Examination of Witnesses (Questions 120-136)
MS CATHY
HAMLYN, DR
VICKI KING,
MS RUTH
STANIER,MS
KAY ORTON
AND MS
ANDREA DUNCAN
WEDNESDAY 26 JUNE 2002
120. And is there any guidance, if you have
got a partnership between several PCTs, and one of those PCTs
is taking the lead on sexual health, will that one lead work across
the three PCTs, or will each PCT have their own?
(Ms Hamlyn) We think it is perfectly acceptable for
there to be one PCT leading, if that is the local arrangement.
Who gets involved in our training and development, I think, is
for them to tell us about who they would want us to communicate
with, involving their training. But we would find it acceptable
if one PCT were to take the lead and identified a collaborative
arrangement; it is equally acceptable for each PCT to have a lead.
121. And what is the role of the Strategic Health
Authority?
(Ms Hamlyn) The Strategic Health Authority has a performance
management role over PCTs, so they will be discussing with each
PCT about progress to meeting the standards and guidelines that
we will be producing, and the development of a local strategy.
So really it is a performance management role.
Julia Drown
122. Can I just pick up some of the issues that
were brought to our attention from the Family Planning Association's
evidence to our Committee, which is what you are going to see,
and just first of all picking up some of their issues on abortion.
You said earlier that you are doing these pilots, and have seen
the Action Plan in other settings, where it is legal; would those
include family planning and community clinics?
(Ms Hamlyn) We are talking about in the context of
the law, and I do not know whether Andrea would like to comment.
(Ms Duncan) The law currently says that abortions
can only be performed in an NHS hospital vested in a PCT, or what
used to be a health authority, or in a place approved by the Secretary
of State for Health.
123. So the Secretary of State for Health could
approve any area, if they wanted to?
(Ms Duncan) But, at the moment, the only places approved
by the Secretary of State are in the independent sector, that
is (BPS, MSI ?) type.
124. But, presumably, it would not be a big,
it is not primary legislation to change it?
(Ms Hamlyn) What we want to do is to pilot, there
could be examples where you have what is regarded still as a hospital
site, but actually is now, because of the development in that
particular area, it is actually more a community setting, where
we can actually pilot it to see how it works, and then we can
actually consider whether that will inform us about the issue
about any changes the Secretary of State might wish to make.
125. So we are not yet dealing in family planning
or community clinics, probably?
(Ms Duncan) There is a facility in the Human Fertilisation
and Embryology Act that the Secretary of State can approve a class
of place[7],
so we do not have to take applications from individual places,
and so these pilots will inform what we can describe as a class
of place.
126. The other thing they suggested was that
nurses should be able to undertake abortions; are you looking
at that?
(Ms Duncan) That would require a change in the current
law, because the law says that abortions can only be undertaken
by a registered medical practitioner.
127. Any views on that though, is that something
that is being raised with the Department?
(Ms Hamlyn) I do not think it has, actually, been
raised with us specifically, no.[8]
128. And, in dealing particularly with the delays,
that obviously women do not want to have, obviously one big request
is for abortion to be available on request, in the first trimester;
what evidence do you have that would actually smooth the process,
lead to a reduction in people having to have very late abortions
when an earlier one obviously would be much less difficult for
them, and for the NHS?
(Ms Stanier) When you say "on request",
do you actually mean a change to the current arrangements for
securing two doctors' signatures?
129. Yes.
(Ms Stanier) Well the position is that the Government
really does not have any plans to look again at those arrangements.
130. But do you get any feedback on whether
that would actually help, in terms of giving women abortions more
timely, and avoiding them having to go very late and it being
more difficult for them and for the NHS?
(Ms Stanier) I am not aware that we have had any such
representations, or seen any evidence on that.
131. The Family Planning Association are also
saying that the information on sexual health is very patchy at
the moment, and a particular feeling that materials are not accessible
in other formats, large print, particular languages, community
ethnic minority languages, Braille, audio, and so on. What steps
are being taken to address that?
(Ms Hamlyn) Those issues are being looked at in the
context of, as I referred to, this review of information leaflets,
and what is available to the public and how they are being used.
132. They pointed out also about, in particular,
their information lines, but how they are not integrated with
NHS Direct; is that something else that you are looking at as
well?
(Ms Hamlyn) We have had discussion with the FPA in
thinking about what should be the model of helpline provision,
particularly in the thinking about the context of having a campaign,
for the people that may need to `phone up a particular service.
And I think we had to distinguish between, here, an information
line, where people get basic information, a line where you have
a professional back-up, that the FPA currently operate, and NHS
Direct, I think, is clearly where some people might argue that,
if that became the main vehicle, that maybe sexual health will
be normalised. But there are some issues about the approach that
is taken in NHS Direct, and, in particular, that people are asked
their name, and so on, but actually when people want to `phone
up, they want to remain more anonymous than that. So we are not
convinced that actually having NHS Direct as the main first point
of reference for our campaign is the right vehicle, but we do
feel that there clearly need to be very strong links with NHS
Direct, because some people will go through NHS Direct. And the
FPA does work already in close concert with NHS Direct, as indeed
do other helplines.
133. One very interesting question. It is rare,
in officials, to have a panel of all women; any idea why? And
there are quite a few women consultants in GUM; why?
(Ms Hamlyn) I think it is probably the case that in
sexual health as a whole, certainly in most of the places that
I go to, there is quite a predominance of women.
Julia Drown: Why
Chairman
134. What conclusion do you draw, why is that,
because it is an issue we may want to address, quite seriously?
(Ms Hamlyn) Yes, that issue has been raised, but,
in fact, for health promotion work with men, that you need more
male workers; that is an issue that is raised.
135. Any thoughts on what we do there?
(Ms Hamlyn) There is some very good work going on
within our Teenage Pregnancy Programme, on young male workers;
we were actually trying to bring them together, in terms of a
network which can support and encourage them, and hopefully, therefore,
we might attract more people into the field.
(Ms Stanier) We also have one male member of our team
here today. I would not like to say that our whole team is women.
Chairman: He is sat on the floor.
Sandra Gidley
136. Just a quickie. I have had a number of
letters from people who seem to be concerned, and I do not know
where they get this idea from, that, with the changes that are
mooted, I think they think because sexual health is going to be
the responsibility of the PCTs, there seems to be a feeling that
somebody has got hold of that you have to go to your doctor to
access these services. I just wondered if you would comment on
that, because not everybody would feel comfortable going to their
GP?
(Ms Hamlyn) There was some confusion that came out
during the consultation process about our model of service, and
we did refer to wanting to see an effective Primary Care service
and the role of Primary Care; but we were really talking about
Primary Care in its widest sense, and not just about general practice,
in that context. So, yes, there were some people who thought that
we were talking about disinvesting from other services and putting
everything onto the GPs, and that is not what we are talking about,
we want to improve choice of access, yes, for people in a local
area, but there is a range of different ways that can be provided,
and, yes, general practice has a part to play, but they are not
the only part to play.
Sandra Gidley: Thanks for clarifying that.
Chairman: Can I thank our witnesses for the
helpful session. You promised us some additional pieces of information,
which we look forward to. We are very grateful for your co-operation.
Thank you very much.
7 Note by witness: For medical termination of
pregnancy. Back
8
Note by witness: The British Pregnancy Advisory Service
raised the issue at a meeting with the Department in November
2000 but were informed that under the current law only a registered
medical practitioner can undertake a termination of pregnancy. Back
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