Select Committee on Health Minutes of Evidence

Memorandum by the Terrence Higgins Trust (SH 82)


  1.1  Thank you for the opportunity to give evidence to this review of the effectiveness of the national strategy for sexual health and HIV.

  1.2  The Terrence Higgins Trust (THT) is the largest HIV charity in the UK. We provide HIV care and sexual health promotion services to people with HIV and HIV prevention programmes for those communities most at risk—gay men and African people in the UK. Through our care services, research and client involvement work, we are in a unique position to comment on the effectiveness of and challenges facing national plans that aim to affect the sexual health and HIV status of people throughout the UK.


  2.1  The UK currently has the highest rate of sexually transmitted infections (STIs) since the NHS began, and they continue to rise dramatically. Between 1995 and 2000:

    —  Gonorrhoea, chlamydia and syphilis rates all rose by more than 100 per cent[1]

    —  In 2001, approximately 4,100 new HIV infections were diagnosed; more than in any year since records began[2];

  2.2  Meanwhile, GU services and the HIV voluntary sector are struggling to meet client need:

    —  THT has found that over 40 per cent of people needing sexual health appointments have to wait more than a week to be seen, and 1 in 10 have to wait more than a fortnight[3];

    —  Clinic workload has increased by 34 per cent in 5 years[4];

    —  Uptake of THT services has increased between 10 per cent and 500 per cent in the last two years[5].

  2.3  A survey by THT and PatientView found that GPs are reporting problems

    —  Collaborating with specialist HIV services;

    —  Understanding complex issues of confidentiality and HIV[6].

  2.4  In the same period, the government has:

    —  Removed sexual health and HIV as a core priority for action;

    —  Removed ring fencing from HIV prevention funding;

    —  Devolved commissioning power to local, non-specialist PCTs;

    —  Issued the draft national strategy for sexual health and HIV but not provided, or indicated an intention to provide a corresponding National Service Framework that could transform principle into practice.


  3.1  The recent dramatic rise in the number of STIs, combined with unprecedented levels of HIV diagnoses make it clear that sexual health and HIV are health issues that require urgent, prioritised action from central government. It is sadly ironic that, as prevalence has increased, the government has undertaken a range of reforms within the NHS that have actively de-prioritised sexual health and HIV. These have had the effect of undermining the national strategy before it has had time to take effect.

  3.2  The government has provided all PCTs with a wide range of targets and priorities for general healthcare provision as well as four specific clinical priorities (cancer, CHD, mental health and older people). Given this government emphasis on performance within the NHS, it is clear that anything outside this framework is unlikely to be a priority for PCTs as they struggle to establish themselves. The voluntary sector, whose services have never been in such high demand, are at particular risk in this new climate.

  3.3  THT welcomes the aims laid out in the draft strategy but recognises that without active guidance, most usefully through a National Service Framework (NSF), they will be difficult, if not impossible to achieve. A NSF would ground the aims of the strategy in practical guidance and give teeth to the upcoming commissioners' toolkit, by

    —  Setting national standards and providing practitioners with service models for a defined service;

    —  Putting in place strategies to support implementation;

    —  Establishing performance milestones against which progress within an agreed time-scale will be measured.

  3.6  Intentions spelt out within the draft strategy to encourage greater involvement in sexual health and HIV testing and treatment by generic healthcare providers, particularly GPs, add to the concern around PCT capacity. The difficulties even HIV friendly GPs continue to face require training and guidance that springs from an in-depth understanding of a complex medical and social issue. Given the already high demands placed on PCTs, there is an urgent need for the government to issue clear guidance for training for all primary care staff and agreed good practice guidelines for GPs and dentists. These would be best developed in consultation with HIV organisations.

  3.6  GU clinics are already under immense strain and there is nothing to suggest that demands on their services will not increase. Increased prevalence of HIV and other STIs; spiralling drug costs; increased client numbers as a result of the national awareness campaigns proposed in the draft strategy; and confusion around PCT commissioning arrangements mean that this situation urgently requires an unambiguous lead from central government; something that is unlikely to happen without sexual health and HIV being re-prioritised at the highest level.


  4.1  To most effectively underpin and support the draft strategy, the government should:

    —  Reprioritise sexual health and HIV.

    —  Develop a National Service Framework for sexual health and HIV.

    —  Issue HIV training and good practice guidelines for generic healthcare providers.

    —  Review levels of investments in GU services against projected trends in STI and HIV prevalence.

June 2002

1   Sexually Transmitted Infections in the UK: New Episodes seen at Genitourinary Medicine Clinics, 1995-2000, Public Health Laboratory Service, 2001. Back

2   Source: Public Health Laboratory Service. Back

3   THT/PatientView/BHIVA survey of GU consultants, 2001. Back

4   Sexually Transmitted Infections in the UK: New Episodes seen at Genitourinary Medicine Clinics, 1995-2000, Public Health Laboratory Service, 2001. Back

5   Terrence Higgins Trust Annual Report 2000-01. Back

6   Managing HIV: a new role for GPs, PatientView in collaboration with Terrence Higgins Trust, 2001. Back

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