Giving priority to sexual health
318. We began our report by noting the crisis in
the nation's sexual health. Nothing in the evidence we have received
convinces us that sexual health is yet accorded the priority it
deserves. We have looked at failings in treatment service; problems
of access to service; poor premises; insufficient numbers of clinicians
working in this area; weaknesses in health prevention strategies;
and sex education still leaving much to be desired. We were very
struck by the fact that we received no evidence either from regional
directors of public health, or from directors of public health
in Strategic Health Authorities, suggesting that a key layer in
the strategic management process is currently neglecting the issue
of sexual health.
319. The crisis in sexual health services seems
to us a consequence of several factors:
- 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
320. During the course of this inquiry, it has become
clear that sexual health services in the NHS are not equipped
to cope with the rising demand for their services sparked by changing
sexual behaviour and an epidemic in sexually transmitted infections.
Equally concerning is the fact that in both acute trusts and Primary
Care Trusts, even in areas of huge sexual health need, development
of sexual health services is being pushed off the agenda by other
issues, such as waiting times for elective surgery, where organisations'
performance against explicit targets is closely monitored by the
Department.
321. NHS organisations have their performance managed
in a number of different ways. NHS Trusts are subject to the star
rating system, which gives an annual assessment of their performance
on nine key targets, 28 wider performance indicators, and Commission
for Health Improvement clinical governance reviews. National targets
such as waiting times are also monitored by the Department in-year
via Strategic Health Authorities. PCTs now produce 3-year Local
Delivery Plans setting out how national targets in six areas will
be met in their own areas, which are agreed and managed by the
overseeing SHA. The targets against which both Trusts and Primary
Care Trusts are managed come from a variety of places. Most general
targets surrounding access to care originate from the NHS Plan,
while the more detailed targets surrounding access to care and
quality of care in particular clinical areas are set out in National
Service Frameworks.
322. The Government has invested significant priority
in the issue of waiting times for NHS services, which it argues
is the issue of greatest importance to patients. When treating
life-threatening conditions or transmissible infections, gaining
diagnosis and treatment as quickly as possible is obviously paramount.
This is something that has come out very strongly in our evidence.
The Government has put in place a broad range of targets surrounding
waiting times, which cover almost every entry point to the NHS:
by 2004, patients should have to wait no longer than 48 hours
for initial assessment by a GP. If they have urgent problems which
require immediate attention in a hospital, their maximum wait
at an Accident and Emergency department should be one and a quarter
hours. By 2005, if patients require a specialist outpatient appointment
for a chronic problem which does not require immediate action,
they should be given an appointment within a maximum of three
months, and a non-emergency surgery appointment within a maximum
of six months. However, access to sexual health clinics remains
one area which is not covered by any of these very comprehensive
targets.
323. Despite a considerable investment by the Government
in targets to improve access to care and to improve health, sexual
health is an area which seems to have fallen completely through
the net. We understand the concerns of NHS organisations who feel
that innovation is oppressed by the imposition of large numbers
of centrally managed performance targets, which may not reflect
local priorities, and for many organisations the recommendation
of further central measures to improve the delivery of sexual
health services may be unwelcome. However, at the moment we are
in a position where so much NHS activity is currently subject
to targets and performance management that those areas where urgent
action is needed but which lack central performance management
are in serious danger of being deprioritised. We therefore
recommend that the Government takes urgent steps to ensure that
access to high-quality sexual health services is prioritised and
resourced.
324. The best way of achieving this would be the
launch of a dedicated National Service Framework for sexual health
and we recommend that this be done. We understand, however, that
the development of an NSF can take a number of years. Therefore,
as an interim step we recommend that the Department should insist
that sexual health is tackled, as a public health priority, at
a strategic health authority level by adding it to the Planning
and Priorities Framework 2003-06. The Department should set
in place a rapid and urgent review of sexual health need, services,
sexual health promotion, and treatment. This will need to be done
jointly with SHAs and PCTs. To ensure that SHAs fully embrace
this new responsibility, SHA Directors of Public Health should
be responsible for the delivery of a 48-hour access target within
their patch within two years, which should be supported by specific
targets relating to reductions in the numbers of cases of the
major sexually transmitted diseases.
325. We are well aware of the danger of prescribing
an NSF as the necessary panacea for any particular problem in
the health service. There are numerous competing demands for priority
and resources within the health service. However, the dramatic
and spiralling decline in the nation's sexual health, the fact
that this decline impacts most seriously on the most disadvantaged
in society, and the danger that if nothing is done there will
be a further deterioration with profound consequences convinces
us that this is an area desperately in need of prioritisation.
Further, we believe that the process of drawing up an NSF in this
area could be expedited. The Strategy and its supporting
documents already provide a very substantial basis, meaning that
the development timescale could be condensed considerably. The
Medical Foundation for AIDS and Sexual Health work on standards
and networks could be woven into an NSF. If this option were pursued,
in our view, the NSF should contain a maximum access target of
48 hours for access to a GUM or specialist family planning clinic,
and be supported by specific targets relating to an eventual reduction
in the number of cases of the major sexually transmitted diseases.
As with other NSF targets, these should form part of PCT local
delivery plans.
326. Each onward transmission of HIV costs the health
service hundreds of thousands of pounds and individual countless
hours of anxiety, if not serious illness; each case of chlamydia
in a young woman has the potential to trigger infertility; each
unwanted teenage pregnancy has the potential to damage the life-chances
of the parents and children involved. It would be profoundly depressing
if a successor Health Committee was to address these issues in
ten years' time, only to find evidence of a further deterioration
of sexual health in this country. 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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