Select Committee on Health Third Report


Sexual health

In 2003, we published a report which described a crisis in sexual health. We recommended the introduction of a maximum waiting time of 48 hours for access to sexual health services, a target the Government has just adopted in its recent White Paper on Public Health. However, rates of sexually transmitted infections have continued to rise, and waiting times for sexual health clinics have, if anything, deteriorated further since our 2003 report into Sexual Health. One consultant described the current situation as "a continuing crisis". We also heard that since our report, funding earmarked for sexual health services has not always reached its targets. Because of this, we have recommended that the Government should closely monitor progress in delivering the 48-hour target, and conduct an audit to ensure that the extra investment promised for sexual health actually reaches the clinics which urgently need to increase their capacity to meet rising demand.

While the introduction of a nationwide screening programme for chlamydia, the most common sexually transmitted infection in young people, is welcome, we are concerned that for such a screening programme to be effective the Government must ensure that men, as well as women are screened for it, and must also ensure that only the most up-to-date screening tests are used. It is unacceptable that nearly half of all NHS laboratories are still using a test which may miss as many as 30% of infections.

As we argued in our previous report, it is essential that GPs are encouraged to address their patients' sexual health needs. However, our evidence indicates that the new GP contract has failed to provide adequate incentives to GPs to promote sexual health services. We have recommended that the Government review the GP contract with a view to giving higher priority to sexual health, and also that a dedicated sexual health training programme is established for GPs and practice nurses.

Much of our evidence has emphasised the importance of improving sexual health services, but once a young person needs to visit a clinic for a sexual health problem, we have, according to one witness, "missed the boat". Educating young people about relationships and sexual health is perhaps one of the most powerful tools we have to promote better sexual health. However, a recent OFSTED report reveals that far too often, young people are being taught about sex and relationships by teachers who lack both competence and confidence in this area, and that Personal Social and Health Education is being afforded insufficient priority by schools. We have therefore recommended that by 2007 all PSHE and Sex and Relationships Education (SRE) lessons must be taught by specialist accredited PSHE teachers rather than by unqualified form tutors. We have also reiterated an important recommendation we made in our 2003 report, that PSHE should be established as a statutory and assessed part of the National Curriculum.

Charges for overseas visitors for HIV treatment

Since our report, the Government has introduced changes to the regulations relating to charges for NHS treatment for overseas visitors in an attempt to combat 'health tourism'. This now means that people who are in the country without proper authority, including illegal immigrants, failed asylum seekers and visa overstayers, will be charged for all NHS treatment. Treatment for certain communicable diseases, including TB and sexually transmitted diseases is exempt on public health grounds. However, treatment for HIV is not exempt. Given the high prevalence of HIV in people born in Africa who are now living in this country, there is concern that this new legislation will have a disproportionate impact on African communities in the UK.

The concept of 'health tourism', whereby people from other countries come to the UK solely to access NHS services for free, whether for a single procedure or course of treatment or for management of a longer term chronic problem, is extremely worrying. Large scale health tourism would clearly have the potential to place an unsustainable burden on the NHS, and to divert NHS resources away from those for whom they are intended. In principle, we support the Government's attempts to tackle this problem wherever it is identified.

We do not in any way underestimate the difficulties of making decisions around the highly sensitive issue of health tourism, and we would not want to suggest that it is an easy area to address. However, we are not convinced that the Government has fully understood the complexity and breadth of the issues involved in charging for HIV treatment, and the potential consequences of getting it wrong.

Although we have received assurances from the Government that abuse of the NHS by 'health tourists' does take place, it is difficult to place much weight on these assurances since the Government was unable to supply us with any data, not even a rough estimate, of the numbers of people allegedly 'abusing' the NHS, nor of the costs that are associated with this.

By the same token, we were surprised to learn that the Government has introduced significant changes to the rules on eligibility for free NHS treatment without, by its own admission, any idea of the relevant costs or cost-savings that might be associated with these changes. Remarkably, the minister agreed with the evidence we have received suggesting that in many cases it might be more cost-effective for HIV+ patients to receive drug treatment as soon as they were diagnosed, rather than for the NHS to have to bear the costs of treating them once they had become seriously ill.

In our view, however, the most serious adverse consequence of these changes is their potentially disastrous impact on public health. Firstly, if free treatment is not available, people may be deterred from taking an HIV test, and will remain in the community undiagnosed and infectious. Secondly, research evidence suggests that HIV treatment can in fact lower an individual's infectivity significantly, reducing the potential for onward transmission.

It is a nonsense that the Government is prepared to fund a person's TB treatment on public health grounds but not treatment of his HIV infection. Untreated HIV+ people living in this country present a serious public health threat, and we have therefore recommended that all HIV+ people, regardless of their immigration status, receive free treatment to reduce the likelihood of the onward transmission of HIV, of mother-to-child transmission of HIV, and of the onward transmission of TB. In order to achieve this, HIV should simply be reclassified as a Sexually Transmitted Infection, which would make treatment automatically free on public health grounds.

We fully accept that the UK must not become a magnet for HIV+ individuals seeking to emigrate to this country simply to access free healthcare. However, we have seen no evidence that this was the case before these rules were introduced, and in fact some European countries have far less stringent requirements for access to HIV treatment than the UK. Nor have we seen any evidence to indicate that the introduction of these restrictions on free treatment will actively discourage people from entering or remaining in this country illegally, most of whom migrate for economic reasons, or to flee oppressive regimes. Furthermore, people either entering and/or remaining in this country without proper authority are a matter for the Home Office and the Immigration Services, and it is up to these services to enforce immigration regulations robustly and swiftly. While they remain in this country, whether illegally or legally, people with untreated HIV pose a threat to the nation's public health, which is why the Department of Health's primary concern must be providing treatment for them to protect public health.

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Prepared 21 March 2005