

A consistent fall in teenage pregnancies over the last 10 years, down to the lowest rate since 1969, is a testament to the systematic application of successful strategies implemented by local authorities, including education, support, and access to comprehensive sexual health services. There remains substantial variation in rates between councils , continued focus is required to maintain this downward trend, particularly where there are persistent high rates linked to multiple deprivation indicators.

The government introduced statutory Relationships, Sex and Health Education (RSHE) in schools in September 2020. However, it not yet quality assured. Children and young people need to be taught to look after their own sexual and reproductive health, free of stigma, worry and judgement. We invite the next government to address the sector calls for improvement. Excellent relationships and sex education is evidenced[iv],[iv] to support improved sexual and reproductive outcomes as young people become sexually active adults.

The importance of delivering high quality and inclusive RSHE  cannot be overstated. It helps keep children safe and gives them the confidence and knowledge they need as they mature through adolescence and into adulthood.

Children and young people who receive comprehensive, high quality RSHE are more likely to delay the first time they have sex, have consensual relationships, be aware of and report abuse, use contraception and condoms when they start a sexual relationship and are less likely to become pregnant under the age of 18 or contract a sexually transmitted infection.

By being able to invest in preventative services again, at a place-based community level, this approach to sexual wellbeing across the life course can impact on other associated areas, including relationships and sex education, sexual violence, safer communities, trafficking and exploitation, reporting abuse, teenage conceptions, unplanned pregnancies, children in care, supporting parents and carers and more.

Develop the use of technology and innovation to keep pace with advancements, expectations of service users to improve access and prevention.

Recommendations

• Develop quality standards for digital sexual and reproductive health services ensuring that all aspects are reviewed with a strong focus on service user journeys, safeguarding, prevention and clinical safety.
• To undertake a review of technologies which support sexual and reproductive health outcomes. To understand current and model future uses and applications across England.
• Establish a coordinated intelligence led programme to drive forward the take-up of relevant digital tools, technologies, and approaches across the sexual health sector.
• Call on DHSC to convene key partners around research and technologies to enable all to understand our marginalised communities and deliver health equity.

Background

Over the last 10 years there have been significant innovations using technology to support sexual and reproductive health services. The imperative for local public services to fully exploit the potential of modern digital tools, technologies, and approaches in order to improve delivery and save money has never been greater. We face rising citizen demand, needs and expectations at a time of severe spending and resource constraints.

There are many outstanding examples of radical IT-enabled service innovation – such as online STI testing, and HIV self-sampling being adopted across the sector, successfully transforming the citizen experience, and reducing costs.

However, comprehensive improvement and development does not happen by chance in a sector as diverse and locally responsive as local government. It requires close collaboration between central and local government and other partners, including the voluntary and private sectors and communities themselves, carefully targeted and managed investment in both local ‘exemplars’ and national infrastructure, a well-coordinated programme of support and communication, and – perhaps most important – leadership at all levels.

Technology offers massive potential not just to make individual organisations and transactions more efficient, but to support innovative, collaborative, and transformative work to redesign services and to act as the ‘glue’ linking disparate service providers.

In response to COVID-19 sexual and reproductive health services in England scaled up telephone and internet consultations, as well as continuing face to face appointments. Over the last six years there has been a significant increase in the number of online and telephone consultations.

However, it is imperative to recognise that online sexual health services are not a substitute or replacement for physical services and should not be treated or relied on as such.

Local authorities have successfully developed and implemented online STI testing and by 2023, 97 per cent of local authorities have this in place.

There are many distinct types of online services that have been developed and which show promising practice for example, STI testing for asymptomatic patients; Chlamydia treatment, HIV Self sampling tests, oral contraception (the pill), oral PrEP continuation, genital warts and herpes treatment, online booking at clinics, partner notifications, and online consultations for LARC.

This is not an exhaustive list and very few local authorities have sufficient funding to commission some or all of the online services. this has led to an uneven coverage of some technologies across England.

Other technologies used are chatbox for advice and information, and confidential texting service for service users to ask questions. Some School nursing and sexual and reproductive health services use Chat health to facilitate this.

Social media and online interventions - social media platforms and online interventions provide unique opportunities for sexual health promotion. Innovation within services could include and not an inclusive list of:

• virtual clinics to improve access.
• remote specialist consultations
• remote prescriptions and direct-to-door medication delivery
• digital platforms offering users an end-to-end service tailored to previously unmet needs.

In this report, we set out how we can build on existing good work to draw together a coherent strategic framework for sexual and reproductive health, and our practical recommendations to government and partners around how to improve the current system for all places.

The LGA, ADPH and the EHSHCG, is calling on the government to commit to a significant and sustained increase in sexual and reproductive health funding for councils in the next Spending Review.

By working together as equal partners across the system and with a shared set of ambitions, we can meet the fundamental long-term sexual and reproductive health challenges facing our communities.