Staffing shortages in sexual health clinics have led to a drop in testing, as hard-pressed nurses admit they have been forced to turn people away, shows a new report from the Royal College of Nursing.
The report includes the findings from a survey of more than 600 nurses working in the field, which found services were under-staffed with few registered nurses, inadequate skills mix and lack of training.
“This is a worrying picture of understaffed services going to extreme lengths to try to cope”
Nurses who took part in the survey carried out earlier this year reported having to turn patients away, and said many were leaving due to low morale and stress.
In all, 61% reported a reduction in the sexual health workforce overall, while 57.1% said there had been a drop in the number of registered nurses.
About half said skill mix in their team had reduced, while nearly a third – 32% – said qualification levels had decreased.
When it came to reasons behind skills and staffing shortages, nearly half said they had been unable to recruit to posts due to recruitment freezes or reductions in posts, while 35% said they were not allowed to recruit to the level of skill required by the service.
Survey respondents also highlighted the fact that potential applicants were being put off due to “their perception of the working environment”.
“Persistent and damaging cuts to the local authority public health budget in recent years have led to clinic closures”
Over the five years since the government moved public health services to local authorities, the RCN warned a “dangerous recruitment freeze” had prevented staff from delivering vital services including testing for Chlamydia and HIV.
The report – Sexual and Reproductive Health. RCN report on the impact of funding and service changes in England – pointed out that during the same period there has been a drop in the number of 18- to 24-year-olds being tested for Chlamydia while diagnoses have gone up.
The report also flagged up a 12% increase in syphilis diagnoses. Meanwhile, it said complex and confusing commissioning arrangements for HIV services is limiting access to testing and creating health inequalities.
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Comments from nurses who took part in the survey revealed concerns about the level and quality of care they felt able to provide.
“Our services are very stretched but sadly due to commissioning changes many clinics have closed and we had to turn people away,” said one.
Others reported that nurses were leaving because they could not provide the kind of care they wanted to.
“Staff are leaving because they are no longer able to provide the service they signed up to,” said one. “The holistic care of client-focused nursing has disappeared into a tick box system to achieve only what the commissioners want.”
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Staff were also leaving because of poor morale and stress, comments highlighted in the report showed.
“Many highly trained and skilled staff are leaving die to low morale and changes to working patterns,” said one nurse.
“Many of my colleagues have taken periods of sickness die to work-related stress,” said another.
The report raised concern about the availability of training in sexual and reproductive health, and also funding and support, from employers.
One issue was the fact there were currently no national standards for nurse education in England around sexual and reproductive health, meaning nurses access training from a variety of sources.
Meanwhile, funding for courses and problems with being released from work for training were cited as issues for the majority of nurses who took part in the survey.
Helen Donovan, professional lead for public health at the RCN, said effective sexual health services required specialist skills and good quality training “both of which are in short supply”.
“This is a worrying picture of understaffed services going to extreme lengths to try to cope, even turning people away – the last thing a health professional ever wants to do,” she said.
“If people are not able to access services then serious STIs could go undiagnosed and untreated – it is a major risk to public health,” she warned.
She said the quality of service was also a “grave concern”. “There are nurse out there doing amazing work, but there are not enough of them with the right skills in the right place as a result of the dangerous recruitment freeze,” she added.
Dr Olwen Williams, president of the British Association for Sexual Health and HIV, said the findings provided “yet more evidence that sexual health services have reached tipping point in this country”.
“Despite the best efforts of staff to maintain standards, persistent and damaging cuts to the local authority public health budget in recent years have led to clinic closures and a worrying increase in the number of patients being unable to access the care they need,” she said.
“With the recent emergence of multi-drug resistant gonorrhoea and record levels of syphilis, these cuts have come at the worst possible time,” she said. “It is, therefore, vital that the government reverses the cuts and provides services with the support they desperately need.”
The RCN report highlighted a move towards online services, usually developed with sexual health experts including nurses.
“It is vital that online provision is not just driven by a need to reduce costs”
It noted that these could be a useful way of directing people to the right support and could allow service users to register and request home testing kits, with results texted to their mobile phone. Treatment was then sent to them after a consultation.
However, the report said the development of such services must not simply be a way to cut costs and it was vital to ensure “quality and safety is maintained”.
“It is vital that online provision is not just driven by a need to reduce costs and online services should not be commissioned in isolation, or instead of, existing services,” said the report.
It recommended that online services must be “developed in a complementary way to current face-to-face provision” and adhere to the same standards.
“Education and training for staff providing online services should equate to that expected from sexual health professionals in clinics,” the report added.