Examination of Witnesses (Questions 40-45)
PROFESSOR GEORGE
KINGHORN, MS
ANNE WEYMAN
AND DR
WILLIAM FORD-YOUNG
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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