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Gaps in information are impeding progress in improving sexual health services provided by the NHS in England, warns a report published last week.
The Healthcare Commission, the body that monitors the quality of NHS care in England, found that gaps in the current data make it impossible to track implementation of guidelines and to recognise where improvements are needed in sexual health services.
As a result, services are limited in their ability to target groups at high risk; to use data to plan and to allocate resources where they are needed; and to monitor people's access to services and levels of sexual health.
Improving sexual health was one of the top six priorities for the NHS in its plan for 2006-7. The United Kingdom has the highest rate of teenage pregnancy in western Europe and rapidly rising rates of abortions and sexually transmitted diseases, such as chlamydia and HIV.
However, the review warned, “Data are currently not adequate to track progress in all areas of sexual health or for commissioners of healthcare services to commission effectively on behalf of their population.”
Only one of eight primary care trusts taking part in the review collected information about the age of people using genitourinary medicine services as part of its contract with service providers. Only two primary care trusts recorded patients' sex. Five recorded the number of people using the service. And none asked about ethnicity.
The review found that data on sexual health are not collected systematically. They are derived from different geographical levels, such as local authorities (areas managed by local government rather than the NHS), primary care trusts, and genitourinary medicine clinics, which give no clear indication of where improvements are needed.
Data are also collected in different time intervals, such as monthly or quarterly, and come from different sources—for example, the Health Protection Agency, the Office for National Statistics, or the Department of Health. This makes it difficult to compare data.
Jude Williams, head of public health with the Healthcare Commission, warned, “The data that are collected are often missing vital information such as age, gender, and ethnicity of patients. This makes it difficult to target prevention and treatment services at those who need them most.”
As a top priority, the review recommended, “There is an urgent need for a comprehensive data set to allow more effective targeting of services for those who need them most and to track progress.”
The commission noted that the introduction of a common data set for sexual health and HIV, currently being developed by the Department of Health, should help. “But if this does not produce improvements in the next year, measures should be introduced to require all providers of sexual health services to collect information on age, gender, and ethnicity as a minimum,” it suggested.
Data on where patients live, through a partial postcode, would enable regulators, performance managers, and others to track achievement more effectively.
Ms Williams said, “It is vital that everyone involved in sexual health services, from the government through to those providing front line services, makes improving data collection, and using that data to deliver effective services, a top priority.”
She considered that efforts to maintain patient confidentiality might have been particularly difficult in collecting data in sexual health services. “However, confidentiality can be maintained at the same time as obtaining information, such as patient age, gender, and ethnicity, needed to track service achievements and what is effective.” The fact that sexual health services are provided by different agencies also made a common data set essential, she said.
To further improve services, the review recommended that the Department of Health introduce measures to monitor progress to its national strategy for sexual health and HIV, which was introduced in 2002, and to review standards for sexual health and HIV service delivery.
The report, Performing Better? A Focus on Sexual Health Services in England, is at www.healthcarecommission.org.uk.