Evaluating sexual health planning for the London 2012 Olympics

Page created by Kenneth Peterson
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
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: lorenca@lsbu.ac.uk

  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

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  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

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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

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                                                                    †   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
                                                                    †   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
                                                                    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
† 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

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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
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
                                                                                   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]

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† 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].







             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
                                                                                           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-
crease in demand for services, perhaps even a decrease, attrib-

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                                                                                              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






                       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-

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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 [07] 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
                                                                                             more generic groups? I think that probably the aim should
                                                                                             have been around good stakeholder engagement which
                                                                                             includes public engagement and I think there was good
                                                                                             stakeholder engagement [Interviewee 09].

                                                                                           Interviewees felt that a range of professionals were engaged,
                                                                                           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-
                         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

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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

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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
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
                                                                                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
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