Welsh sexual health nursing system 'creaking' under pressure | Nursing Times

A report by Public Health Wales found STI testing was at a 10-year high in 2022, at 384,800 tests taken, primarily driven by a huge increase in online and postal testing.

"You don’t want to test people to give them half a service"

Darren Cousins

The same report found that chlamydia and gonorrhoea infections were also at the highest in a decade (9,215 and 4,126 in 2022 respectively), with greater proportions of positive tests – meaning the numbers are not just higher due to more testing.

Cardiff-based sexual health consultant Dr Darren Cousins, chair of the Welsh branch of the British Association of Sexual Health and HIV (BASHH), said that while greater access to STI testing was a positive thing, the nursing workforce in particular must be bolstered to keep up with greater demand.

Dr Cousins described the Welsh sexual health system as “creaking”, airing fears it could become overwhelmed as more people test positive and seek help from an already-stretched nursing workforce.

The system of online and postal testing, introduced in 2020, gave more people the chance to check if they have an STI than ever in Wales, leading to a big decline in people going to clinics to be tested.

While the postal testing system has facilitated a rise in tests taken overall, the proportion of tests coming back positive has also increased for some STIs.

For chlamydia, the “positivity” rate was 9.5% in 2022 – up from 8.6% in 2021, and 7.5% in 2019, before the Covid-19 pandemic, according to the Public Health Wales data.

Similarly for gonorrhoea, the positivity was 4.9% in 2022, compared to 2.4% the previous year, and 2.1% pre-pandemic.

There were also increases in the numbers of syphilis and genital herpes diagnoses in 2022 compared to 2021.

Dr Cousins explained that the shift in testing methods had changed the workload of nurses.

“As far as the nursing workforce is concerned, it’s moving from testing in clinics, to dealing with people coming in with positive results, having already tested themselves," he said.

In his view, this is a better use of the expertise nurses in sexual health clinics possess.

However, he continued, the current state of the workforce was far from ideal: “The challenge is to make sure services are fit for purpose, that they can adapt to this change, and support nurses for this change.

“From seeing patients to test them, to focusing on them with a condition, that’s a big change and it puts pressure as it’s less predictable.

“Before, we could limit how many people we had in clinic. But now, you get the list of people who are positive in the last 24 hours; it could be five, or it could be 500 – there’s stress related to that.

“As more and more tests are done, more people are coming our way and those positive tests need actioning.”

He also highlighted the impact these demands could have on nurses' prevention work.

“Nurses provide contraception, and PrEP (pre-exposure prophylaxis) for people at higher risk of HIV, and the expectation is that if someone comes in with chlamydia, they might need contraception or PrEP," said Dr Cousins.

“That puts more pressure on the nurse taking that call; the easiest thing is to give antibiotics and say, ‘off you go’, but what you want to do is provide a better service.”

"We now have a clearer picture of the numbers of STIs in Wales, and this information will help to develop services"

Josie Smith

Dr Cousins’ worries in Wales are similar to that of his BASHH colleague, Jodie Crossman, who told Nursing Times earlier this year of concerns she had about the nursing workforce in England becoming overwhelmed with a record rise in STIs.

Dr Cousins added: “What this data from Public Health Wales has done is it’s provided evidence that investment in sexual health services, particularly nursing, is needed.

“You don’t want to test people to give them half a service.

“The onus is now on the health boards to provide the correct staffing structures to mean those tests are being actioned.

"The report is very positive, in that it is specific, and it provides clear parameters for health boards to look at what local health needs are.”

Dr Cousins further said that he hoped the numbers of new HIV patients continued to fall, stating that any HIV infections were unacceptable because Wales had the tools to “not accept it as normal”.

The report showed that 60 new HIV cases were diagnosed in Wales in 2021, the latest data available, down from 77 in 2020 and 126 in 2019.

Josie Smith, senior epidemiologist for Public Health Wales, said the increase in postal testing allowed people to more quickly get access to treatment.

Speaking after the release of the data, Ms Smith said: “Postal testing is free of charge, and available for anyone in Wales aged 16 years and over and has proved to be highly acceptable, resulting in greater numbers of infections being identified.

"We now have a clearer picture of the numbers of STIs in Wales, and this information will help to develop services."