Conclusions and recommendations
1. The costs of testing vary significantly
between PCTs. The Health
Protection Agency should, by April 2010, complete its costing
review and publish its results. The Department should require
PCTs to review their costs against the findings of the review
and report the results to Strategic Health Authorities by July
2010. Where costs are significantly higher than the Agency's estimate
of an appropriate achievable cost per test, Strategic Health Authorities
should seek explanation from the individual PCT and require a
cost improvement plan to be implemented within twelve months.
2. PCTs' localised procurement and commissioning
of the equipment and services needed to run chlamydia testing
programmes is inefficient. As a matter
of priority the Department should:
a) establish, as soon as practical, national
or regional arrangements for the procurement of testing kits,
patient record forms, laboratory processing of samples and other
standardised, high volume goods and services;
b) evaluate the case for a national website from
which young people can request testing services, with a national
brand identity;
c) review the number of separate Chlamydia Screening
Offices currently in place (91 for 152 PCTs), with the aim of
cutting the administrative costs of the Programme, and
d) require the Agency to complete its plans for
a model contract for chlamydia screening in GP practices and pharmacies,
and provide PCTs with guidance, including indicative payment rates,
by April 2010.
3. The Department does not have a mechanism
in place to measure the Programme's impact on the level of infection.
The Department should develop a business plan with a clear timeframe
for measuring the Programme's impact on chlamydia and related
health complications. This should specify a trajectory for the
reduction in chlamydia prevalence which the Department expects
the Programme to deliver.
4. Although the Programme instructs health
professionals to advise young people on safer sex when they are
tested for chlamydia, not all of those tested say they are receiving
such advice. The Agency should provide
renewed guidance to all those delivering testing to remind them
of the importance of providing advice alongside testing.
5. During the five years that the Programme
was rolled out, the Department did not exploit opportunities to
learn lessons, particularly around how costs might be reduced.
The introduction of the Vital Signs target in 2008 required a
step-change in PCTs' activities, which magnified existing inefficiencies.
For key forthcoming strategies, such as that for autism, the Department
should demonstrate that it has learned lessons from the chlamydia
programme by:
a) establishing regional and national structures
where appropriate, to support the most efficient commissioning
arrangements, and
b) setting out how it intends to evaluate the
cost effectiveness of these new strategies, with defined milestones
and success criteria.
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