Memorandum submitted by Nick Springham,
Newcastle Primary Care Trust (SH 151)
INTRODUCTION
I currently work as a manager with Newcastle
Primary Care Trust, commissioning a rage of services including
sexual health and sexual health promotion. Prior to this, I worked
for 11 years in Newcastle and North Tyneside Health Promotion
Department where I developed and managed the Sexual Health Promotion
Team. Before this, I worked as a teacher in a Gateshead comprehensive
for eight years where I played an active role in the development
of sex education within the school and the LEA.
NEWCASTLE AND
NORTH TYNESIDE
PCTS
Newcastle and North Tyneside are now two separate
PCTs, having been previously a single Health Authority District.
However, we have maintained one Health Promotion Department working
across the two PCT areas. This service is currently hosted by
Newcastle PCT.
There was some discussion about splitting the
service in two, in order to better serve the individual PCT areas.
However, it was felt that if this were to happen, expertise developed
across Newcastle and North Tyneside would be lost to one or other
of the PCTs. Consequently, we have maintained the service across
the districts. This is working well, but I have concerns that
in some areas in the country a valuable and scare resource has
been watered down by the fragmentation of the old Health Authority-wide
Health Promotion services into separate PCTs.
SEXUAL HEALTH
PROMOTION ACROSS
NEWCASTLE AND
NORTH TYNESIDE
The role and importance of Sexual Health Promotion
across Newcastle and North Tyneside has grown steadily over the
years. We are now in the position of having a dedicated central
Team of seven Sexual Health Promotion Officers, based in the Health
Promotion Department, developing a full range of sexual health
promotion interventions within various settings and with diverse
communities. This Team consists of:
— A Schools and Colleges Worker;
— A Boys' and Young Men's Worker;
— A Young Women's Worker; and
— A Black and Minority Ethnic Communities
Worker.
The aim of the Team is predominately to support
the development of community-based sexual health promotion initiatives
through the provision of resources, training, information, skills
and expertise. It seeks to maximise the involvement of all workers
who have sexual health as part of their remit and ensure that
the work undertaken is co-ordinated and evidence-based.
This central Team works closely with community-based
workers and community development projects locally to support
and develop their practice. These include:
— MESMAC—Gay and Bisexual Men's
Project;
— HIV Prevention Project—Community
Development with Women including a designated worker to develop
work with Black and Ethnic Minority Women;
— Teenage Pregnancy Team;
— Teacher and Youth Workers;
— Contraception Services; and
THE ROLE
OF SEXUAL
HEALTH PROMOTION
IN THE
SEXUAL HEALTH
STRATEGY
In any strategy, which seeks to improve the
sexual health of a population, sexual health promotion must be
a key component. It is acknowledged that sexual health clinical
services are of vital importance in the treatment and management
of sexually transmitted infections and pregnancy. However, if
we are to seek to improve the sexual health of the nation, we
need to be "working upstream". We need to ensure that
our treatment services are the best that can be provided, but
we also need to ensure that we invest in services that will help
to prevent people from getting sexually transmitted infections
or becoming pregnant when they do not want to. Put simply "prevention
is better than cure" and, in the long term, is more cost
effective. In order to prevent sexual ill-health, we need to be
working to promote the sexual health of the nation.
The promotion of sexual health is complex and
needs resources and expertise to be effective. We know, from a
growing health promotion evidence-base, that information alone
is not enough to change people's behaviour. Campaigns that promote
"just-say-no" messages are ineffective, as they do nothing
to provide people with the skills and resources they may need
to act on the information presented to them. Clearly, information
is important, but it needs to be relevant to the target group,
accessible, understandable and not seen as moralistically preaching
a message. Even when this is achieved, it is only a first step
in the promotion of sexual health.
The second step is to ensure that people have
the skills and resources they need to be able to act on the information.
It is of limited use, for example, to promote condoms to people
who do not have the resources to access them, the assertiveness
to negotiate with their sexual partner, the skills to use them
properly or the support to continue using them.
In order to promote sexual health, we need to
be working at various levels. We need to ensure that people have:
— the information and the understanding
they require;
— the interpersonal skills to negotiate
acting on this information;
— the practical skills needed to act
on the information;
— the resources they need to make sexual
healthy choices easier; and
— the community and social support
they need to keep making sexually healthy choices.
THE C-CARD
IN NEWCASTLE
AND NORTH
TYNESIDE
In practical terms, this is usefully demonstrated
by a series of Newcastle and North Tyneside initiatives to support
the use of condoms amongst young people. These initiatives cover;
Information and Understanding. A range
of local and national resources are used to ensure that young
people are aware of the need to use condoms. This includes media
work, outreach and education.
Interpersonal Skills Development. A programme
of assertiveness training for staff working with young people
so that they can model interpersonal skills and support young
people in making choices they want to make, rather than be pressurised
into potential damaging behaviours.
Practical Skills Development. Teachers,
youth workers, community workers and a range of health workers
are trained to be able to demonstrate the practical skills involved
in correct condom use. All young people accessing free condoms
are trained in their use prior to being given condoms. A reminder
"How to use a condom" booklet is given out with condoms.
Provision of Resources. Condoms are provided
free to young people in a range of community-based settings through
the C-Card scheme. This scheme allows young people, after a consultation
with a health professional, to access free condoms at a series
of venues across the city on the production of their C-Card credit
card. These access points are placed predominately within areas
of social deprivation.
Community Support. The C-Card scheme
is placed with, and supported by, a range of community centres
and community development projects across the city. This ensures
that sexual health is seen a part of the young person's overall
wellbeing.
These initiatives have proved to be very successful
in engaging young people. We now have 7,031 young people registered
with the C-card scheme. The scheme has had particular success
in engaging young men and bringing them into services.
COMMISSIONING SEXUAL
HEALTH PROMOTION
The development of the Commissioning Toolkit
to support the National Strategy should be of great help at a
local level. However, it is most important that this document
gives clear guidance on the importance of commissioning sexual
health promotion services. Pressure to achieve clinical targets
might result in sexual health promotion being marginalised. Fighting
for funds to work "upstream" is difficult at the best
of times. The toolkit needs to set out the importance of this
area of work, with clear standards. Many commission managers do
not necessarily have the background and experience in the field.
They are often more experienced in commissioning clinical services
rather than community support, education and health promotion
activities. The Commissioning Toolkit needs to address this and
give clear guidance, thus ensuring Sexual Health Promotion Services
are commissioned appropriately.
CONCLUSIONS
It is great step forward that we now have a
National Sexual Health Strategy. This is universally welcomed
in the field. However, it must be said that there is some concern
about the role and future sexual health promotion.
— Pressure to achieve clinical targets
focus attention on clinical treatment services. The role that
sexual health promotion plays in this work might be in danger
of being overlooked;
— Much sexual health promotion work
has historically been funded through ring-fenced HIV prevention
monies. With this money no longer being ring-fenced there is a
danger that this work might not be prioritised locally;
— Many areas do not have a Sexual Health
Promotion Team. In many places there is one person with this responsibility
(in some cases as part of a wider remit). If we are to create
a sexually healthier nation, sexual health promotion needs to
have the capacity to make a difference;
— The sexual health of diverse communities
needs to be addressed. Section 28 is still used as a barrier to
working with young gay men. The sexual health needs of lesbian
and bisexual women are generally ignored. The sexual health needs
of people with learning disabilities are for the most part still
unacknowledged. Deaf communities continue to be disadvantaged.
The diverse and complex needs of refugees and asylum seeks is
a growing priority; and
— Sexual health promotion is all too
often seen in terms of preventing something happening, rather
than positively promoting the idea of a sexually healthy nation.
THE FUTURE?
Sex and sexuality need to be "normalised".
They are a fundamental part of what it is to be human. They are
neither smutty nor dirty. They are not clinical issues but social
issues. They need to be seen within the context of people lives.
We are all sexual beings and our sexuality needs to be integrated
into our relationship with ourselves and others.
The promotion of sexual health is about the
promotion of healthy relationships. Relationships that value the
rich diversity of human sexuality. If we are to make a difference
to the sexual health of future generations we need to ensure that
people grow up with the knowledge, skills and resources to protect
and care for themselves and others. This needs to become a key
obligation on statutory organisations.
We could continue to plough all of our resources
into reacting to, and dealing with, the symptoms of sexual ill-health,
or we could try to make a real difference through the promotion
of sexual health. This is the challenge for the future!
November 2002
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