Memorandum by Royal College of Nursing
The Committee will undertake a short inquiry
into recent policy developments surrounding HIV/AIDS and sexual
health servicesspecifically, it will address:
The consequences of the new
and proposed changes in charges for overseas patients with regard
to access to HIV/AIDS services.
Progress to date in implementing
the recommendations of the Committee's inquiry into Sexual Health
(the Committee's Third Report of Session 2002-03).
1.1 With a membership of over 370,000 registered
nurses, midwives, health visitors, nursing students, health care
assistants and nurse cadets, the Royal College of Nursing (RCN)
is the voice of nursing across the UK and the largest professional
union of nursing staff in the world. RCN members work in a variety
of hospital and community settings in the NHS and the independent
sector, including the workplace. The RCN promotes patient and
nursing interests on a wide range of issues by working closely
with the Government, the UK parliaments and other national and
European political institutions, trade unions, professional bodies
and voluntary organisations.
1.2 The RCN has worked in partnership with
the Teenage Pregnancy Unit (DfES) and Sexual Health and HIV Strategy
Team (DH England) to establish a Sexual Health Skills distance
learning programme. It is a 15 week course, with two experiential
learning and assessment days at RCN centres across the UK and
Northern Ireland. It operates as a foundation in sexual health
care, and its intended learning outcomes focus upon improving
sexual health assessment skills, detailed knowledge on all methods
of safe sexual contraceptive techniques and sexual health infections,
and referral methods for Genito-Urinary (GU) services. The course
aims to work towards Patient Group Directions, or similar protocols.
2.1 Our members have made it clear that
they are still unclear about the specifics of these changes. In
particular there are concerns around poor dissemination of information.
2.2 Many nurses consider it would be a dereliction
in the duty to care if a personno matter what their politico-legal
statusif, on clinical grounds, needs Highly Active Anti-Retroviral
Therapy (HAART) or other HIV medications/treatments, and were
denied these simply because of their status. Similarly, many feel
they would be put in a dreadful situation if they were party to
refusing necessary medications to a person, because of the client's
politico-legal status. Our members do not want to be put in the
position of policing what treatments patients are entitled to.
Indeed, for those working in Genito-Urinary services, issues of
confidentiality are prescribed in the Venereal Diseases Regulations.
2.3 The RCN is wary of public and media
misconceptions of "asylum seekers" and overseas patients.
Given the exceptionally small numbers of people this policy refers
to, and the fact that good sexual health provision helps prevent
further escalation in the UK's sexual ill-health statistics, the
RCN believes that it would be inequitable to charge overseas asylum
seekers requiring sexual health assistance.
3. PROGRESS TO
3.1 Recommendation No 6Sexual
Initial indicators are that practices are slowly
improving. However, the lack of commensurate resources for clinical
service provision is still a major barrier to care. In addition
sexual health remains a limited area of care and is therefore
not seen as part of good holistic care.
It might be a useful model to consider, however
the RCN has now implemented the UK's first nation-wide professional
and academically validated distance learning course in Sexual
health Skills (www.rcn.org.uk/sexualhealthlearning). This course
has already been accessed by over 300 nurses, midwives and health
visitors across the UK and Northern Ireland. The current curriculum
is validated for three years and is credit rated at academic levels
II and III, by the University of Greenwich. According to course
evaluations, the participants have been able to increase service
provision around aspects of sexual health prevention and care.
3.2 Recommendation No 8Expansion
of Consultancy Posts
There is still a lack of resources to maximize
the great potential of various nurse-led initiatives, especially
Nurse Consultants. Our members have pivotal roles in various programmes
and services of prevention, assessment, treatment and management
of people affected by the poor consequences of sexual ill-health.
Nursing roles have developed in response to client needs, as well
as specialist academic study to enable better qualifications.
In all of these initiatives, a lack of facilities (including funding)
for nursing development and career enhancement is a key factor
in poor recruitment and retention in key areas and important posts.
3.3 Recommendation No 11Diversion
Feedback from our members indicates that diversion
of funds does still occur. Many sexual health clinics have had
to significantly cut condom budgets due to the cost of HIV drugs,
which are still currently around £10,000 per person per annum.
It is imperative that designated sexual health funding is allocated
appropriately. This should also include monies for prevention,
for no matter how much the costs of treatment spiral, prevention
is not only less economically expensive, but in total human terms,
is ultra beneficial too. Greater resources should be allocated
to significantly raising the awareness of safer sex and condoms
as contra-infection, and not simply contraception alone.
3.4 Recommendation No 13Waiting
The RCN has not seen any evidence of reduced
waiting times since the publication of the Health Committee's
report. Increasing the number of nurses trained across sexual
health specialities would greatly improve access to care, and
help diminish long waiting times. In looking at waiting times,
special regard should also be paid to specialist clinics, such
as those based on individual gender and sexual orientation, as
these are often in shorter supply than mainstream GUM and sexual
3.5 Recommendation No 15Chlamydia
The National Chlamydia Screening programme is
gradually being implemented across the UK with full roll out due
by 2008 and the RCN's Sexual Health Skills distance learning
course supports this programme. It enables far more nurses, especially
in Primary Care, to be able to talk about sexual health, make
sexual health and risk assessments of clients, and be prepared
to contribute towards Chlamydia screening. Greater resources are
required to improve wider availability of testing.
The Royal College of Nursing is about to publish
the RCN Chlamydia educational initiative, a learning resource
aimed at improving the knowledge and skills of nurses in Primary
Care settings around Chlamydia prevention, screening and treatment.
This important initiative will ensure nursing staff have the
appropriate skill set to be able to test-screen, treat and or
refer patients, which will enable fast tracking.
3.6 Recommendation No 16Male sexual
health outside traditional settings
The RCN Sexual Health Skills distance learning
course has a wealth of material looking at specific issues for
male sexual health needs, and encourages nurses, in line with
the Health Select Committee's 2003 Report of the Inquiry into
Sexual Health, to think "outside the box" of traditional
services, especially for males and other hard-to-reach populations.
For example, the homeless, the prison population and providing
services in pubs, clubs and health centres.
3.7 Recommendation No 18HIV statistics
2003 saw the highest numbers of newly diagnosed
cases of HIV since testing first began in the 1980s. This figure
also showed the overwhelmingly high percentage of UK endogenous
new infections to continue among under 24 year old gay, bisexual
and other men-who-have-sex-with-men. This can be attributed in
part to the almost complete invisibility of HIV prevention strategies
outside of the SRE arena, particularly in schools to all young
3.8 Recommendation No 28Primary
Care service provision
As sexual health does not have a National Service
Framework (NSF) it does not gain the priority it deserves.
The large percentage of nurses in Primary Care,
including GP services, who are undertaking the RCN Sexual Health
Skills distance learning course are laying the foundations
for improving sexual health services across the care setting.
A number of nurses in NHS Direct have also accessed this course,
and report that it meets the demands for their learning, as sexual
health questions can crop up on a daily basis. PCT Sexual Health
Leads, prison nurses, school nurses, A&E, mental health care
nursesin fact, nurses across the spectrum of carecan
benefit from undertaking this course.
Negotiations are currently underway with the
Faculty of Family Planning and Reproductive Health Care (FFPRHC),
British Association of Sexual Health and HIV (BASHH), the Department
of Health and the National Association of Nurses for Contraception
and Sexual Health (NANCSH) looking at ways of enabling or supporting
the primary care team to deliver on sexual health. The Medical
Foundation for Aids and Sexual Health (MEDFASH, a charity supported
by the British Medical Association) is also currently drafting
standards around sexual health to be launched in the spring.
3.9 Recommendation 35Sexual health
Nurses in all areas of care could have the potential
opportunity for promoting good sexual health, especially messages
of prevention appropriate to individual clients, their abilities
and skills. At this moment in time, nurses are still being underused
in this way.
3.10 Recommendation 41-51SRE Education
and the National Curriculum
The fact that young people's sexual health is
still such a cause for concern in the UK, compared to many other
western European nations, shows that much work still needs to
be done. This is especially true for nurses working with children
and young people in schools, Young Offender's Institutions and
in various outreach services. Many of these nurses highlight how
they need specific learning on sexual health to empower them to
deliver customised messages effectively. The optional nature of
SRE in schools is a key stumbling block, and a lack of joined-up
collaborative work across all young people's services continues
to hinder the full and equitable teaching of sexual health appropriate
and available to all.