Levels of sexually transmitted infections in the UK have soared. Lisa Power looks at some of the organisational reasons why and invites entries to Terrence Higgins Trust's Sex Factor best practice competition

Levels of sexually transmitted infections in the UK have soared. Lisa Power looks at some of the organisational reasons why and invites entries to Terrence Higgins Trust's Sex Factor best practice competition

This year marks the 25th anniversary of the first diagnosis of HIV in the UK. The year 2007 also sees the roll-out of the national chlamydia screening programme across England, with primary care trusts embarking on the final leg of efforts to achieve 48-hour genito-urinary medicine access by 2008.

NHS staff and the voluntary sector have fought long and hard to push sexual health up the political agenda and retain it among the national priorities, and one glance at the figures tells you why. In 2005 there were almost 800,000 acute STIs diagnosed in GUM clinics across the UK.

Diagnoses of syphilis had risen by a staggering 1,954 per cent since 1995, new chlamydia cases had gone up 207 per cent and the workload for GUM clinics increased by 268 per cent.

The number of people accessing NHS HIV care has trebled in the past 10 years and, although we are slowly making improvements, Britain's teenage pregnancy rates are still the highest in western Europe..

Where progress is being made on sexual health, it can tend to be patchy and very dependent on local circumstances. A Terrence Higgins Trust survey of English and Welsh GUM clinics taken from October 2006 to February 2007 showed that whether or not you get seen at a GUM clinic within 48 hours not only varies by where you live but also from month to month. Some clinics were able to offer appointments within 48 hours 75 per cent of the time in December, but by February could only do so 43 per cent of the time.

So how do we get it right? Just like the welter of manuals that tell us how to make our sex lives better, even though the human race has been making ends meet for many thousands of years, there is no shortage of good advice for NHS trusts and health boards about how to improve sexual health services. In both cases, the problem lies in putting the advice into practice.

The latest piece of excellent advice on how to manage sexual health comes in the form of the Standards for HIV Clinical Care report from the British HIV Association, the Royal College of Physicians, the British Association for Sexual Health and HIV and the British Infection Society. They contain clear recommendations on who should provide HIV care and how services could be organised at local level to better match the needs of patients.

These standards sit alongside a wide range of other useful UK and national guidance, such as the Department of Health's sexual health and HIV commissioning toolkit, the chief medical officer's circular Improving the Prevention and Treatment of STIs Including HIV, the Terrence Higgins Trust's Blueprint For The Future an FPA (formerly Family Planning Association) handbook of sexual health in primary care. Overarching them are English, Scottish and Welsh sexual health strategies.

Sadly, good advice in national guidance often founders on the rock of local finances and when the first priority of the chief executive has to be the balancing of books, areas of long-term need like sexual health are often those that suffer..

In Disturbing Symptoms, an annual survey of English PCTs and sexual health clinicians, it was found that in 2006, almost two-thirds of PCTs had diverted all or part of their Choosing Health funding elsewhere. It also showed that increasingly, responsibility for sexual health planning was being shifted to non-specialist staff with a lower profile in the PCT and a greater range of other competing responsibilities. Yet, against this difficult and challenging backdrop, it also found many examples of good practice.

Something we do not do enough of in sexual health is celebrate and share our successes. Dig a little deeper and it soon becomes clear that despite the overwhelming problems, some sexual health services are making headway. Disturbing Symptoms showed that, where funding got through and where innovative thinking took place, modernisation was making a positive impact on both services and staff morale.

Lisa Power is head of policy at the Terrence Higgins Trust.


Rising stars: make your entry in THT's Sex Factor competition

Do you know a rising star in sexual health improvement? It is something that HSJ and the Terrence Higgins Trust are keen to explore - with your help.

Has your health board discovered new ways to promote self-management of HIV as a long-term condition? Does your PCT embody best practice through its integrated care network for sexual health? Has your trust successfully integrated STI and contraception services without any nervous breakdowns from consultants? Are you innovating in the educational system to set up healthy patterns for life?

If so, tell us. We want to hear about the local or national sexual health initiative that you are particularly proud of working on, from HIV through STIs to contraception and abortion. All you have to do is visit hsj.co.uk and explain briefly why your service or strategy has star quality that deserves highlighting to politicians and planners. The best will be celebrated at a reception and presented on THT's stand at the NHS Confederation conference in June.

We want to look at good news in performance against targets - maybe the 48-hour access to GUM services.

Entries should reach us by 24 May. Click here for more information.


Innovation at work

The integration of HIV health and social care services at King's College Hospital foundation trust in London so that doctors and nurses are freed up to concentrate on treatment and clinical care despite operating in an area of high social need and deprivation.

The FPA's community project Jiwsi, funded by six local health boards in North Wales, delivers a six- to 12-week SRE programme to vulnerable young people aged 11-25 who find it difficult to access sex and relationship education programme through mainstream settings. It also provides training for professionals and ongoing professional development and support through a practitioners exchange.

Leeds PCT's provision of a sexual health testing and contraception clinic through THT's community-based city centre offices, targeted specifically at students and young people, aims to reduce pressure on oversubscribed GUM services in Leeds.

Healthy Respect, a programme of partnership working to promote positive sexual health and sexual relationships for young people, is a demonstration project funded by the Scottish Executive in Lothian.

A GP in Oxfordshire is providing a Saturday morning sexual health clinic in the community, targeted at gay men but open to anyone without a GP or reluctant to approach their own GP about sexual health matters.

The Sandyford Initiative in Glasgow, funded by NHS Glasgow and the city council and providing everything from contraceptive services and abortion referrals to menopause support and a helpline for male survivors of childhood sexual abuse.

A partnership between Chelsea and Westminster Hospital foundation trust and community services in west London provides community-based testing services aimed at people reluctant to use traditional GUM services.