Comprehensive Impact Assessment Template Assessment being undertaken Directorate: Service: Name of Officer/s completing assessment: The commissioning of Integrated Comprehensive Sexual Health Services in Cornwall. Education, Health and Social Care Public Health Lynne Davey, Commissioning Manager, Louise Sweeney, Public Health Practitioner and Lex Gainsbury, Advanced Health Practitioner. Date of Assessment: 12 May 2016 1. Why are you doing this CIA? A brief explanation of Cornwall Council has an obligation to adhere to the Public the reason. Is it for: new/change in policy, procedures, Contract Regulations 2015 to ensure that services strategy, function, service. (Please refer to the provided to residents are appropriate for the needs of guidance for the definitions) Cornwall s population and represent best value. For this reason Cornwall Council will be exploring a range of options with regard to the delivery of an Integrated Comprehensive Sexual Health Service for Cornwall from 1 April 2017. 2. What are the aims, objectives, outcomes, purpose of the policy, service change, function that you are assessing? Cornwall Council is exploring options with regards to the future delivery of Integrated Sexual Health Services, will result in a full commissioning process. The Council is engaging with existing and potential providers through a Market Engagement event held on 20 May 2017 and stakeholders and service users via an on-line questionnaire which commenced on 23 May 2016 to 16 1
July 2016. The commissioning process will enable the Council to reassess how sexual health services are delivered in Cornwall ensuring that that it meets the current need of service users/patients. Services in scope include:- Sexually Transmitted Infection (STI) testing, treatment and management across a range of platforms (including requisite laboratory services) Local delivery of the National Chlamydia Screening Programme Full range of contraception including emergency contraception Pregnancy choices and testing services HIV prevention services General sexual health advice, information and promotion Sexual health clinical leadership and oversight of pathways across primary, tertiary and acute care settings Delivery of relationship and sex education Workforce training and education Young people sexual health and contraception services. Cornwall Council will be reviewing and assessing need across Cornwall to ensure priorities outlined in the Sexual Health Strategy meet the need of Cornwall s population 2
and will ensure appropriate provision of sexual health services across the County. Although the Council is likely to undertake a formal commissioning/procurement process, sexual health services will continue but may be delivered in a slightly different way to those at present to ensure they are accessible, equitable and provide choice. The new delivery model is will include a consultant led comprehensive sexual health service that provides full diagnosis and management of sexually transmitted infections including HIV and a full contraception service. Such service will be provided across a number of clinics in Cornwall. In addition, there will be a specialist sexual health service for young people across a number of clinics in Cornwall. To complement and support the above provision an on-line service will be commissioned to provide on-line information, advice and guidance, triaging of patients to face to face services and on-line STI screening by way of free testing kits to test for chlamydia, gonorrhoea, syphilis and HIV. 3. Who implements or delivers the above? State if this is undertaken by more than one team, service, and department including any external partners. 4. Equality and Diversity - Who will be affected by this proposal? Is the proposal likely to result in positive or negative impacts/risks? If so what are they? What Services identified in scope are currently delivered by a range of providers, including RCHT, Brook Cornwall, Kernow Positive Support and The Eddystone Trust. The Council s vision and principles for sexual health services are guided by a set of core values which are 3
plans do you have in place, or are developing, that will mitigate the likely identified negative impacts/risks? integral to the Sexual Health Strategy, these are: Services should be accessible to all and we should do all we can to ensure equitable access. Individuals have a right to choice. People have a right to access services that are respectful, non-judgemental, confidential and person centred. Diversity should be celebrated and individuals have the right to live free of stigma and discrimination. Individuals have a right to live free from coercion. Sexual health and sexual development should be considered as part of an individual s wider health and wellbeing. All residents and visitors to Cornwall will benefit from an Integrated Sexual Health Service and specific consideration has been given to the following protected characteristics:- Age: Young people under 25 carry the burden of sexually transmitted infection (STIs). Two thirds of chlamydia diagnoses, the most prevalent STI in the UK, are amongst 15-24 year olds. 4
Positive impact: An integrated sexual health service will provide sexually transmitted infection testing, treatment and contraception services by providing a range of services to meet the needs of the population. Such services will include the management of more complex treatment needs, on-line testing and free condom service via the condom card (c-card) scheme to young people aged 13-25. In accordance with the Sexual Health Strategy 2016-20 (draft) services are likely to include a dedicated service for young people that provides an open access STI testing and treatment service that is integrated with contraceptive services in locations that are accessible to young people. Young people would still be able to access all age clinics and their own GP if preferred. Comprehensive relationships and sex education in schools and colleges is also likely to be provided in order to improve knowledge, attitudes, awareness and selfefficacy of young people in order to prevent sexually transmitted infections. In addition, it is intended that sexual health services are provided via a range of platforms in order to remove barriers and ensure as easy access to provision as possible. These include better innovation (on-line services) and collaboration with other services. Negative impact: Access is a major issue for young 5
people and therefore having an integrated service offering testing and treatment of STIs together with a comprehensive contraception service will better support young people as it will enable them to routinely access sexual health and contraception in one location/visit. Services will need to be placed in locations that best meet the needs of young people and be open at times that best meet the needs of the population. The use of innovation, such as on-line provision and collaboration with other organisations will increase accessibility of services and is response to changing patterns of internet use and access. Disability: Positive impact: An integrated sexual health service would be accessible to all, regardless of disability and would provide sexually transmitted infection testing, treatment and contraception services by providing a range of services to meet the needs of the population. Such services will include the management of more complex treatment needs, on-line testing and free condom service via the condom card (c-card) scheme. In addition, it is intended that sexual health services are provided via a range of platforms in order to remove as many barriers to access as possible. This is likely to include better innovation such as on-line services and collaboration with other organisations. Any on-line provision will be subject to future Business Impact Assessment and a separate Comprehensive Impact Assessment. Negative impact: The rural nature of Cornwall makes 6
access a particular issue. An integrated service offering both testing, treatment of STIs and contraception services within one appointment is likely to better support patients. Services need to be strategically placed and be available at times that best suit patients across the County. The use of innovation, such as on-line provision and collaboration with other organisations to ensure services are accessible to all will be a key requirement of future provision, in order to support the Sexual Health Strategy 2016-20. Gender reassignment: Transgender young people and people of all ages need equal access to sexual health services. Transgender women are disproportionately affected by STI s such as HIV. Positive impact: An integrated sexual health service will provide sexually transmitted infection testing, treatment and contraception services by providing a range of services to meet the needs of the population. Such services will include the management of more complex treatment needs, on-line testing and free condom service via the condom card (c-card) scheme. On-line testing would include chlamydia and HIV. Patients could still access services from their GP or low level screening and treatment A key requirement of the Sexual Health Strategy 2016-20 is to support the sexual health workforce in promoting good sexual health and access to services and to 7
effectively sign post through continued review and development of the Talk relationship and sexual health workforce training programme. In addition, the strategy outlines the importance of increased awareness and uptake of HIV testing by high risk groups by implementing and monitoring the HIV Testing Strategy and action plan to ensure HIV testing is accessible through both primary care (GPs) and specialist sexual health services including on-line self-sampling. In addition, specialist services are likely to be commissioned to raise awareness across the community to both prevent and protect individuals. A key requirement of the Sexual Health Strategy 2016-20 is for young people to be supported to access services without fear or embarrassment by continuing to provide young people friendly service through SAVVY Cornwall, ensuring services are supported to reach a standard where young people feel reassured about accessing such services. Negative impact: The rural nature of Cornwall makes access a particular issue. An integrated service offering both testing, treatment of STIs and contraception services within one appointment would better support patients. Services need to be strategically placed and be available at times that best suit patients across the County. The use of innovation, such as on-line provision and collaboration with other organisations to ensure services are accessible to all will be a key requirement of future provision. 8
Sexual Orientation: Men who have sex with men (MSM) also carry a significant burden of STIs. Research shows that MSM are significantly more likely to have an STI than their heterosexual counterparts. Furthermore, research has found that the lesbian, gay, bisexual and transgender (LGBT) community are less likely to access routine screens. Stigma and bullying is a huge issue at school with over half of LGBTQ young people experiencing bullying at school. Positive impact: An integrated sexual health service will provide sexually transmitted infection testing, treatment and contraception services by providing a range of services to meet the needs of the population. Such services will include the management of more complex treatment needs, on-line testing and free condom service via the condom card (c-card) scheme. Patients could still access services from their GP or low level screening and treatment Diversity, sexual attitudes and addressing stereotypes is a core element of relationships and sex education. A key requirement of the Sexual Health Strategy 2016-20 is to support the sexual health workforce in promoting good sexual health and access to services and to effectively sign post through continued review and development of the Talk relationship and sexual health workforce training programme. In addition, the strategy outlines the importance of increased awareness and 9
uptake of HIV testing by high risk groups by implementing and monitoring the HIV Testing Strategy and action plan to ensure HIV testing is accessible through both primary care (GPs) and specialist sexual health services including on-line self-sampling. In addition, specialist services will be commissioned to raise awareness across the community to both prevent and protect individuals. A key requirement of the Sexual Health Strategy 2016-20 is for young people to be supported to access services without fear or embarrassment by continuing to provide RSE and young people friendly services through SAVVY Cornwall, ensuring services are supported to reach a standard where young people feel reassured about accessing these services. Negative impact: The rural nature of Cornwall makes access a particular issue. An integrated service offering both testing, treatment of STIs and contraception services within one appointment would better support patients. Services need to be strategically placed and be available at times that best suit patients across the County. The use of innovation, such as on-line provision and collaboration with other organisations to ensure services are accessible to all will be a key requirement of future provision. Pregnancy and Maternity: Chlamydia often has no symptoms and if left untreated can lead to 10
significant health problems for the individual and may have life defining consequences. Untreated Chlamydia can lead to pelvic inflammatory disease, ectopic pregnancy and tubul factor infertility. It can also be passed from mother to child during childbirth. Access to young people friendly contraceptive services has been cited as one of two factors having the biggest impact on teenage pregnancy rates. Young women are more likely to engage with maternity care later than their older peers and statistically face more difficult outcomes including higher infant mortality, lower birth weights and higher rates of post natal depression. At all ages many unplanned pregnancies that continue will become wanted. However, unplanned pregnancy can cause financial, housing and relationship pressures and have impacts on existing children. Positive impact: An integrated sexual health service would allow access to sexually transmitted infection testing, treatment and contraception services and would provide a range of services to meet the needs of patients. This would include the management of more complex treatment needs and on-line testing for both chlamydia and HIV. Patients could still access services from their GP for low level screening and treatment Good access to contraception services is recognised as key in enabling women to have reproductive choice and avoid unwanted pregnancy. 11
A key requirement of the Sexual Health Strategy 2016-20 is to support the sexual health workforce in promoting good sexual health and access to services and to effectively sign post through continued review and development of the Talk relationship and sexual health workforce training programme. Negative impact: The rural nature of Cornwall makes access a particular issue. An integrated service offering both testing, treatment of STIs and contraception services within one appointment would better support patients. Services need to be strategically placed and be available at times that best suit patients across the County. The use of innovation, such as on-line provision and collaboration with other organisations to ensure services are accessible to all will be a key requirement of future provision. The promotion of Long Acting reversible contraception as the most effective form of contraception and clear pathways between emergency contraception and long term contraceptive planning is also key to enabling reproductive choice. Race: Black Caribbean ethnic groups have been shown to have higher rates of STIs and people from different backgrounds, including economic migrants, may have unique needs relating to sexual health such as language difficulties or cultural and religious beliefs that 12
impact on service accessibility. Positive impact: An integrated sexual health service will provide sexually transmitted infection testing, treatment and contraception services by providing a range of services to meet the needs of the population. Such services will include the management of more complex treatment needs, on-line testing and free condom service via the condom card (c-card) scheme. A key requirement of the Sexual Health Strategy 2016-20 is to support the sexual health workforce in promoting good sexual health and access to services and to effectively sign post through continued review and development of the Talk relationship and sexual health workforce training programme. In addition, the strategy outlines the importance of increased awareness and uptake of HIV testing by high risk groups by implementing and monitoring the HIV Testing Strategy and action plan to ensure HIV testing is accessible through both primary care (GPs) and specialist sexual health services including on-line self-sampling. In addition, specialist services will be commissioned to raise awareness across the community to both prevent and protect individuals. In addition, any service commissioned by the local authority would be required to comply with the Equality Act 2010 and in accordance with the Sexual Health Strategy vision and principles outlined above. 13
Negative impact: The rural nature of Cornwall makes access a particular issue. An integrated service offering both testing, treatment of STIs and contraception services within one appointment would better support patients. Services need to be strategically placed and be available at times that best suit patients across the County. The use of innovation, such as on-line provision and collaboration with other organisations to ensure services are accessible to all will be a key requirement of future provision. Religion and belief: Positive impact: An integrated sexual health service would allow access to sexually transmitted infection testing, treatment and contraception services and would provide a range of services to meet the needs of patients. This would include the management of more complex treatment needs and on-line testing for chlamydia and HIV. Patients could still access services from their GP or low level screening and treatment A key requirement of the Sexual Health Strategy is to support the sexual health workforce in promoting good sexual health, access to services and to effectively sign post through continued review and development of the Talk relationship and sexual health workforce training programme. In addition, the strategy outlines the importance of increased awareness and uptake of HIV testing by high risk groups by implementing and monitoring the HIV Testing Strategy and action plan to 14
ensure HIV testing is accessible through both primary care (GPs) and specialist sexual health services including on-line self-sampling. In addition, specialist services will be commissioned to raise awareness across the community to both prevent and protect individuals. In addition, any service commissioned by the local authority would be required to comply with the Equality Act 2010 and in accordance with the Sexual Health Strategy vision and principles outlined above. Negative impact: The rural nature of Cornwall makes access a particular issue. An integrated service offering both testing, treatment of STIs and contraception services within one appointment would better support patients. Services need to be strategically placed and be available at times that best suit patients across the County. The use of innovation, such as on-line provision and collaboration with other organisations to ensure services are accessible to all will be a key requirement of future provision. Sex: An integrated sexual health service will provide sexually transmitted infection testing, treatment and contraception services by providing a range of services to meet the needs of the population. Such services will include the management of more complex treatment needs, on-line testing and free condom service via the condom card (c-card) scheme. Patients could still access services from their GP or low level screening and 15
treatment A key requirement of the Sexual Health Strategy 2016-20 is to support the sexual health workforce in promoting good sexual health and access to services and to effectively sign post through continued review and development of the Talk relationship and sexual health workforce training programme. In addition, the strategy outlines the importance of increased awareness and uptake of HIV testing by high risk groups by implementing and monitoring the HIV Testing Strategy and action plan to ensure HIV testing is accessible through both primary care (GPs) and specialist sexual health services including on-line self-sampling. In addition, specialist services will be commissioned to raise awareness across the community to both prevent and protect individuals. The Sexual Health Strategy 2016-20 highlights the importance of young people being supported to access services without fear or embarrassment by continuing to provide Relationships and sex education (RSE) and young people friendly services through SAVVY Cornwall, ensuring services are supported to reach a standard where young people feel reassured about accessing such services. Traditionally men access sexual health services less than their female counterparts. By increasing the platforms through which individuals can access STI screening, and through initiatives such as the C-CARD which target 16
young men and aim to provide a gateway to wider sexual health services, we can support a redressed balance. Negative impact: The rural nature of Cornwall makes access a particular issue. An integrated service offering both testing, treatment of STIs and contraception services within one appointment would better support patients. Services need to be strategically placed and be available at times that best suit patients across the County. The use of innovation, such as on-line provision and collaboration with other organisations to ensure services are accessible to all will be a key requirement of future provision. Socio-Economic: An integrated sexual health service will provide sexually transmitted infection testing, treatment and contraception services by providing a range of services to meet the needs of the population. Such services will include the management of more complex treatment needs, on-line testing and free condom service via the condom card (c-card) scheme and enable access to those for whom transport issues can prevent attendance at clinic. A key requirement of the Sexual Health Strategy 2016-2020 is to support the sexual health workforce in promoting good sexual health and access to services and to effectively sign post through continued review and development of the Talk relationship and sexual health workforce training programme. In addition, the strategy 17
outlines the importance of increased awareness and uptake of HIV testing by high risk groups by implementing and monitoring the HIV Testing Strategy and action plan to ensure HIV testing is accessible through both primary care (GPs) and specialist sexual health services including on-line self-sampling. In addition, specialist services will be commissioned to raise awareness across the community to both prevent and protect individuals. In particular, it is recognised that young women from deprived areas have an increased risk of teenage pregnancy and STI rates correlate with indices of multiple deprivation (IMD). Negative impact: The rural nature of Cornwall makes access a particular issue. An integrated service offering both testing, treatment of STIs and contraception services within one appointment would better support patients. Services need to be strategically placed and be available at times that best suit patients across the County. The use of innovation, such as on-line provision and collaboration with other organisations to ensure services are accessible to all will be a key requirement of future provision. However it is important to note that the internet is not accessible to all, and thus will not replace alternative routes to access. Rural Isolation: Cornwall s geography presents a further access challenge, particularly affecting those reliant on public transport 18
(including young people) or with limited budgets. Transport between rural and urban centres is expensive and can lack connectivity. For young people living in very rural areas access can be dependent on clinics being located near schools to utilise existing travel routes. Approximately 60% of Cornwall s population live in areas classified as rural and 54% of young people aged 15-25; approximately 36 000 young people. An integrated sexual health service would allow access to sexually transmitted infection testing, treatment and contraception services and would provide a range of services to meet the needs of patients in one appointment reducing the need to travel. Access to online screening and triage would also enable a level of access without needing to travel at all. Delivery of services within primary care means patients can still access contraception and some screening their GP before being supported into community service as required. A key requirement of the Sexual Health Strategy 2016-20 is to support the sexual health workforce in promoting good sexual health and access to services and to effectively sign post through continued review and development of the Talk relationship and sexual health workforce training programme. In addition, the strategy outlines the importance of increased awareness and uptake of HIV testing by high risk groups by implementing and monitoring the HIV Testing Strategy and action plan to ensure HIV testing is accessible through both primary care (GPs) and specialist sexual 19
health services including on-line self-sampling. In addition, specialist services will be commissioned to raise awareness across the community to both prevent and protect individuals. The Sexual Health Strategy 2016-20 also highlights the importance of supporting young people to access services without fear or embarrassment by continuing to provide RSE and young people friendly services through SAVVY Cornwall, ensuring services are supported to reach a standard where young people feel reassured about accessing such services. Negative impact: The rural nature of Cornwall makes access a particular issue. An integrated service offering both testing, treatment of STIs and contraception services within one appointment would better support patients. Services need to be strategically placed and be available at times that best suit patients across the County. The use of innovation, such as on-line provision and collaboration with other organisations to ensure services are accessible to all will be a key requirement of future provision. 5. Safeguarding - Who will be affected by this proposal? Is the proposal likely to result in positive or negative impacts/risks? If so what are they? What plans do you have in place, or are developing, that will mitigate the likely identified negative impacts/risks? Who will be affected by this proposal? Sexual Health services see a number of vulnerable people; adults and young people including victims of domestic abuse and sexual violence and those who are at risk or experience child sexual exploitation (CSE). 20
What are the positive impacts/risks if any? Sexually Transmitted Infections (STIs)/repeat screening and pregnancy are all risk indicators of child sexual exploitation. Confidential access to sexual health services play a key role in protecting people (particularly young people) against exploitation by facilitating disclosure of potential abuse; encouraging people to engage with professionals and enabling discussion around healthy relationships to both support understanding that a situation may be abusive providing opportunities for disclosures and risk assessments. Commissioned services will be required to work within local safeguarding policies ensuring that employees are skilled and experienced in identifying and responding to safeguarding risks. What are the negative impacts/risks if any? None, however, careful consideration will need to be given to the on-line platform to ensure accessibility, safeguarding and data protection and appropriate pathways/triaging to face to face services. 6. Information Management What type of information will be required to deliver this proposal? Is the proposal likely to result in increased risks to the information? If so, what are they? What plans do you have in place, or are developing, that will mitigate the likely identified negative impacts/risks? What type of information will be required to deliver this proposal? Commissioned services will be required to manage patient records in line with legislation. Confidentiality is an important factor in delivering sexual health services in 21
Cornwall. Is the proposal likely to result in increased risks to the information, if so what are they? The risks are not envisaged to increase as confidentiality and adhering to the Data Protection Act and all pertinent legislation will be a requirement. With regards to the introduction and launch of an onsexual health service where patients can access free testing kits on-line a full Business Impact Assessment (BIA) is being undertaken with the Information Management Team and support provided by IS to support the drafting of specifications and tender evaluations. What plans do you have in place, or are developing, that will mitigate the likely identified negative impacts/risks? Services that are decommissioned will be requested to provide exit strategies on how they will ensure service user/patient confidentiality. Information management considerations will be discussed and mitigated and added to the risk register and necessary BIA s undertaken. 7. Community Safety/Crime and Disorder - Who will be affected by this proposal? Is the proposal likely to result in positive or negative impacts/risks? If so what are they? What plans do you have in place, or are Who will be affected by this proposal? Victims of domestic abuse and sexual violence (DASV) for whom accessing a sexual health service may be their gateway into support. 22
developing, that will mitigate the likely identified negative impacts/risks? DASV, wider workforce understanding, access to services and pathways into support has been identified as a priority area going forward for the Sexual Health Partnership Group. Communications will include sufficient information on accessing the sexual assault referral centre. What are the positive impacts/risks if any? What are the negative impacts/risks if any Not applicable 8. Health, Safety and Wellbeing - Who will be affected by this proposal? Is the proposal likely to result in positive or negative impacts/risks arising from: Individual lifestyles, social and community influences, living, working and economic conditions, access to or quality of services or any other direct or indirect effects on health, safety and well-being? If so what are they? What plans do you have in place, or are developing, that will mitigate the likely identified negative impacts/risks? Who will be affected by this proposal? Increased difficulty in accessing sexual health services could prevent at risk individuals from accessing services resulting in an increase in sexually transmitted infection (STI) transmission as infections such as chlamydia, gonorrhoea, syphilis and HIV remain undetected and untreated. Untreated infections can lead to long term health consequences and even death. It could also result in an increase in unplanned pregnancies. Whilst unplanned pregnancies that continue will become wanted, unplanned pregnancy can cause financial, housing and relationship pressures and have impacts on existing children. Approximately 50% of teenage conceptions result in a termination; a cost to the NHS and an avoidable traumatic experience for the young people involved. 23
What are the positive impacts/risks if any? A greater integrated sexual health service that links with specialised services for young people, HIV services and better on-line access to information, advice and guidance, on-line testing that increases accessibility across Cornwall would better support patient access and choice. Key priorities in Cornwall relate to late diagnoses of HIV and reaching the national chlamydia detection rate, it is anticipated that more on-line services would support these priorities identified within the Sexual Health Strategy and, in addition, be embedded within future provider specifications. What are the negative impacts/risks if any? None, however, careful consideration will need to be given to the on-line platform to ensure accessibility, safeguarding and data protection and appropriate pathways/triaging to face to face services. 9. Have the impacts indentified in Questions 4 to 8 been assessed using up to date and reliable evidence and data? Please provide a link to the evidence/data or state what the evidence/data is. The data and research page on the intranet is a useful resource. Do you need to engage or consult with any representative group/s? Are our staff affected? Have the unions or staff forums The Sexual Health Strategy 2016-20 was reviewed using confidential STI data provided by Public Health England, Contraception, conception and abortion data and informed by the Joint Strategic Needs Assessment and the Sexual Health Needs Assessment. Recommendations have been made in line with the Framework for Sexual Health Improvement in England and Making it work, a guide to whole system commissioning for sexual health reproductive health and HIV. 24
been involved? If not do they need to be? 10 What plans do you have in place to monitor the impact of the proposals once they have been implemented? The full impact of the policy/decision may only be known after the proposals have been implemented. A Consultation Plan agreed and signed off by the Sexual Health Commissioning Board has been used to support a countywide consultation on how sexual health and contraception services should be delivered in Cornwall in the future. This consultation concluded on the 15 July 2016. Ongoing analysis of data and evaluation which will be monitored by the Sexual Health Commissioning Board and future contracts will be monitored in accordance with Contract Procedure Rules. 11 Are there other implications not covered by this CIA that need to be considered? These can include: staffing, procurement and contracts, property, climate change, transport, waste and economy. If yes then please explain. Depending on the outcome of the commissioning process there may be implications in relation to the decommissioning of services. Discussions will be ongoing with commercial services in this respect and potential risks highlighted and mitigations implemented. Refer to the Committee Report Template Guidance page for further information. 25
What course of action does this CIA suggest you take? More than one of the following may apply. Please state the Residual Risk score. (Refer to the CIA Guidance regarding Risk Management) Outcome 1 - Green: No change required. The CIA has not identified any potential for adverse impact or risk. (Residual risk score of 6 or less) Outcome 2 - Amber: Continue with the proposal but mitigate the identified risk/s. Despite the potential of an adverse risk/impact continue but make sure you have suitable mitigation plans in place to manage and monitor the risk or impact. (Residual risk score of 8 to 16) Outcome 3 - Red: Stop and rethink. The risk and or impacts may not be acceptable even with mitigation. (Residual risk score of 20+) Highest Risk Score Green Summary of this CIA (Copy and paste into the report template) What are the key risks/impacts both positive and negative? Are there any groups affected more than others? What were the identified risks and their mitigation? Do you consider that the identified risks are cumulative? If yes make this clear in the Summary. What course of action are you advising as a result of this CIA? Positive impact: An integrated sexual health service would provide a comprehensive sexual health and reproductive service which would provide a joined up sexually transmitted infection testing, treatment and contraception service that would provide a range of services to meet the needs of patients including young people. This would include the management of both testing and more complex treatment needs together with a full range of on-line sexually transmitted infection (STI) as well as being able to undertake comprehensive STI screens within contraceptive appointments and vice versa. It is intended that an integrated sexual health service would be provided via a range of platforms in order to remove as many barriers to access as possible. This is likely to include better innovation (on-line services) and collaboration with other organisations. 26
A key requirement of an integrated sexual health service is for the workforce to promote good sexual health and access to services and to effectively sign post through continued review and development of the Talk relationship and sexual health workforce training programme. There will also be a requirement for increased awareness and uptake of HIV testing by high risk groups by implementing and monitoring the HIV Testing Strategy and action plan to ensure HIV testing is accessible through specialist sexual health services including on-line self-sampling. In addition, specialist services will be commissioned to raise awareness across the community to both prevent and protect individuals. In addition it is likely that young people will be supported to access services without fear or embarrassment by continuing to provide RSE and young people friendly services through SAVVY Cornwall, ensuring services are supported to reach a standard where young people feel reassured about accessing such services. Negative impact: Services that are decommissioned will be requested to provide exit strategies on how they will ensure service user/patient confidentiality. Information management considerations will be assessed and mitigated and added to the risk register. The is a risk to HIV services and sexual health services being fragmented due to HIV prevention commissioned by Public Health, HIV support services currently commissioned by Adult Care and Support and HIV treatment by NHS England. Such issues have been identified as risk and will be monitored as the commissioning processes progresses. Careful consideration needs to be given to the on-line sexual health service to ensure accessibility for all, that personal data is protected Such service will be subject to a Business Impact Assessment and support from Information Services (IS) and the Council s web team to ensure risks are mitigated. 27
DEAG Sign Off Name David Coleman Date 25 August 2016 Comments from DEAG 28