What’s happening with sexual health services in Bristol, North Somerset and South Gloucestershire?

Tendering - a waste of resources

Currently sexual health services - Unity Sexual Health - are part of University Hospitals Bristol and Weston (UHBW) and staff are direct employees of the NHS. These services are provided across the whole of Bristol North, Somerset and South Gloucestershire (BNSSG).

The service is currently going through a tendering process, the outcome of which will determine future service provision.

In our view, this seems to be a waste of resources. The process is being managed by Bristol City Council (as the service comes under its public health umbrella). The process is impacting negatively on staff who, because of uncertainty about their future and the services they provide, are feeling undervalued and unsettled. Many staff are looking for alternative jobs. This is a huge shame as a fantastic team has been built at Unity over a number of years with huge expertise in dealing with an often vulnerable client group.

The services that Unity Sexual Health provide and ones at risk of being privatised or lost are:

1. Sexually Transmitted Infections testing and treatment
2. Contraception
3. Pregnancy advice (although pregnancy advisory services likely to join Marie Stopes clinic/fall under a different umbrella)
4. Chlamydia Screening services
5. Specialist clinics in chronic pelvic pain, recurrent or persistent pelvic infections and complex contraception
6. Innovative vending machines for STI test kits and HIV point-of-care kits (see Free sexual health test vending machines launched - BBC News

Concerns when non-NHS providers running services

There are many concerns when sexual health services are tendered out with potential for non-NHS providers taking over

1. Patient care - focus on high volume low cost would mean complex long-term conditions and infections may not be covered with a focus on reducing costs. There are conditions that are not sexually transmitted however which fall under the remit of sexual health services. A non-NHS provider may choose not to diagnose or treat these conditions. Medical consultants often see sexual health cases in hospital that they cannot manage. They rely on the ability to refer to a specialist within the city. They have had situations where the advice given by a different specialist was not sufficient. They would also not expect patients to travel outside Bristol.
2. Loss of expertise - there are many conditions that only specialists in sexual health can manage with years of training and expertise. There is no guarantee that a non-NHS provide will employ all the staff as it deems them surplus to requirements. The expectation would be that one consultant could supervise many nurses in different localities. This has serious clinical supervision and governance issues. Staff are also worried about the impact on their employment and seeking jobs elsewhere. This has destabilised the current service with low morale and staff seeking employment elsewhere.
3. Loss of training opportunities – a private provider will not be able to accommodate medical or nursing trainees. This would include infectious disease trainees, GPs, obstetrics and gynaecology, dermatology and reproductive health. Where would they receive training in sexual health conditions? This is a real worry as there will be a large cohort of trainees not exposed to frequently presenting conditions and serious infections like syphilis that are on the rise.
4. Lack of decision-making leadership – a private provider could exclude consultants from involvement in service planning and development which means a loss of expertise in ensuring safe and effective patient care tailored to the area. This also has an impact on research and innovation.
5. Higher burden on primary care – GPs have called for collective action and the capacity to absorb seeing conditions related to sexual health and contraception may well be reduced.
6. We understand there is a pressure to reduce costs and sexual health services are under intense pressure financially as the funding has reduced due to council cuts. Integrated care pathways are key, as poorly connected services mean a risk of people falling out of the system without receiving the care they need.

   Tendering risks fragmenting the pathways already in place. This would have a disproportionate impact on women’s health as well as those at high-risk such as young people and sex workers. 

   We cannot have both better care and cheaper care. There is a risk that governments seek short-term reductions at the expense of long-term outcomes by privatisation, via the outsourcing of services to the private sector.

What can you do?

Please support Unity Sexual Health by writing to and calling on Green councillors, who have a majority on the council, and local MPs, to do everything possible to ensure these services remain within the NHS for the following reasons:

• The service has a highly skilled staff group (which may be broken up).
• Unity has many vulnerable clients who deserve the best possible services e.g. clients who have been victims of abuse or who are at risk of abuse, substance users , commercial sex workers, women seeking expert contraceptive advice and treatment, emergency contraception, unplanned pregnancy referral, excellent services for young people.
• The majority of the public think that transferring NHS staff to private companies is unacceptable (Unison research).
• Privatisation costs more in the long term, damages the services people rely on, and drives down the terms and conditions of those providing them.
• Outsourcing staff to private companies creates two-tier working conditions, with pay rates and pensions not always following NHS rates.
• Sexual health issues are best addressed by the NHS: excellent staff training keeping everyone up to date, the backup of a large NHS Trust in terms of safeguarding, training and response to emerging issues.
• Ensuring equality of access for all communities.

For more information contact Bristol Protect Our NHS at protectournhs@gmail.com