“During this review it became apparent how some young people have trouble finding the relevant support when they have needed advice and help with sexual health. This was confirmed with our findings and stated by the end users during the youth survey.
“Nonetheless, it was encouraging to discover that the council is working hard with Public Health England (PHE), Berkshire Healthcare Foundation Trust (BHFT) and young people to start addressing these issues.
“The panel took the opportunity to speak with the service provider BHFT to ascertain any problems they have been having in providing the best service for our young residents. We are encouraged by how hard they are working and how receptive they are in improving the excellent service they are already offering.
“We believe our recommendations can add value to the service and enable more young people to have a first-class service within the borough”.
Councillor Egglestone
Chair of the Health and Care Panel
Recommendations
Recommendation 1
Advise schools to change website restrictions to allow young people to access services including NHS Choices, Brook and Safe Sex Berkshire.
Review: 6 months
Recommendation 2
Make sure the OxWell student survey includes questions to get the views of young people regarding sex education they receive. This will be fed back to individual schools and taken into consideration when reviewing policies.
Review: 12 months
Recommendation 3
Make sure young people’s views of the services, including those of vulnerable children, are sought by public health as part of the service development improvement plan with Berkshire Healthcare Foundation Trust (BHFT).
Take this information forward for consideration in the next contract tender process. Make sure views captured in the survey in April 2024 are used to inform service development. Use an engagement plan to make sure a representative sample of young people will be reached.
Review: 6 months
Recommendation 4
Request Garden Clinic attendance data from BHFT that is specific to Bracknell residents for review by the Executive member.
To differentiate those patients referred from Bracknell due to medical needs and those who went to Slough due to lack of availability in Bracknell. This will be reviewed by the Cabinet member within 6 months ahead of the next contract renewal which is due 1 July 2026.
Review: 6 months
Recommendation 5
Improve promotion and awareness of sexual health services for young people.
A key aim is to help normalise sexual health and reduce the stigma around it through:
- promoting sexual health services on school websites
- increasing leaflets and signage in pharmacies.
- greater visibility of information on Safe Sex Berkshire website
- improve promotion of the services that pharmacies offer regarding sexual health.
Review: 6 months
Background information and local context
Specialist sexual health services are provided through local authorities who receive funding from a Public Health Grant. In Bracknell Forest this is delivered through the Berkshire Healthcare Foundation Trust (BHFT) who hold the main contract for sexual health services. A subcontracted company, SH24 provide the home sexually transmitted infection (STI) test kits as part of the new service specification.
The BHFT provide a tier 3 sexual health service which is based at the Garden Clinic in Slough. This delivers services for complex STI’s, recurring infections and long-acting reversible contraception. Skimped Hill health centre in Bracknell is open 2 days a week for routine STI testing and long-acting reversible contraception. It also has walk-in clinic on a Thursday for people aged 18 and under.
There are a range of other services and settings involved in supporting good sexual health. These include schools and colleges, youth services and provision of support and information for parents. Access to high quality information from trustworthy sources is important. All of these can help individuals make informed choices regarding STI testing and contraception choices.
Key points about sexual health provision in Bracknell Forest
The main 3 providers of sexual health services, in order of number of users, with the highest first are:
- online access through SH24 – this highlights the impact of the COVID pandemic
- The Garden Clinic in Slough
- Bracknell Forest Skimped Hill Health clinic
Numbers using Skimped Hill have declined since the pandemic and there is an increase in numbers visiting the Slough clinic. A hypothesis for this, put forward by Public Health, is that people who are not able to use online services have more complex needs that need the specialist care provided by Slough.
STI positivity rates have fallen in recent years, which means fewer people testing for STIs are found to have them. This highlights that people are more informed and feel able to get STI tests if they feel at risk. Bracknell Forest positivity rates are significantly lower than the national rate and in line with local authorities with a similar level of deprivation.
There is good coverage of long-acting reversible contraception (LARC) through local GPs (8 out of 10 GPs provide LARC).
Good practice
During the review the below areas of good practice were identified.
Under 18 conceptions, one of the main indicators used to look at sexual health among young people, is lower than the national average. This has been lower than the national average since 2004. In Bracknell, data suggests young people have good take up of contraception in GP’s.
STI positivity rates have fallen in recent years, which means fewer people testing for STIs are found to have them. This highlights that people are more informed and feel able to access STI tests if they think they are at risk.
Results of a recent focus group run by Public Health identified that young people know a lot about what they need for good reproductive health. They can also identify some places they would go to for advice or services.
Ongoing work with the marketing and communications team is looking into streamlining the provision of online STI kits and adding some educational videos to the SH24 website. This is due to be delivered by 1 July 2024.
Throughout the review the panel identified areas for improvement and in response one of these is already being actioned. The lack of signage at the sexual health clinic at Skimped Hill is something that the members of the panel feel strongly about. As a result of their work on this review, BHFT estates acknowledged the problem and are working on signage with an indicative time frame for signage to be in place by June 2024.
Review findings
Information accessibility
Participants said they mainly rely on peer groups and friends for information. They also said they would speak to their parents if they had a good relationship with them.
Some participants mentioned trusted online sources and the NHS was seen as a strong and trusted brand where they could get advice or help.
However, there was a lack of recognition of specific websites or apps when participants were shown images and logos. This suggests limited awareness or use of digital resources for sexual health information.
The panel noted that it would be valuable to make sure that young people’s settings such as schools or youth services had up to date information about clinic locations and opening times. This information was used to develop recommendation 5 regarding improving promotion and awareness of sexual health services.
Service accessibility
- this included the misconception that access to services would require them to attend with an adult or parent
- participants were worried about judgement by professionals because they need to access sexual health services
- concerns were shared over waiting times for appointments with participants saying that the process to get to an appointment would require them to overcome mental, physical and emotional barriers - they therefore want to feel all their needs will be met during the appointment
- financial constraints can be an issue and this was raised with regards to travel to a clinic or needing to pay for emergency contraception
Many were hesitant about using online services stating concerns about parental controls on phones or parents checking sites visited.
Schools often lock down searches for key words which means they are unable to search for help online at school. It was noted that schools may have a responsibility to allow access to certain websites.
This information was used to shape recommendation 1, to advise schools to change some website restrictions.
Through their own research, members of the panel found that school sex education polices in schools varied across the borough. One school sought opinions from pupils on the provision of sex education and these comments are reviewed by senior managers and taken into consideration when the curriculum is prepared for the following year. This was felt to be a good example of a school being responsive to needs and providing students with the education they need on topics they feel are important to learn about.
It was felt that more research around content and relevance of sex education through measuring the opinions of young people was needed.
This led to recommendation 2 which should make sure that schools receive feedback from pupils about the value of the sex education they receive using the OxWell student survey.
The OxWell survey is a large-scale annual survey designed to measure the wellbeing (health and happiness) of children and young people aged 9 to 18 years old.
The survey is a collaboration between young people, schools, local authorities, the NHS and the OxWell research team at the University of Oxford’s Department of Psychiatry.
Feedback from the survey can be used for schools to develop policies, alongside government guidelines, in response to needs of young people.
Provision of emergency contraception and information about sexual health in pharmacies was found to be mixed. Some pharmacies were able to offer emergency contraception without appointment whereas others required you to book an appointment online.
It was felt that advertisements and signage outside the pharmacy to advertise their services would be beneficial.
There were also online pharmacies that offered paid for emergency contraception.
It was felt there could be more information or advertisement of services stating that emergency contraception is freely available on the NHS.
These findings link to recommendation 5 which is about better promotion of sexual health services and provision of leaflets and signage in pharmacies. This will be achieved through collaboration with the Integrated Care Board (ICB) and the local authority.
The review looked in detail at the difference between tier 2 and tier 3 provisions of sexual health. Through discussions with BHFT and public health the panel developed a good understanding of the difference.
This was illustrated with an example patient. If a patient presented with vaginal discharge but no other symptoms such as abdominal pain, they could be treated at a tier 2 setting. If they also presented with pain, were pregnant, had sores or other physical symptoms then they would be referred as a complex case.
However, staff at a tier 2 setting would provide as much care as they could to a patient, for example a course of antibiotics could be started before referral. If a patient needed to go to a tier 3 setting for further treatment this would be arranged for them, sometimes on the same day.
To request attendance data from BHFT that is specific to Bracknell residents, to include those referred from Bracknell due to treatment needs and those who went to Slough due to lack of appointments in Bracknell. It is proposed that this will be reviewed by the Executive member ahead of the next contract renewal on 1 July 2026.
Through this review discussions took place with BHFT and public health and the panel heard about many positive aspects of the sexual health provision within the borough.
The work that public health has undertaken with focus groups and a recent questionnaire with young people highlights the value of gaining insights from service users to make sure their needs are met.
The panel are keen that this work continues and therefore made the recommendation to make sure young people’s views of the services are sought by public health as part of the service development improvement plan with Berkshire Healthcare Foundation Trust (BHFT).
Financial considerations
There are no direct financial implications arising from this report.
Review Panel
- Councillor Cochrane
- Councillor Collings
- Councillor Egglestone (Chair)
- Councillor S Forster
- Councillor Harrison
- Councillor Virgo
- Councillor Watts
- Councillor Webb
- Councillor Welch (Vice Chair)
Contributors to the review
| Name | Job role |
|---|---|
| Rebecca Willans | Consultant in Public Health |
| Heema Shukla | Acting Director of Public Health |
| BHFT | Service Manager for HIV and Integrated Sexual Health Service |
| BHFT | Service Director for Scheduled Care Community Adult Services |
| BHFT | Lead Nurse, Sexual Health Service |
| BHFT | Associate Director or Contracting and Service Development |
| Councillor Megan Wright | Executive Member for Adult Services, Health and Housing |