Notes from meeting with Anna Soubry

As you will know from previous posts, we met with Anna Soubry in January. Here are the notes of the meeting.

Notes from meeting with Anna Soubry and Judith Hind (Contraception Manager, Sexual Health Team, Department of Health)
30thJanuary 2013

Anna began her meeting by telling us that she was aware of our issues but it was clear as we presented the extent of problems within Walthamstow that she had not understood the seriousness, particularly in relation to the blanket approach at Addison Road Medical Practice. Although she had heard anecdotes about single practice doctors denying sexual health provision based on religious or ethical grounds, she had never heard of an entire practice doing so. She said this was appalling and could not believe that this situation could have remained unaddressed for so long.

Judith Hind concurred that in four years on the Sexual Health Team she never came across such a case. Although contraception is an additional service, those refusing to provide it on moral or religious grounds are obliged to refer patients to another practitioner within the area. When asked whether there should be a legal requirement for every practice to have at least one doctor able and willing to provide such services Anna replied that this would not be possible as GP practices are private organisations and their autonomy is a “freedom they enjoy”.

Stella informed her that since the closure in 2006 of a specialist clinic on Hurst Road there has been a massive gap in sexual health and contraceptive provision in this area of Walthamstow. The service to which patients were referred to (Oliver Road Clinic) was not a practical option for many being a drop-in service and in a location difficult to get to from Walthamstow. This was emphasised by Jenny, whose own experience of trying to access contraception from both Addison Road and Oliver Road led her to challenge levels of provision through the creation of WoWstow.

Anna wanted to understand why the problem hadn’t been tackled seriously until now –was it the fault of the PCT and why didn’t Stella’s predecessor address it? Why had the NELFT not stepped in and commissioned an appropriate service to fill the gap? Stella replied that it has been difficult for her and members of the public to get a full understanding of who is responsible and ultimately accountable for the provision and performance of sexual health and contraceptive services.

The provision of a drop-in clinic at Comely Bank was entirely the result of pressure from the WoWstow campaign but it was noted that the local councillors, especially Councillor Khan (remit for Public Health), understood the concerns and were keen to help address them. The problem for them was funding, which had become obvious at a meeting some members of WoWstow had had with Councillor Khan the previous day.

Jenny made clear Councillor Khan’s concerns about the budget allocation. He had indicated that the extra 10% from central government for public health would be swallowed up by an inherited deficit for genitourinary medicine services and other aspects of public health, which had not been accounted for in the government’s allocation.

Anna responded that the money for public health is ring fenced and there is a statutory duty for sexual health services to be provided. With the 10% uplift awarded to Waltham Forest there should be no excuses for not providing proper public health services. She was very proud of the 10% the government had been able to give but acknowledged that it “can’t change the budget” and it “can’t change the law”(over the collective opt out of GPs who don’t want to provide contraceptive services on religious or moral grounds). Adequate sexual health provision needs to come from the public health budget. She advised that we have two powerful tools for ensuring this happens: the Local Authority and the Director of Public Health.

Caroline pointed out that while the 10% increase in funding was welcome, it still fell short of what the government itself said should be spent per head on public health in the borough. The outgoing primary care trust had not prioritised public health, as a result of which the local authority was starting off from a low baseline figure and would have a lot of catching up to do.

Anna argued that the upcoming shift in responsibility to local authorities should be a positive step for this campaign. However, Anna recognised the seriousness of the situation in Walthamstow and said she would write both to the local authority and to Duncan Selbie, Public Health England. PHE can intervene if a local authority is not meeting its statutory duties.

Lynn raised our concerns about the continued existence of the Comely Bank clinic, which WoWstow had successfully fought for.  Councillor Khan had told WoWstow that the government had advised local authorities to stick with their current contracts for the next year, irrespective of how good they thought these were.

Anna responded that the PCT award 12 month contracts and that the local authority can change these if they are not meeting their objectives.  Stella suggested that the clinic at Comely Bank was most likely an outpost of the Oliver Road service and probably would not have its own separate contract.  WoWstow would need to ask Councillor Khan and the PCT to confirm this.

Anna and Judith acknowledged that contraception has traditionally been seen as a poor relation to other sexual health areas e.g. STIs. This would be addressed in the new Sexual Health strategy document to be published in the next few weeks. Since her appointment last September, she said she had rewritten large parts of the report e.g. abortion, child protection, age of consent. Contraception is to the fore – a whole section is devoted to it. Fewer unwanted pregnancies is a particular target. This document will provide guidance to CCGs across England and will be going out to all local authorities in the next few weeks. There will be outcome indicators for sexual health.

Public Health England is committed to making the transfer of public health to local authorities work and wants to make more CCG level information available to the public online, Anna said.

Lynn also asked about safeguarding provision for patients in London seeking advice on sexual health/contraception outside their own borough. For example, a number of WoWstow campaigners have used the Margaret Pyke Centre in Camden as it’s easier to get services there than in Walthamstow. Anna assured us that the secondary legislation would protect such services and open access would remain across London. There is an issue with funding with the outer boroughs and that would need to be sorted out between them.

WoWstow also drew attention to the wider issues of sexual health beyond contraception, including the prevalence of unplanned teenage pregnancies, repeat abortions and STIs – see briefing for statistics.

Conclusion and next steps

In order to protect what we have already achieved and to further our campaign Anna’s advice was that we “need to hit councillors hard’ and “demand full disclosure”. If necessary we should go to straight to the Chief Executive of the council as this is such a serious issue. Anna wants to make sure local authorities have “nowhere to hide” and provide the services the public needs. She is keen to support us and said she would write to both Councillor Khan and Duncan Selbie in the next few days. Stella will be copied in on this letter.

Wowstow Concern over new Council Responsibilities

Walthamstow Guardian published an article this week highlighting concern over the council to deal with its new public health remit. This focuses on the areas of concern which Wowstow has been stressing and stating again that the formula used by the government is fundamentally unfair. Here’s the link:

http://www.guardian-series.co.uk/news/wfnews/10239464.Concern_over_council_s_new_public_health_responsibilities/?ref=rss&utm_source=twitterfeed&utm_medium=twitter

Guest post: Changes to Sexual Health Services

Changes to Sexual Health Services from April 2013

Guest post:
Dr Gabby Ivbijaro MBE, Chair, Waltham Forest Clinical Commissioning Group

To introduce myself, I’m a GP in Walthamstow practicing at Wood Street Medical Centre and I’m also the chair of the Waltham Forest Clinical Commissioning Group, (CCG) a group of local GPs that, from April 2013, will be responsible for planning and designing local health services.

I asked if I could guest blog to explain how the changes to the NHS will impact on sexual health services.

As part of the NHS reforms, changes are happening to the way primary health care is managed and who is responsible for what.  Information about this is available from the Department of Health website, but to quickly summarise how the responsibility for sexual health services in Waltham Forest will be divided:

Organisation Responsibility for commissioning:
Waltham Forest Clinical Commissioning Group GPs can provide sexual health services through their GP contract.  This will be monitored by the NHS Commissioning Board.

  • Vasectomies
  • Sterilisation
  • Abortion services (TBC)
London Borough of Waltham Forest Contraception (outside of the GP contract), i.e. at clinics such as Comely Bank Clinic in Walthamstow and Oliver Road in Leyton.

  • Sexually Transmitted Infection testing and treatment
  • Sexual health promotion
  • HIV prevention

Local authorities are mandated to provide appropriate access to sexual health services – this means confidential, open access STI testing and treatment services and contraception services, including free supply of any STI treatment and reasonable access to all methods of contraception.

NHS Commissioning Board
  • HIV treatment services

Waltham Forest CCG wants to improve the health of local people, deliver high quality health care services, ensure value for money and tackle health inequalities – so we have much work ahead of us.

To make sure we meet the sexual health needs of local people and improve health outcomes we need to make sure we provide good quality services in the right place, at the right time.  We will work closely with the council and with service providers to achieve this.

We have already begun to achieve good results for local people, with a weekly walk-in family planning and sexual health screening service offered every Thursday from 2pm-7pm at Comely Bank Clinic in Walthamstow. More information about local sexual health services is available on our website.

As a local GP leader, I want all our GPs to provide a good service, and that includes sexual health.  If you don’t feel this is the case, please tell someone – comments should first be raised with the practice manager of the GP practice concerned but you can also contact our Patient Advice and Liaison Service (PALS) by telephone – 0800 0926 995 – or by email to r-pct.palscomplaints@nhs.net.

Gabby
Dr Gabby Ivbijaro MBE,
Chair, Waltham Forest Clinical Commissioning Group

Local sexual health campaigners meet with public health minister

Here is our press release following our meeting with Anna Soubry.

We thought it a very productive meeting. Lets see what comes out of it.

WoWstowPR3

 

 

Today we have a meeting with Anna Soubry

Later today some members of the campaign will be meeting with Anna Soubry, the minister whose brief includes public health, and therefore sexual health services.

Wanting to make the most of our time we prepared a briefing paper so we would have everything to hand, and so we could – and have – send it to her office, so allowing her to prepare and also making sure that what we wanted to say was already in writing. Who says we’re cynical.

This is a really fabulous document which summarises the situation in the borough and the achievements of WowStow to date. It also outlines our concerns and the questions we will put to her this afternoon. I’d like to say thank you to the members of the team who compiled it and I’m sure this will be a useful and powerful resource for others too. Also a big thank you to the other organisations who have helped with contacts and figures. Here’s the link: WOW briefing for Anna Soubry 30.1.13

Claire

Public health settlement – why we’re worried

We’ve yet to hear the final settlement but it’s been suggested Walthamstow will get just £36 per person per year to address public health issues – and that includes sexual health. Sexual health clinics transfer from NHS to local authority control in April (but not GP family planning provision.) We’ve written to public health minister Anna Soubry about our concerns. We hope to raise them at a meeting set up with her on 30 January.

Here is the letter we sent earlier this week:

Dear Anna,

 Prior to our meeting with you on 30 January, we are writing to draw your attention to the impact of the low level of public health settlement in Waltham Forest, and its potential negative impact on sexual health provision in this area.

As you may know, women in Walthamstow (known as Wowstow, or Women of Walthamstow) have been so concerned at the poor provision of both contraceptive and wider sexual health services in the central area of the borough that we have raised the issue with our MP, addressed the All Party Parliamentary Group on Sexual Health and successfully persuaded local health officials to address our concerns. The group has also been recognised by the Family Planning Association for its work.

But we are very concerned about the shortfall in the public health budget for Waltham Forest.

We are aware that Cllr Ahsan Khan, Health and Wellbeing Portfolio Holder with Waltham Forest Council, has been in touch with you about how the council istrying to work closely with local people like us to ensure the councils is able to deliver public health services that reflect residents’ needs.

Women of Walthamstow have successfully fought for additional contraception/sexual health provision in the central E17 area – leading to a new clinic being set up at Comely Bank Clinic in the village every Thursday afternoon. This responsibility, we understand, will transfer to the local authority from April.

We have also worked with local health officials to ensure that medical and nursing staff at a local GP practice who wished to do so should be enabled to provide family planning services for the local population (a provision that will remain an NHS responsibility under the CCGs).

But we understand that the proposed settlement for the borough is substantially lower than the amount required to meet necessary public health provision, including sexual health services. Knowing the pressure that is on that budget, we do not want to see the services we have fought so hard to secure – and which are still below what we feel is acceptable – to be eroded. We would appeal to you to ensure this does not happen.

We also understand that, due an accounting error, the council’s final allocation could be a least £2 million lower than the amount the NHS received for public health in this area for 2010/11. The council has already indicated that such under-funding risks the success of it being able to ‘fully embrace the opportunity of taking on responsibility for public health’.

We live in a borough where rates of teenage pregnancy and incidents of acute sexually transmitted infections are above the national average. Cutting the already limited sexual health provision in the borough will only worsen these serious problems.

Members of the Women of Walthamstow have fought hard not only to increase access to contraceptive services in the borough but to ensure there is adequate provision of wider sexual health services including HIV/Aids.

We would urge you to take account of our concerns in the months ahead as the impact of a considerably reduced funding allowance begins to bite. We would want to ensure that, as part of the mandate for sexual health provision, it should be made clear that there should be no reduction in the level of provision we have fought so hard for. 

We look forward to the opportunity to discuss this with you further on 30 January.

Yours sincerely,

Jenny Lennox, Chair,

Wowstow, on behalf of the Women of Walthamstow campaign

 

 

Meeting with health officials, 7 Dec

Here’s a summary of what happened at our recent meeting, attended by Stella Creasy MP and Diane Abbott, Shadow Health Secretary.

———————————————————————————————————————

Notes of 2nd meeting between Women of Walthamstow and officials from North East London Health Trust,  Friday 7 December 2012

Meeting held E17 from 6.30 – 8.30

Approximately 50 people came to our meeting on 7 December, at the Salvation Army Hall, Forest Road.

Among them was Stella Creasy MP and guest speaker Hackney MP Diane Abbott, who is shadow minister for public health. Health officials, including the lead GP for the clinical commissioning group which takes over responsibility for commissioning health care services and the director of public health were also there.

Dr Gabby Ibvijaro said the new Clinical Commissioning Group, which will buy in health care from April, was keen to get started. However there was a £16m shortfall in funding and he said they have been trying to contest the population figures for the borough which they believe to be inaccurate.

Dr Kay Eilbert, the director of public health, explained that from April her department, which will run from Waltham Forest Council, will take over most of the sexual health provision as local government around the country is due to take over all public health provision. She said there has been debate about the level of settlement for Walthamstow – just £36 per head, which is the same as the far less deprived Richmond. Although they hoped the figure would improve they could only wait to see what the budget for public health overall would be. This is due to be announced before Christmas.

Diane Abbott warned the Women of Walthamstow to pay close attention to this as the settlement was announced. She said the lack of detail was a problem. The new health and wellbeing boards (set up to give patients and local councillors a say in commissioning for their area) had no powers. Instead the real power would lay with GPs who would be the main people sitting on the Clinical Commissioning Groups – these will decide the health care needs for their area. People won’t know whether they need to go to the CCG or the local authority if a service is not being properly provided, she predicted.

Diane praised the work of Wowstow and said it was good to see so many active local women at the meeting, but we should not forget those women who would not be able to get involved.

Health officials tried to allay fears that women seeking help for sexual health services outside their borough might encounter difficulties. A complex cross-borough funding arrangement was being discussed.

Attendance at the new Thursday afternoon clinic at Comely Bank health centre has been good with 174 attendances since it started in the summer, of which 124 were from the E17 area. The health officials are considering having a second clinic at St James street, possibly on a Wednesday and/or Friday, while retaining the Thursday at Comely Bank.

There was concern about the local authority settlement, due to be announced on 19 December, and Wowstow later decided to write to Health Minister Anna Soubry to push the case for adequate public health and sexual health provision.

Stella Creasy reported that Wowstow has a meeting with the Health Minister Anna Soubry on 30 January at the Department of Health. Local women were invited to join the group attending the meeting.

You can see a photo of those at the meeting in Stella’s twitter feed if you follow this link

http://twitter.com/stellacreasy/status/277150624364249088/photo/1.

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