Examination of Witnesses (Questions 1100-1119)
THURSDAY 23 JANUARY 2003
MS HAZEL
BLEARS MP AND
MR STEPHEN
TWIGG MP
Mr Taylor
1100. Minister, are there any plans to ration
anti HIV drugs or regulate control the entry of new drugs?
(Ms Blears) There are no plans to ration access to
clinical treatment.
1101. That was a snappy question and a snappy
answer. Again very quickly, there have been calls for compulsory
testing of asylum seekers for HIV because we know the large proportion
of new heterosexuals are bringing it in from abroad. What is your
view on compulsory testing, or even voluntary testing for asylum
seekers?
(Ms Blears) Certainly at the moment our policy is
to have voluntary testing. Anybody can get a test at a GU clinic
in a confidential and sympathetic environment, but there is a
review going on between the Department of Health, Home Office,
Foreign and Commonwealth Office and the Cabinet Office to look
at the whole issue of imported infection and immigration because
it is not just HIV but also other serious communicable diseases
involved, and therefore we are right at the beginning of a scoping
study to look at the facts and see what the issues are. Clearly
in a changing international and global situation it is important
that we look at the implications for infectious diseases as a
whole.
1102. Considering some of our long-term residents
cannot access these clinics, if it is going to be voluntary for
newly arrived people to find a clinic and have a test, it is not
going to be very effective, is it?
(Ms Blears) There is a pilot at the moment in east
Kent where newly-arrived people have a medical assessment and
are being referred to TB screening and that may be something we
want to look at, but obviously that is a pilot and we will be
learning the lessons from what is happening in east Kent.
1103. We have been told that the Aids Control
Act figures are not felt to be reliable by providers or commissioners.
In fact, the SOPHID data is used by the PHLS and still has its
problems. Why such emphasis on figures gathered from an unreliable
source?
(Ms Blears) I am not aware it is an unreliable source.
As I say, we do need to look at the way the Aids Control Act returns
have functioned, and I will be getting some recommendations from
officials to see if we can make that information more relevant
and appropriate, but I am not aware of the fact that they are
said to be unreliable.
Chairman
1104. So you contest that?
(Ms Blears) I have not had information that they are
unreliable.
Jim Dowd
1105. Just following that up, the term "newly-arrived"
is used in this context. Could I ask you for your view on UK nationals
who may have returned from areas of high risk? Will the study
look at those as well?
(Ms Blears) At the moment the Cabinet Office are right
at the beginning—they have only had one meeting—and
they are looking at scoping the issues of imported infection and
immigration. I am not aware whether they are looking at that specific
issue but that is something I would certainly feed back to the
group. I think it is important because the term "imported
infection" means that any of us could be importing infection
in those terms, so I will feed that back into the review that
is currently being established.
1106. Can I move on? You have been into detail
about the apparent friction on the role of PCTs in sexual health
and also you mentioned reducing ring-fencing. It is very difficult
in a National Health Service to guarantee national standards and
yet have a degree of devolution where local budgets can be spent
effecting that, so the National Service Framework obviously exists
to address that in certain areas. However, sexual health does
not really feature in that and is unlikely to, and given that
we have had evidence that one in four PCTs have not included sexual
health within their service and financial frameworks, are you
sure that this system is robust enough to give this the priority
it deserves?
(Ms Blears) In terms of a strategy, what we have tried
to do in sending it out as levels 1, 2 and 3 is to provide a framework
for PCTs to look at what they have in their community; does it
fit; have we got the level 1 services; level 2; level 3; are they
in the appropriate place? So in those terms it is a framework
for what a good service should look like. That is backed up by
the commissioning toolkit which is very lengthy but I make no
apologies for that because it goes into great detail about what
a good service can look like, how to commission it and design
it, make sure it works in practice. So all of that information
is out there now. In terms of making it happen, as I say, I think
increasingly we are seeing PCTs take up the agenda and those PCTs
will be performance-managed by the strategic health authorities
on their delivery of services, and it is very clear that PCTs
are required to provide a range of sexual health services in their
community varying from contraception services through GPs and
community clinics to sexually transmitted infections, then to
HIV specialist commissioning. So there is a number of different
roles that they have to undertake and they will be performance-managed
by the strategic health authorities on how well they are delivering
across the range of their responsibilities. The very fact we have
a strategy—and I know it is not an NSF but we did not have
anything before, and it is this Government that has decided this
is an important area of work and therefore we have our national
strategy—and our 10 Year Plan, our communications programme,
and our significant investment sends a very clear message to the
National Health Service that this is an important area of work—perhaps
more so than it has been for decades in this country.
1107. Moving on to sexual health strategy and
sexual dysfunction, it is mentioned fleetingly in the strategy
but we have received evidence saying that in the US, for example,
there is research data to say 50% of all people will suffer from
sexual dysfunction of one kind or another. Why is it not given
more prominence in the strategy?
(Ms Blears) It is in the strategy and in the action
plan and I know you have evidence from officials that we are about
to develop the sexual health standards to back up the action plan,
and there will be more work done on it. Initially it is fair to
say it was not a big issue in the strategy because the pressures
were about the waiting times, the pressures on services, the increasing
number of sexually-transmitted infections—those were the
big drivers for why we needed the strategy—and therefore
though it is in there and will be developed I think it is fair
to say that it was not at the heart of the strategy in the early
days. I think increasingly, however, the issue of sexual dysfunction
is becoming more widely acknowledged and recognised but is not
again just a medical issue; it is about a whole range of primary
care services, counselling, psychological support, and community
support, and therefore perhaps it needs to be assessed in a more
imaginative way than simply looking at it in terms of medical
services.
Sandra Gidley
1108. Psychosexual counselling is very low in
priority but what is available which helps many people are anti
impotence preparations which are restricted in access. Government
a couple of years ago did a consultation and 98% of the responses
said that the access to the drugs should be widened and Lord Hunt
said, "No, we cannot do it, because we have not got the money",
in which case what was the point in doing the consultation, but
there is increasing evidence to show that men taking anti impotence
preparations have thrown away the anti depressants, for example.
Has the Government looked at that aspect to see if, in effect,
in the same way as screening, there is a long term benefit in
making these products more widely available?
(Ms Blears) This was quite a difficult area of policy-making
when decisions were originally adopted because clearly there are
pressures from a number of different areas to make those decisions,
and I think the decisions reached were the right ones—we
have certain circumstances in which the products are available
but we take into account the priorities and the pressures that
are on the National Health Service and have made the decision
accordingly. I am not aware of any research myself about the long
term savings that might accrue as a result of investment in this
area, but I am satisfied that the decision in relation to the
criteria is the correct one
Andy Burnham
1109. Could I move you up, Minister, to teenage
pregnancy and unintended pregnancy? Looking at the earlier figures
the trend seems to be going the right way finally. Could you comment
on that?
(Ms Blears) Yes. We are I supposed quietly delighted
that the teenage pregnancy strategy is having a significant effect,
and also that the numbers appear to be coming down in the areas
where we have done the greatest work, and it is always particularly
heartening that it is evidence-based that what we are doing is
making a difference. We do have the largest teenage pregnancy
rate in the whole of western Europe so it is a key priority for
us and it is working, and I think it is that combination of issues
in the strategy making it effective—not just access to services
but also the information campaign and the support for young parents
to get back into training and work together with the sex and relationship
education, so it is a multi-faceted approach which mirrors the
sexual health strategy which again draws it in a range of responses
really.
1110. The health of the nation target to reduce
teenage pregnancies under 16 by 50% failed—the document
launched in 1993. What is different about this? Is it the rounded
nature of the approach to teenage pregnancy that makes it different?
(Ms Blears) I think very definitely. I have a sure
start plus programme in my own constituency and I have talked
to some of the people involved particularly in terms of getting
young mums back into education and training and giving them a
sense of future, that it is worthwhile looking at qualifications
and all that kind of issue, and that is hugely important, as well
as access to good quality contraceptive advice.
1111. Is that side of it more important? The
kind of life chances, aspirational education?
(Ms Blears) I think the evidence is that where you
get high rates of teenage pregnancy it is inextricably linked
with people who have a sense that life does not offer them very
much, and with social class, deprivation, poverty and lack of
ambition, but access to good services, proper information, sexual
relationship education and life chances is the way you do this
in the round, I think.
1112. I notice in the national strategy there
is a general target to reduce unintended pregnancy not just teenage
pregnancy, and the majority of unplanned pregnancies and abortions
occur in women aged 20 to 30. Is there a danger that there is
too much emphasis on teenage pregnancy at the expense of focusing
on women slightly older? Secondly, I do not think there is any
specific target on women in their 20s and 30s. How are you making
the progress you want to in that older age group when there is
no clear target?
(Ms Blears) I think we want to do both. We want to
try and reduce unintended pregnancies across the board but I make
no apology for focusing on teenage parents and young people because
the evidence is overwhelming that multi pregnancies in the very
early years affect people's life chances right the way through.
I think it is important, however, that older women as well in
their 20s, 30s and 40s have access to really good contraceptive
facilities. There is a need to make sure that people have the
whole range of contraception—not just simply the contraceptive
pill—and good advice about what is suitable for them. So
I think contraception needs to be highlighted too.
1113. Moving on to that point specifically,
we have taken evidence that contraception services are patchy
and have disappeared in some parts of the country, and that access
to contraception varies quite markedly. The young people who came
before us last week talked very much on this particular point
about the difficulties that they found with accessing condoms
and talked about having them in the toilet in the pub but that
they were very low quality and were not safe to use. Are you looking
at that area particularly, and how you improve access to contraception?
(Ms Blears) Yes. Inextricably linked with the GP contract,
which we are currently negotiating at the moment, for most people
their first port of call is GPs but community clinics are very
important particularly for young people who do not want to go
to their GP. I had the pleasure of meeting some of the young people
from Yorkshire who had done a survey of their local contraception
clinics and one young women, only 16, a fantastic girl, had gone
into this clinic, stood there for 10 minutes, nobody said "hello"
to her, and I think on the table they had Gardener's World
and on the television they had Countdown, and she said
it was the most inappropriate setting for 16 and 17 year olds
and that if they had put some teenage magazines out and had Radio
1 on then it would have been a lot more welcoming. Simple practical
suggestions like that make a world of difference in making people
feel welcomed at contraceptive clinics.
1114. Presumably these are the value added,
one stop shops, the three pilots to take it away from GP services?
(Ms Blears) We do not want to take it away; we think
there should be a range of services. In some places GPs would
be perfectly appropriate and could be providing extremely good
services but in other places people want to have the choice, so
we are saying to PCTs that their responsibility is to put in place
a choice and a range of services for their local community that
meets their needs.
1115. And is the GP contract not just quantifying
how much contraception, because then there is a target that says
that it is very much quantitative rather than qualitative backing
up GP training and what advice is given with the contraception.
Will the contract get on to that particular issue?
(Ms Blears) I do not personally know the details of
that module in the contract. Clearly it is still subject to negotiation.
I think GP services do vary and, again, I think some GPs have
a real interest in this area and want to provide a whole range
of services; some might decide to provide a fairly limited service
in their community.
1116. Lastly, the Sex Lottery advertising campaign.
The very same young girl you were just referring to talked to
us about it and said she found it effective and it made you read
it and it was quite arresting really, but that the focus is on
STIs and not on unintended pregnancies. Is there any intention
to carry on the same theme but also to push the idea of teenage
pregnancies and unintended pregnancies?
(Ms Blears) In a way it is almost the reverse. We
have had a really good campaign on teenage pregnancy. 70% of the
intended audience are aware of the messages and we have built
the adult sexual health campaign aimed at 18-30 year olds on the
teenage pregnancy information campaign. The Sex Lottery campaign
is controversial but is hard-hitting, it has humour, it is credible
with realistic information, it is aimed at that group of young
people, not us, and really does seem to be having an effect. I
am looking forward to the evaluation of that campaign later this
year and looking at the awareness and the effect on behaviour.
As I said right at the outset, this is about immediate services
but also that long term behaviour change, and I think the sexual
health information campaign is going to be really instrumental
in getting that long term change we need to get into the system.
Dr Naysmith
1117. Another area recognised in the teenage
strategy, although as Mr Burnham has pointed out it has a wider
relevance than teenage, is the unacceptable variation in access
to abortion services throughout the country, so the new maximum
three week target that is suggested is very welcome to lots of
people. However, the Family Planning Association said to us that
this could make things worse in a funny sort of way because there
are pressures at the moment on the Service with a shortage of
consultants, patchy access to GP referral for contraception, and
inadequate provision of information in many areas, and in some
communities in areas where information is available to some and
not others. What is the Government doing to address these problems
which are fairly widely recognised, even though the three week
target is widely welcomed?
(Ms Blears) We think this is a very important area
for us to make sure there is equity of access across the country
to early, safe abortion provided the women obviously meet the
legal requirements, and we will be monitoring this very carefully.
We put a million pounds this year into the areas where abortions
were taking place much later than we would have wanted. There
were 51 PCTs where we targeted that money who had the longest
referral times, and it is right to say it is patchy across the
country. Some places are doing extremely well and in other places
it is far too late. I am particularly concerned about young people
who tend to present later in any event and therefore getting them
swift access is very important. The target is for three weeks
from the first referring doctor and we intend to monitor that
waiting time extremely closely to make sure that women can have
proper access. It is a very important issue indeed. It is about
putting more money in but it is also about making those services
more available locally as well. 75% of abortions in this country
are funded through the National Health Service, 45% of them are
undertaken in the independent sector, and we want to be looking
at the referral patterns to see where the delay comes in to the
Service and can we re-design it to be quicker and faster.
1118. It is interesting that you say that teenage
pregnancies tend to be referred later. What can you do about that?
That is due to the lack of information, one suspects. It may be
information on various different aspects but it is certainly due
to lack of information, I think?
(Ms Blears) Very much so, information and confidence
to be able to get into the system, and I think making sure that
information is available on a wider range of settings for young
people is very important, not just simply through the GP but also
through their advisers, their contacts with youth workers in any
of the settings where they would feel comfortable, and having
confidence and trust and making sure they have quick access and
proper support.
Chairman: At this stage could I bring in the
Education Minister in and express our thanks to you so far. Please
remain with us for the rest of the session because there will
be issues where we may want to question you. Can I welcome you,
Mr Twigg, and say how grateful we are and apologise for keeping
you waiting so long. Your ministerial colleague gives extremely
long and thorough answers.
Jim Dowd: Not as long as some of the questions!
Chairman
1119. Could I ask you to introduce yourself
to the Committee and say a little bit about where we are with
the sex education elements of your responsibility? One of my colleagues,
Mr Burnham, made the point that there has been an announcement
over the last few days which relates to this, so could you mention
where you are on this?
(Mr Twigg) Thank you very much indeed. Can I say,
first of all, that I am very pleased to have the opportunity to
join you here today and I think our Department, along with the
Department of Health, very warmly welcomes the inquiry you are
undertaking and the important contribution it can make to the
development of policy in this area. I am the junior schools Minister
and amongst my responsibilities are two curriculum areas that
I think are relevant here today which is PSHE and citizenship.
I think the key two milestones of the recent past were the publication
by the previous Department for Education and Employment in the
2000 of this document, Sex and Relationship Education Guidance,
and the more recent publication last year of Ofsted's report on
Sex and Relationships. I think what the OFSTED report demonstrates
is that a great deal of progress has been made that the new guidance
we issued in 2000 has had an impact in most but not all schools,
but that a great deal of further work needs to be done particularly
in the area of training and professional development for teachers,
and I think if there is one key lesson that we have taken as a
Department from the Ofsted report it is the need for us to do
more working with colleagues in the qualifications and curriculum
authority in this area. We have a programme that we are launching
this year of new continued professional development training for
teachers, both in primary, secondary and special schools, starting
with 500 teachers in April and then a further 250 in September
which we see as an important first step to get a more consistent
practice across schools around the country. On Andy Burnham's
issue about the announcement this week, we had it on Tuesday of
how we are taking forward 14-19 education, and as part of that
we reaffirmed that sex and relationship education remains part
of the core curriculum between 14 and 16.
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