Challenge

The Greater Manchester Health and Social Care Partnership wanted to explore the possibilities of moving towards a GM-wide digital offer for sexual and reproductive health and HIV services. They were looking to maximise opportunity by fully exploring the art of the possible, identifying innovative and creative opportunities that are currently unprecedented in England.

The Partnership is made up of local NHS organisations and councils. It also includes staff from NHS England and NHS Improvement, emergency services, the voluntary sector, Healthwatch and is connected to the Greater Manchester Combined Authority (GMCA) and the mayor of Greater Manchester (GM).

FutureGov was asked to support the partnership and investigate the opportunity for a GM-wide digital offer for sexual reproductive health and HIV, while understanding where the greatest opportunities were to build a human-centred service.

Approach

Driven by service user-need, we aimed to understand existing specialist sexual and reproductive health and HIV services, including the expanding digital service offer across Greater Manchester. This work explored the possibilities of a GM-wide blended physical/digital offer, using research insights to identify strengths, assets and opportunities.

Throughout the discovery, we focused on services for:

• information and guidance about sexual health
• sexually transmitted infections (testing and treatment)
• contraception
• planned contraception (hormonal and implants)
• emergency contraception (hormonal and physical termination)
• HIV (testing and treatments)

Our research for the discovery consisted of understanding these services, which we mapped with staff from the GM Sexual Health Network. We also mapped the ‘as is’ users journeys for contraception, STIs and HIV services with service providers.

To develop our user understanding, we ran interviews with patients around their experiences with these services to understand pain points and design opportunities. Our discovery also focused on identifying and engaging with innovative sexual and reproductive digital services provided by the private sector to help define the challenges and opportunities these approaches afforded.

Shift to remote research

Three weeks after we started the project, lockdown in the UK was enforced which led to challenges for clinical teams and users to engage and input with this work. During this time of restricted movement and inability to be physically together, we utilised a host of digital collaboration tools and project rhythms and rituals to ensure we could work effectively with the GM SRH Commissioners and GMHSCP, users and innovators. We continued to use these tools to deliver new products and services for councils and health providers over the lifetime of the project.

Learnings

We learned that there are 64 repeating service patterns across three service pathways. 52% of these patterns included getting information, finding a clinic, booking appointments, receiving reminders and triage. We found that getting people into the right service in the right place is challenging. Parts of the system are overstretched while others are underutilised. However, once people are in the service and in the right place, the quality of their experience is very good.

STIs and contraception services

We learnt that convenience is a priority for people with raised expectations in the digital age. Inability to book appointments increased difficulty around access for people with busy or complex lives and a lack of signposting and perception of where to go meant people resorted to default mental models of how to engage with the service. There’s also concern about privacy and discretion in the face of stigma.

HIV services

The discovery uncovered a need for emotional support and connection, which many users felt was as significant as medication. The challenges around stigma and coming to terms with living with HIV delayed people fully engaging with treatment. And for some, a long term relationship with their clinician was an important part of their treatment. We also identified that a sense of isolation leads to instability and worsened mental health.

Impact

There’s a real opportunity to deliver a seamless, joined-up sexual and reproductive health and HIV service across Greater Manchester that leverages the very best of what digital can offer to ensure that physical points of access and clinical specialism are available for those that need it most at times that are appropriate and flexible.

Core elements of a joined-up approach would include providing a consistent digital triage process, real-time data, building transparency across the system and enabling both staff and patients access to quality and timely information and guidance. Insights from the sector innovators and existing online providers in GM showed that having a single view of services users through data was a powerful tool to identifying safeguarding issues across the region.

These recommendations are based on interviews with providers and service users, taking into account the challenges experienced by all those in the system and building on work already being delivered across Greater Manchester.

We’ve recommended that the partnership undertake a process of prototyping one or more opportunity areas that would provide a clear digital front door for SRH + HIV services, r to guide users to access digital and physical services from a range of providers regardless of changes in the way provision is commissioned.