Increasing performance, reducing cost: perspectives from the new sexual health landscape

By Mark Clune, Business Development Manager

In my role with SH:24 I spend a lot of time at market engagement events talking to providers and commissioners of sexual health services. This has given me a unique insight into what the landscape looks like for sexual health services and what the challenges are.

Pretty much every provider of sexual health services that I speak to mentions the following as key challenges;

  • Services are being re-commissioned with the same activity levels, but for a smaller financial envelope
  • Demand outstrips what they currently provide
  • There is a move to a prime provider model, which means they take on the management and risk for the full sexual health system in the area
  • There is a move from activity based contracts, to outcome based contracts

These challenges are driven by cuts to the public health budget, both in-year and for (at least) the next 5 years.

In December 2015 it was announced that there would be a £200m in-year cut to public health budgets and between April 2016 and April 2021 there would be a further reduction of £600m – this accounts for 20% of the total budget, in real terms this is about a 4% reduction per annum.

For most local authorities this is the first time they have had the opportunity to re-tender services since they transferred over from the NHS in 2013 and they are faced with a real problem. There is a demand for services that outstrips the budget available for the services. This forces them to make some tough decisions about how they reassign the budget. These are the options and, as I see it, some of the possible consequences.

Option 1.  Reduction to population level screening

A reduction to population level screening would ensure that resource is still available for targeted outreach work with hard-to-reach groups. Reduction of population screening could mean a reduction in clinic opening times or staff capacity or closing some clinics altogether. Focusing activity on outreach would ensure the sexual health of the most at-risk improves, however the sexual health of those who access sexual health services at population level will decline.

Option 2.  Reduction of targeted work with those in the most at risk groups

A reduction in targeted work would ensure there is enough resource available for population level screening. However the sexual health of those from the most deprived areas and at risk groups, who don’t access services without intervention, would get worse. Ultimately the gap in sexual health inequalities between the most and least deprived would get bigger.

Option 3. Reduction of targeted work and population level screening

The sexual health of both groups gets worse.

None of the options above are ideal. In newspapers, health experts warn on a weekly basis of the consequences of reduced provision; more unwanted pregnancies, higher levels of sexually transmitted diseases and consequent social inequity. It must be tough for commissioners that have done a really good job to reduce sexual health inequalities between the most and least deprived over the years to now have to choose which parts of the service they can re-commission, potentially derailing their hard work. I imagine that this is even more tough as these commissioners will have strong professional and personal relationships with their providers.

It must be equally challenging for incumbent providers to bid for contracts knowing the contract envelope isn’t large enough to sustain the current staffing structure. We have talked to some incumbent providers of services who have taken the decision not to bid for the contract they currently provide because of this.

We have seen that non-incumbent organisations are more willing than incumbent ones to take on contracts that include transformation. Providers that have developed winning service models have built the service from the bottom up to, creating a new fully integrated service model. A key part of this service model has been to shift people who don’t have any symptoms but want an STI screen online, helping to reduce costs, increase capacity of the service and improve the patient experience.

This is where SH:24 has worked very successfully with providers to develop innovative service models, helping people without symptoms access sexual health testing online, more conveniently, within a challenging budget. 

If you would like to talk to me about how SH:24 could work with you to help you address the challenges you are seeing in your sexual health service, send me an email –