Select Committee on Health Third Report


73. The Government's National Strategy for Sexual Health and HIV, first published in 2001 as a consultation document, is divided into four broad themes, covering:

    Better prevention, including public information campaigns, targeted sexual health information, helplines and information and support for professionals;

    Better services, based around a new model setting out three different levels of service provision that should be available within each PCT area, with specific targets for improvements in several areas of service provision;

    Better commissioning, including the establishment of local multi­agency commissioning panels;

    Supporting change, including measures to improve information, research and training in the field of sexual health.

74. Currently, sexual health services are delivered in a variety of different settings. Genito-urinary Medicine (GUM) services, for people with suspected STIs and HIV, are run as self-referral clinics usually attached to acute hospitals. Contraceptive services are provided both by GPs and by community based specialist-family planning clinics, which again operate on a self-referral basis. Termination of pregnancy services, where they are provided on the NHS, are provided within the obstetrics and gynaecology units of acute hospitals, and women seeking a termination of pregnancy must be referred there either by their GP, or from a family planning clinic. Although some family planning clinics offer screening tests for chlamydia, and some GUM clinics are co-located with family planning clinics, the disciplines of GUM and family planning have evolved separately from different branches of medicine (urology; and obstetrics and gynaecology respectively), and services in the two branches of sexual health remain largely distinct.

75. The Strategy's plan to improve sexual health services in the NHS introduces a new model of integrated working based on three levels:

    Level 1 services will be provided in GP surgeries, although the Strategy concedes that not every GP is able to provide these services at present.

    Level 2 covers many of the services currently provided in specialist GUM and specialist family planning clinics, and the Strategy proposes that these should be provided by primary care teams with a special interest in sexual health, or local family planning and GUM clinics working in conjunction with General Practitioners.

    At Level 3, the top tier of sexual health service provision, the Strategy envisages that specialist clinical teams will deliver the more specialist aspects of care that need to be provided across more than one PCT.

76. The services that will be provided at each level include the following:

Level 1
Level 2
Level 3
Sexual history and risk assessmentInvasive sexually transmitted infection testing for men Specialist genito-urinary medicine
Contraceptive information and services Testing and treating sexually transmitted infections Specialised HIV services
STI testing for womenPartner notification Highly specialised contraception for people with complex medical conditions
Assessment and referral of men with STI symptoms Insertion of IUDs and contraceptive implants Local co-ordination and back up for sexual assault
HIV testing and counsellingVasectomy Termination of pregnancy services
Cervical cytology screening and referral   Services for people with psychological and sexual problems
Pregnancy testing and referral   Outreach for sexually transmitted infection prevention
Hepatitis B immunisation   Outreach contraception services
     Specialised infections management, including co-ordination of partner notification

source: National Strategy for Sexual Health and HIV


77. The Strategy includes four targets. These are:

    • increasing the uptake of the test by those offered it to 40% by the end of 2004 and to 60% by the end of 2007;
    • reducing by 50% by the end of 2007 the number of previously undiagnosed HIV infected people attending GUM clinics who remain unaware of their infection after their visit.
  • By the end of 2003, all homosexual and bisexual men attending GUM clinics should be offered hepatitis B immunisation at their first visit;

    • expected uptake of the first dose of the vaccine, in those not previously immunised, to reach 80% by the end of 2004 and 90% by the end of 2006;
    • expected uptake of the three doses of vaccine, in those not previously immunised, within one of the recommended regimens to reach 50% by the end of 2004 and 70% by the end of 2006.
  • From 2005, commissioners should ensure that women who meet the legal requirements have access to an abortion within 3 weeks of the first appointment with the GP or other referring doctor.

As the Strategy does not have National Service Framework status, these targets are not included in the Priorities and Planning Framework around which PCTs base their annual agreements, and progress against these targets will not be measured as part of the NHS performance management system.[53]

78. A great many service providers welcomed the arrival of the Strategy, and endorsed its general aims. They were pleased to see that in 'joining up' HIV/AIDS with broader sexual health issues, the Strategy presented a strong case for prioritising sexual health on the grounds of public health. For some participants in the Department's consultation, the breadth of the Strategy was its strongest aspect. In written evidence to us Dr Simon Barton, Clinical Director of HIV and Genito-urinary Medicine at the Chelsea & Westminster Hospital, said it was essential that:

    sexual health and HIV, united together in a national strategy, would be identified for primary care trusts and strategic health authorities as areas of health care requiring prioritisation on public health grounds, as well as ensuring that they developed an integrated approach between HIV and sexual health services on a network basis.[54]

79. However, much concern was expressed about whether overstretched services would be able to implement the Strategy. Consultant Physician Janette Clarke's response is representative of the evidence we received:

    The Sexual Health Strategy offers a vision of comprehensive open access service for HIV, sexual infection and contraception services. I sincerely hope that we can work towards the vision but would plead that patients need services in the interim.[55]

80. Dr Barton told us that he and his colleagues responded to the Strategy with enthusiasm in July 2001:

    Although the publication of the Strategy had been delayed for several months, we were optimistic that the consultation period which ended on 21 December 2001 would be followed swiftly by clarifications of the Strategy and the implementation action plan and identification of the resources to achieve this. Unfortunately, since the end of the consultation period, we are unaware of any formal response from the Department. This is particularly disappointing and has contributed to losing the momentum, which had been gained in the production and consultation period of the Strategy.[56]

81. In June 2002 the Department announced that owing to the overall support for the aims and interventions proposed in the Strategy, the Strategy itself would not be revised in light of the response to consultation. Instead, the Department published an Implementation Action Plan for the Strategy, which included a response to the key points raised by the consultation.

82. Although we support the Government's drive to improve sexual health services via the Strategy, without wholesale advances in sexual health provision these targets will be tokenistic.

83. The Strategy specifies that from 2005, commissioners should ensure that women who meet the legal requirements have access to an abortion within three weeks of the first appointment with the GP or other referring doctor. In our view, three weeks is too long for people to wait in these circumstances.

53   National Service Frameworks set national standards and define service models for a service or care group, put in place strategies to support implementation and establish performance milestones against which progress can be measured. Established NSFs comprise cancer, paediatric intensive care, mental health, coronary heart disease, diabetes and older people: NSFs in preparation are: renal services; children's services, long-term conditions focusing on neurological conditions and the involvement of the pharmaceutical industry. The Department has suggested that there will only normally be one new framework a year ( Back

54   Ev 421 Back

55   Ev 316 Back

56   Ev 421 Back

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