Select Committee on Science and Technology Written Evidence

Annex 1

Modernising Genitourinary Medicine Services in England and Wales


  The incidence of STIs and HIV in England and Wales has risen dramatically since 1997. Although most GUM departments operate an open access policy for patients who need to be seen urgently, recent surveys have shown that most GUM services are experiencing severe workload pressures that are exacerbated by restrictions in the physical infrastructure of clinics. This has resulted in unacceptable patient waiting times for accessing GUM services, which will inevitably have a very detrimental impact on the control of STIs.

  In April 2001, MSSVD and AGUM set up a working group to investigate the need for improvements to clinic infrastructure and to estimate the associated national costs. Clinics were classified into units based at London teaching hospitals, at Regional Teaching Hospitals, at District General Hospitals (subdivided into services served by more than one and by single-handed consultants), and within integrated sexual health services. The Group developed a template for assessing needs. Building cost calculations were based on detailed costings from nine representative units, which have either been modernised recently or are about to undergo major rebuilding programme. In addition an informal telephone survey of other centres took place to identify their needs.

  The survey identified the urgent need for substantial investment to improve service effectiveness, accessibility and acceptability. For most centres, this would mean refurbishment (including extensions where necessary) to improved access, especially for the disabled and facilities for patients with young children. If all clinics were refurbished, we estimated the total cost to be £151.5 million.

  The deficiencies of some clinics are so great that a major rebuild rather than refurbishment will be necessary. We believe that this will apply to 20 per cent of current clinics. This increases the estimated total building costs to £248 million. This figure does not include professional fees or VAT.

  Service delivery and effectiveness were also impaired by inadequate information technology. Virtually all units need to improve or develop computer links with laboratories and update of existing IT systems to enable efficient archiving of clinical records, and improvements to telephone systems. We estimated this to cost a further £28.5 million.

  Extending opening hours, subject to availability of resources and manpower, may also enhance accessibility to some clinics. A separate working group is currently assessing these immediate needs.

  The Group recommends that a clinic modernisation programme be phased in over a period of six years. We recommend that each region make its own comprehensive assessment of premises over the next 12 months to enable fully costed proposals to be made for a capital programme.

October 2002

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