Sexual health made headlines yesterday as shadow public health minister, Andrew Gwynne claimed in The Guardian that the Labour Party’s analysis had found as much as £40 million could be cut from local councils’ sexual health budgets and that this would have a consequent effect on (already increasing) STI rates. This analysis doesn’t take into account the opportunity for online STI testing services to deliver efficiency savings and improve access to STI testing through remote home testing.
So we thought it would be helpful to share our experience. As part of SH:24’s business planning, we undertook some analysis of our own to ensure that our social enterprise service model would:
- be able to scale and,
- would genuinely be able to deliver value to NHS services and local government operating under increasingly stretched budgets
Since its launch, SH:24 has been proven in concept and practice in terms of the benefits it can bring to service users (discreet, confidential, rapid testing 24/7) and the significant savings it can realise through its cheaper online tariff. We estimate that if SH:24 were to be rolled across the UK it could create £80 million worth of savings. This would make a huge difference in the current financial climate which requires local authorities to make very difficult decisions about the future of public health services. Shifting service users from clinics to online means that clinicians and nurses have greater capacity to work with more complex cases - for example, fitting a coil for a woman who might otherwise be at risk of unplanned pregnancy - another concern that was mentioned in The Guardian’s article.
SH:24 has been commissioned to deliver its online sexual health service in Southwark and Lambeth, and is due to launch in three new areas in April this year. Added to this, SH:24 is working with a number of NHS Trusts and providers across the country to respond to other tender opportunities. These are exciting conversations - thinking through how new integrated sexual health models can make services more accessible but also sustainable in an environment where resources are scarce.
Ultimately, however, SH:24 would like to be able to sees this sort of service available to everyone in the UK whether you live in the Outer Hebrides or Brixton (and saving £80 million along the way!). As service users who live outside regions that we operate in ask - why should it be a postcode lottery to get a test online in 21st century Britain? With well over 80% of the population accessing the Internet regularly and with over 40% shopping on a smartphone in the last year, we think you should be able to do the same for an STI test (over 60% of our users order a test on their smartphone by the way).
We have the technology, we have the platform/s, we have the professionals to integrate at the front line but unfortunately commissioning cycles (and sometimes fear of the new) can stifle system-wide change: the fact that local authorities commission their sexual health services individually and in unaligned timescales means that making sexual health services ‘digital by default’ is more challenging than you would think.
So what’s the answer? Local government, commissioners, NHS and supporting umbrella organisations - be bold and brave. Listen to users (who overwhelmingly say they would like online services in most Sexual Health Needs Assessments and surveys) and work collaboratively to radically change the sexual health landscape for the better. Encouragingly, this is what local authorities are already doing in London through the London Sexual Health Transformation Project - which is exploring commissioning online sexual health services on a pan-regional basis. Ambitious.
The coming months will offer new learning on how online sexual and reproductive health services can make a difference. Later this month we will launch our nurse-led web chat after successfully trialling ‘talk by text’ last year. We’ve found people are likely to speak more openly by text and more quickly (more on this on our Power of Text blog) meaning we’re well placed to answer questions people might have otherwise waited to go into a clinic to ask or more worryingly, dismissed from their mind. There’s a real opportunity to help inform people to better self-manage their sexual health and open up conversations for them to get support more quickly.
Then, later in the year, we will also make contraception and chlamydia treatment available by post, again, improving access to services while delivering considerable savings. Branching into delivering online contraception services will throw in more complexity in terms of funding, with some elements commissioned by Clinical Commissioning Groups (CCGs) and others by local authorities. But again commissioning and differing funding pots needn’t pose a barrier - if professionals, service designers and commissioners come together there is enormous opportunity for front line services to be enhanced through sensitive adoption of digital technology.
If you are interested in working for SH:24 (see our recent Guardian ad), would like to know more about partnering with SH:24 to deliver sexual health, or would like to just share your thoughts on how sexual health services can be improved - get in touch.