Summary
England is currently witnessing a rapid decline in its sexual health. Around one in ten sexually active young women (and many men) are infected with chlamydia. Syphilis rates have increased by 500% in the last six years and those for gonorrhoea have doubled. Rates of teenage pregnancy are the highest in Europe. Sexual dysfunction is a largely silent problem within society.
Sexual health services appear ill-equipped to deal with the crisis that confronts them. Median waiting times to services are currently around 10-12 days and some services are turning hundreds of people away each week. We call for a target of 48 hours for patients to be able to access genito-urinary medicine, for the Government urgently to review staffing levels and for it to ensure that genito-urinary medicine needs are properly addressed. Genito-urinary medicine clinics are often dilapidated so we ask trusts to give priority to improving them. Although the Government's Sexual Health Strategy calls for more sexual health commissioning to be delegated to Primary Care Trusts we received little evidence to suggest PCTs were ready to take on these responsibilities. We also call for improvements in access to sexual dysfunction treatments and services.
Chlamydia screening has been piloted at two sites; the results were so worrying that we recommend the immediate introduction of a chlamydia screening programme nationally in a range of settings. We also urge the abandonment of the most widely used test, which produces far too many false-negative results, in favour of more sophisticated tests generally used elsewhere.
HIV continues to be the most important communicable disease in the UK. As the dramatic impact of the awareness campaigns of the 1980s has faded, worrying new trends in the infection and its transmission have emerged. Combination therapies for HIV have radically improved the health and lifestyles of people living with the infection but poor adherence to treatments promotes the development and transmission of resistant strains of HIV. Although gay men remain at greatest risk of acquiring the infection, the number of people who have acquired the infection heterosexually has risen. Currently, the majority of these heterosexual infections were not acquired in England, but abroad, predominantly in sub-Saharan Africa. This new trend has intensified the stigma around HIV, as marginalised groups in society, such as minority ethnic communities, bear a disproportionate burden of infection.
As mortality rates for HIV have decreased, the number of people living with HIV has risen. Not only are there now more HIV patients than ever before, but there are more infections to be diagnosed—an estimated 6,500 new diagnoses in 2002. This report gives an indication of how specialist HIV service providers, alongside other sexual health service providers, have been struggling to meet increasing demand for counselling, testing and treatment. We examine the implications of the Strategy for HIV services, in the context of recent fundamental changes to the way in which HIV services are co-ordinated: the end of dedicated or 'ring-fenced' funding for HIV services, and the transition to PCT-led commissioning arrangements. Our recommendations draw attention to serious concerns that the spiralling cost of HIV drugs will continue to deplete the resources needed by clinical and support services for sexual health, and that the vital prevention, health promotion and evidence-gathering work undertaken in the community and voluntary sector could be lost if PCTs withdraw funding.
The Government's teenage pregnancy strategy, now in its fourth year of implementation, is cited by many as an example of good practice in taking a well researched, multi-faceted approach to health promotion to tackle a specific issue with young people. However, we heard that sexual health services are not meeting the needs of young people, and they are also being failed by an education system which persistently delivers 'too little, too late', often placing a mistaken emphasis on sex at the expense of young people's wider concerns about relationships. We therefore recommend that sex and relationships education is made a statutory part of the National Curriculum, supported by dedicated professionals who are able to meet the needs of young men as well as young women. The Government should also explore the possibility of improving young people's access to health services through providing specialist advice facilities.
The Government's sexual health strategy states that the prevention of unplanned pregnancy by NHS contraception services probably saves the NHS over £2.5 billion a year already. Despite this, in 2001 over 176,000 women underwent abortions, and the evidence we heard pointed to persistent deprioritisation of contraceptive services, with one of our witnesses pointing out that contraception appeared to have totally 'disappeared' from the Government's sexual health strategy. As well as a pressing need to rectify this priority imbalance, the report emphasises the importance of ensuring, through the GP contract, that GPs offer the same high standards of contraceptive care found in dedicated family planning clinics. The report also recommends that, within the current legal framework, practical steps are taken to improve access to safe, early abortions on the NHS for those who meet the legal criteria.
We conclude that the crisis in sexual health of the nation arises from:
- A failure of local NHS organisations to recognise and deal with this major public health problem
- A lack of political pressure and leadership over many years
- The absence of a patient voice
- A lack of resources
- A lack of central direction to suggest that this is a key priority
- An absence of performance management
We recommend that the Government should take urgent steps to ensure that access to high quality services is provided. The best way of achieving this would be a dedicated National Service Framework, but in the interim the Government should tackle sexual health as a public health priority at a strategic health authority level.
We have been appalled by the crisis in sexual health we have heard about and witnessed during our inquiry. We do not use the word 'crisis' lightly but in this case it is appropriate. This is a major public health issue and the problems identified in this report must be addressed immediately.
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