Select Committee on Health Written Evidence


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.


2.1  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.

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