Select Committee on Health Written Evidence


Memorandum by Royal College of Nursing (HA 19)


  The Committee will undertake a short inquiry into recent policy developments surrounding HIV/AIDS and sexual health services—specifically, 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 person—no matter what their politico-legal status—if, 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.


  3.1  Recommendation No 6—Sexual Health Provision

  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 ( 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 8—Expansion 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 11—Diversion of funding

  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 13—Waiting times indicator

  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 health services.

  3.5  Recommendation No 15—Chlamydia Screening Programme

  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 16—Male 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 18—HIV 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 non-heterosexuals.

  3.8  Recommendation No 28—Primary 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 nurses—in fact, nurses across the spectrum of care—can 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 35—Sexual health promotion

  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 41-51—SRE 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.

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