Transcript

I haven't received any apologies. Has anyone got any apologies to anyone else? No apologies, just other than that I'm going to be on phone with camera off because I'm going to be driving for the next 15-20 minutes. Thank you, thank you, drive safely, thank you, the joys of trying to get children to locations. Absolutely. So it enderites them too, any declarations of interest, members are also required any discloseable, the cuteness or affected interest and the nature of that interest, as listed in the agenda item. So I know all around, excellent. So, as we all know at the overview in the screen to me, our first review was accepted to go ahead, which is excellent, so that is going to be the sexual health review. And the reason for the review is the test of sexual health service provisions was sufficient to meet the needs of young people in the borough with a particular focus on how people access the services. So the key areas that we're going to test is access to sexual health clinics, identify reasons for issues with access with a focus of those aged under 25, access to protective contraception, identify reasons for any issues in access with a focus of those under 25. Is engagement with aged and black and white other women regarding access to contraception advice and services sufficient in the borough? What does the PHSE provision in schools cover regarding sexual health? Is information provides about how young people can access local services? And spending money, what impact can improvements to sexual health services have on wider local authority budgets? And also, we have to understand the viewpoints of young people in the borough with regards to the sexual health provision. And how are we going to go about this? Well, over the next week, we're going to be doing scene setting meeting and review of public health data. We're going to use the involvement of young health champions. We're going to do a desktop review of school relationships and sex education, RSE policies and review analysis of SAIT sex barks your website, focus on access and provision of services and mystery shopper exercising, contacting visiting services to gain first-hand understanding of sexual health services. And then we're also going to interview other local authorities to see how they're doing and what we can learn from them. Does anyone have any questions? Congratulations. Nobody has any questions? I will move on, though, brilliant. So my invite Councillor Rites to speak at this point. Thank you very much, Councillor Agustin. So I'm the executive member for health, and I suppose my first sort of exposure to the sexual health services in Bratton or was that letter, that email that we all got sent, and was sent to a couple of journalists as well. So it was quite a rude awakening to say the least, and obviously that prompted me to ask quite a few questions about what was going on in the sexual health provision. And so very quickly, I became friends with Bex, who gave us quite a few updates. And in doing so, I was able to visit the goals and clinic and slough and speak to the people who are managing the contract from the NHS point of view, so from the HFT. And we also have, at the same time, we had the emerging issue of youth services providing contraception, providing access to contraception in schools, being a service that wasn't really separate to what was going on with regards to this current contract with the forest, the clinic garden clinic, and because of issues there, this came to light because the doctor who was currently working on that, working on that provision was about to leave. And it was only really that it came to light there that this wasn't really being supervised by it, or wasn't having adequate supervision by public health at Bratton or Forest. So we have a situation now, which I'm sure is why you've called this review about looking at what are we providing for young people? Is it good enough? Are we either any gaps there? You know, we have had to stop a service that's going to schools and for very valid reasons, but at the same time, it's not ideal to stop a service without a plan for how you're going to replace it. So I'm really glad that you've called this review. I think it's the right thing to do, and I'm glad that you've been quick about it. And it would be great to kind of have a quick response from this so that we make sure that we are providing adequate services for everyone in the borough, and especially the under-25s, because I feel it could potentially be a real risk for young women not being able to access adequate family planning services, as well as the other prevention of STDs and awareness there. Becca Woolens has done a fantastic presentation. I'll hand over to her. Unless there's anything else I need to say right to that? Is there anything I've missed out? No, thank you very much. Yeah. OK. Tony's got his hand up, I think. Tony, Councillor Beggo. Would you like to hear? Sorry, Councillor Beggo. Yes, please. Becca, what is the cost, have we got costs on what we're paying to this company that's supplying it? That would be my first point. And is there a proper contract that the committee can see and read with the original, you know, the original installation of the company, a company of the word? But can we read something in what we're paying for this company to actually do? I don't know. I've not seen the audience. There's two things here, because we've got the contract for the supply of the actual medical, sorry, the supply of the actual medicine, so that's the long-acting contraceptive, and also the emergency hormonal contraception. And then we also have the contract for the actual provision of the services, so the sexual health workers, the clinics, et cetera. Becca, are you able to give summaries of those costs? Yeah, I'd have to pull them up on my screen, but I can get those for you. In terms of the committee being able to have access to a breakdown of what we've paid in the previous financial year and projections for next financial year, I can supply that. And also I can supply the-- we call them service specifications, so that's what the provider has to work to. So we have Berkshire Healthcare Foundation Trust who provide the bulk of the sexual reproductive health services. We have some pharmacies who provide what we call the emergency hormonal contraception service, which is just targeted at young people, so people aged 13 to 24. And then we have the long-acting reversible contraception, which local GPs provide, so I can provide the service specifications for those three different services and the underpinning contract. All right, can I ask a further question, Caroline? Yes, go ahead, Councillor Beggo. Rebecca, just following on for that, obviously some of the complaints that we had with the service were that it wasn't very accessible to people because the number of days, in fact day, I think, it was open to the public, to the residents, was about one or maybe two, which seemed to me totally unacceptable, to be honest, and I wondered if this was on the original contracts that Brackmore, you know, under Dale, actually, I suppose, let's be honest here, under Dale Burch signed with the company, or whether that's just transposed that way. So the contract that Berkshire Healthcare are currently working to, which ends at the end of June, doesn't specify the number of days of a week or the specific opening hours that they need to provide the services for. They deliver under what's called a block contract, so they have to deliver a wide range of provision and within the budget envelope that we give them, they have to work out what's financially feasible in terms of the number of clinical sites they're able to open and how the staff, because they have a small number of staff that operate across those sites. So with the new service specification we're moving to, we have asked that they review the number of sites. We've also asked that they review the online provision because although online access isn't suitable or appropriate for everyone, what we saw within Bracknell Forest, indeed mirroring national trends during and ever since the pandemic is a public preference for online sexually transmitted infection testing, so it's been recognised, that's sort of a necessary part of the service model. And what it means in terms of what you're getting at, which is sort of physical access for patients who need that, the idea is those patients who don't need to walk into a clinic face to face and who are happy to go online can do so. And that should mean more provision for those patients who want to or need to face to face access. So we're still working on that with BHFT at the moment to look at what provision specifically in the three boroughs covered by this contract will get from the 1st of July of this year. Bracknell, you see, the thing that worries me with what you just said is that it's all based on internet and not on personal communication. From my experience, people that have a sexual problem, not necessarily pregnancy, but a sexual problem, men and women, for that matter, boys and girls, need to go to see someone to talk about it and they find it terribly embarrassing that they've got it, right, and they don't know who to turn to. And the sexual clinic at the garden clinic at Slough is a pretty good provision, actually. And it does that. It exactly does that. I think if we move completely, which I certainly wouldn't be in favour of, are moving completely to the internet, I think it defeats the object of a personal communication between the patient and the clinician. And it worries me enormously that we go into a contract and we don't even state the number of days that that clinic would be open. I find that absolutely amazing, to be honest. I just think, why would I do that? I wouldn't leave it to Berkshire to tell us, Oh, you can only have it one day. I'm sorry, I'm being a bit forward here, but I just think that is not a good value for money for the residents of this borough. It's that's right. Sorry, Caroline. That's okay. This is why we're having the review. We've got to, obviously, we're paying money for something that we might not be getting the best service for. So that is what we need to gather the evidence at BEX, but for I hand over to Councillor Harrison, what is the timeline from say somebody who wants to see somebody face-to-face? How long is it taking before they actually see somebody in or outside of the borough, if they have to go to slough or whatever else? Yes, so within two days, that's our key performance indicator, and the service delivered about 98%, so 98% of people who need to be seen as seen within two days of contact in the service. Thank you. Councillor Harrison. Yes, thanks, Caroline. The question I want to do, I'm actually quite surprised because the email that we had, the complaint that we all had, I think, was the first that I've had in about 25 years, but then I'm not actually that surprised. If you come back to that sort of issues, Tony was talking about, there's an embarrassment factor there, and I think that's probably why if there is dissatisfaction with the service, people are unlikely to be approaching us as Councillors, you're not going to go to your local accounts and say, I've got a sexual problem that needs attention, so we've got an issue that it's going to be difficult for us to get hold of the truth about what's going on and how people's experience is, and does anybody have any ideas about how we can get that information from the users in a way that doesn't embarrass them? Under the disagree with Tony about people not wanting to use the internet, I think that's the ideal for talking about something you're embarrassed about, you really, I don't think people would want to go and see somebody in person. They'd probably rather initiate the contact over a chat, a chat forum or something like that, and then be given the things that they can do, but they don't need to be options. Councillor Welsh. Yes, so I actually took a phone call from the resident who sent the letter, and obviously the one day a week was a big concern, but they were more concerned about the amount of the online tests that could be sent out, as in if we were to increase that, I think they would be happier with that in the meantime, until we can find better solutions further on, and I do agree to a certain extent, people like to be seen face to face, but if it is embarrassing, I think they will like to go online and just have a test sent out to them in that manner, and I'd also like to know really what is done on social media, because if we're looking at younger people under 25 who use a lot of social media, and what is being done in that arena really, for them to see what they can access, would you let me to respond to that? Sure, so with regard to social media, we previously had a public health communications team, and they did do a lot of promotion, particularly with the Safe Sex Berkshire website and any national campaigns, that team were no longer funded from last year due to insufficient budget, basically, but we do still work with BHFTs, sorry, with the Brownell Forest comms team and the other comms team, communications teams in the borough for things like HIV testing week that we might want to promote. We're currently working with colleagues in Berkshire West, so the local authorities in the other half of Berkshire, because they also fund the Safe Sex Berkshire website, and we are scoping a review of that at the moment, because that hasn't been reviewed, particularly since the, again, since the pandemic, so although we anticipate, I've had my own staff look at things like making sure the links work, what we do know based on our analysis of it is most people accessing our local sites, Safe Sex Berkshire, we're going there specifically to access the pages about service provision, specifically most often using a mobile phone and looking to get STI testing, and so what we've said to the organisation that we commissioned to run the website, Reading Web Services, is we really need to look at what the best product is for local people, because there are other websites that we might want to sign them, post them to as a local authority, I think I previously gave the example of Rook as a website that is designed for young people where they have far more resource than I think the local authority could ever invest to really keep an up-to-date website that's got really good functionality, so it's not saying we won't do anything locally, but we need to acknowledge what people want in terms of a local online provision, and also what we recognise as good quality trustworthy sources, we just did some focus groups with young people in Brighton and Forest, and something they flagged was that anything that's got the word sexon is often blocked on their school computers, and also they said you know if my mum's checking my phone or they've put parental blocks, anything with certain keywords in it's going to get blocked or they won't look, so it's those kind of things we really need to explore, what do people need us to do locally that complements the national provision, so that's answered what you were asking about, Councillor Weltz. I think you may show it at online STI testing as well, I'm sorry, should I speak to that too? Sorry, I didn't know who he's at, I mean I'm just here to introduce Bex, but what I was going to say is Bex has prepared a presentation, I don't know if you guys have seen it, but it is quite long, but I just wonder if it might be worth it, because I think it might be worth pulling out from there some of the things about you know how we compare to other boroughs, there's some things in there which I think you might find quite useful and interesting, so I don't know if she wants to present that, I mean I'll leave that up to you, Councillor Egleston, and whether or not you as the panel want to say it, but it might just give you a bit more of an idea of the context. Yes, I think that's going to be a really good idea Bex, because it refreshes us and we know, because we're now about to start, it gives everyone their complete focus. Can I ask a quick question before we start? In schools, do they have anything like a school nurse who goes in anymore? Do they have a go-to person for those who haven't got like the modern technology or? Yes, so the local authority commission of the school nursing services part of the not-19s contract, which my team don't manage, but there are school nurses on site at schools, and I could certainly ask Hema, who's your deputy director of public health, whose team are responsible for that contract to make sure that that's supplied as part of this review as well, so you can see what's within the school nursing contract. The schools are legally required now, both at primary and secondary school level to provide relationships education and in secondary school sexual health education. Apologies as this isn't my own expertise, but my understanding is that the relationship local authorities have now with schools is quite different since the introduction of the academy type model, so the extent to which black and forest councils are able to kind of influence what the schools do in terms of delivering on their statutory responsibility. I genuinely don't know, but that's personally when I was working with democratic services, I said I think it would be quite helpful for us to understand as a local partner how the local authority in schools might work together to make sure that is good quality. Thank you. Could you present your slides, please, Becks? Sure, and acknowledging they are, there's a lot of content, but I'll just whip through them, there's a lot of visuals, so. Do you let me know? Is that displaying? Would it be helpful if I presented them and you just said next slide, please? Yes, happy for you to do that. I know it's hard to see when people have got their hands up, so let them go. All right, can you see this guys? No. Not yet, okay, hold on one second. Is that it? Can you see it now? Yeah, it's over here, right, so it's on the wrong screen. A different screen, that's usually the... Yeah, I thought I'd be helpful. I'll just ask that one. Right, you should see it now, yeah? Yes, sorry, right, and then just shout next slide when you're ready. Thank you. Okay, so this is the only the second slide, the first one was an introductory slide, so I presented this at the previous overview and scrutiny committee attended, this is just a run through of the services currently commissioned in Bracknell Forest and across Berkshire East to provide sexual health care, so Berkshire Healthcare Foundation Trust have the main contract, which you'll find in other areas, you tend to have one major specialist integrated sexual health provider who can provide all levels of sexual health provisions, that means even the most complex care for things like complicated intrauterine device fits or people with recurrent sexually transmitted infections, they need to be seen by that specialist service and they can also see everyone else below that hyper specialist level. They subcontract currently an organization called SH24, who provide the home STI test kits and as part of the new service specification, they're reviewing that service specification and the provisions to make sure the quality and the supply is better matched to demand. In Bracknell Forest, you currently have eight of your 11 general practices providing the long-acting reversible contraception, nationally NHS, commission all GPs to provide advice about contraception and access to most forms of contraception, it's just when public health spits out of the NHS for some reason, they put LARC with local authorities, so that's why we just commissioned that bit. We have a varying range of pharmacies year on year who want to sign up to the emergency hormonal contraception, there was only really one really active in that in 2022/2023. People can purchase EHC from any pharmacy, but the reason there is a national service specification for those aged 13 to 24 is it's firstly recognised, many of that age group won't purchase it, they probably can't, but also because it's really important to make sure the pharmacy does more than just supply them with the EHC, that they also offer some safeguarding so they will speak to the young person, assess the things like risk of child sexual exploitation and they'll also offer them some sexual health promotion advice advice about contraception. We are anticipating, and again, this is what I said last time, there is now nationally an NHS oral contraceptive specification, I know four pharmacies in Bracknell Forest have signed up to that, and that we're expecting more will basically be interested in the EHC and also be able to provide an ongoing supply of contraception, so I anticipate our pharmacy offer should improve, and then the safe sex bar, and then the other ones aren't particularly relevant to this review, so next slide please, Councillor Wright. So I thought it is useful possibly as part of a review and scrutiny process to understand the things that are going well, so that the focus on what's not going to be informed by that too, so next slide please. So the first thing just in general across the whole population is that with regard to sexually transmitted infections, if your eyes drawn to that diagram, the orange line reflects the positivity rate, so that's the proportion of sexually transmitted infection tests Bracknell Forest residents have requested, they've come back positive, and what you can see is that since the pandemic we've seen a reduction in the numbers that are coming back positive, so it could suggest lower rates of sexually transmitted infections circulating, although we did have an increase just before the pandemic. The blue line shows our STI testing rate, so as we saw nationally we did see a slight dip during the pandemic in terms of the number of people requesting tests, but it looks like we're recovering beyond post-pandemic levels, and again that's trained in terms of increasing demand for STI testing, we're seeing nationally, it basically means that people are more informed and feeling better able to go and get an STI test should they think they might be at risk, so that's a good news story, and it's also good news because that's coinciding with us actually seeing fewer people who've had a testing positive for that. Bracknell Forest's positivity rates are significantly lower than the national rate and in line with local authorities with a similar level of deprivation, it's fine to be on this side Councillor Rite. In terms of HIV testing, we can move to the HIV testing one, that's fine, thank you. Prevalence and pre-exposure prophylaxis, if you look at the diagram basically, if there's a green dot it means that Bracknell Forest are performing statistically significantly better than local authorities in a similar area, similar level of deprivation. The reason that's important is that we tend to see HIV and demand for PrEP more aligned with deprivation, so that's a better comparator than national. So broadly we're performing really well in terms of lots of people coming forward for HIV testing across different protected characteristics groups. We also perform much better in terms of having a low or in the recent data reporting period of zero, HIV late diagnosis among heterosexual and bisexual women who were first diagnosed in the UK. Bracknell Forest has a much lower HIV prevalence rate compared to other areas similar to Bracknell Forest. And the little blue dot at the bottom is an indicator where you're not necessarily performing better or worse, it shows whether you're higher or lower. So we have a higher proportion of people who need pre-exposure prophylaxis, axing that and initiating it. So they all are good news stories for HIV. Next slide please. For long-acting reversible contraception, our prescription rates for LARC are higher than national rates, but slightly lower than the comparator deprivation decile rates, so again compared to similar local authorities, slightly lower but not significantly lower. But there is good geographic coverage, so of the 8GPs who provide LARC in the area, if you see a little white blob on that purple map to the right-hand side of my screen, that represents a GP practice who are offering LARC and where there's a little green circle, that means there's two quite close. And the darker purple areas on the map represent more highly densely populated areas. So broadly we have a lot of GP practices signed up to this and they are located where we've got more people living. If you look just on the border of Bracknell to the east near Ascot, there is a GP practice in Windsor and Maidenhead just on that border, so again recognizing the high population density there, there is a GP practice offering LARC near to those people too. And our rate of LARC prescribing, this is just to show that again we have seen an increase since the pandemic, so we're starting to see increasing numbers of women coming forward for that service again. Thank you. Next slide please. For under 18 conceptions, which is one of the main indicators we use to look at sexual health among young people, in Bracknell Forest, the rate of conceptions among people under 18 has been lower than the national average since the late 1990s, and it's been lower than the regional average since 2004. Deprivation is a really important factor associated with when young people first have sex, and when they first have sex is highly associated with the risk of teenage pregnancy, and Bracknell Forest performs better than most of the local authorities in a similar level of affluence. So the next couple of slides just show diagrams to back up what I've said there, so next slide please. So the darker, sorry, one back Councillor right, there we go. So the line graph at the top, the darkest green line at the bottom shows under 18 conceptions rates in Bracknell Forest, so you'll see what I've just said about as being lower for quite some period of time compared to southeast region in England, and similarly for under 18 conceptions rates, and the under 18 births rate, under 16 conceptions rate, the reason it's not a continued line is the numbers are so low, we don't have enough data points to map that. Next slide please. And then here is Bracknell Forest under 18 conceptions rate per 1,000 women in 16 similar local authorities, so you'll see Bracknell Forest is right down the bottom there, and the green means that we're statistically significantly have lower and under 18 conceptions compared to local authorities with a similar level of affluence. Next slide please. The other thing we know locally is that we have quite high uptake, relatively speaking, of contraception among young people in general practice, so we know nationally across all age groups, about 70% of women choose to go to their GP for contraception, generally because they're a trusted source, they can offer a broad range of advice on contraception, and they can offer all forms of contraception outside of a specialist setting, and there aren't many other providers in any other areas in the country that can do that. In Bracknell data suggests young people are finding that one of the acceptable ways of getting their contraception, so Bracknell Forest you'll see as the top line, if we compare that to firmly integrated care system geography, 2% 10 to 14-year-olds, 29% 15 to 19-year-olds, and 55%, and you can see across all of those age groups, relatively larger proportion of young people are going to their GP compared to Windsor Maidenhead, which is fairly similar in terms of level of affluence and also the friendly average. Next slide please. Regarding a specialist sexual health service, which we currently have BHFT for until June 2026, in the last five years the service has performed well against its current contract against its key performance indicators, so when I was asked earlier about things like the proportion of patients seeing quickly, that's the sort of thing we have a key performance indicator for, and generally they perform really well across all of those, and I acknowledge the point made earlier about the council not receiving complaints and possible reasons for people not wanting to complain about that, but the service themselves, so Berkshire Health Care Foundation Trust, haven't received any complaints directly, and we know, and I'll show you on the next slide, that most Bracknell residents choose to access the service from the local service provider, so if we go to the next slide I'll explain what I mean by that. So when it comes to what we call Genito urinary medicine or gum, and now often they're referred to as ISH because they're integrated sexual health, so both STI testing and treatment, and also contraceptive services, they're often combined, people can choose to access those anywhere in the country, national survey data suggests there are a myriad of factors that affect where people choose to go, so for example if you might not want to go somewhere close to home because it might be more convenient or more anonymous to go closer to where you work or study, so people may choose to travel actually further to access these sorts of services, if for some reason they don't want to be identified in their local area. What we've seen in recent years in terms of the, so the bar diagram you're looking at here shows percent, each column is shown the percentage of Bracknell Forest residents accessing those specialist sexual health services by the service provider, so in recent years you'll see a much higher proportion of people have chosen to go online, that increase during the pandemic and sustained in the most full reporting year we've got. People also choose largely to either use the garden clinic or in slough or skimper till in Bracknell Forest and also the Royal Berkshire site in Reading. There was a site commissioned I believe by Surrey County Council in Firmly Park Hospital, that doesn't provide those services anymore, but what we can see is well over 80% in recent years over 90% of Bracknell Forest residents are choosing to use the local commission services when they could choose to go to Surrey or other bordering local authority areas, so again for me this is a good news sort of story because if they weren't satisfied they might be choosing to vote with their feet and go further afield. Next slide please. So some areas for improvement or further exploration, next slide please. So we completed a health needs assessment last year, it's currently in draft but as soon as I've completed it it can be made available to this over you and screwed any committee, but some of the high level findings we identified, one was that although we're performing well for many of our HIV indicators we are below the national target for late HIV diagnosis as a whole and also we felt that access could be improved for some sub-populations, so for young people we picked up on the fact that we have lower chlamydia screening and detection rates and we were also conscious that in terms of a targeted provision for young people there wasn't that much available either through our specialist service but also because of the challenge of having pharmacies sign up or any other kind of service setting. Neurodiversity, that was something local professionals raised with us, it's unclear the extent to which it's affecting the population because the recording of neurodiversity and service tends to be poor but we've suggested some engagement work to understand what would look like good service access for our neurodiverse population on what our providers could do to improve that and then we picked up on differential access to contraception based on ethnicity with lower contraception in all settings by women of Asian and white other ethnicity and lower uptake in GP settings among women of black ethnicity. Now again although we know actually that could just be down to preference some people you know many pregnancies are ambivalent and some people may choose for various reasons not to access contraception we need to understand whether that is the case or whether yeah we need to understand that better. Next slide please. So regarding HIV-late diagnosis, Bracknell's late HIV diagnosis is significantly worse than the national target of having less than 25% of new diagnoses being late. Bracknell's historically performed worse and that is strongly influenced by the fact that Bracknell has a really low prevalence so a small number of new late diagnoses can significantly shift that percentage you know if we have seven HIV diagnosis in a three-year period it would only take a really small number to really sway how we look on that performance indicator. We also wear none of the 13 local authorities in a similar of deprivation are performing against that target and Bracknell has one of the lower absolute numbers of late HIV diagnosis in the most recent reporting period but regardless we recognize there is a need to take action to reduce late diagnosis if there is anything more we could do. So if we just see the next couple of slides, Councillor Wright please. So this one just shows what I've said about we've historically performed worse against the target for HIV-late diagnosis. Next slide please. This one shows how Bracknell fares compared to local authorities with a similar level of affluence. You can see the red basically means nearly all of them are performing significantly worse than the target but you can also see in the third column along where it says count. In the three-year period 2020 to 2022 we had seven late diagnoses. You can see as I say in terms of absolute numbers there are other similar local authorities in terms of affluence who fare worse in terms of the absolute numbers that translates to. Next slide please. So actions being taken already regardless of us to improve that. We have a small grants program for pre-exposure prophylaxis. We've recently commissioned a provider to work with high-risk communities to understand what's their awareness, beliefs and barriers to HIV testing and also access to pre-exposure prophylaxis if they're eligible for that. Recently as part of a national initiative so it's not a Bracknell Forest initiative. Local hospitals are now offering proactive HIV testing in accident and emergency settings. That's because it's been recognized that sometimes those not diagnosed in primary care might well be going through A&E. BHFT are auditing prep uptake so they're looking at those individuals who are eligible for prep and they're trying to understand why they're not taking up the offer of prep and they've also introduced opt-out HIV testing so rather than before they would say would you like a HIV test now they'll actively say as part of your STI screen will offer you a HIV test if you'd like to decline it can we ask you why and they record that. They've also introduced point-of-care testing to help those who have needle phobia so that's not a barrier and they've also BHFT have been successful in some grant funding to do some work with refugee and asylum seeker groups and we do know many of our HIV diagnoses are among people who are not from the UK recent migrants and so they're trying to reach out into those communities and finally HIV testings included as part of the basic online STI test kit screen locally to normalize testing and next slide please with regard to access to services for young people I won't go through all of this as I said earlier we know with our chlamydia screening and detection we need to improve and we also need to improve the number of settings young people can access services from so if we go to the next slide please this just shows that historically we have had a lower chlamydia detection rate again it's linked to the fact that Bratton was a more affluent area so there could genuinely be lower prevalence of chlamydia circulating so it might be something that actually we will always struggle to improve even with really good screening offer and next slide please and this one just backs up what I've just said really so again it's comparing Bratton forest to other local authorities with a similar level of affluence so although yes we want to be ambitious as a local authority and we do want to see increased detection rates and we're still fairing similarly to other similar local authority areas and next slide please so the things we're doing to explore and understand young people's access and improve it as I mentioned earlier we're holding focus groups with local young people to understand barriers to accessing both information and services for sexual health we've developed a questionnaire which I hope will be signed off to go out later this month to local young people to understand their preferences regarding settings for sexual health information and services we've been interviewing professionals who work with higher risk groups of young people to understand their views and also we're working closely with the integrated care board pharmacy commissioner and local pharmaceutical committee and local pharmacies to understand how they might look to improve their offer um signing up for our EHC service but also the oral contraception service I think I'm getting to the end of the slides here um yeah I don't think we need to cover this one this is effectively saying what I've said about neuro diversity that um we don't really understand what the barrier is there and finally access to contraception for women invasion black another ethnicity um it wasn't just that the contraceptive access is lower we know from from the integrated care board that um ethnicity is associated with poor and maternal and infant health outcomes locally um and so what the conversation we need to be having in partnership with our NHS colleagues is if women are choosing not to access contraception or do not want contraceptive services with the very least need to work with the NHS to provide what we call good preconception care so basically if a woman's not on contraception the things she could be doing should she become pregnant to try and make sure it's a healthy pregnancy um next slide please and this is the last one so these were just things in advance of today I was asked by Esther to recommend smears um us could look into so I've mentioned neuro diversity um contraception among certain ethnic minority communities and also as I mentioned earlier really keen to understand the quality of sexual health education in schools I thank you that's the end of my presentation thank you very much by throwing informative does anyone have any questions please Councillor Vair go thanks thank you very much um I just want to explore this a little bit um you mentioned that a lot of residents maybe I shouldn't use it a lot uh visit the garden room in slough would it be possible to get the number of um brat or forest residents that actually do go there or is that difficult to do you want me next I can give you the data that's publicly available on that I have a feeling that it's what we call throughput because um we obviously I think we get unique what we call unique attendances and repeat attendances but I can provide the committee within with the information that's publicly available the challenge we might have as you can anticipate with the sexual health services is is how open people have been in terms of identifying themselves but but certainly I can give you how brat and forest compares to some of the other local authority areas accessing that service I think what I'm trying to get at is people are using the garden room because they're not getting um you know direct facility from brat or forest because you're not open enough you're only open one day and the only way to do that is to go to the garden and just check but I think if I remember you don't have to give you a full name in the garden room do you so I don't know quite how that works so there might be you know record of that there's a there's a national um data set called gumcad that we use that's of the as accurate as we can get that will give us a sense of the the number of unique brat and forest residents that go there and the other thing to say about the the slough garden clinic site is that that is for what we call level three provisions so people who need to see a really specialist doctor who wouldn't be able to see for example they um although there is the site in brat and forest at skimp until it's open two days a week it might be that they've called the service and they've said actually for the type of um contraceptive fit you need or for the um you know due to your recurring STI you need to be seen by a specialist doctor and I think I'd advise the committee previously but again you'll pick this up through your review that specialist sexual health clinics are a bit you have to think of them a bit like um specialist cancer care services and others types of healthcare setting where you you're not guaranteed five days a week in every um in every borough and they tend to be modeled around a single hyperspecialist site and then and then what we call spokes um so some of what we're seeing in brat and forest I suppose is saying demand that perhaps is necessarily in the tier three setting but recognize the two days a week might be a barrier for some people who could otherwise be seen in in brat and or just have a supplementary um going back to the HIV problem backs um and the late diagnosis why do you think that is basically what's your what's your opinion um so based on the information we picked up in the health needs assessment I think partly for brachnol knowing that um you know we we only have to be careful we have to be careful what we can disclose publicly with this because as I say we're looking at seven diagnosis in a three-year period so it's a really small number of people um what we do know from from Berkshire Health Care Foundation trust who also provide the HIV treatment is a lot of those people are people who came who arrived in the UK within the last two or three years and so either as part of the entry to the UK perhaps haven't accessed health care perhaps they they've had other needs more pressing like accommodation um whatever else that might be and not familiar with our health care system so that's partly why bhft are doing this outreach work with refugee and asylum seeker populations the other thing um could just be some of the late diagnosis seen nationally are in older age groups people who wouldn't have thought they're at risk and haven't tested um which is why um it's so important that um we we normalise HIV testing through things like HIV testing week or if you have an STI test screen you're offered that as routine now so it's not seen as only if you're at risk anyone who thinks they need an STI test kits told you should have a HIV test and if you think you shouldn't can you tell us why so we can understand that so I think some of it's new entry to the UK and some of it's low risk groups who frankly will be really difficult to identify um but what you can do and what we are doing is to just normalise testing if anyone thinks they need an STI test of any sort can I just expand it sorry can I just one more thing and then I get back um if that if someone calls you um in the clinic and say that they're worried about something um obviously you would try and fix an appointment would you that would be the first thing um but would you also try and do that by um camera by um you know as we're doing now like teams um or the same system do you have that capability? So at the moment um I don't think BHFT have continued particularly with what we'd call telemedicine um but it's something again we've we've asked them to explore as part of this new service model so we would pick that up in triage but I suppose just to qualify when the committee originally asked us about STI testing online um a point I'd emphasise is that yes it's really important that people want who want to access the service their preference is to go online we need to acknowledge that but what we need to do is make sure that's a really good quality offer so they're not just getting multiple STI test kits and they're actually getting the consultation advice system yeah understand thanks Carol I'm sorry I was positive that's okay um I just wanted to follow up on that as well so if it is a language barrier what a BHFT doing then is there like a translator service for them and are they yeah how are they made aware of that currently? Um I don't know how BHFT are promoting the translator service um I know they work with uh local voluntary community sector community group to try and raise the profile of the service but I think that's something they've acknowledged they need to do better um so again a new aspect of the service specification I'll be working to from the 1st of July has increased um what we call outreach provision so what's covered in that is saying to them it's great to have these clinical sites but what we need to make sure you're doing is is reaching out more into those higher risk groups lovely and does that also mean they're working alongside faith groups to perhaps reach? I don't know if they're working also faith groups at the moment I don't believe they are and but that indeed could be part of what they do with the new service model from the 1st of July Thank you. Has anyone else got any questions? No thank you ever so much Bec that's much appreciated as always that's okay happy to help I've noted some actions and um I guess I drop off the call and let you have further discussion if or I can stay if you want me to whichever you choose Bec's is absolutely fine by us Okay thank you I'm happy to stay and listen just in case there's anything else I can pick up yeah absolutely so um thank you everyone and thanks Bec for that so what's going to happen now as I explained is we're going to be having discussions on obviously we need to start taking this forward now we need to present this in the July overview and scrutiny and so obviously we need to be finished this by the end of May and what we follow days and that coming up we need to sort of get a move on with it so the first thing we're going to do is work out different scenarios of people perhaps with about the Becs as well to help us with our mystery shopper as such so that would mean a difference or people counselors on this group who are happy to go along and see if they were almost like doing a role play on different scenarios um accessing as we said online um how would they find that from different if you were had problems with or you had neuro diversity or if you had a language barrier or you're trying to design quite secretly would that be achievable online if you wanted to go along and you knew it was at the Garden Clinic could you just walk in there are there any leaflets you could pick up are there any barcodes that you could scan where the Garden Clinic is in Bracknell so if we got in the group four volunteers who would like to do the mystery shopper part don't all shout at once so we've got Councillor Bergay thank you Sophie thank you Jerry anybody else and Sherice so that's our for the mystery shopper and what will happen is don't worry you will be given like a question sheet so although you'll all be doing something slightly different you'll all be asking the same questions so when it comes to reporting back you're not like devising report yourself you're just answering some questions so then we've got other parts of it that i'd love volunteers for at this point anyone would like to do the desktop review of the school relationships and sex education RSE and policies so Esther has kindly sent us the link um to where all these policies can be found and then we can see across Bracknell exactly how different each school and what each school is doing and perhaps because that could be one big issue if everyone's doing something different and they're not sign-posting to these services that sex and her team are trying to put in place so is there anyone who would like to take that part of the review on thank you Janet okay fine okay and who else was that who said they wanted to do it would you like to do that Sheila perfect yeah we'll do lovely is there anyone who hasn't got a role that would like one at this point Councillor Harrison is he still there you can't hide even if you can go on I am I am yeah I just want to try to find the button to switch the microphone back on that old chestnut um are you happy to um join in with the ladies on that one would you like to rephrase that so yeah so what is what I mean so that's the review and analysis well that's the sorry desktop review of school relationships and sex education okay so Esther's kindly sent everybody the links so it's something that you could do sort of do as and when but we're aiming for this to be back in about two weeks so we can gain all of this so we can start forming that part so that when we sort of start talking to the youth champions which we we've got a rough idea of what's happening because we've reviewed it and we already know what's going on in schools and then we can talk to them knowing having the evidence in front of us and asking then what they would like to see different so has anyone got any questions on that presumably Karen the as Bex was saying we don't have a lot of information about non-counsel schools doing yes so that's a more slightly trickier way to find that out well that's where hopefully are you um are you champions would be able to help us on that one yeah and it also be um for Janet and Sheila at something they they could ask because even once again you can put your mystery shopper hat on you know you're interested in the school yeah what's their policy could they just be interested because I'm opposite Landbrook school you know and I'd be interested the difference between what they say at Landbrook and say at Brockendale or something I'd just be interested yes I think this is going to be very interesting because I'm sure they're all going to be very different within a strong stroke of each other all these schools yeah and if we can recognize that it's something we can talk to the children the young people about because it'd be very interesting to see how they signposts as well to the wonderful services that the team are trying to set up and obviously it's got to start within the school area so that's going to be very interesting and once again there'll be a template so don't anyone panic you know you don't have to sort of like once you sort of had a look and reviewed we'll come to some key points that you've rather than having to think you've got a right and essay on each particular one we will be looking at specific points that we can bring back and then you can compare amongst yourselves as well at how different so what will happen is then I will get our work with the team and we will get the templates of what questions you need and some scenarios for our mystery shoppers and then that's what we'll be doing over the next couple of weeks and then the next time obviously if anyone's got any questions please ask them and then the next time we come back it would be very interesting to everyone to be able to share what they've learned so far before we then engage with the next part if everyone's agreed so that was anyone got any further questions Jeremy you've got your hand up I've got my puff now just um you said you would go to look into schools and obviously I'd like to know whether that would include FE education as part of that because you've got 16 to 18 year olds have you got any um desire to look at that set of um that area yeah yeah that sort of age group in yes because we're covering the sort of under 25 yes it will take us all the way through right so without the way they're going to yeah be taught that or at least be able to gain the information because even children young people I should say at college how are they informed yeah well yeah they do have people come in but obviously that's something that you might like to know a bit more about what's going on and I notice it's quite what are they going in for compared to the secondary school yeah see yeah to compare what they're being taught or shown compared to secondary schools so I would like to think obviously there there would be a big difference in what the children and young people can gain up during secondary school level they're moving on to college mm-hmm I would assume it's they're given more information yeah yeah does that matter time in their life that they actually need it I hope it just doesn't drop off at that point but then I suppose when you look at schools you've got six form which would equate the same sort of information that people at college would get yes because that's the same age group yeah I don't know this is what I'd like to know there you go you see yeah this is what we're going to be feeding back as to how it how it changes and what what the service is that we are providing our children yes Councillor Harrison you know just just a comment even when I was at university that was just posters everywhere about sexual health and they gave out condoms at freshest fairs so I think it's very high profile and very you know very in your face in colleges in schools I think they're probably going to be a bit more restrained about that because it's not so much student to student communication as a teacher to student and they've got to be a bit careful about how they do it so it'd be interesting to look at how it is actually communicated in schools yes I saw the government just stop giving condoms to a certain group I questioned I thought I heard this but I don't I didn't understand it meals but they go no that's something because I say before I mean I remember very much up by the Granger in Bracknell they used to be open places where the children and young people because it was children as well I'm sort of saying like 12 year olds etc who are going up just out of curiosity and sort of even if it broke the conversation of look what I've picked up and you'll sort of like put it down it was it sort of started that conversation yes you know and if they knew what it was that was a good thing because they were being taught at school yeah but we don't know being sort of older it's interesting Caroline because there's a lot of controversy from Asian groups isn't there that they don't want sexual education spoken at schools they feel I'm paraphrasing it should come from the parents and not from the teachers or the you know whatever I don't know how that affects our borough and whether there is a problem there or you know whether that's well that's what we'll be finding out yeah yeah that's the interesting thing is it because some who decline inside of my children in sexual education at school so where are they learning it from yeah quite is it from social media are they from the internet yeah yeah you know how are they getting information should they need these services then if they're not in in the room work where the information's being given out quite important to look at how they approach pastoral care in the schools as well because I usually don't be ahead of form or something that is the teacher that is specifically designated to look after the the welfare of the children more so than the team you know not not just the teaching that's it because that's one thing a question can be added on to that the schools if people want to sort of get more involved okay you're reading the information on a website but how does that work in reality you know is there someone that they can go to if yeah discuss it or to discuss it I mean that that's what we used to have back in the day but is it the same and are the children comfortable yeah with that person that they've got I mean and this is where our youth champions can come into it as well to advise us so we can take it forward on the best way that they feel that maybe they haven't got so much for a voice and I mean I personally I'm at even around schools even if they had like posters up where they had one of these scanner things on that you just like zap it go off and look at the information later I mean I don't know what is actually in schools but the school team I've got a lot of work now to have a look at and delve deeper if they wish to pass the policies and so actually I've just read that and I've got a couple of questions on that because you can go as deep as you want to and this three shoppers of course you will have different scenarios now will you know what you're particularly looking at on this you're going to be particularly looking at the neurodiversity you're going to be looking at those so when you're sort of doing your role playing think of those who have not either the language skills or have different you know they might need translation services to those who's you know who might have something more complicated they ring up and they're told well hold on we don't do that in Bracknell you've got to go to Slough they're 15 they haven't got the chance what they haven't got any money they're not allowed out on so-and-so to go to Slough so you've got to sort of this is where you can do a really good review on the fact that well how would I get there and if I phone up their GP are we going to get the third degree from the receptionist who wants three of them here which could be a bit of a barrier to actually accessing those GP services especially for teenagers who don't want their parents to know what they do yeah I think that's a very good point because I think if you go to GPs the basic thing is you got to write down exactly what the problem is and you know there's a big I mean ridiculous I think but you know there's a big pro former of have you done this have you done that you know who's going to do that they're not especially that age so yeah it's it's we don't we don't necessarily know that though because obviously we're looking at it for no point of view we haven't you know if we pretend to be a child it might be a very different story to what they can actually get from a GP so we that's the whole point in this to find out exactly what it's being offered yeah yeah so you can all put your prorotashes on and really delve deep and I can already see particularly Shuris and Tony and you're going to drag the other two in you get your false glasses your false nose a beard right we all know who you are don't you worry I've got a uniform that's it we've already got you sussed but thank you there was so much for your time I do apologize for running over tonight but now everyone knows what they're going to be doing and hopefully everyone will enjoy what they're going to be doing so I think it is going to be we we can really delve deep in this yeah I agree it's great and add real value because obviously this contract is coming up oh our our young people getting good value from money yeah as the residents are paying for this service and I'm sure they'll be very invested on how we're spending the money as a council and to make sure their young children are safe and have services to go to if they can't get particularly if they can't go to their parents yeah so thank you all for your time tonight much appreciate it and thank you for coming back and as always thank you for your views and everything [BLANK_AUDIO]