Sue Bunn, Commercial Director, Inform Health, looks at how sexual health services are levelling up to better protect children from harm.

An independent review into child sexual exploitation (CSE) in Rochdale, published at the start of the year, found ‘compelling evidence of widespread organised sexual exploitation of children’ and highlighted serious failings by multiple agencies in Greater Manchester.

Rochdale’s Crisis Intervention Team (set up in 2002 to provide sexual health advice and support to young people) played a key role in identifying and attempting to prevent CSE in Rochdale and brought Sexual Health’s role in safeguarding vulnerable young people into sharper focus.

Understanding the scale of the issue

According to police-recorded crime data, during 2021/22 there were 17,486 crimes logged by police in England and Wales where children had been sexually exploited. A 10% increase from the previous year and an average of 48 offences a day.

While it’s typical for young people experiencing this kind of abuse to disengage from many statutory services, according to Dr. Karen Rogstad, Consultant in HIV and Sexual Health at Sheffield Teaching Hospitals NHS Foundation Trust, sexual health services often provide a safety net: ‘Due to the type of abuse being perpetrated, exploited young people will continue accessing sexual health services, which gives us a unique opportunity to identify and prevent harm.’

And while data collected between 2019 and 2021 highlights a concerning 103% increase in CSE cases raised by sexual health services, this can be partially attributed to the forward leaps sexual health services have taken to improve the way vulnerable patients are managed and information is collected.

Bringing safeguarding to the fore in sexual health services

In 2014 The British Association of Sexual Health and HIV (BASHH), in collaboration with Brook and with the support of a multi-agency advisory board, working group and input from young people, produced Spotting the Signs.

Dr. Rogstad, co-author of Spotting the Signs, explains its premise: ‘It was designed to provide a strong, standardised approach to support health professionals to better identify young people attending sexual health services who are at risk of experiencing CSE. It’s been an effective tool to empower front-line staff to pursue their professional curiosity, capture important information and, ultimately, protect children from harm.’

Reflecting the changing landscape

Recently updated to reflect the changing landscape of CSE, the Spotting the Signs tool now accommodates child criminal exploitation (which often goes hand in hand with CSE) and is designed to work more effectively across remote consultations.

Dr. Dawn Wilkinson, Consultant Sexual Health and HIV and lead on Young People’s Sexual Health and Contraception services at the Jefferiss Wing, Imperial College Healthcare NHS Trust, who works on the Spotting the Signs Project Team Board, as a representative of BASHH Adolescent Sexual Health special interest group, comments:

‘Sexual health has a special role to play in advocating on behalf of young people. We’ve used the refresh as an opportunity to engage with young people to ensure we continue to understand and address their needs. The safeguarding landscape has changed enormously in the last decade so this new version, developed following a comprehensive engagement process with all stakeholders, will support professionals to understand the key concepts behind its use and apply a best practice, trauma-informed approach to spotting the signs of abuse and taking appropriate action within a multidisciplinary team.’

The funding conundrum

The introduction of the updated tool, and the roll out of training that will follow, can only go so far. Ensuring sexual health services can effectively resource this safeguarding function will be crucial, as Dr. Rogstad points out: ‘Services need to be funded properly so they’re able to see vulnerable young people face to face. They need to be empowered to allocate enough time to appointments so a rapport can be established with young people, and the right questions asked in the right way. It’s also vital that other agencies, including social care, can action referrals made from sexual health services.’

Yet while demand for sexual health service consultations has increased by a third since 2013, funding isn’t keeping pace. According to recent analysis by the Local Government Association, the public health grant has reduced in real terms by £880m since 2015.

Understanding demand

So, how do sexual health services do more with less? According to Dr. Wilkinson, the first step is to understand demand so that future provision can be appropriately targeted and factored into local authority commissioning processes.

‘There’s a huge amount of safeguarding work that goes on in sexual health services but if it isn’t being logged properly, if it’s being miscoded or just not inputted into reporting systems, it’s effectively happening under the radar.’

Dr. Wilkinson continues: ‘This means it’s invisible to commissioners and without the data to demonstrate demand it’s difficult to make a strong case for increased funding. By standardising codes for safeguarding and inputting them into an electronic patient record system after each consultation, we can effectively report on activity numbers and use it as an indicator of the safeguarding workload that’s occurring within sexual health services. It could also open conversations with commissioners about the merits of moving towards tariff-based safeguarding payments that better reflect the work taking place and ensure services are able to properly resource safeguarding activity in the future to keep children safe.’

Identifying patterns across regions

The move towards specialist integrated sexual health services promotes better patient access and outcomes. The model is designed to improve sexual health by providing ‘non-judgemental and confidential services through open access, where most sexual health and contraceptive needs are met at once, often by one health professional, in services with extended opening hours and locations.’

Yet, these models can also make the task of monitoring vulnerable patients harder. For instance, exploited young people may be deliberately taken to myriad clinic locations by perpetrators intent on concealing their abuse.

As provider services offer integrated sexual health care, inevitably individual providers amalgamate to cover larger geographical areas. And while this is great news for patient access, it can make it easier for victims, or those at risk of CSE, to slip through the net.

Appropriate data sharing is key to avoiding this issue. Tools that give access to responses to questions asked at previous encounters and allow the clinician to discreetly review these against the responses being given today, make it easier for professionals to compare information, identify patterns, spot the signs of abuse, and take meaningful action.

Offering a pick ‘n’ mix of access options

These are some of the ways technology is supporting safeguarding efforts in sexual health services. Another, is through optimised service management and ensuring vulnerable patients, who may be at risk of CSE or have complex needs, can access specialist care and support face to face. Achieving this in light of the current funding shortfall is difficult but by enabling patients who are capable of self-management to access and manage more services independently – such as STI testing, treatment, or contraception – it’s possible to free-up clinic resource without compromising outcomes for any one patient cohort.

Dr. Wilkinson agrees: ‘Flexibility is key in prioritising access for all and upholding safeguarding responsibilities. Digital technology isn’t for everybody and there’s good evidence to suggest young people still want to be seen face to face. In the absence of an increase to the public health grant, offering a pick ‘n’ mix of access options will support sexual health services to better accommodate increasing demand, provide a safe space for exploited young people and invest the time and resources needed to educate, identify, and prevent CSE.’