Community Practitioners' and Health Visitors' Association

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The National Sexual Health & HIV (England)



The Community Practitioners’ & Health Visitors’ Association welcomes the opportunity to comment on the above strategy.

The CPHVA is the UK professional body that represents registered nurses and health visitors who work in a primary or community health setting. The CPHVA is an autonomous section of the MSF trade union.With 18,000 members, it is the third largest professional nursing union and is the only union, which has public health at its heart.

Overall the CPHVA feels the strategy is wide reaching and ambitious, however we also believe the targets are realistic with adequate resourcing. We would like to offer the following specific comments.

Chapter 3 – Better Prevention

The CPHVA feels that a survey of consumer/public opinion and views would have assisted in the formulation of the strategy. There appears to be a great deal of emphasis on medical services rather than on relationship/confidence building aspects of sexual health promotion. This may then have resulted in a more proactive approach to primary prevention.

The CPHVA believes that subtle messages in influential media can have an impact. Soap operas offer a good medium e.g. Eastenders has incorporated a number of health issues such as HIV and sickle cell anaemia in its storyline. Anecdotal evidence demonstrates that this has led clients and the public in general to seek information on these issues. Repetition in different forms over long periods is also felt to be effective.

One area is considering the use of mobile phones as a means of getting health educational messages out to young people.

The ‘safer sex’ slogan is widely adopted, therefore if it is widely understood it may well be best left alone. However a new strategy maybe the ideal time to re-emphasise the message – the CPHVA suggests along the lines of ‘healthy sex’.

Chapter 4 – Better Services

The CPHVA feels that the proposed new model for sexual health services is encouraging.

Developing services that are patient centred and sensitive to local communities and their cultures should begin with focus groups being set up. Likewise for people living with HIV and service users generally to feel more involved in policy making and service planning there must be consultation at the planning stage with response to service users recommendations. With the recognition that the priorities of professionals and communities may be different. You tell me - I hear you, you show me – I learn, you involve me – I understand.

There is a need for greater dissemination of information to the public as a whole. There are still many people who believe that to be tested for HIV irrespective of the result will have an adverse effect on things such as insurance.

The CPHVA welcomes the development of one-stop sexual health clinics and the planned primary care youth services. However there is a need to address access issues, particularly for the young that these pilot projects may not achieve. The nature of secure units or young offenders institutions are that young people may be there from one day to eighteen months and on the day the service is provided may not be in the unit but for instance attending court.

There is also the issue of rural areas and therefore the need to take services to young people, particularly in schools.

In Herefordshire a school nurse has established a full primary care service adjacent to a secondary school. 48% of Herefordshire’s young people live at least three miles from a town centre. The service is provided by the school nurse and local GP’s who can prescribe and treat any pupil. Pupils from the school self refer with the school bus service giving them equal access. In the first year 20% of the school population have attended.

n Southampton an initiative set up the TPU has been the introduction of a sexual health bus, the 739 bus (739 on a mobile phone corresponds to the letters sex). The initiative has only been set up this month and plans to travel to areas either lacking in services or where there is a high incidence of teenage pregnancy.

The CPHVA fully supports the proposals for the introduction of chlamydia screening. We would like to see this introduced as soon as possible and opened up to a wider group of women. M.Larkin (1998) recommends twice yearly chlamydia screening for adolescent girls. The Lancet 352 (9127):55. The CPHVA would welcome the move nationally to bring together GUM clinics and family planning clinics as complete sexual health services. We feel the separation of these two services has only contributed to access difficulties and compounded the stigma of GUM clinics. Such continued services have contributed in reducing STI’s in other countries and there have been successful pilots in the UK (Bloxhams et al 1999 ‘Combining GUM and contraception services for young people: profile of an innovative clinic’ in British Journal of Family Planning 25 (3): 18-21. There is also evidence to suggest that young people believe that any method of contraception also protects them from STI’s.

The CPHVA welcomes the proposals for training standards and audit. We do feel however that stronger partnerships between health and education need to be fostered. Sex education that is relationship based should be compulsory. Sexual health advice should be accessible including access to emergency contraception, or all young people. School nurses could be ideally placed to provide these services.

Chaper 5 – Better Commissioning

The CPHVA fully supports the need for partnership working to ensure effective delivery of services. However as with the recruitment and retention of nurses there is also a problem with the recruitment and retention of staff in social services. This is then likely to jeopardise the priority that should be placed on the role as outlined in 5.16 and 5.17.

The CPHVA would like to highlight an issue relating to how funding is released for short term projects which is further compounded when trying to implement initiatives in partnership with schools. Financial years and educational years do not co-incide. Managers have informed us that bids for TPU monies are not generally known until the summer. With project money then needing to be spent by 31 March leaving two education terms for initiatives to be implemented. We would urge that money be ring fenced with an end to short term projects.

Chapter 6 – Supporting Changes

The CPHVA welcomes the Government’s proposals for supporting change.

We also heartily endorse the potential research proposal for links between drugs, sex and alcohol and the identification of effective interventions. School nurses in particular are aware that both the effects of alcohol as well as socio economic factors play an important role in teenage pregnancy and sexual health generally. The Government is tackling inequalities through initiatives such as Sure Start and SRB. Alcohol consumption and young people is becoming frighteningly high as has been highlighted in a number of recent media reports and there is an urgent need for this to be addressed.

Professional Officer for
School Health and Public Health

December 2001