Select Committee on Health Written Evidence


Memorandum by Barnardo's (HA 9)


  Barnardo's works directly with more than 100,000 children, young people and their families in 361 services across the UK. These services are located in some of the most disadvantaged neighbourhoods where child poverty and social exclusion are common features. We work with children affected by today's most urgent issues: poverty, homelessness, disability, bereavement and abuse. Some of our services have sexual health as a special focus; others include this perspective in their overall approach to children and young people. We support families affected by HIV and Aids, encouraging safer lifestyles, and we have a number of projects for young people who are sexually exploited.

  This evidence addresses the second of the terms of reference of this inquiry—ie progress to date in implementing the recommendations of the Committee's inquiry into Sexual Health (the Committee's Third Report of Session 2002-03).


  Many of the children and young people we see are isolated within their families and schools and have few links with the health services. Their self confidence is low and they are at risk of developing partial or abusive understandings of their own sexuality and sexual relationships with others. So it is encouraging that sexual health is now a priority on national and local government agendas and that major initiatives have been launched in the last few months, taking up many of the Committee's earlier recommendations.

  For example, Choosing Health (the Public Health White Paper) identifies improving sexual health as one of government's overarching priorities. Three developments are particularly welcome:

    —  The new national campaign targeted at younger men and women about the real risk of unprotected sex, and the benefits of using condoms to avoid the risk of sexually transmitted infections (STIs) or unplanned pregnancies.

    —  Piloting, from 2006, health services dedicated to young people designed around their needs, including sexual health.

    —  Provision of targeted material for specific groups such as disabled children, young people in public care and care leavers.

  The National Service Framework for Children, Young People and Maternity states:

    "Health promotion for young people is targeted to meet their needs, and in particular, to reduce teenage pregnancy; smoking, substance misuse, sexually transmitted infections and suicide. Young people are actively involved in planning and implementing health promotion services and initiatives. "


  Barnardo's supports the aims of both the White Paper and the NSF. However practical progress will depend on whether the resources and staff are available to implement the proposals, and on how quickly this can be achieved. We know that the planning and setting up of the right kinds of services takes time. Nevertheless the issue is increasingly urgent and some of the timescales proposed in the White Paper seem to us worryingly slow. For example, the White Paper sets out the goal that by 2008 everyone referred to a GUM clinic should be able to have an appointment within 48 hours. Three years is a long time to wait for such a basic service to be available. All delays place young people—and others—at risk; in boroughs where a high number of young people are vulnerable, every effort should be made to achieve this goal well before 2008. We urge the Select Committee to use its influence to speed up the planned changes.


  The evidence from our work with children abused through prostitution is that the sexual exploitation of children can only be reduced if sexual health services are readily available and user-friendly. Young people tell us that:

    —  They value Barnardo's non judgmental, confidential and young person centred services. When they need sexual health services they want to talk to a worker whom they have already checked out, whom they know and trust and who approaches them as a whole person.

    —  They think that services should be where they feel most comfortable to access them. They do not want to sit in waiting rooms where they feel judged and made to feel guilty that they have sex.

    —  They want multi-agency partnerships to work for them and provision not to be random. This means that local strategic partnerships have to make sure their services are joined up on the ground; multi-agency services to young people must be properly resourced and there must be services for the young people as well as their babies.

    —  They want the advice and information services that they use regularly to be holistic and able to respond to connected issues such as substance misuse. They do not want to have to go from service to service repeatedly asking for help.

    —  They want to have a say through their focus groups or committees on how those services should improve.

  In our local partnerships Barnardo's is already taking forward the principles outlined in the National Plan for Safeguarding Children from Commercial Sexual Exploitation. We are committed to the multi-agency working emphasised by standard 5 of the National Service Framework.


  Barnardo's is a member of the Sex Education Forum, which has argued for many years that SRE should be statutory. The Public Health White Paper recognises the importance of SRE but disappointingly keeps it at the level of guidance. This affects the status of the subject in schools and the confidence of staff responsible for teaching it. Some schools deliver SRE very competently. They encourage students to look at sexual health in its widest sense, covering sexual boundaries, respect for others, keeping safe and the risk of STIs. Other schools treat the subject in a nervous and limited way; they confine SRE to the physical, biological and reproductive elements in science lessons and fail to address wider relationship aspects.


  The Committee report emphasised the need to support parents in this area and to help them feel confident in talking to their children. Again this recommendation is taken up in the proposals of the White Paper. Our experience is that in a highly sexualised culture it is increasingly important that young people learn how to draw sexual boundaries between themselves and others, and are helped to become more assertive about what they want and need. Professionals do have a role here, but parents clearly have a large part to play in helping their children develop healthy approaches to sexuality and relationships.


  The provisions of the Children Act 2004 and the Change for Children programme offer many opportunities to bridge the traditional divides between health, social care and education. The link between health and education is crucial. Many young people would be greatly helped by being able to get confidential advice from sexual health professionals visiting or based in their schools.

  We also notice that the young people we work with often been excluded from school or have poor attendance records; they have therefore missed out on SRE. For them preventive multi-agency work in the community can be crucial. For example Barnardo's and Brook Advisory Centre have jointly run a weekly drop-in sexual health session in a homelessness hostel in London for 10 years. The session is well attended. Lead by the young people themselves, it has enabled many of them to talk about sex and relationships, and make up for what they missed at school.


  One of the most troubling developments since the Committee last reported on this issue in 2002-03 is the growing threat to children's and young people's sexual health posed by the internet. Barnardo's report Just One Click (2004) demonstrated the risks that internet and mobile phone technology can pose. Although the internet can be a source of useful information and advice for children and young people, it can also be used by adults for abusive purposes. The evidence is that the children involved in this form of abuse are getting younger, the abuse more severe and the settings more everyday.


  The Committee in its report described sexual health in this country as being "in crisis" and identified it as a major public health issue. Despite the recommendations at the time, funding remains precarious for many sexual health services, including our own. Some of our services receive money from the Teenage Pregnancy Unit but this does not cover the important work with young men, especially young gay men. Small but important matters make the work more difficult. For example one of our projects used to be given free condoms so that young women who wished could be to some extent protected from unsafe sexual activity. Now the condoms have to be purchased by the service itself, thus using up valuable resources.

  Finally, we record our experience that sexual health policies and provision still vary considerably from one part of the country to another.

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