Director of Public Health Annual Report 2011 - NHS North Somerset

Sexual Health in North Somerset
Director of Public Health
Annual Report 2011
Making North
Somerset
Healthier

Director of Public Health Annual Report 2011
Contents
Acknowledgements ...........................................................................................................................
Introduction ........................................................................................................................................
Recommendations ..............................................................................................................................
iii
iv
v
Executive Summary ............................................................................................................................ 1
Chapter 1 : Sexually Transmitted Infections ..................................................................................... 3
Chapter 2 : Human Immunodeficiency Virus (HIV) ........................................................................... 9
Chapter 3 : Unintended Pregnancies ................................................................................................ 13
Chapter 4 : Teenage Pregnancy ......................................................................................................... 18
Chapter 5 : Sexual Assault ................................................................................................................. 22
Director of Public Health Annual Report 2010 Recommendations – Update ................................ 26
Sexual Health Services in North Somerset (Centre page pull out)
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Director of Public Health Annual Report 2011
List of Figures
Figure 1 : Location of chlamydia tests in 15 – 24 year olds in North Somerset (2010 – 11) ........... 4
Figure 2 : Number of individuals seen for HIV care in North Somerset (2005 – 2010) ................... 9
Figure 3 : Termination of pregnancy rates in North Somerset and England (2008 – 2010) ......... 13
Figure 4 : Variation in prescribing of Long-acting Reversible Contraceptives (LARC)
in general practices in North Somerset (2010/11) ........................................................... 17
Figure 5 : Under 18 conception rolling quarterly rates in North Somerset,
South West and England (1999 – 2010) ........................................................................... 18
Figure 6 : North Somerset Commissioning Model ........................................................................... 24
Tables
Table 1 : Rate per 100,000 population of chlamydia infections in North Somerset
and England in 2010 ........................................................................................................... 4
Table 2 : Number and rate of warts, herpes and gonorrhoea in North Somerset
and England in 2009 – 2010 ................................................................................................ 5
Maps
Map 1 : Termination of pregnancy rates by ward in North Somerset ........................................... 14
Map 2 : Termination of pregnancy rates in Weston-super-Mare ................................................... 14
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Director of Public Health Annual Report 2011
Acknowledgements
Thanks to Kathie Harper and Cath Vickery
(Weston Integrated Sexual Health Centre),
Sharon Hartmann, and Debbie Chalk (‘No
Worries!’ Teenage Health Service), Carrie
Worth and Carolyn Heath, Substance and
Advice Service (SAS), Bonnie Holt and
Louise Sweeney (Terrence Higgins Trust),
and Dr Caroline Haddy (Brockway
Medical Centre) for providing
patient stories, providing details
of their services, and commenting
on drafts.
Thanks also to Susan Hamilton, Ginette
Corr and Sandra Shcherba and the NHS
North Somerset Public Health Directorate
for writing and editing the report. Finally,
to Kay Sandy and Debbie Criddle for their
administrative support.
This annual report can
be provided in another
language or in different
formats such as Braille or
large print. Please contact
the Department of Public
Health on 01275 885 132.
iii

Director of Public Health Annual Report 2011
Introduction
I am pleased to present my second Director
of Public Health annual report. This year I
have chosen to focus my attention on sexual
health.
Sexual health remains a key public health
issue. Rates of sexually transmitted infections
(such as chlamydia) continue to rise and both
teenage and unintended pregnancy remain a
concern. It is estimated that we spend about
two and a half million pounds each year on
sexual health services in North Somerset
(excluding specialist HIV treatment and
primary care treatment). We need to make
sure we invest this money wisely and achieve
the best outcomes for our local community.
I recognise that sexual health is a
controversial topic on which there are many
diverse views and opinions. My report aims to
give readers an accurate and up to date
picture of sexual health across North
Somerset. It is intended to provoke discussion
and debate and inform those responsible for
commissioning and providing local services. It
looks at what we are currently doing to
improve outcomes and reflects on the
learning from our recent peer review. This
year it includes a ‘pull out’ sheet containing
contact details of key local services as a useful
resource and includes personal stories which
illustrate how local people have been
affected by sexual health issues. It provides a
review of progress made to achieve the
recommendations set out in my last year’s
annual report and finally recommends further
action to improve sexual health in the future.
We live in changing
and exciting times.
In July 2011, the
publication “Healthy Lives, Healthy People –
Update and way forward”, confirmed that
local councils will take on new responsibilities
for public health supported by a local ringfenced
budget. This provides new
opportunities for community engagement
and innovative approaches to improve health
and wellbeing and tackle the wider
determinants of health (e.g. housing, leisure,
planning, transport, employment and social
care).
Over the coming year, I am committed to
working towards the effective transition of
public health to North Somerset Council by
April 2013. We continue to build strong
relationships with the new and emerging
partners (including the Clinical Commissioning
Groups across Bristol, North Somerset and
South Gloucestershire and the newly
established North Somerset People and
Communities Board) to support the delivery
of integrated sexual health services and public
health programmes across North Somerset.
I welcome any feedback on the content of
this report and look forward to working with
partners to address the recommendations set
out in this report.
Becky Pollard
Director of Public Health
NHS North Somerset
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Director of Public Health Annual Report 2011
Recommendations
1. Focus on prevention, particularly to
address the interlinked behaviours of
alcohol, drugs and unsafe sex. Sex and
relationship education programmes should
be maintained and developed and
contraceptive services targeted at those at
greatest risk.
2. Focus on men, particularly young men and
men who have sex with men, in order to
increase levels of testing for sexually
transmitted infections and reduce levels of
undiagnosed and late diagnosed HIV
infection.
3. Reduce levels of child poverty to break the
intergenerational cycle of teenage
pregnancy and ensure where possible that
any service changes or budget reductions
do not disproportionately affect those at
greatest risk of teenage pregnancy.
4. Develop a clear sexual health care
pathway so professionals and the public
understand what each service (including
GP practices, ‘No Worries!’ Teenage Health
Service and the Weston Integrated Sexual
Health (WISH) Centre) provides and how
these services relate to each other.
5. Strengthen community provision of
contraceptive and sexually transmitted
infection services, ensuring through staff
training, audit and monitoring the quality
of services is high.
6. Improve data collection to ensure we
understand the level of sexually
transmitted infections in our community,
which groups experience poor sexual
health and access services, and the quality
of those services.
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Director of Public Health Annual Report 2011
Executive summary
The executive summary gives the main
findings from the information presented in
the report and the key issues identified.
Sexually Transmitted Infections
Chlamydia is the most commonly diagnosed
sexually transmitted infection in North
Somerset, followed by genital warts, herpes
and gonorrhoea.
Chlamydia infection peaks in young people
aged 15-24 year olds, with 854 infections
diagnosed in that age group in 2010.
The rate of chlamydia infections in North
Somerset is much higher than the England
average. The rate of testing in men (17.7%)
is the second lowest in the England.
There is a strong link between alcohol, drugs
and risky sexual behaviour.
Treating sexually transmitted infections in
North Somerset costs in excess of £1.1m each
year.
HIV
In 2010 there were 104 people living in North
Somerset accessing treatment for HIV.
The number of people living with HIV is
increasing but the level of infection in North
Somerset is lower than the England average.
The most common route of infection in those
living with HIV in North Somerset was sex
between men and women (49%) and sex
between men (41%).
Black African groups and men who have sex
with men in North Somerset are
disproportionately affected by HIV.
In 2010, the total of HIV/AIDS treatment in
North Somerset was estimated at £1m.
Termination of Pregnancy
In 2010, there were 399 terminations of
pregnancy in women living in North Somerset,
a10% reduction from the previous year.
The termination of pregnancy rate locally is
lower than the England average and peaks
in the 20-25 age group.
It is estimated that £249,000 were spent on
abortions in North Somerset in 2010.
Teenage Pregnancy
Over the last ten years, teenage pregnancy
rates have remained low. They have
fluctuated but remained consistently within
the bottom third of the country.
In 2009 there were 123 teenage pregnancies
in those under the age of 18, with a
concentration in Weston-super-Mare Central
and South Wards.
Reducing teenage pregnancy is only possible
if action is taken to address the underlying
risk factors, such as poverty, educational
underachievement and low aspirations.
Sexual Assault
In 2010/11, 131 sexual offences (of which 23
were rape) were reported to the police by
people living in North Somerset. Many
offences remain unreported.
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Director of Public Health Annual Report 2011
National data indicates that 54% of serious
sexual assaults in women were committed by
a current or ex-partner and many involved
alcohol and drugs.
Planning for the future
North Somerset has a sexual health strategy
that mirrors the Government’s vision for
integrated sexual health services.
A recent peer review shows North Somerset
has demonstrated strong commitment and
leadership in integrating sexual health
services in North Somerset.
Further improvements could be made by
providing a medical abortion service within
North Somerset and further strengthening of
services at the Weston Integrated
Sexual Health (WISH) Centre and within
GP practices.
Information Gaps
Addressing gaps in information is essential for
ensuring those most in need are receiving the
right services.
Locally, there are gaps in knowledge in
relation to levels of sexually transmitted
infections and sexual dysfunction; the sexual
health of certain vulnerable group (including
those with learning difficulties, mental and
physical health problems, and black and other
ethnic minority groups); and the quality and
accessibility of services.
2

Chapter 1
Sexually Transmitted Infections
What’s the problem?
Over the last decade, there has been a
significant rise in the number of diagnosed
sexually transmitted infections nationally.
This is a result of increased sexual behaviour
risk, better access to services, and improved
diagnostic techniques 1 . Young people and
men who have sex with men remain at
particularly high risk of sexually transmitted
infections.
Sexually transmitted infections are not only a
cause of distress and illness for those infected,
they are also a major financial burden to the
NHS. The cost to North Somerset of treating
sexually transmitted infections has been
estimated at £1.1m each year. This does not
include the cost of sexually transmitted
infections treated in GP practices or HIV
treatment.
Chlamydia
Chlamydia is the most commonly diagnosed
bacterial sexually transmitted infection both
in North Somerset and in England. There is a
higher risk of getting chlamydia in people
who don’t use condoms, frequently change
partners, or have several sexual partners at
the same time. Chlamydia can also get passed
from a mother to her baby during childbirth.
Consequences for those infected with
chlamydia can be serious, particularly for
Director of 1Public Health Annual Report 2011
women. If untreated, 10-15% of women with
the infection go on to get pelvic inflammatory
disease. Infection can also cause infertility,
pelvic pain and potentially life threatening
ectopic pregnancies. Treatment is straight
forward with antibiotics.
Chlamydia is the most commonly diagnosed
sexually transmitted infection locally but it is
difficult to know exactly how many people
are infected. This is because three quarters of
women and half of men with the infection
don’t have any symptoms. In people aged
under 20, 8.1% attending GP surgeries and
5% in the general population are thought to
be infected 2 . Chlamydia is most common in
young adults, peaking in women aged 15-19
and men aged 20-24.
In 2010, 854 chlamydia infections were
diagnosed in those aged 15-24 in North
Somerset, a rise from 2009 when 638
infections were diagnosed. The rate of
diagnosed chlamydia infections in North
Somerset is much higher than the England
and South West rate for younger age groups
(Table 1). It is not clear why this is the case.
It could be that services in North Somerset
are good at identifying those at high risk of
having the infection. It could also mean that
not enough people are being tested and
treated in order to reduce the level of
infection in the community, or there is a high
level of sexual risk taking behaviour locally.
1
Rise in new diagnoses of sexually transmitted infections (UK, 2009). Health Protection Report 2010, 4(34),27
August 2010. Available at: http://www.hpa.org.uk/hpr/archives/2010/hpr3410.pdf
2
Adams E, Charlett A, Edmunds W et al. Chlamydia trachomatis in the United Kindom: a systematic review and
analysis of prevalence studies. Sex Transm Infect 2004;80:354-362
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Director of Public Health Annual Report 2011
Table 1: Rate per 100,000 population of chlamydia infections in North Somerset and England
in 2010
North Somerset South West England
Age < 25* 3876.9 2037.9 2219.1
Age > 25 81.1 60.3 93.3
All ages 468.7 304.8 359.4
Source: Health Protection Agency. Genito-Urinary Medicine Clinic Activity Dataset (GUMCAD)
except * which includes data from the National Chlamydia Screening Programme.
What are we doing about it?
In 2003, the Department of Health set up the
National Chlamydia Screening Programme.
This programme is designed to increase
awareness and testing of chlamydia in the
under 25’s, reducing the serious long term
consequences of infection.
Every year more young people are being
tested for chlamydia infection in North
Somerset. In 2010/11, 5,618 chlamydia tests
were taken by 15 to 24 year olds in North
Somerset. Chlamydia tests are available from
a wide range of places, the most popular
being GP surgeries followed by the Weston
Integrated Sexual Health (WISH) Centre
(Figure 1).
Figure 1 Location of chlamydia tests in 15 – 24 year olds in North Somerset
(2010/11)
Source: Avon Information Management and Technology Consortium. *The term CASH stands for
Contraceptive and Sexual Health clinics such as No Worries! and Brook Advisory Centre
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Director of Public Health Annual Report 2011
The level of testing in 2010/11 in young
people aged 15-24 in North Somerset (24.5%)
was higher than the South West average
(20.9%) but slightly lower than the national
average (25.2%). North Somerset has the
second highest proportion of chlamydia tests
that are positive in the country in this age
group (8.9% compared to 5.2% in England).
About two thirds of partners of those with
chlamydia will also be infected. The process of
informing partners so that they can get tested
and treated is called partner notification.
Some local services, including the Weston
Integrated Sexual Health (WISH) Centre and
the Avon Chlamydia Screening Programme,
which processes about half of all tests in
North Somerset, have high levels of partner
notification. But the level of partner
notification in other settings, including GP
practices, is unknown.
A challenge for North Somerset is to increase
the numbers of men tested for chlamydia.
North Somerset has the second lowest
proportion of men (17.7%) aged 15-24 tested
for chlamydia of any area in England.
Information is needed about where in North
Somerset testing is low and infection rates
high so that services can be focused in
geographical areas of highest need.
Other Sexually
Transmitted Infections
There are many other sexually transmitted
infections apart from chlamydia. After
chlamydia, the three most commonly
diagnosed infections in North Somerset
patients attending genito-urinary medicine
(GUM) clinics, which are specialist sexual
health clinics such as the Weston Integrated
Sexual Health (WISH) Centre in Weston-super-
Mare, are genital warts, herpes and
gonorrhoea.
Gonorrhoea is also caused by bacteria and like
chlamydia can result in pelvic inflammatory
disease, pain and infertility. Genital warts are
caused by a virus, and infection increases the
risk of cervical cancer. Herpes is also caused by
a virus, and those infected sometimes
experience mild or no symptoms.
The number of warts and herpes infections
diagnosed in North Somerset patients
attending genito-urinary medicine clinics
increased between 2009 and 2010 although
gonorrhoea cases fell (see Table 2). Many of
these infections are also diagnosed in other
health care settings such as GP practices, so
the true figure will be higher. The number
diagnosed in other settings is unknown.
Table 2: Number and rate of warts, herpes and gonorrhoea in North Somerset and England
(2009 and 2010)
2009 2010
North Somerset England North Somerset England
Number
Rate per
100,000
Rate per
100,000
Number
Rate per
100,000
Rate per
100,000
Warts 202 96.6 144.3 240 141.5 141.7
Herpes 128 61.2 48.4 140 67.0 52.9
Gonorrhoea 43 20.6 27.8 16 7.7 28.0
Source: Health Protection Agency. Genito-Urinary Medicine Clinic Activity Dataset (GUMCAD)
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Director of Public Health Annual Report 2011
What are we doing about it?
A number of steps are being taken in North
Somerset to reduce the level of sexually
transmitted infections in the community. As
well as being part of the National Chlamydia
Screening Programme, there are actions
aimed at sexual health promotion and
improving access to services.
Health Promotion
It is essential that action is taken to prevent
sexually transmitted infections, including HIV,
occurring in the first place to reduce both
human and financial costs. North Somerset
has a programme of sexual health promotion
aimed at increasing awareness of the signs
and symptoms of sexually transmitted
infections, and encouraging safer sex. This
includes:
● Free condoms given to those attending ‘No
Worries!’ Teenage Health Service, Weston
Integrated Sexual Health (WISH) Centre, the
Terrence Higgins Trust, the Youth Services,
Youth Offending Service and some GP
practices and pharmacies.
● Training of Local Authority and NHS staff in
relation to sexually transmitted infections
and HIV, including the ‘No Regrets’
programme aimed at providing young
people with the skills to delay sexual
activities and training to foster carers.
● Publicity campaigns to improve awareness
of chlamydia and HIV, including club
promotion evenings, a sexual health bus for
young people, bus campaigns, radio adverts
and a quarterly newsletter for young
people and professionals.
● Terrence Higgins Trust provides online
advice on internet sites for men who have
sex with men, such as Gaydar and delivers
national prevention campaigns locally.
Access to services
It is important that those with a sexually
transmitted infection are diagnosed and
treated quickly. This reduces the risk of
serious illness to themselves and the chance
that infection will be spread to others. All of
North Somerset patients attending the
Weston Integrated Sexual Health (WISH)
Zoe’s Story
Zoe (not her real name) is 17 and
started on the contraceptive pill three
years ago to control her periods which
were painful, heavy and erratic. She
has a boyfriend now and needs contra -
ception. In the last two months she has
had migraine like headaches.
Zoe went to her GP and discussed stop -
ping the pill and alternative options.
She was interested in having a contra -
ceptive implant, and went away to
rethink. She then booked an appointment
with a GP trained to fit
an implant.
Before she left, the GP asked her to
do a chlamydia test which came back
positive. She went back to the GP with
her partner and the GP provided treat -
ment for them both to run concurrently.
She had no other contacts. He had had
a previous girlfriend and because she
lives away from the area he agreed that
the chlamydia screening team could
contact her.
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Director of Public Health Annual Report 2011
Centre are offered an appointment within
48 hours, and 95% are seen within 48 hours,
meeting the national targets.
Many people prefer to go to other services
such as GP practices and ‘No Worries!’ clinics
for sexually transmitted infections. Because
of lack of routinely collected data and
computerised systems in some services, it is
not clear how accessible these other services
are in terms of availability of appointments;
waiting times to get seen and treated; or if
areas in North Somerset are poorly served.
Understanding the risks: Alcohol and drugs
There is a strong link between alcohol, drugs ‘celebrity’ behaviour resulting from sex, drugs
and risky sexual behaviour – leading national and alcohol and advertising which glamorises
expert Professor Bellis describes it as a ‘fuel alcohol can encourage similar behaviour in
for a sexual health crisis’. A national report by young people.
the Independent Advisory Group on Sexual
Health and HIV found people who take risks North Somerset also has a higher level of
in one area are more likely to take risks in adult problematic drug use (heroin or crack
others 3 .
cocaine) and alcohol admissions to hospital
than the regional average. There is a
The media and the alcohol industry play a key concentration of alcohol and drugs problems
role. Some alcohol advertising is directed at in Weston-super-Mare, closely linked to levels
young people. Positive media coverage of of deprivation.
3
Independent Advisory Group on Sexual Health and HIV. Sex, Drugs, Alcohol and Young People. A review of the
impact drugs and alcohol have on young people’s sexual behaviour. June 2007.
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Director of Public Health Annual Report 2011
Jack’s story
Jack (not his real name) is a 15 year old
boy and went to the ‘No Worries!’
service asking for an appointment with
a nurse as he had concerns about
herpes. Whilst waiting to be seen, he
was offered a chlamydia test and
invited to join the free condom scheme.
The nurse addressed the young man’s
concerns regarding herpes and
explained how to access the clinic,
information on sexual health available
and useful websites. The male staff
member who saw him also learnt that
he had previous contact with the Youth
Offending Team and a Substance
Advice Worker but that at the time was
reluctant to access the support they
were offering.
Once his sexual health concerns had
been dealt with, issues relating to the
Youth Offending Team and Substance
Advice Worker were discussed. The
young man spent time talking through
his experiences and was offered a new
referral to the Substance Advice Service
but he declined the offer.
The following week the same young
man returned to clinic requesting
condoms.
Once again the male worker struck up
conversation. He revealed that he didn’t
actually need condoms but wanted to
talk. This time he did want to re-engage
with the Substance Advice Services to
start to address his drug use.
8

Chapter 2
Human Immunodeficiency Virus (HIV)
What’s the problem?
HIV is a virus that attacks the body’s immune
system leaving those infected at risk of other
infections or diseases such as pneumonia or
cancer. The infected person can remain with -
out symptoms until advanced stages of HIV
infection – this stage is also known as acquired
immune deficiency syndrome or AIDS. HIV can
be passed from one person to another in a
number of ways including unprotected sex,
sharing of contaminated needles, or from a
mother to her unborn child.
In 2010, there were 104 people living in North
Somerset who were accessing treatment for
HIV, two thirds of whom were men. Since
2005, the number of people living with HIV in
North Somerset has increased by 63% (Figure
2). Despite the rise, the level of infection is
lower than the England average.
Director of Public 2Health Annual Report 2011
It is not clear how much of this increase is
due to people living longer with HIV, new
infections acquired in North Somerset, or
people with HIV moving into the area. Data
on new cases of HIV is only available on those
diagnosed in genito-urinary medicine (GUM)
clinics, where five new cases were diagnosed
in 2010.
For those people in North Somerset living
with HIV in 2010, the most common way they
became infected with HIV was sex between
men and women (49%) and sex between men
(41%). This pattern has remained relatively
unchanged since 2005. Only 4% of HIV
infections of those living with HIV in 2010
were from injecting drug use, a reduction
from 7% in 2005.
Over half of all infections were detected in
the 35-54 age group and approximately half
of those living with HIV reside in the Westonsuper-Mare
area.
Figure 2 Number of individuals seen for HIV care in North Somerset (2005 – 2010)
Source: Survey of Prevalent HIV Infections Diagnosed (SOPHID).
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Director of Public Health Annual Report 2011
Understanding the risks: Black ethnic groups
Nationally, black Africans experience higher Locally, black Africans are disproportionately
levels of HIV and black Caribbean populations affected by HIV. 23% of those living with HIV
higher levels of other sexually transmitted were black African. However there is no
infections such as gonorrhoea, chlamydia and comprehensive data available on other
syphilis but not HIV 4 . Population estimates for sexually transmitted infections locally to be
2009 show that North Somerset has a much able to determine if black or other ethnic
lower proportion of black ethnic groups groups are at particularly high risk.
(1.1%) than the England average (2.9%) 5 .
What are we doing about it?
Testing
Early diagnosis and treatment of infection are
critical to reduce the likelihood of infecting
others and of developing serious and life
threatening medical conditions. Nationally, it
is estimated that a quarter of people with HIV
are unaware of their infection and half of all
HIV infections are diagnosed late – after the
point at which treatment should have
started. 6 Starting HIV treatment late results in
up to 15 years loss of life 7 .
HIV testing is offered in several services
including the genito-urinary medicine clinics
such as the Weston Integrated Sexual Health
(WISH) Centre, Terrence Higgins Trust and GP
practices. All pregnant women are now
offered an HIV test and uptake is over 95%
in the hospitals providing care to pregnant
women in North Somerset. The genito-urinary
medicine clinic in North Somerset has the
lowest level of HIV tests offered (68%) and
taken up (32%) in the South West. The amount
and appropriateness of testing in other
services, such as GP practices, is unknown.
4
Health Protection Agency. Sexually transmitted infections in black African and black Caribbean communities
in the UK: 2008 report. http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1225441605082
5
Office for National Statistics. 2009 Population Estimates by Ethnic Group.
6
Health Protection Agency. HIV in the United Kingdom. 2010 report. http://www.hpa.org.uk/hivuk2010
7
May M, Gompels M, Delpech V et al. Impact of late diagnosis and treatment on life expectancy in people with
HIV-1: UK Collaborative HIV Cohort (UK CHIC) Study. BMJ 2011; 343; 6016
10

Director of Public Health Annual Report 2011
Understanding the risks: Men who have sex with men
Men who have sex with men (MSM) are at
greatest risk of acquiring HIV infection in the
UK and are disproportionately affected by
other infections such as gonorrhoea and
syphilis. An estimated one in four MSM living
with HIV are unaware of their infection 8 . The
Gay Men’s Sex Survey indicates that in the
South West about a third of men have never
been tested for HIV or other infections 9 .
There is no local data on sexuality. However
a national survey undertaken in 2010/11
reported that 94% of adults identified them -
selves as heterosexual/ straight; 1% as lesbian
or gay; and 0.5% as bisexual 10 . The South West
region has the highest proportion of lesbian,
gay and bisexual adults (2.0%) after London
(2.5%). The true figures of lesbian, gay and
bisexuals may be higher as people are often
reluctant to disclose their sexuality in surveys.
Treatment
There is no known cure for HIV and there is
no vaccine to stop infection. However, since
the 1990s, treatments have been developed
that enable most people with HIV to live
relatively normal lives. Most people with HIV
in North Somerset are treated at the HIV /
AIDS service based in Southmead Hospital in
Bristol. In 2010, the total annual cost of HIV
treatment in North Somerset was estimated
at £1m.
Access to Services
Although the long term prospects for those
living with HIV have improved considerably,
the infection is still associated with stigma
and serious illness for many people. Those
living with HIV often benefit from additional
practical and emotional support.
The Terrance Higgins Trust and the Brigstowe
Project provide support to individuals and
groups of people living with HIV, including
counselling, information, advocacy, and help
in applying for benefits and housing. The
Local Authority is responsible for raising
awareness and providing care for people
living with HIV and AIDS, and works closely
with the Terrence Higgins Trust and the
Brigstowe Project to achieve these aims.
Being diagnosed with HIV
I was diagnosed with HIV in hospital
last year, which was a huge shock. I was
transferred to Southmead Hospital
where I received lots of support. They
contacted the Terrence Higgins Trust
and got me emotional support. I felt
completely safe there with staff that
told me that I was going to be ok. They
explained about the HIV drugs and I felt
better.
8
Health Protection Agency. HIV in the United Kingdom: 2010 Report.
http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1287145264558
9
Sigma Research. Gay Men’s Sex Survey. Vital Statistics 2010.
http://www.sigmaresearch.org.uk/gmss/region/south_west
10
Office for National Statistics. Integrated Household Survey April 2010 to March 2011 : Experimental Statistics.
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Director of Public Health Annual Report 2011
Living with HIV
We have been very fortunate to have
a very understanding GP. He never
asks about our status only about what
we have gone in to talk about. I don’t
need to be reminded of my HIV status.
My partner is much more up front
than I am about it. I feel some times
that I have HIV tattooed across my
forehead, although it has got easier
as the years have gone on.
12

Sexual Health in North Somerset
Sexual Health Services
in North Somerset4 PAGE
PULL OUT
SECTION
Making North
Somerset
Healthier

Sexual Health Services in North Somerset
Brigstowe Project
The Brigstowe Project offers free
confidential and independent
information, advice and support for
people affected by HIV.
They provide floating support, together
with advice and information, as
appropriate to the needs of the person to
improve their quality of life.
0117 955 5038
176-178 Easton Road
Bristol BS5 0ES
www.brigstowe.org/
Bristol Sexual
Health
Bristol Sexual Health Services are the
main provider of NHS sexual health,
contraception and pregnancy advisory
services in Bristol. Located in Bristol
City centre.
0117 342 6900
Central Health Clinic
Tower Hill
Bristol BS2 0JD
www.uhbristol.nhs.uk/
sexual-health
Brook Young
Peoples Clinic
Confidential sexual health services
information and advice for anyone aged
24 and under. Appointments and drop-in
sessions Monday to Saturday. Based in
Central Bristol.
0117 929 0090
1 Unity Street, College
Green, Bristol BS1 5HH
www.Brook.org.uk
Central Booking
Line
For NHS Abortion care. Counselling and
help for unplanned pregnancies.
Central Booking line
0845 872 5435 and
0117 927 6362
www.uhbristol.nhs.uk/
patients-and-visitors/
your-hospitals/otherservices-in-bristol/bristolsexual-health-services/
abortion-care/
II

Sexual Health Services in North Somerset
Chemists /
Pharmacies
Chemists offering a range of sexual health
services including free emergency
hormonal contraception to under 25 year
olds, chlamydia screening and treatment
and free condoms to under 19 year olds.
See ‘No Worries!’
website for up to date
information
www.northsomerset.nhs.
uk/PublicHealth/
No_Worries
General
Practitioners
(GPs)
Individuals should contact their own
General Practice.
A list of GP practices in
North Somerset can be
found on the Primary
Care Trust website
www.northsomerset.nhs.
uk
‘No Worries!’
Teenage Health
Service
Teenage Health Service for young people
under the age of 21 in North Somerset.
Confidential advice on a range of teenage
health issues including sexual health and
contraception advice. Drop in clinics
throughout North Somerset. Helping
young people to make positive choices
about their health.
01934 425 718
The Childrens Centre
Drove Road
Weston-super-Mare
BS23 3NT
www.northsomerset.nhs.
uk/PublicHealth/
No_Worries
‘No Worries!’
Teenage Health
Service Outreach
Nurse
Support for young women under 18 who
discover they are pregnant. Help with
decision making about the outcome of the
pregnancy, contraception choices post
termination/post natal and accessing
contraception.
01934 425 718
07824 450 991
III

Sexual Health Services in North Somerset
Sexual Assault
Referral Centre
(SARC) The
Bridge
Substance Advice
Service (SAS)
An integrated, comprehensive sexual
assault support service for men, women
and children in the Avon and Somerset
area.
The Bridge has specially trained,
experienced professionals who can provide
support with:
• Sexual health information and referral
services;
• Information about reporting to the
police and judicial processes;
• Forensic medical facilities;
• Counselling;
• Post-sexual assault follow-up care;
• Support through the criminal justice
system;
• Practical support and referrals to other
community services;
Consultation services to other professionals.
A service for young people seeking advice
and support for drugs and alcohol. All SAS
advisors are trained in basic sexual health
services as provided by ‘No Worries!’
0117 342 6999
The Bridge
2nd Floor
Central Health Clinic
Tower Hill
Bristol BS2 0JD
www.turntothebridge.org/
01275 888 360
sas@n-somerest.gov.uk
Terrence Higgins
Trust (THT)
Weston
Integrated
Sexual Health
Centre (WISH)
Provides information and advice,
counselling and group support, training,
health promotion, and practical support
services.
HIV testing with results within one hour
and STI testing on Monday evenings at
Fastest.
Terrence Higgins Trust also provides an
online support service for people living
with HIV at www.myHIV.org.uk
Provides sexual health care and
contraception advice and treatment. Open
Monday to Friday with evening clinics on
Tuesdays and Wednesdays.
THT Direct: 0808 8021221
(from 10 till 10 weekdays
and from 12 till
6 weekends)
Bristol office: 0117 955
1000 (10am to 4pm,
Monday to Friday)
Terrence Higgins Trust
Aled Richard Centre
8-10 West Street
Old Market
Bristol BS2 0BH
http://www.tht.org.uk
01934 881 234
WISH Centre
Weston Area Health Trust
Weston General Hospital
Grange Road, Uphill
Weston-super-Mare
BS23 4TQ
www.waht.nhs.uk/WISH/
Produced by NHS North Somerset, December 2011
IV

Chapter 3
Unintended Pregnancies
What’s the problem?
Unintended pregnancies are common with
almost one in three pregnancies being either
mistimed (earlier than desired) or unwanted 11 .
Unintended pregnancies can lead to poor
physical and emotional health of mother and
child. This is due to a number of possible
factors including delayed antenatal care and
a higher likelihood of alcohol consumption,
smoking and sexually transmitted infections
and domestic violence.
Some unintended pregnancies will result in
a termination of pregnancy – also known as
abortion. As well as the potentially negative
physical and emotional effects to the women,
there is a considerable cost to the NHS. It is
estimated that the cost of abortions in North
Somerset during 2010 was £249,000.
Director of Public 3Health Annual Report 2011
In 2010, there were 399 terminations in
women living in North Somerset, a 10%
reduction from the previous year. Over the
last five years, terminations locally have been
declining and levels are lower than the
England average.
The age group most likely to have a
termination in North Somerset is the 20-24
age group, an older age profile than the
national average (Figure 3).
In women aged under 25, 19% were repeat
terminations which is lower than the national
average of 25%.
Women living in Weston-super-Mare had
the highest rate of terminations in North
Somerset although rates in Central and South
Wards are low.
Figure 3 Termination of pregnancy rates in North Somerset and England (2008 – 2010)
Source: Department of Health Abortion Statistics
11
National Institute for Health and Clinical Excellence. Long acting reversible contraception: the effective
and appropriate use of long-acting reversible contraception. Clinical Guideline 30. October 2005.
13

Director of Public Health Annual Report 2011
Map 1 Termination of Pregnancy Rates by ward in North Somerset
Map 2 Termination of Pregnancy Rates in Weston-super-Mare
Source: Termination provider information (excludes data from University Hospitals Bristol NHS
Foundation Trust)
14

Director of Public Health Annual Report 2011
The risk of complications from a termination
increases with the length of the pregnancy.
Locally, 76% of terminations were under 10
weeks of pregnancy, with a trend over recent
years to more early terminations. In 2001 a
national standard of a maximum waiting time
of three weeks was introduced. In 2010/11,
local women waited between one and six
days for their initial consultation.
Women are offered a choice of two different
termination methods, medical and surgical
terminations. Around 23% of terminations
in North Somerset were performed using
the medical method in 2010, a much lower
proportion than across England and Wales
(43%). Currently, medical terminations are
only available in Bristol.
What are we doing about it?
Contraception services in themselves result in
reduced costs. It is estimated that for every
£1 invested in contraception services, the NHS
saves £11 12 . Further cost-saving can be achieved
by ensuring prompt access to emergency
contraception and by using more effective
contraceptive methods.
Emergency hormonal contraception is very
effective at preventing pregnancy if used
soon after unprotected sex – up to 72 hours.
Emergency contraception is available from
GPs, at the Weston Integrated Sexual Health
(WISH) Centre, and the ‘No Worries!’ Teenage
Health Service. It is available in 24 out of the
36 pharmacies located within North Somerset
where it is free for those aged under 25 years.
Long Acting Reversible Contraception (LARC)
methods are the most effective methods of
contraception and are more cost effective
than the pill 13 . These methods include
intrauterine devices (coils), injectable
contraceptives (depo) and implants.
Understanding the risks: Young adults
Nationally young adults (aged 16-24) have the
highest rates of termination of pregnancy
(abortion) and sexually transmitted infections.
Compared to older adults, young adults are
more likely to have a higher number of sexual
partners; more sexual partners at any one time;
and a higher level of alcohol and drug use.
Over the last couple of decades there has
been a trend toward increased risk-taking
sexual behaviour in young people. This
includes a lower average age of first
intercourse, more new partners, and an
increased likelihood of being involved in two
or more sexual relationships simultaneously 14 .
In 2010, there were an estimated 22,500
young adults living in North Somerset.
Although the proportion of young adults
locally (11%) is lower than England (13%),
North Somerset is projected to have a
considerable growth in population - 40% in
all age groups and 20% in young adults by
2033 15 . The highest levels of growth are
expected in Weston-super-Mare with 5,500
new homes planned in two village extensions.
12
Teenage Pregnancy Independent Advisory Group: Annual Report 2008/09
13
National Institute for Health and Clinical Excellence. Long acting reversible contraception: the effective and
appropriate use of long-acting reversible contraception. Clinical Guideline 30. October 2005.
14
Parliamentary Office of Science and Technology. Postnote number 217. Teenage sexual health. April 2004.
15
Office for National Statistics 2008 population projections.
15

Director of Public Health Annual Report 2011
Emily’s story
Emily (not her real name) is a 15 year
old girl in care who has a support
worker. Her support worker
accompanied her to the WISH (Weston
Integrated Sexual Health) Centre,
explaining that Emily had told her that
she’d had sex and was worried about
infections.
Emily was quiet and reluctant to talk
but with reassurance she expressed her
concerns around sexually transmitted
infections and wanted a check up. Emily
shared concerns around her relationship
with her boyfriend age 16 as they
weren’t reliably using condoms and she
wanted a contraceptive implant.
Sex was consensual but strategies
around negotiating condom use and
reducing her alcohol intake were
discussed and encouraged as part of
increasing her own self esteem.
The nurse suggested she start the pill
with a view to having an implant fitted
in the near future. Emily mentioned that
she had been having counselling but
hadn’t been seen recently. Following a
phone call by the nurse to Emily’s social
worker, these counselling sessions were
rearranged. Emily responded positively
to the nurse.
GP practices are the biggest provider of LARC
in North Somerset. In 2010/11, GP practices in
North Somerset increased LARC usage by 9%
compared to the previous year 16 . At the same
time, prescribing of the oral contraceptive pill
reduced by 5%. However, there are large
variations in prescribing between GP practices
(Figure 4), and some practices do not offer
the full range of LARC. LARC methods are also
available from the Weston Integrated Sexual
Health (WISH) Centre and ‘No Worries!’
Teenage Health Services.
A service has been developed to support and
follow-up young women who have had a
termination. ‘Clinic in a Box’ is a free,
confidential, informal, mobile contraception
and sexual health service and can be delivered
in a range of settings to meet the needs of
vulnerable young people in North Somerset.
16
Injectable contraceptives (DEPO) are given around four times
per year and prescription data adjusted to allow comparisons
16

Director of Public Health Annual Report 2011
Figure 4 Variation in prescribing of Long-Acting Reversible Contraceptives (LARC)
in general practices in North Somerset (2010 – 11)
Source: NHS Prescription Service
Clare’s Story
Clare (not her real name) is 31 and went
to her GP for a pill check. She was due
a cervical smear but had forgotten. Her
periods had been getting much heavier
and she had gained weight. The GP
discussed the options of having a coil
or a contraceptive implant and she felt
that might solve her period problems
and contraception.
She had her smear done at the appoint -
ment and was given some information
to read. She chose to have a coil at the
GP practice which is within walking
distance of her home. When she next
came to see the GP about another issue
she was able to tell the GP what a
success this had been.
17

Director of Public Health Annual Report 2011
Chapter 4
Teenage Pregnancy
What’s the problem?
Although young people can be very good
parents and we have many examples locally,
teenage parents and their children are more
likely to experience a range of negative
outcomes. These include a higher risk of
poverty; low self esteem; low levels of
educational attainment; social isolation;
depression; and poor physical, sexual and
mental health 17 . This is often an inter -
generational cycle, with children born to
teenage parents up to three times more likely
to become teenage parents themselves.
The rate of teenage pregnancy in North
Somerset has remained relatively low,
4
consistently within the bottom third in the
country, but has fluctuated greatly
throughout the ten year period (Figure 5).
Between 1998 and 2009 North Somerset
achieved a 2.5% reduction in teenage
pregnancies. This compares with an 18.1%
reduction in England.
Reflecting the national picture, the areas in
North Somerset with the highest number of
teenage pregnancies are those with higher
levels of poverty. These are predominately in
Weston-super-Mare, with a concentration in
Central and South Wards.
Figure 5 Under 18 conception rolling quarterly rates in North Somerset,
South West and England (1999 – 2010)
Source: Office of National Statistics (ONS) conception statistics.
17
Department of Health. Teenage Pregnancy research programme briefing. Long-term consequences of teenage
births for Parents and their Children. March 2004.
18

Director of Public Health Annual Report 2011
Sarah’s Story
Sarah (not her real name) suffered a
miscarriage at the age of 15. Her
pregnancy was unplanned but Sarah
wanted to get pregnant again. She was
struggling at school and had no
aspirations for the future.
Sarah was seen by the outreach nurse
at school who identified that both
Sarah and boyfriend Paul were
struggling emotionally to come to
terms with the loss of the baby. They
explored where Sarah wanted to be in
five years time and looked at scenarios
where Sarah became a teenage mum
and ones where she did not.
Contraception was discussed and the
nurse explained to Sarah that having
reliable contraception in place would
allow her to be more in control about
decisions affecting her future. The
nurse helped Sarah to arrange access
to an appointment at her GP practice
to get a contraceptive injection.
Sarah was referred to a young person’s
counselling service to help her deal
with her grief and to a Connexions
worker to discuss options for her
future. Paul agreed to a referral to the
local Boys and Young Men’s worker for
support.
The nurse made several follow up visits
and phone calls. After discharge Sarah’s
feedback expressed how she would
have been pregnant again without
outreach support to help her make
appropriate decisions and to get
contraception.
19

Director of Public Health Annual Report 2011
In 2009, there were 123 teenage pregnancies
in those under the age of 18 in North
Somerset. Of these, 53% resulted in a
termination of pregnancy. The number of
pregnancies in those aged under 16 is small,
averaging 20 a year between 2006 and 2008.
Approximately two thirds of these
pregnancies were terminated.
In North Somerset approximately 69% of
teenage parents known to Connexions (an
advice service for 13-19 years olds) are not in
education, training or employment 18 .
What are we doing about it?
Preventing teenage pregnancies not only
results in better outcomes for young people
and their children, it also saves money. It is
estimated that every £1 spent on a teenage
pregnancy strategy saves £4 in the long term.
North Somerset has an action plan which sets
out how teenage pregnancies will be reduced
locally. The plan draws on evidence of what
works, and co-ordinates actions across North
Somerset Council, the local NHS and other
organisations. Action to reduce teenage
pregnancy is also recognised in the local Child
Poverty Strategy. Specific actions to reduce
teenage pregnancy in North Somerset include:
● An award winning teenage health service
‘No Worries! Teenage Health’, providing
advice and contraception to young people
including an outreach ‘clinic in a box’
service;
● LUSH - a targeted sex and relationship
programme for vulnerable young people in
areas of high teenage pregnancy which
aims to raise young people’s self esteem
and reduce risk taking behaviour;
● Intensive health visitor support for teenage
parents in Weston-super-Mare.
Reducing teenage pregnancy will only be
possible if action is also taken to address the
underlying factors, such as poverty,
educational underachievement, low
aspirations and lack of engagement in
learning after the age of 16.
Continued provision of good sex and
relationship education in and out of
educational settings is also essential. The
amount and quality of sex and relationship
education currently delivered in educational
settings such as schools is unclear. There is
also uncertainty about the impact of funding
cuts to services which currently contribute to
reducing teenage conceptions.
Understanding the risks: Poverty
Teenage pregnancy rates nationally and in
North Somerset are closely linked to levels
of poverty. Although levels of deprivation
in North Somerset are generally low, some
areas experience very high levels of
deprivation. According to a national measure
of deprivation, the Indices of Multiple
Deprivation 2010, Weston-super-Mare has
areas in Central and South Ward in the 10%
most deprived nationally. Some areas in South
Ward are now in the 1% most deprived. We
need to tackle poverty as part of our overall
action plan if we are to reduce teenage
pregnancy.
18
Connexions: Raising the Participation Age report July 2011
20

Director of Public Health Annual Report 2011
Anna’s Story
Anna (not her real name) was 16 when
she started using cocaine and cannabis.
Within months she was homeless,
pregnant and had begun to work as a
sex worker to feed her drug habit.
Anna referred herself to the Substance
Advice Service and she was offered one
to one specialist drug and alcohol
support.
Anna was scared and found it hard to
trust people but eventually she began
to trust the staff. Part of her care plan
involved a referral to North Somerset
Housing. She was also supported to
access the Pregnancy Advice Service
and the WISH (Weston Integrated
Sexual Health) Centre.
At the WISH Centre, Anna received
a full sexually transmitted infection
screen and was given information
about a service in Bristol that works
with sex workers. They also gave her
information about her pregnancy
options and supported her with her
decision. Anna has now moved home
with her parents and is attending
college.
21

Director of Public Health Annual Report 2011
Chapter 5
Sexual Assault
What is the problem?
Sexual assault can cause severe and long term
harm to individuals. Immediate health risks
include pregnancy, sexually transmitted
infections, injury and psychological
problems 19 . In the long-term victims have an
increased risk of a number of health
conditions including depression, drug misuse,
self-harm and suicide. Each adult rape is
estimated to cost society over £96,000 from
time off work, and costs to the NHS and
criminal justice system.
5
In 2010/11, there were 131 sexual offences
reported to the police by people living in
North Somerset. Of those, 23 were for rape.
This compares to 123 sexual offences and 32
rapes reported in 2009/10. The rate of police
recorded rape in North Somerset (21.6 per
100,000 women) was significantly below the
England average (53.1 per 100,000 women) in
2010/11.
Despite progress in recent years, national
estimates suggest that up to nine in ten rapes
go unreported and 38% of serious sexual
19
The Government Response to the Stern Review. An independent review into how rape complaints are handled
by public authorities in England and Wales. Cabinet Office, March 2011.
22

Director of Public Health Annual Report 2011
assault victims tell no one about their
experience 20 . In serious sexual assaults in
women aged over 16, 54% were assaulted
by a current or ex-partner with 36% of cases
involving alcohol and 9% drugs.
What are we doing about it?
Victims are much more likely to take positive
steps to recovery when given appropriate
support. Sexual Assault Referral Centres
(SARCs) were established to promote recovery
and health following a rape or sexual assault,
whether or not victims wish to report to the
police. A Sexual Assault Referral Centre
provides specialist clinical care to victims,
forensic examination, counselling (up to ten
sessions), and support through the criminal
justice system.
In North Somerset the local Sexual Assault
Referral Centre is provided by The Bridge
based in central Bristol. In 2010/11, it
supported 40 clients from North Somerset,
30 of whom received forensic medical
examinations and counselling. The number
of clients seen in the Sexual Assault Referral
Centre is well below the number of reported
sexual offences. Efforts are being made to
reach more women with a marketing
campaign run by The Bridge with GP practices
in North Somerset. In addition, an outreach
service has been established to provide
counselling sessions in Nailsea since June
2011. The outreach counsellor sees five clients
per week. However, due to the high level of
under-reporting there could be as many as
ten times this number of people needing
support in North Somerset.
The Home Office and Department of Health
have made it a priority to increase specialist
service provision. Their proposed objective is
to ensure that every victim of serious sexual
assault in England (and Wales) should have
access to a Sexual Assault Referral Centre as
part of a co-ordinated community response.
Avon and Somerset Police run awareness
campaigns to prevent sexual assaults and rape
across the area.
Planning for the Future
The Government’s White Paper on public
health, ‘Healthy Lives, Healthy People’,
published in 2010, highlights sexual health
as a priority area 21 . The paper describes the
Government’s vision of an integrated model
of sexual health service delivery, with services
being confidential and non-judgmental.
North Somerset is developing a sexual health
strategy that mirrors this vision.
Historically, local sexual health services such
as contraception, sexually transmitted
infections, abortions and health promotion
have been provided in different places. An
integrated service means that these different
services are provided in one place, with
referrals made only for specialist care. This
makes it easier for patients to access services,
is more cost effective and improves overall
sexual health outcomes.
20
Kevin Smith (Ed.), Kathryn Coleman, Simon Eder and Philip Hall: Homicides, Firearm Offences and Intimate
Violence 2009/10 Supplementary Volume 2 to Crime in England and Wales 2009/10, Home Office, January 2011.
21 Department of Health. Healthy Lives Healthy People White Paper. Our Strategy for public health in England.
November 2010.
23

Director of Public Health Annual Report 2011
North Somerset has already established an
integrated sexual health service based at
Weston Hospital, the Integrated Sexual
Health Centre (WISH) Centre. It is one of only
a few integrated services across the South
West.
It is important that both professionals and the
public understand what is provided at the
Weston Integrated Sexual Health (WISH)
Centre and other sexual health services.
Figure 6 set out below illustrates which of the
three levels of sexual health service is
available from each service.
To make it easier for people with uncompli -
cated needs to access services closer to home
or work, we aim to increase contraception
and sexual health provision in community
settings and GP practices. We plan to provide
new community services providing an
integrated level one or two services (see
Figure 6). Over time this will result in fewer
inappropriate referrals to specialist services
such as the Weston Integrated Sexual Health
(WISH) Centre allowing these services more
time to see complex cases, develop a medical
termination service, and provide outreach
services to vulnerable groups.
General Practice
We are currently working with GPs to review
levels of sexual health service they provide,
Figure 6 North Somerset Commissioning Model
Specialised Services
e.g. WISH Centre
Level 3
• Investigation and management
of complex STIs and HIV
• Complex contraception
• Termination of pregnancy
Patient Access
Level 2
Level 1
• Provision of Long-Acting
Reversible Contraceptives
(LARC)
• Testing and treatment of
symptomatic STI’s
• Oral contraception
and emergency
hormonal
contraception
• Condoms and
pregnancy testing
Community Services (including
general practice and pharmacies)
• Asymptomatic
testing and
treatment
24

Director of Public Health Annual Report 2011
and to identify ways to increase level one and
two provision. Research has shown that more
people have, or would, consult their GP about
contraception or sexual health in preference
to other health care providers. For around
80% of women, GPs are the preferred
providers of contraception.
Pharmacy
The role of pharmacists as providers of
contraception and sexual health advice and
services has broadened over the last decade.
An increasing number of pharmacies have
been commissioned to prescribe emergency
hormonal contraception and to provide
chlamydia screening and treatment. We will
work with our local pharmacies to assess
future opportunities for broadening the
sexual health provision they provide.
Review of our performance
In March 2011, North Somerset took part in a
peer review to assess the effectiveness of local
sexual health services. We were visited by a
team of 11 professionals involved in sexual
health services across the South West. The
peer review team consisted of doctors, nurses
and managers who met those involved in
commissioning and providing sexual health
services locally.
The review team’s final report was published
in July 2011 and gave praise to the strategic
approach taken by the many organisations
concerned with sexual health in North
Somerset. The report recognised the
commitment locally to providing frontline
services for young people and the desire to
engage young people on their terms to
encourage ownership of sexual health
services. It recognised strong executive and
commissioning leadership, with a clear
commitment to improving sexual health
outcomes and commended the leadership
shown through the Weston Integrated Sexual
Health (WISH) Centre.
The report set out a number of recommend -
ations which have since been included within
the North Somerset Sexual Health and HIV
delivery plan 22 . The review team suggested
that further improvements could be made by
providing a medical abortion service within
North Somerset and further strengthening
services at the Weston Integrated Sexual
Health (WISH) Centre and within GP practices.
22 Available at http://www.northsomerset.nhs.uk/Publications/meetings/PCT_Board_Meetings/2011/July/10%
20sexual%20health%20%20appendix%204%20delivery%20plan%202010%20-%2011.doc
25

Director of Public Health Annual Report 2011
Director of Public
Health Annual Report 2010
Recommendations – Update
Recommendation from 2010
1. Maintain a strategic commitment
and focussed approach to reduce
health inequalities across North
Somerset, supported by local plans
detailing the short, medium and
long term actions to tackle the
underlying determinants of health.
Action: North Somerset
Partnership, NHS
and Local Authority
2. Understand and monitor the
contributions of NHS and partner
agencies in reducing health
inequalities, through regular
reviews of local action plans.
Action: North Somerset
Partnership
3. Assess the impact on health
inequalities on any service redesign
or disinvestments.
Action: NHS, Local Authority and
other local organisations
4. Undertake specific work through
the Joint Strategic Needs
Assessment to assess the health
needs of ‘hidden and vulnerable
populations’ at risk of poor health.
Action: NHS and Local Authority
and Voluntary sector
2011 Update
The North Somerset Partnership has established a
multi-agency North Somerset People and
Communities Board. This group will take on the
functions of a local health and wellbeing board as
required in the draft Health and Social Care Bill 2011.
The Board has agreed as a key priority for its work to
improve health outcomes and reduce health
inequalities. Actions to reduce health inequalities
across North Somerset will be reflected in its future
strategy and work plan.
Recommendations from the Health Inequalities
National Support Team have been shared with
relevant lead partnership groups to incorporate
in their work programmes. A Health Inequalities
Coordinating Group has been established which
will oversee the implementation of these
recommendations.
Equality impact assessments have been undertaken
as part of North Somerset Council’s Medium Term
Financial Plan and impacts on health inequalities
considered by NHS North Somerset as part of their
ongoing commissioning processes.
Gypsies and travellers have some of the poorest
health outcomes of any community. A health needs
assessment for this group is underway, with
colleagues across the West of England. A further
needs assessment is planned to consider needs of
people with mental health problems.
26

Director of Public Health Annual Report 2011
Recommendation from 2010
5. Ensure all front line staff are trained
and provided with opportunities to
undertake preventive work in high
risk groups.
Action: NHS, Local Authority,
Community and Voluntary
sector
2011 Update
NHS North Somerset has developed an electronic
brief intervention training programme which will be
cascaded to staff working directly with members of
the public and patients seeking to change their
behaviour to lead healthier lifestyles.
6. Improve early diagnosis and
treatment of circulatory diseases
and cancer, including increasing
uptake of Health Checks with high
risk groups.
Action: NHS, Local Authority
and Community and
Voluntary sector
A health equity audit of Coronary Heart Disease in
North Somerset has been undertaken, to identify the
extent of health inequalities and to inform work to
reduce health inequalities. The audit highlights the
importance of early diagnosis and treatment for
patients in the most deprived areas of North
Somerset. The recommendations will be discussed
with North Somerset General Practitioners in late
2011 and an action plan developed.
The NHS Health Checks programme is designed to
identify risk factors for major causes of premature
death, and offer advice, treatment and referral to
reduce the risks and improve health. The way these
checks are delivered to eligible patients aged 40 to
74 in North Somerset has been reviewed this year. A
revised Locally Enhanced Service will be offered to
general practices by the end of the year to improve
take up.
7. Work with GPs and the new GP
commissioning groups to identify
systematic ways to address local
health inequalities within primary
care.
Action: NHS and Local Authority
The NHS North Somerset Public Health Directorate
has grouped all general practices across North
Somerset into four taxonomy groups based on similar
characteristics, such as age and deprivation. During
2011, half of all GPs in these groups attended a series
of sessions led by public health on understanding the
health needs of North Somerset. GPs in each
taxonomy group have identified their commissioning
priorities to improve health for North Somerset, their
taxonomy group and to reduce health inequalities in
North Somerset.
27

Director of Public Health Annual Report 2011
Recommendation from 2010
8. Work with local communities and
the voluntary sector to develop
their capacity and capability to
reduce inequalities in health.
Action: North Somerset
Partnership, NHS and Local
Authority
2011 Update
Over the past year, a small team of Health Trainers
has been recruited by NHS North Somerset and the
For All Healthy Living Centre to work directly with
people living in areas of Weston- super-Mare. Their
role is to provide tailored one to one support to
anyone who wants lifestyle advice or signposting on
issues such as quitting smoking, exercise and sensible
drinking. The service is available through the Health
Shop, Health Central, in the centre of Weston super-
Mare and the For All Healthy Living Centre in
Weston-super-Mare South Ward.
NHS North Somerset and North Somerset Council
continue to provide support to the For All Healthy
Living Centre to strengthen its capacity and capability
to tackle local inequalities in health.
Working together, North Somerset Council and NHS
North Somerset have recruited 100 volunteer health
walk leaders from across North Somerset to be
trained to lead health walks.
28

Director of Public Health Annual Report 2011
Notes
29

Making North
Somerset
Healthier