Examination of Witnesses (Questions 404-419)
MONDAY 18 NOVEMBER 2002
MR NICK
SPRINGHAM, MS
EVELYN ASANTE-MENSAH,
PROFESSOR MIKE
KELLY, MS
KAYE WELLINGS,
MR SIMON
BLAKE AND
MRS LINDSAY
ABBOTT
Mr Austin
404. I welcome you to this evidence session
of the Health Committee's inquiry into sexual health. I apologise
for the absence of our Chairman, David Hinchliffe, who is unable
to be with us today for personal family reasons. Could I ask our
witnesses if they would, across the table, briefly introduce yourselves
and say which agency you are from.
(Ms Asante-Mensah) My name is Evelyn
Asante-Mensah. I am Chief Executive of the voluntary agency called
the Black Health Agency working with black and minority ethnic
communities in Greater Manchester. I also chair Central Manchester's
Primary Care Trust.
(Mr Blake) I am Simon Blake. I am from the National
Children's Bureau. I lead on personal social health education
and citizenship for the Bureau, which includes sexual relationships
education. The unit, which I am Assistant Director of, hosts the
Sex Education Forum, which is a collaboration of over 50 organisations
that work together on sex education.
(Ms Wellings) I am Kaye Wellings. I am at the Centre
for Sexual Reproductive Health at the London School of Hygiene
and Tropical Medicine. I do research into sexual health.
(Professor Kelly) My name is Mike Kelly. I am the
Director of Research and Information at the Health Development
Agency.
(Mrs Abbott) Lindsay Abbott, Deputy Head Teacher,
Slough and Eton Church of England School, teaching SRE. Thank
you.
(Mr Springham) Nick Springham, Health Improvement
and Commissioning Manager for Newcastle Primary Care Trust.
405. Thank you very much. I think we will be
dealing our questions to you in a thematic way. We may direct
questions to particular witnesses but if anyone feels they want
to intervene, please indicate and we will try to get to you. Can
I just start off, first of all, with a question to Ms Asante-Mensah
and to Mr Springham. This is wearing your PCT hat rather than
a voluntary organisation hat. One of the issues that has been
raised with us as we have been making visits is the absence of
a national service framework in this area and, therefore, no earmarked
resources, and also the ending of the ring-fencing of HIV monies.
To the two of you first of all I would like to ask what prospect
you think sexual health has of achieving recognition as a priority
area in the newly established PCTs?
(Ms Asante-Mensah) I think our experience in Manchester
is that sexual health will be a priority. We have quite a high
prevalence of HIV, sexually transmitted infections, and we have
recently had a syphilis outbreak. We have got a significant African
community as well as other minority ethnic communities and refugee
communities. I think the issue for us is around capacity and how
we prioritise sexual health within all the other things that as
a PCT we need to prioritise to ensure that we raise it up the
agenda. We have a lead within the organisation but I think there
is a difference between having a lead and somebody whose role
it is to ensure the effective implementation of the Sexual Health
Strategy. I think, for me, the issue is about areas where prevalence
may not be so high and where, because of the other conflicting
priorities we have as PCTs, we have to make decisions in terms
of what we focus on within our limited resources. In those areas
it may be a priority but it may slip slightly off the agenda.
(Mr Springham) I would like to echo that as well.
One of the things that does help is the fact that we have got
the teenage pregnancy targets listed as one of the key targets
in the local delivery plans that PCTs have to come up with. Really
and truly that will help us prioritise or make a case for prioritising
sexual health locally. One of the difficulties around that is
that does nothing to prioritise GUM issues because those are specially
around teenage pregnancy. It is a problem and those of us who
are working within Primary Care Trusts and have a background and
interest in sexual health are constantly trying to get it pushed
forward on those priorities but, as Evelyn said, there is a whole
list of priorities that we need to meet. It is there but it is
struggling.
406. Apart from resource issues, do you see
any difficulties that PCTs are faced with in delivering promotion
and prevention programmes?
(Ms Asante-Mensah) I think again it really is the
capacity and expertise and experience within PCTs. As health authorities
were dis-established a lot of staff were displaced and did not
come into PCTs and they have left with an awful lot of experience
and history about both sexual health and HIV promotion and prevention
particularly. As a PCT, or Central Manchester Primary Care Trust,
we have had quite a deficit in terms of commissioning sexual health,
we have not had the experience and the expertise there. For me
it is about capacity, it is also about prioritising who we are
actually going to target in terms of prevention and recognising
that we do have to target because we have finite resources and
we need to really look at how we provide sexual health and implement
the strategy. I do not believe at the moment we have all the expertise
we need within PCTs and that is a hindrance to us.
407. Even if you had sufficient financial resources
you would still have difficulty?
(Ms Asante-Mensah) I think if we had financial resources
we would be able to bring in capacity to do it whereas at the
moment capacity for us is an issue.
(Mr Springham) I think that there is an issue even
with the capacity and the resources because that capacity and
those resources are quite often needed within clinical areas,
so to make a case for sexual health promotion and HIV prevention
services on top of that is doubly difficult. The clinical services
themselves are struggling with the resources and the capacity.
If more were to come through the system we could make that case
for actually, if you like, the softer areas of work, education
work out in the community, rather than frontline clinical services
that are struggling with waiting lists etc., etc. It is not just
about resources, it is also about the will and the commitment
to health promotion and HIV prevention work rather than purely
treatment care.
408. The Committee has just come back from Manchester
and I think we would bear out your comments about creaking at
the seams with treatment. Do you think that it is going to be
really difficult, given the pressures on the treatment side, to
direct resources into prevention and promotion campaigns?
(Ms Asante-Mensah) I think it is about the will of
PCTs to ensure that prevention remains a priority and that resources
do not get syphoned off into treatment and care. I think we have
all got pressures around prescribing generically and looking at
treatment generically. I believe that as PCTs we have to have
the commitment to actually undertake work in this area and focus
our efforts on prevention. If we do not have treatment and prevention
hand in hand then no matter how much money you put into treatment
we are missing out a whole part of society that we need to do
a lot more work with. If we are going to look at reducing targets
then we need to look at prevention and sexual health promotion
and the will has to be within the PCTs to focus on that and to
ensure that through our contact with health promotion, through
our partnerships with voluntary agencies and community groups,
we keep prevention on the agenda.
Julia Drown
409. Given the shortage of resources Nick Springham
has referred to, is the commissioning being done at the right
level or is there a danger that we have got lots of different
organisations doing the same sort of work which is unnecessarily
replicated throughout the health service and there could be a
more efficient way of commissioning services?
(Ms Asante-Mensah) I think that there could be a more
efficient way of commissioning services. Our experience in Manchester
at the moment is that one of the PCTs is leading on treatment
and care. My PCT leads on family planning and teenage pregnancy.
There is not very much being done around sexual health and I think
we need to look at it as a serious service and therefore we need
to look at how we commission, I suppose, on a city-wide basis.
John Austin
410. One of the things that puzzled me, and
I think puzzled some of my colleagues, when we went to Manchester
was that there was a not a single PCT responsible for commissioning
all the sexual health programmes, it was carved up in little bits
with three PCTs having different bits of it.
(Ms Asante-Mensah) That is where some of the issues
are because that is when we do get into duplicating provision.
We have got three contracts potentially with one agency and rather
than having that we could look at services across the city. I
think the difficulty is that we, as PCTs, need to have that discussion
around how we are going to commission, what services we want,
what our populations are and what services they need. I think
what we are doing is falling into the historical pattern at the
moment because we do not have the capacity and we do not have
the expertise.
Julia Drown
411. It is not an issue about the way the Government
is organising the services, it is for PCTs to sort this out and
as far as this Committee is concerned there is no need for regulations
that need to be structured in a different way, it is for the PCTs
on the ground to sort out how to do it.
(Ms Asante-Mensah) I think it is a mixture of both.
412. What would you want the Government to do?
(Ms Asante-Mensah) I think it is about re-looking
at how services are structured and the commissioning toolkit will
be a great support to PCTs but we, as PCTs, have to have both
discussion and agree—
413. So it is the toolkit that is helpful?
(Ms Asante-Mensah) Yes.
Dr Taylor
414. We have got the picture in Manchester where
it is split up but could we know how it is split in Newcastle
and any experience anywhere else because certainly at home it
is very split up. I would like to know if it is a nationwide picture
that it is split, which must make working extraordinarily difficult.
(Ms Asante-Mensah) It is very difficult.
415. Then we do need recommendations.
(Mr Springham) In Newcastle we are quite fortunate
because we have one Primary Care Trust that is just coterminous
with the local authority boundaries there. Historically there
was a health authority that stretched across Newcastle and North
Tyneside, which is the neighbouring local authority area. What
we have managed to keep in Newcastle and North Tyneside is one
health promotion department working across Newcastle and North
Tyneside because we felt that it was not sustainable to split
that department into two because one or other of the PCTs would
lose expertise unless we had extra investment that we could put
in to make sure that did not happen. That is holding together
but it is one of the few things that are working across to Primary
Care Trusts at the moment and how sustainable that is I do not
know, especially when targets come through to PCTs and this is
our target, we need to meet it, our heads are on the line if we
do not meet it, so we want our service that is going to meet our
targets. There is a growing feeling of "Well, Newcastle and
North Tyneside Primary Care Trust perhaps need their own service",
but I am not sure about that. I think it would be much better
to use the expertise that we have across Primary Care Trusts.
416. So you would like to keep this as a single
service for the whole of the county, as it were?
(Mr Springham) Yes, I think it makes sense because
it is quite a small geographical area with quite a lot of people
in that area and you do not have to duplicate the resources you
have, the library, and the expertise that you have into both areas.
417. Would you lump together sexual health promotion
and GUM services?
(Mr Springham) I am just talking about health promotion
services so sexual health promotion services as well as other
services related to health promotion, not the clinical services.
At the moment there is a GU clinical service provided in North
Tyneside and provided in Newcastle so there are links between
the services but they are separate services.
418. Is that satisfactory?
(Mr Springham) Yes, and I think that we need to be
making those links better between services and that is happening
locally as well. There are networks being set up across GP services
so those links are better made.
Dr Naysmith
419. Would they be better as one service—you
talk about bettering links—or would they be better as one
service? Would there be any advantages to a single service?
(Mr Springham) It is particularly difficult in Newcastle,
and my clinical colleagues would flag that up themselves, because
we are just south of Northumberland which is a huge county and
there is no GU service provided, and we are just north of Gateshead
and there is no GU service provision in Gateshead. So Newcastle
itself suffers a bit from people coming into our service when
maybe they should have their own.
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