Reset and Rebuild - sexual health and blood borne virus services: recovery plan

Introduction

Sexual Health and Blood Borne Viruses (SHBBV) services play an essential role in safeguarding and improving the health of people in Scotland. A robust, sustainable network of service provision is necessary if Scotland is to continue to offer and further develop world-class prevention, treatment and care for hepatitis B and C, HIV and other sexually transmitted infections (STI), and to empower people to take control of their own sexual health and reproductive choices.

The SHBBV Framework was first published by the Scottish Government in 2011 and updated in 2015^[1]. In 2011, it brought together policy on sexual and reproductive health and wellbeing, HIV and viral hepatitis for the first time. It set out five high-level outcomes which the Government wished to see delivered, and it sought to strengthen and improve the way in which the NHS, academia, the third sector and local authorities supported and worked with individuals at risk of poor sexual health and/or blood borne viruses.

In addition to NHS Board funding, through the Framework, the Scottish Government has provided funding of over £2 million between 2018 and 2021, and we remain committed to the principles of the Framework and its outcomes, outlined at Box 1.

Box 1

SHBBV Framework Outcomes

Outcome 1: Fewer newly acquired blood borne virus and sexually transmitted infections; fewer unintended pregnancies.

Outcome 2: A reduction in the health inequalities gap in sexual health and blood borne viruses.

Outcome 3: People affected by blood borne viruses lead longer, healthier lives, with a good quality of life.

Outcome 4. Sexual relationships are free from coercion and harm.

Outcome 5: A society where the attitudes of individuals, the public, professionals and the media in Scotland towards sexual health and blood borne viruses are positive, non-stigmatising and supportive.

These high level outcomes have guided activity over the last ten years and will continue to do so as we aim to recover SHBBV services following the COVID-19 pandemic. However, we must acknowledge that the pandemic and its impacts have directly threatened our ability to deliver those outcomes. Moreover, the effect of the pandemic on SHBBV-related harm and resulting service demand through its social, financial, behavioural, educational and wider health impacts is only beginning to be understood. At the same time, responding to the virus has shown us that new ways of working are possible, and some of the innovations that kept services running during the most difficult months of 2020-21 may help us build a more sustainable future for SHBBV services.

The severity of the pandemic remains the single biggest factor that will affect recovery. However, achieving recovery will also take concerted effort and planning. In recognition of this, we committed in the 2020-21 Programme For Government^[2] to develop an interim Recovery Plan for SHBBV services, ahead of a more fundamental review of the Framework in 2022. This Plan, coproduced with our NHS and third sector partners, takes stock of the impacts of the COVID-19 pandemic on SHBBV services and people that use them.

The Plan does not seek to set out a detailed roadmap or to cover the full range of actions that will be necessary to bring us back to full service. Early in the pandemic, much of that operational detail was provided by clinicians, academics and third sector services as they developed localised interventions, co-ordinated through the existing national network structures^[3]. This work, described in Box 2, allowed rapid implementation of innovative, agile solutions.

Box 2

SHPN COVID-19 Recovery Plan for Specialised Health Services in Scotland: Stages of Recovery

Recovery within services involves 3 stages and builds on the current essential care arrangements. The timescale will be influenced by the severity of the COVID-19 pandemic nationally and locally, in addition to the availability of staffing, accommodation and other services, such as laboratory capacity. It is a fluid framework that can guide further service restrictions if there is a resurgence in COVID-19 or should other unforeseen critical events arise.

1. Baseline service: Pandemic arrangements - urgent and essential care only

2. Reset and Rebuild Stage 1: Balancing the risks – increasing care for priority groups

3. Reset and Rebuild Stage 2: Fulfilling Public Health duties – widening access to care

4. Reset and Rebuild Stage 3: Providing comprehensive care to meet the needs of all the citizens of Scotland

These operational plans will be central as services rebuild. However, to succeed, they must be underpinned by clear commitments to sustained recovery and a set of common goals that will ensure a national focus. This complementary plan therefore establishes key aims which will underpin a number of priority actions and recommendations in 2021/22.

These aims are:

• To re-establish a comprehensive range of SHBBV services across Scotland;
• To understand the impact of the pandemic on people with SHBBV service needs, particularly those facing additional barriers accessing services, and to develop targeted responses where possible;
• To assess and begin to mitigate the SHBBV inequalities that the pandemic will have exacerbated or created;
• To ensure that the innovations and service redesigns in response to the pandemic are evaluated, that learning is shared, and local or pilot projects are scaled up where successful and appropriate.

These aims underpin both the actions proposed in the plan, and our wider work going forward. They will be supported by the Scottish Government; however, they will also rely on the commitment and high-level support of Health Boards, including work to ensure the return of sufficient numbers of appropriately skilled staff. Finally, the collaboration between and among Health Boards, third sector organisations, academics and local and national government which has sustained services during the pandemic must be maintained as we begin to rebuild.