Evaluating sexual health planning for the London 2012 Olympics
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Journal of Public Health Advance Access published August 30, 2014 Journal of Public Health | pp. 1– 9 | doi:10.1093/pubmed/fdu064 Evaluating sexual health planning for the London 2012 Olympics Ava Lorenc, Nicola Robinson Faculty of Health and Social Care, London South Bank University, London SE1 0AA, UK Address correspondence to Ava Lorenc, E-mail: firstname.lastname@example.org A B S T R AC T Background The public health impact of mass gatherings should not be underestimated, requiring careful planning. This evaluation identified the Downloaded from http://jpubhealth.oxfordjournals.org/ by guest on September 30, 2015 successes and failures of a programme targeted to mitigate against potential increases in sexual ill health during the London 2012 Olympics. Methods Programme planning was evaluated using documentary analysis. Stakeholders’ experiences were explored using an online survey. Finally, selected stakeholders were interviewed in depth. Results Over 100 documents were analysed, 36 survey responses received and 12 interviews conducted. Most respondents felt aims were appropriate, potentially overambitious. ‘Business as usual’, with no disruption or increased demand, was reported in sexual health services. Some interviewees felt evidence for increased demand was limited, although contingency planning was needed. Signposting service users and providing ‘residual risk responses’ appeared successful. Planned service transformation was not fully achieved and perhaps inappropriate, although new service collaborations emerged. Over 2000 individuals participated; wider public engagement was seen as inappropriate. A ‘Sex Factor 2012’ competition was particularly successful. Legacy opportunities included planning work, groundwork for transformation, relationship building and continuing the resilience changes. Conclusions The Games allowed sexual health services to explore new ways of working, engage with stakeholders and develop new relationships, although in reality demand for services did not increase. Keywords health promotion, health services, Olympic Games; mass gatherings; sexual health Introduction detected during the Atlanta 1996 Games.6 A literature review to inform the London Olympic Games (unpublished) con- Large-scale mass gatherings such as the Olympic Games cluded that ‘increase in sexual health services in an Olympic present signiﬁcant health challenges to the host country, in- Games host city is necessary. Adequate provision of STIs cluding public health issues and increased risk of illness and awareness and prevention and the provision of sufﬁcient injury such as respiratory and diarrhoeal diseases and sexually sexual health services are vital prior to, during and post transmitted infections (STIs).1 Games’ (S. Dakshina, unpublished results). A review to However, published data on health service planning for inform public health planning for the London Games recom- events such as the Olympics is limited.2 The impact on mended condom distribution and preventative literature for sexual health is also unclear (S. Dakshina, unpublished visitors on avoiding STIs.7 results), being difﬁcult to study STIs in the context of mass In addition to planning for the impact of events on public gatherings or to attribute any changes.3 One study following health, mass gatherings such as the Olympic Games have the Sydney 2000 Games demonstrated an increase in use of sexual health services and of bacterial STIs, and a surge in demand for sex workers during Games time.4 Another study of the 2010 Winter Olympics suggested adopting evidence- Ava Lorenc, Research Fellow based public health strategies in relation to sex work.5 Nicola Robinson, Professor of Traditional Chinese Medicine (TCM) and Integrated However, although anticipated, there was no increase in STIs Health # The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: email@example.com. 1
2 J O U R NA L O F P U B L IC H E A LT H huge potential for health promotion of the population as a sexual health in previous Olympic and Paralympic games. whole, including safe sex.8 Interventions might include provi- Information was extracted to quantify the process, including sion of condoms, educational programmes and campaigns to the number and frequency of meetings convened, type of raise awareness,3 for example the safe sex campaign at the e-mails sent/required, etc. Atlanta 1996 Games.6 Phase 2 was a survey of all key stakeholders, including For the London 2012 Olympic Games, sexual health was those directly and indirectly involved with MBARC. A ques- prioritized by the Government in public health planning. tionnaire was designed for the project using the Survey London Sexual health Programme (LSHP) commissioned a Monkey software. In October 2012, the survey was sent as a private company, MBARC Ltd, to deliver the London 2012 hyperlink in an explanatory email to 195 individuals identiﬁed Games Sexual Health Planning and Legacy Programme (here- by the documentary analysis, MBARC staff and LSHP lists. after referred to as ‘the programme’). Activities within this They represented key stakeholders, including: programme were conducted by a range of stakeholders, sup- † 2012 data group ported and co-ordinated by MBARC. The programme was † Members of the original sexual health promotion group set up to understand the impact of London 2012 Games on † Sexual health commissioning network sexual health, to mitigate against increased sexual ill health Downloaded from http://jpubhealth.oxfordjournals.org/ by guest on September 30, 2015 † Special health authority sexual health leads and contribute to a positive sexual health legacy. It had three † ‘Sex Factor’ Ideas 2012 winners themes: ‘Resilience’ (‘business as usual’, safeguarding services, † MBARC sexual health ambassadors minimizing cost and call on the UK’s National Health Service † 2012 Games sexual health management group (NHS)), ‘Transformation’ (using resilience development to † Organizers of sexual health Showcase events transform services and relationships for lasting beneﬁt) and † Judging panel for ‘Sex Factor Ideas 2012’ competition ‘Engagement’ (maximizing public participation and raising † MBARC staff awareness). † LSHP staff. The overall 2012 public health work was funded by the Department of Health; NHS London (NHSL) and the LSHP The survey questionnaire was designed based on Phase 1 set all the deliverables. The programme commenced in results and focussed on methods and success of methods of 2008 – 09; MBARC were funded from 2010 to 2011. engagement with stakeholders and whether objectives were This paper reports an independent evaluation of MBARC’s achieved. Results were analysed using descriptive and bivariate work on this project, including relevance and achievement of statistics and content analysis where appropriate. aims (resilience, transformation and engagement), govern- Phase 3 used qualitative interviews with key informants ance, challenges, need for sexual health planning and legacy selected from those completing the survey or suggested by of the programme. NHS London/LSHP to ensure representation from a range of stakeholder groups and experiences. Participants were invited via email and provided with a copy of the participant Methods information sheet. Interviews were held either over the The overall aim of the project was to evaluate MBARC’s de- phone, at their place of work or at London South Bank livery and co-ordination of the public health interventions University (LSBU). A consent form was signed. Interviews and support for sexual health service planning to plan for and were digitally recorded and transcribed. mitigate against increased sexual ill health at the London 2012 All interviewees were assigned a code; no other identiﬁers Games. were used on study materials. All materials were kept in a The evaluation used a mixed-methods study design and locked ﬁling cabinet at LSBU or on a password-protected consisted of three separate phases, roughly sequential. The computer ﬁle. evaluation was commissioned in August 2012 and completed We did not anticipate any sensitive issues would be dis- in January 2013. cussed; however, participants were free to withdraw from the Phase 1 used a documentary analysis to describe the study at any time for any reason. process. Documents were provided by MBARC, LSHP and Ethical approval was given by London South Bank NHSL and included minutes of contract meetings; heads University Research Ethics Committee in October 2012, ref- of agreement documents; quarterly reports; management erence UREC 1268. reports; planned activities with stakeholders; Dakshina’s lit- Quantitative analysis used frequency tables and bivariate erature review (S. Dakshina, unpublished results); evaluation statistics. Qualitative data were analysed using content analysis forms from events and a brief background of the literature on to identify key themes. Quotes were anonymized.
S E X UA L H EA LT H P L A N NI N G FO R T H E LO N DO N 2 0 1 2 O LY M P I CS 3 The key issues to be explored in the analysis included: local stakeholder and distributing condoms. Ten respondents were responsible for engaging or representing others. † Success of stakeholder engagement Most were involved in attending meetings and taking part † Were deliverables achieved in or helping to run an event or programme (Table 2). † Skills set/qualiﬁcations required by personnel to carry out The majority of the 24 answering the question felt able to such a programme (over a short time scale) contribute (5 very much so; 13 to some extent). Five felt that † Details of the resources required (time, money etc) and they were ‘not really’ or ‘not at all’ able to. whether resources used were appropriate (especially ﬁnancially). † Recommendations and key learning on the above to Governance and communications inform future planning of mass events which could be Governance was originally managed by four groups (sexual used worldwide health promotion, data surveillance, sexual health services † The themes ‘Resilience’, ‘Transformation’ and ‘Engagement’. and people who sell sex). As the programme moved towards delivery (as MBARC became involved), this structure was reorganized by NHSL. Various governance methods were Downloaded from http://jpubhealth.oxfordjournals.org/ by guest on September 30, 2015 Results used, including a project management group, a ‘Fresh Thinking Group’, a manager at MBARC, LSHP and sexual Participants health commissioners reviewing progress reports. Records Over 100 individual documents were analysed. Invitations were kept of all meetings, and of achievement of deliverables, and one reminder to participate in the survey were sent to 195 risks and contingencies. The only concern about governance individuals. Thirty-six responses were received, an 18% re- sponse rate. Twenty individuals were invited to participate in Table 2 Participants’ role in the programme interviews, 10 from the survey and 10 suggested by NHSL/ LSHP/ MBARC. They were selected to represent a range of Number of % of respondents organizations and experiences. A total of 12 agreed. responsesa (n ¼ 26b) Nineteen (53%) of survey participants were currently working in the NHS—nine in management, six in commis- Member of the sexual health 9 34.6 sioning and four clinical (data were unavailable for four) commissioners group Involved in running ‘Sex Factor 7 26.9 (Table 1). Involvement in the programme varied, including Ideas’ attending meetings, mentoring young people, local dissemin- Member of 2012 Olympics sexual 4 15.4 ation, contributing to materials, management board member, health management group Participant in ‘Sex Factor Ideas’/ 4 15.4 Table 1 Participants supporting participant Involved in running sexual health 3 11.5 Job categorya Survey respondent number Interviewee showcases number Staff member at NHS London 3 11.5 Working in NHS to implement the 4 15.4 NHS clinical 07, 17, 27, 33, 34 programme NHS managerial 03, 11, 12, 13, 14, 15, 19, 22, Member of the HIV and sexual 3 11.5 28, 29, 31 health commissioners group NHS 02, 04, 05, 11, 16, 35, 36 01, 06, 08, 10, England commissioning 11 NHS sexual health or public 3 11.5 Public health 18, 24 02, 07, 09, 12 health lead Voluntary sector/ 37 Participant in sexual health 2 7.7 NGO showcases Local authority 20 Staff member at LSHP 1 3.8 Government 28 Sexual health ambassador with 1 3.8 Education sector 08, 21, 25 MBARC Studying 05, 09, 26, 27 Sponsor 1 3.8 Private sector 06, 10, 32 a Respondents could tick all that applied. a b Respondents could tick more than one category. 10 missing responses.
4 J O U R NA L O F P U B L IC H E A LT H was a loss of leadership prior to appointment of a programme [it may have been better to] concentrate on achieving less manager. Also, interviewees felt that accountability was initial- but better [Interviewee 08] ly blurred. The key methods of communication with stakeholders I think [they were] pretty ambitious aims. . . But no, I think were as follows: those were the right ones [Interviewee 09]. † Communications strategy linked to NHSL Communications Interviewees’ opinions conﬂicted as to the appropriateness of Team, which aimed to signpost and provide key messages to having a separate sexual health programme to other health the public issues. Most (apart from NHSL, LSHP and MBARC) felt that † Reporting from MBARC to LSHP/NHSL it could have been within existing public health plans and † Flyers, ‘Sex Factor Ideas 2012’ competition blog, Twitter, messaging. Facebook, posters and press releases for ‘Sex Factor’ [we] should have focussed on [our work] being part of a † Direct contact with young people at sexual health show- broader area which wouldn’t have exceptionalised sexual cases and ‘Sex Factor’ events, as well as peer interviewers, health, it would have put sexual health back into the idea of online blog, posters and newspaper adverts. health [Interviewee 08] Downloaded from http://jpubhealth.oxfordjournals.org/ by guest on September 30, 2015 † Monthly E-newsletters sent to over 700 people † NHS Choices website I suppose, why sexual health and why not harm reduction † Brieﬁng papers for the LSHP Board which reported to per se, or why not drug prevention, what was, why chose London specialized commissioning group. sexual health and isolate that? That would be my question [Interviewee 09] Overall aims, focus and achievement More survey participants felt the planning aims were achieved I’m really pleased that we, London, were able to prioritise than the legacy aims (Fig. 1). Some people felt the aims were sexual health in the way we have, and I think there will be only partly achieved, attributed to external inﬂuences, lack of lots of lessons [from it] [Interviewee 10] buy-in and limited resources. Some felt the aims changed Three interviewees felt sexual health messaging during the during the programme to ensure delivery. Games was inappropriate, opportunistic and attention grab- The majority of survey respondents (22/36; 61%) thought bing, and likely to be lost in other messages/advertising. the programme focus was appropriate. A minority felt it was not appropriate (5/36); reasons included a lack of increased you’ve got everybody in public health with their own little service use, overambitious ideas and unclear focus from the baby wanting to use it as an opportunity for smoking or outset. Three interviewees felt the aims were overambitious, for sexual health and it would have been just too many especially given the budget. mixed messages [Interviewee 06]. 12 12.5 10 10.0 8 Count Count 7.5 6 5.0 4 2.5 2 0.0 0 Yes, very Yes to Not sure No not No not Yes, very Yes to Not sure No not No not much so some extent really at all much so some extent really at all Do you think sexual health planning for the London 2012 games was achieved? Do you think a lasting legacy for health was achieved? Fig. 1 Survey responses regarding achievement of aims.
S E X UA L H EA LT H P L A N NI N G FO R T H E LO N DO N 2 0 1 2 O LY M P I CS 5 Resilience: achieved but was it necessary? we did a lot of signposting to pharmacies, to GP practices The programme aimed to achieve resilience by safeguarding and to other sexual health services not so close to the sexual health services during the Games, ensuring lower cost Games site. . .we were able to direct people away from the interventions and minimizing the call upon NHS resources. It main sexual health services so we know that can be done used planning templates and a communications strategy (cir- [Interviewee 12] culated to sexual health commissioning and 2012 regional The most popular signposting methods (from 21 (58%) leads), public health messaging (including signposting users survey respondents) were NHS Choices 2012 webpages (par- away from GUM (Genito Urinary Medicine) and condom dis- ticularly NHS managers and clinicians), ‘Summer Lovin’ cam- tribution (500 000 ‘Capital City Condoms 2012’ condoms paign materials (also particularly NHS managers and clinicians), were distributed). Resilience was discussed extensively by sexual health legacy e-news (all sectors) and stakeholder interviewees. presentations (all sectors). The evidence base for planning for an increase in demand The strategy stated that MBARC would distribute 440 000 for services was seen as perhaps being limited and anecdotal. condoms; the October 2012 newsletter says that 500 000 were Participants unanimously recognized that there was no in- distributed. crease in demand for services, perhaps even a decrease, attrib- Downloaded from http://jpubhealth.oxfordjournals.org/ by guest on September 30, 2015 MBARC set up a daily assurance reporting template for a uted to Londoners leaving London due to ‘marketing’ by sexual assault referral centre (SARC) covering the Olympic Transport for London (the ‘Sherman’ effect). However, most boroughs, a last-minute provision. The SARC did experience respondents felt it was ‘better to be safe than sorry’ rather increased referrals during the Games. Respondents felt that than risk ‘a PR disaster’ [Interviewee 02]. this initiative was very successful, providing routes for escal- Generally London was a lot quieter during the Games, ation for any problems, ensuring the SARC could stay open. which showed on the health services, it didn’t have a major impact [Interviewee 06] Health promotion: some success Most survey respondents felt health promotion aims were Respondents felt supported and prepared and that resilience achieved to some extent (Fig. 2). ‘London Organising was achieved, with additional capacity and ‘business as usual’ Committee of the Olympic and Paralympic Games’ (LOCOG) and no evidence of disruption. Only one interviewee (07) felt commissioned a private sector provider to deliver the health that resilience planning was not right. promotion messaging campaign and condom distribution, but Signposting was most commonly reported as successful, this was withdrawn at short notice. Programme managers were fewer felt the communications strategy was useful, especially unaware of the problem until it was too late, although MBARC NHS managers. The FAQs and statements for press especial- and the Terrence Higgins Trust (THT) were praised by inter- ly lifted spirits and prevented bad news stories about local viewees for putting together a campaign at the last minute. sexual health. The planning template was least useful. Health promotion was perceived as having limited impact and 12 12 10 10 8 8 Frequency Frequency 6 6 4 4 2 2 0 Yes, very Yes to Not sure No not No not 0 much so some extent really at all Yes, very Yes to Not sure No not No not much so some extent really at all Do you think the Programme raised awareness of personal responsibility and positive behavioural changes to ensure good sexual health? Do you think the Programme improved sexual health promotion? Fig. 2 Survey responses regarding achievement of health promotion aims.
6 J O U R NA L O F P U B L IC H E A LT H visibility and being scaled down from what was planned due to Transformation successes were providing groundwork for avoiding negative association of STIs, limited funding and the future changes, and services’ successful resilience planning, private sector provider issue. It was felt to be too generic, and considering how to be more evidence based and cost- which NHSL explained was necessary and ‘it was more about effective: making sure people knew how and when to access which I think some of the transformation stuff was around ser- health services if they needed them. . .facilitating people to act vices knowing how ﬂexible they can be. You don’t often responsibly’ [Interviewee 06]. get forced to be ﬂexible. . .So I think yes, it was transform- The most successful health promotion was the ‘Sex Factor ation in that services ﬂexed their ﬂexibility [Interviewee 09] Ideas 2012’ competition. Ten/13 survey respondents (77%) found the ‘Summer Lovin’ health promotion materials useful, [signposting is] something we ought to be doing all the particularly NHS managers and clinicians. time, but the Games was sort of like a catalyst for us to really look where our services are in terms of access to If you raised awareness of a dozen young people I suppose them, and if people can’t access them what alternatives do that in itself is better than nothing [Interviewee 01] we have in place [Interviewee 12]. Survey participants identiﬁed problems distributing the cam- Downloaded from http://jpubhealth.oxfordjournals.org/ by guest on September 30, 2015 paign materials to the public and not reaching the right client group. Engagement: successful Estimates from documentation suggest that nearly 2000 Transformation: limited success people were engaged in the programme, plus many more The programme aimed to transform services and relation- from the health promotion campaign. This included young ships through resilience planning, a pharmacy self-testing people (450 people), NHS providers (280 people) and com- pilot, signposting and the ‘Sex Factor Ideas 2012’ competi- missioners (80 people), voluntary and community organiza- tion. However, the timetable appears to have been overambi- tions including British Pregnancy Advice Service (BPAS), tious, not allowing sufﬁcient time for required approvals. Brook, THT (around 20 people). Minimal (around 10 or less) Data suggest that transformation was the least successful aim people were engaged from people who sell sex, NHS (Fig. 3). The pathway pharmacy pilots were not implemented. London, LSCG, LSHP, local/national government, health protection, educational sector and commercial sector. the idea around. . .self-testing out into the community Key engagement methods were events, activities and would have helped to deliver some of the QIPP [Quality presentations, collaborating on material design, meetings, Innovation Productivity and Prevention] agenda, but as it e-newsletters and the NHS Choices website. was it wasn’t actually realised [Interviewee 06] Interviewees seemed unclear what ‘public’ engagement One interviewee  felt that London 2012 Games was the meant and whether it was appropriate. wrong time to try out new technologies and pathways due to I’m not sure about public engagement. . .if you break that existing disruption to services. down does that mean campaigns for the public, and if so, which members of the public, is it at-risk groups or is it 10 more generic groups? I think that probably the aim should have been around good stakeholder engagement which 8 includes public engagement and I think there was good stakeholder engagement [Interviewee 09]. Frequency 6 Interviewees felt that a range of professionals were engaged, 4 in particular service providers and the third sector: ‘I think they tried very hard to reach out to sexual health 2 services’ [Interviewee 01] I really did see some fantastic voluntary sector collabora- 0 Yes, very Yes to Not sure No not No not tions. I would say that was good legacy [Interviewee 09] much so some extent really at all Do you think the Programme transformed services and Professionals felt to be less well engaged included commis- relationships between partners and stakeholders for lasting benefit sioners, senior leadership decision-makers and perhaps the in line with QIPP? Fig. 3 Survey response regarding achievement of transformation. wider public health community.
S E X UA L H EA LT H P L A N NI N G FO R T H E LO N DO N 2 0 1 2 O LY M P I CS 7 There was a unanimous view that MBARC were ‘great’ and to be a challenge to get buy-in, ownership, involvement and ‘really good’ at engaging young people. ‘Sex Factor Ideas participation from the necessary stakeholders – when 2012’ competition may provide a model for engagement funding did materialise (it took time) there was insufﬁcient in the future rolled out and localized as a ‘toolkit for local time to build/re-build the necessary coalition to take the engagement’. work forward [Survey 16]. Other challenges from progress reports included problems Legacy: some potential but unclear with technology, e.g. NHS staff accessing YouTube for ‘Sex Survey participants were split 50/50% regarding the pro- Factor 2012’; lack of prioritization of Games time provision gramme’s legacy. Some felt it was too early to conclude. Some by commissioners and worsening ﬁnancial climate impacting felt legacy was limited due to NHS reorganization and lack of sponsorship. a clear plan and commitment from the NHS. Potential legacy opportunities were: the planning work that was done; trans- formation ideas; relationship building and continuing the Discussion changes implemented in the resilience work. The transform- Main findings of this study Downloaded from http://jpubhealth.oxfordjournals.org/ by guest on September 30, 2015 ation models ( pharmacy pilots, self-testing, condom distribu- Results suggest that the aims of the programme were tion and ‘Sex Factor’) provide groundwork and potential correct, although perhaps overambitious given the resources legacy if taken forward. available, in particular transformation aims. They appeared some softer stuff around relationships which is worth only to be achieved in part due to ‘over-promise’ and exter- recording as part of the legacy. I think it brought providers nal factors. and commissioners together in common purpose Results highlighted that the evidence base for the decision rather than what is sometimes a more adversarial role to plan for an anticipated increase in demand for sexual [Interviewee 05] health services may have been insufﬁcient. Despite stake- holders reporting no increase in demand for services, the I think the legacy is getting existing services doing some- Olympic Games provided an opportunity for sexual health thing slightly different, and know[ing] that they can do it services to try new ways of working, engage with stakeholders and it’s not going to be onerous [Interviewee 09] and develop new relationships. Aims to transform services and relationships were relatively Challenges unsuccessful, attributed to lack of time to achieve sufﬁcient Awaiting sign off by senior staff was a key documented delay- buy-in and confounded by NHS restructuring. ing factor. Governance and communication seemed very thorough. Respondents felt that major restructuring and reform of One of the key problems mentioned in this evaluation was the the NHS during the programme had a major impact on its issues with private sector involvement. success, particularly in engaging NHS stakeholders and Successful engagement was reported, although many parti- restricting funding. cipants felt aiming to engage the public was inappropriate and There were much bigger issues that people in the NHS overambitious. were grappling with so this programme probably ended up Although unclear, the main potential legacy opportunities being much less of a priority for people. . .. [Survey 4] were the planning work that was done; the groundwork for transformation ideas; relationship building and continuing the Progress reports and respondents also identiﬁed the difﬁcult changes implemented in the resilience work. relationship with the private sector as a challenge (see health promotion above). What is already known on this topic A number of interviewees cited limited resources as Although a study of the Sydney Olympics demonstrated restricting health promotion and engagement, particularly the increased use of sexual health services and STIs,4 other eva- reduced funding (also documented in progress reports), al- luations of the London and Sydney Games have found little though the programme was generally seen as successful change in routine activity in other services9 and no major within the ﬁnite resources. Time was also limited, particularly public health incidents.2,10 In addition, the evidence base for for achieving transformation. the decision to plan for an anticipated increase in demand was Funding and therefore legitimacy were always neglected with limited across public health services.2 Black et al.2 found that this work programme – without funding it was always going initially NHSL anticipated minimal impact on health services,
8 J O U R NA L O F P U B L IC H E A LT H but, as the Games approached, planning for increased messages. Future programmes should be cautious about demand increased, perhaps due to anxiety about responsibility attempting transformation of services during the event, al- among NHSL and doubt as to the relevance of data from pre- though opportunities for transformation should be recognized. vious Olympics. Extensive, diverse, regular stakeholder engagement, in Similarly to this evaluation, Black et al.’s evaluation also particular commissioners, is crucial and can provide an excel- found that systemic improvements to public health, rather than lent opportunity for collaboration; however, public engage- a health legacy, were seen, such as changes to service delivery ment should be focussed to avoid wasting resources. Third and relationships.2 Lack of clarity regarding legacy was also sector organizations are vital in ensuring engagement with identiﬁed, attributed to unclear deﬁnitions, lack of funding, hard-to-reach groups and in achieving outcomes. Young ‘deprioritization’, unsustainability and lack of measurement.2 people are often enthusiastic and the ‘Sex Factor Ideas 2012’ Participants’ concerns about the lack of consistency in lead- competition model could be used for future events and en- ership and accountability (due to MBARC taking over after the gagement with young people in sexual health. programme had started and delay in appointing a programme Participants were divided as to whether sexual health manager) appears legitimate, as Tsouros et al. cite strong and should have been dealt with separately to other health issues. consistent leadership as a critical factor in public health This is perhaps part of a wider debate, for example in the Downloaded from http://jpubhealth.oxfordjournals.org/ by guest on September 30, 2015 planning for Olympic Games.8 The relationship between NHS sexual health used to be commissioned by specialist NHSL and LOCOG was also problematic in Black et al.’s services and is now predominantly commissioned as part of evaluation, particularly differences in culture and priorities.2 public health (by local authorities).11 The pros and cons of Successful engagement is known to be key, for example in including sexual health as part of general health promotion Black et al.’s evaluation where connections between the NHS or developing separate programmes should be considered at and stakeholders were a key factor in successful delivery of future events. the public health planning for the Games.2 The NHS reforms did have a signiﬁcant impact on sexual Limitations of this study health services11 and their commissioning and were not As the evaluation was commissioned after the programme without controversy.12 The impact of the NHS reforms on was completed we were unable to compare results before and the programme echo those seen in the Athens Games due to after and relied on LSHP and MBARC to recommend who a change of government 5 months before the start.8 we should invite to participate. Commissioning the evaluation as part of the initial planning for the programme may have What this study adds prevented delays. As the ﬁrst ever host city to have a sexual health programme, Response rates were low, which may be due to NHS the plans and documentation can provide support, process reform occurring during the evaluation period, meaning that lessons and data for future events, e.g. Rio in 2016, the many potential respondents had other priorities and had Commonwealth Games in Glasgow in 2014 and potentially perhaps changed jobs. The results of the evaluation should the Gay Games in London in 2018. thus be used with caution as the evaluation sample is unlikely This study conﬁrms that a clear vision, evidence-based aims to be representative of all stakeholders. and consistency in leadership and accountability are important Given more time and resources we would have liked to for the success of programmes of public health planning interview a wider range of stakeholders, in particular those for mass gatherings.8 The governance and communication who were not actively engaged in the programme, to evaluate processes in this programme should inform future similar its wider impact. programmes. Careful planning, timely reporting and commu- nication strategies are crucial10 and programmes may need to Conclusion allow extra time for approvals needed from senior staff, espe- cially if other external factors may inﬂuence their priorities. This evaluation provides recommendations for sexual health Decisions regarding potential increase in demand should services during future events. Sexual health services were not be made on a local basis, although a programme to cope with disrupted by the 2012 Olympic and Paralympic Games, and potential extra demand for services can provide assurance to demand did not appear to increase. Although services were stakeholders and ensure preparedness. Signposting users away not transformed as intended, the programme resulted in a from GUM and a SARC residual risk response may be useful. number of legacy opportunities to improve sexual health ser- The Games may not have been the best time to attempt vices in London, particularly engagement, relationship build- transformation, in particular amongst so many competing ing and resilience of services.
S E X UA L H EA LT H P L A N NI N G FO R T H E LO N DO N 2 0 1 2 O LY M P I CS 9 Acknowledgements 4 McNulty AM, Rohrsheim R, Donovan B. Demand for sexual health services during the Olympic Games: both sides of the Sherman Dr Lorenc and Prof Robinson would like to thank all the effect. Int J STD AIDS 2003;14(5):307 –8. survey and interview participants, as well as MBARC for their 5 Deering KN, Chettiar J, Chan K et al. Sex work and the public health cooperation. impacts of the 2010 Olympic Games. Sex Transm Infect 2012;88(4):301– 3. 6 Brennan RJ, Keim ME, Sharp TW et al. Medical and public health Ethical approval services at the 1996 Atlanta Olympic Games: an overview. Med J Aust 1997;167(11 – 12):595– 8. Ethical approval was given by London South Bank University 7 Enock KE, Jacobs J. The Olympic and Paralympic Games 2012: lit- Research Ethics Committee in October 2012, reference UREC erature review of the logistical planning and operational challenges 1268. for public health. Public Health 2008;122(11):1229 – 38. 8 Tsouros A, Stergachis A, Barbeschi M et al. The Athens 2004 Olympic Games and public health: main conclusions and lessons Funding learned. In: Tsouros AD, Efstathiou P. (eds). Mass Gatherings and This work was supported by the London Sexual Health Public Health. The Experience of the Athens 2004 Olympic Games. Downloaded from http://jpubhealth.oxfordjournals.org/ by guest on September 30, 2015 Copenhagen: WHO, 2007. Programme (LSHP). 9 Williams K, Sinclair C, McEwan R et al. Impact of the London 2012 Olympic and Paralympic Games on demand for microbiology gastro- intestinal diagnostic services at the Public Health Laboratory References London. J Med Microbiol 2014;63(Pt 7):968 – 74. 1 Hadjichristodoulou C, Mouchtouri V, Soteriades ES et al. Mass gath- 10 Jorm LR, Thackway SV, Churches TR et al. Watching the games: ering preparedness: the experience of the Athens 2004 Olympic and public health surveillance for the Sydney 2000 Olympic Games. J Para-Olympic Games. J Environ Health 2005;67(9):52– 7. Epidemiol Community Health 2003;57(2):102 – 8. 2 Black G, Kononovas K, Taylor J et al. Healthcare planning for 11 FPA. What does the Health and Social Care Bill mean for sexual the Olympics in London: a qualitative evaluation. PLoS One health services in England? 2012. http://wwwfpaorguk/sites/ 2014;9(3):e92338. default/ﬁles/health-and-social-care-bill-and-sexual-health-services- 3 Abubakar I, Gautret P, Brunette GW et al. Global perspectives for march-2012 pdf (1 July 2014, date last accessed). prevention of infectious diseases associated with mass gatherings. 12 Maynard A. NHS reform: the risks of jumping on the spot again. J R Lancet Infect Dis 2012;12(1):66– 74. Soc Med 2013;106(5):164 – 6.
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