Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 40-45)


27 JANUARY 2005

  Q40 Chairman: Would it be fair to say from this short session that the impression, particularly from Professor Kinghorn's evidence, is that we still have what we term a crisis in sexual health? If that is the case, what further steps can we take perhaps to press for what I think to us was the most obvious step forward, which was the issue of sex education? The message we got loud and clear, whatever our views as a committee, was that where there is good quality sex education, despite the views of some, that tended to delay the onset of sexual activity and people were more aware of the implications. We made recommendations about the National Curriculum and sex education at a younger age which, sadly, have not been picked up by the Government. What do you think we can do to press this issue further, bearing in mind the serious state of the services that you and Professor Kinghorn have described?

  Professor Kinghorn: There is a continuing crisis and in some respects the situation is worse, as I was trying to indicate, than it was in 2001. We have an opportunity, and we are very grateful for that opportunity, to address the problem. Education is important at all levels, not just for young people. It needs to start with young people but it needs to be continued and it needs to be seen to be applicable to all of us, whatever our age. It also needs to be sustained. The danger has been in the past that education campaigns have come and they have gone. Unless it is sustained and there is seen to be a commitment for the future, then it will only have a temporary effect. It is important that education and service provision should go hand in hand, that we should not fail to meet the expectations of our public. If we have stimulated them to looking after their health in a better way, we have to be ready to provide the services that they require. We need to be able to extend services not only within secondary care but also in primary care. There is a huge need, as Dr Ford-Young was explaining, for training within general practice and developing potential providers. It is important that it should be co-ordinated and we should not see it as either being one or the other. There has to be this combined attack on the problem.

  Ms Weyman: If I may say something about sex education, this week we have had the report from the Chief Inspector of Schools about personal, social and health education and sex relationships education, which was damning about what is going on in schools. I do not think there has been very much progress since your report. Although the Department of Education says that it is committed and then there is guidance for schools, it is quite clearly not happening. I think we have to go on making the demands for sex and relationships education to become a broad programme, not the small amount of sex education that is currently compulsory but that we have this within the National Curriculum from an early age. I think it would be very valuable if your Committee continued to press for it, otherwise we are failing in providing young people with their entitlement to appropriate education and the capacity that that can provide for them to protect their sexual health and make responsible decisions about what they do to protect themselves and their partners. I think this is an area which needs constant pressure and that the Government's response has not been strong enough.

  Q41 Dr Naysmith: Dr Ford-Young, you were nodding vigorously when education was mentioned. In our previous report we came across at least a couple of instances in this country, and two or three in other countries, of general practitioners, primary care professionals, going into schools in a kind of very informal way, a drop-in way, and students could drop in. I wondered, given the previous discussion about the lack of incentives and so on, how we could try to make that happen more widely in various communities around schools, as well as what the Chairman was asking for.

  Dr Ford-Young: I would certainly echo what my two colleagues have said about the importance of relationships and education on sexual health taking place in education. As a general practitioner, I have an advantage in that when I see a patient I can provide some education, but that is all too often too late because they may be presenting me with a problem and we have missed the boat. That has to take place in education and not be left to health. I have mixed feelings about professionals like myself going into schools to deliver education. I do that for our local high school, and it goes down well with them. Apparently I can say things that the teachers or other people cannot say. I think it is a great shame that I can and they cannot say things. However, I am not trained as a teacher or an educator, and I think that needs to be looked at. I am here as a general practitioner and if I go into a school I am there as a GP not as a teacher or an educator.

  Q42 Dr Taylor: Can I go back to raising the profile, which we have all agreed is absolutely essential, particularly with strategic health authorities and PCTs, because the alarming rate of increase alone has not been enough to do it? Who should be the champion at PCT level? Should it be the public health lead; should it be the specific PCT lead for sexual health, if there is one; or should it be consultants in infectious diseases or GUM? Where should the push come at PCT level to make them get it into their local delivery plan as a high priority?

  Dr Ford-Young: Speaking from experience as a sexual health lead for our PCT and having met other ones around the country, I think the lead needs to come not actually at PCT level but probably at strategic health authority level to ensure that PCTs do incorporate sexual health messages and lines into their local delivery plans. I think one of the biggest drivers we have, and maybe in a way this is the thin end of a wedge around sexual health, is about chlamydia and chlamydia screening. I understand that LDPs are now going to have a line in on chlamydia screening. I think chlamydia screening is a good opportunity for us to improve our approach to sexual health because it is the commonest STI we have; it affects young people; and the screening can be delivered in a whole variety of health care and non-health care settings. For a PCT, that is a great line to have in their LDP. I would call it the thin end of the wedge because it can then help us to talk about sex in the generalist setting, which we have difficulty doing, and we have difficulty with our skills. That then means we should then be able to start talking about other STIs, other risk-taking behaviour, and we could start maybe to normalise talking about HIV and HIV testing in general practice, which we know we need to do but there is great reticence in the profession to do that. I think the way in and the way forward is through chlamydia screening with local delivery plans and PCTs actually being performance-managed on the uptake of chlamydia screening.

  Ms Weyman: I want to make a comment about what has been happening in London. I think there have been very interesting developments in the strategic health authorities in London. The five chief executives of the strategic health authorities decided that they would make sexual health an area that they wanted to look at in greater depth. They set up a steering group to develop a strategy for London, with certain levels of performance that they wanted to see. That has now been adopted across London. The strategic health authorities are discussing with their PCTs how that can be put into effect in the local development plans. Some of the objectives in the strategy are more rigorous than those which are within the White Paper commitments. What we have to see now is how that really does come down to PCT level and how that is delivered and monitored within London to make sure that that is happening.

  Q43 Dr Taylor: In London, that is at chief executive level?

  Ms Weyman: There is a cabinet of chief executives and they decided that they would look at this as one of the issues which they consider across the whole of London together. They chose this as one of their issues. They have been working on it now for I suppose about a year to lead into the local development plans for the coming period.

  Q44 Dr Taylor: On the PCT lead, would you have a direct route to get in touch with the chief executive of your strategic health authority? How helpful would the public health specialists be in this field?

  Dr Ford-Young: I think it would be very variable from PCT to PCT and PCT lead because we are very disparate people. I am a GP; a PCT lead could be a health promotion officer; someone else might be the director for public health.

  Q45 Dr Taylor: Is there some sort of recommendation we should make on that?

  Dr Ford-Young: I think the recommendation should be that a sexual health lead in a PCT should be somebody who has some clout within that organisation.

  Chairman: May I thank you for a very helpful session. We hope we can take things a bit further. We are grateful for your participation today.

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