Memorandum by Brook (HA 11)
Brook, a registered charity, is the country's
leading sexual health organisation for young people, offering
young women and men up to the age of 25 free and confidential
sexual health advice and services.
2. PROGRESS TO
2.1 Access target for GUM services
Brook welcomes the goal set by the White Paper
Choosing Health for everyone referred to GUM clinics to have access
within 48 hours. However, in light of the annual increases in
STI diagnoses, especially amongst younger people, it is of some
concern that the date for achieving this target is 2008.
Brook believes that more integration between
contraceptive and GUM services which enables STI testing and treatment
to take place in community settings would make services more accessible
to young people and reduce the risk of transmission caused by
long waiting times at GUM clinics. This model is already in place
in many Brook centres across the country. The announcement in
the White Paper that testing and screening for STIs will be increasingly
delivered in the community is therefore welcome but we believe
treatment should also be available in these settings if transmission
is to be reduced.
2.2 Planning framework
We welcome the Government's commitment in Choosing
Health to issue a "supplementary technical note" to
ensure that NHS Local Delivery Plans address inequalities in sexual
health. However, we regret that sexual health was not more explicitly
included in the original planning framework for 2005-08 as recommended
by the Committee. The positive impact that specific inclusion
in the planning framework can have is clear from a survey of Strategic
Health Authorities in England carried out by Brook, fpa, Medical
Foundation for AIDS and Sexual Health, National AIDS Trust and
Terrence Higgins Trust in 2003. This found that plans for improving
sexual health were included in only 10 out of 28 Local Delivery
Plans. This is in contrast to teenage pregnancy which was addressed
in all the plans as a result of its inclusion in the priorities
and planning framework and the Department of Health's Public Service
Agreement. Without ring fencing or a strong focus on sexual health
within the planning framework, there must be concern as to how
far local organisations will use the additional funding earmarked
for sexual health for its intended purpose.
2.3 Sex and relationships education
We are particularly disappointed that the Government
has not implemented the Committee's recommendation that Sex and
Relationships Education become a core part of the National Curriculum.
Brook believes that the most effective way to
ensure that the current and future generations of young people
are enabled to make informed choices about their sexual health
is to make Sex and Relationships Education a statutory entitlement
for all children within the PSHE curriculum.
There have been welcome improvements in SRE
as a result of the teenage pregnancy strategy but consistency
and quality would be further improved by a statutory curriculum
instead of leaving it to the discretion of individual schools
to define within their SRE policy what is taught, if anything.
Brook believes that age-appropriate sex and
relationships education should begin in primary school and be
built on as children progress through school, continuing into
colleges and further education institutions.
The Sex and Relationships curriculum should
not just focus on information-giving but should help young people
to develop the skills to act on the information they have been
given and help them clarify their values and attitudes. Young
people need to be specifically helped to develop the ability to
recognise and resist pressure so that they can delay intercourse
until they are ready for it; to develop healthy relationships;
and to negotiate and practise safer sex.
The needs of young people who attend school
irregularly or who are excluded from schools should not be forgotten.
It is all too easy for these particularly vulnerable young people
to miss out on SRE altogether. Brook has found that outreach education
work in youth and community centres, peer education and detached
work are all effective methods of reaching young people. Youth
workers, with appropriate training, would be in an ideal position
to deliver sex and relationships education to young people who
may not have received education in mainstream settings. SRE must
also be delivered within Pupil Referral Units.
We strongly recommend the development of links
between schools and clinical services. International research
has shown that good and comprehensive sex education combined with
easy access to contraceptive services leads young people to delay
first intercourse and results in them being more likely to use
contraception when they do become sexually active. Brook Centres
have found it particularly effective to use outreach education
workers to deliver information sessions about Brook services in
schools, or to host visits from classes of local school pupils
to introduce them to the services available so that they will
feel comfortable to use them when they need to.
2.4 Abortion services
We agree that waiting times for abortion should
be reduced. However, this alone will not address the difficulties
women may experience in getting a referral in the first place.
Callers to Brook's Young People's Information Service still report
problems obtaining referrals from GPs some of whom are clearly
not following guidance to refer women to other doctors if they
have a conscientious objection to termination of pregnancy.
Experience from Brook Centres suggests that
the development of self-referral systems locally has done much
to improve early access to termination services. Brook would like
to see these systems evaluated and rolled out nationally if appropriate.
We welcome the committee's recommendation to
improve the availability of medical abortion. However, one Brook
Centre has experienced its local hospital deciding to provide
only medical abortions. This results in women who do not want
a medical abortion or who are more than nine weeks pregnant having
to be referred to clinics in other areas. This can be particularly
problematic for younger women. A choice of appropriate methods
should be made available to all women.
2.5 Young people's sexual health services
There have been welcome increases in the number
of services for young people as a result of the Teenage Pregnancy
Strategy with around 85% of local authorities having at least
one service for young people. However, not all of these provide
a full range of services, often resulting in young women having
to be referred back into mainstream services if they require a
termination referral for instance. It is to be hoped, therefore,
that the prospectus for extended schools, which is expected shortly,
will encourage the provision of comprehensive sexual health services
for young people.
Brook is concerned that the information sharing
proposals in the Children Act, could compromise young people's
right to confidentiality and put them off using services at a
time when they are most vulnerable. Research has consistently
demonstrated that confidentiality is of paramount importance for
young people using contraceptive and sexual health services as
has been acknowledged by government guidance. Any measures to
record young people's use of sexual health provision would undermine
their belief in the confidentiality of services. This could act
as major deterrent to their seeking help at a time when England
and Wales continue to have the highest rate of teenage pregnancy
in Western Europe and rates of sexually transmitted infection
amongst young people are increasing.