Transcript NHS London Sexual Health

London Sexual Health Forum
Improving outcomes
Jeremy Burden
Deputy Director of
Performance
NHS London
Improving the sexual health of
Londoners
• Part of NHS London’s Prevention Strategy
• Key element of Health Care for London and Next
Stage Review
• One of the five priority areas
• Key focus is HIV infection, STI, Chlamydia screening
and teenage conceptions
GUM Attendance
• In Q2 2009/10 there were 47,298 attendances to
GUM Clinics across London.
• Over the last few years the number of attendances
has remained approximately stable with some
seasonal variation.
Total GUM Attendances
60000
50000
40000
30000
20000
total attendances
10000
Sep-09
Jul-09
May-09
Mar-09
Jan-09
Nov-08
Sep-08
Jul-08
May-08
Mar-08
Jan-08
Nov-07
Sep-07
Jul-07
May-07
Mar-07
Jan-07
Nov-06
Sep-06
Jul-06
0
GUM First attendances
• The vast majority of GUM patients in London are
offered their first appointment with 48 hours of
request.
• This has been the case with 99.9% of patients since
Percentage offered a First appointment within 48 hours
January 2009.
100%
90%
80%
70%
60%
50%
40%
Sep-09
Jul-09
May-09
Mar-09
Jan-09
Nov-08
Sep-08
Jul-08
May-08
Mar-08
Jan-08
Nov-07
Sep-07
Jul-07
May-07
Mar-07
Jan-07
Nov-06
Sep-06
Jul-06
30%
HIV rates
HIV prevalence of previously undiagnosed
HIV infection among attendees of sentinel
GUM clinics across the UK, 2007.
Diagnosed HIV infected young adults
(16-24) by SHA 1999 - 2008
Country and SHA of residence
England East Midlands
East of England
London
North East
North West
South Central
South East Coast
South West
West Midlands
Yorkshire and The Humber
2
England Total
Wales
Northern Ireland
Scotland
British Isles other3
No fixed abode 4
Not reported
Abroad
Total
Year of survey
2003
2004
1999
2000
2001
2002
2005
2006
2007
2008
24
28
339
8
68
28
26
31
39
32
25
32
343
14
72
35
44
35
46
24
44
62
471
14
77
51
45
33
50
31
65
81
586
25
121
86
67
38
73
53
76
104
636
41
158
107
77
52
107
77
87
111
708
42
174
97
99
65
149
81
117
133
761
57
203
108
109
87
179
105
112
142
832
54
231
119
122
111
167
120
104
146
890
52
242
128
128
103
144
99
92
134
972
44
253
127
128
106
147
132
641
722
878
1,198
1,437
1,613
1,860
2,010
2,039
2,135
15
0
37
17
1
37
22
0
45
21
4
53
31
5
66
33
14
90
37
18
101
53
18
104
60
17
112
51
24
89
0
0
0
0
0
0
0
0
1
0
-
-
-
-
-
-
-
1
0
0
21
1
25
1
39
1
40
0
29
0
36
2
31
2
27
1
13
1
34
1
715
803
985
1,316
1,568
1,788
2,049
2,214
2,243
2,334
STI Rates 2003 - 2007
Gonorrhoea Rates by Age Group
Rate per 1000 population
(age ranges shown as indicative proportions)
140
120
100
45+
35-44
80
25-34
60
20-24
16-19
40
<16
20
0
2003
2004
2005
2006
2007
Syphilis Rates by Age Group
Rate per 1000 population
(age ranges shown as indicative proportions)
14
12
10
45+
35-44
8
25-34
20-24
6
16-19
4
<16
2
0
2003
2004
2005
2006
2007
Chlamydia Screening Coverage
• Chlamydia screening levels in aggregate across London
in 2008/09 were good (18.1%). This was above the
national average of 15.9%
• A number of PCTs failed to screen sufficient numbers of
people.
PCTs Screening Less than 10% of Population
PCTs screening between 10 and 15% of Population
Westminster (6.7%)
Brent (10.3%)
Ealing (10.7%)
Enfield (11.4%)
Hammersmith and Fulham (11.0%)
Harrow (10.3%)
Hillingdon (11.2%)
Hounslow (14.5%)
Kensington and Chelsea (11.9%)
Sutton and Merton (13.1%)
Positive Chlamydia Screening Tests
• In the last year, the percentage of positive tests has reduced.
This was below the 7.3% national average for 2008/09.
• Q1 2009/10 has seen an increase in cases.
Percentage of Postive Chlamydia Tests in London by Quarter
9%
8%
7%
6%
5%
4%
3%
2%
1%
0%
2008-09 Q1
2008-09 Q2
2008-09 Q3
2008-09 Q4
2009-10 Q1
Teenage Conception rate
•
The Conception rate per
1000 population rate
shows a great deal of
variation between PCTs.
•
Significant time lag with
this data (currently 20042006 and 2007 data),
more up to date
information is expected in
December.
England
London SHA
Barking & Dagenham
Barnet
Bexley Care Trust
Brent Teaching
Bromley
Camden
City & Hackney Teaching
Croydon
Ealing
Enfield
Greenwich Teaching
Hammersmith & Fulham
Haringey Teaching
Harrow
Havering
Hillingdon
Hounslow
Islington
Kensington & Chelsea
Kingston
Lambeth
Lewisham
Newham
Redbridge
Richmond & Twickenham
Southwark
Sutton & Merton
Tower Hamlets
Waltham Forest
Wandsworth
Westminster
NCHOD 2004-06 NCHOD 2004-06
Under 16
Under 18
Conception Rate Conception Rate
(13-15)
(15-17)
7.7
41.2
8.8
47
8.4
65.4
5.9
31.5
9.3
36.9
7
47
3.5
32.7
25.4
41.9
14.5
61.7
4.5
56.3
9.5
36.4
8.7
51.1
12
62.9
23.5
44
5.8
65.8
7.5
29.9
9.5
35.9
6.3
45
8.9
47.1
2.9
56.2
6.5
31.3
23.5
25
17.2
83.2
5.2
70
5.2
48.3
2.3
32.4
21.9
23.6
6.1
77.8
11.2
34.7
9.7
44.3
6.9
48.6
4
56.9
25.3
31
ONS 2007
Under 18
Conception
Rate
41.7
45.7
60.0
29.8
37.6
43.1
34.0
38.3
57.1
54.6
31.8
48.1
65.2
50.7
70.0
25.7
34.6
45.7
46.9
50.5
29.5
23.2
74.4
70.6
45.0
31.0
15.7
76.2
37.9
45.8
53.0
61.3
31.6
Vital Signs 2009/10
Planned under 18
Conception Rate
46.58
22.16
24.51
28.3
20
37.03
36.1
41.35
29.22
40.31
32.3
35.84
58.77
18.99
24.93
32.93
38.57
33.42
23.17
21.11
59.78
41.86
34.27
24.92
15.16
49.08
25.09
29.7
40.01
40.7
21.25
Termination Rates
• The Termination
Rates across London
are significantly
higher than the
national average.
• This is reflected
across each of the
age ranges including
under 16s.
England
London SHA
Barking & Dagenham
Barnet
Bexley Care Trust
Brent Teaching
Bromley
Camden
City & Hackney Teaching
Croydon
Ealing
Enfield
Greenwich Teaching
Hammersmith & Fulham
Haringey Teaching
Harrow
Havering
Hillingdon
Hounslow
Islington
Kensington & Chelsea
Kingston
Lambeth
Lewisham
Newham
Redbridge
Richmond & Twickenham
Southwark
Sutton & Merton
Tower Hamlets
Waltham Forest
Wandsworth
Westminster
Number of
Abortions
186,218
48,679
1,507
1,697
1,054
2,129
1,256
1,235
1,943
2,236
1,868
1,788
1,826
1,158
1,676
1,162
1,058
1,403
1,437
1,293
830
681
2,574
2,321
1,958
1,492
599
2,632
1,735
1,596
1,779
1,490
1,266
Rate per 1000 women
reident ages 15-44 (ASR)
18.3
27
40
25
25
33
23
18
34
32
26
30
35
25
31
27
25
25
28
24
19
18
37
37
30
27
17
37
22
24
36
20
19
NHS London approach -metrics
View metrics as enablers
Generate understanding and responsibility
Help generate confidence and provide assurance
Improve decision making
Uncover unpredictability and variance
Help us work with rigour with what is
Generate conversations about performance
improvement
..but we
need to continue to improve our
commissioning of sexual health services
• 4 elements built around users
–
–
–
–
Strategic commissioning
Care pathway development
Market management
Performance management
London Sexual Health
Services Framework
• Promotion of good sexual health
• Improving access
• Improving people’s experience of services through