Memorandum by the Department of Health
1. This memorandum sets out evidence from
the Department of Health on the consequences of:
the new and proposed changes in charges
for overseas patients with regard to access to HIV/AIDS services.
an update on progress in implementing
the recommendations of the Committee's inquiry into Sexual Health
(the Committee's Third Report of Session 2002-03).
FOR HIV/AIDS SERVICES
2. The concept of charging patients who
do not live in the United Kingdom for NHS treatment they may need,
while staying here temporarily, is not new. Section 121 of the
National Health Service Act 1977 gives the Secretary of State
powers to make Regulations concerning charging anyone who is not
ordinarily resident in the UK for services provided under the
NHS Act 1977. "Ordinarily resident" in this context
is a common law concept interpreted by the House of Lords in 1982
as someone who is living lawfully in the United Kingdom voluntarily
and for settled purposes as part of the regular order of their
life for the time being, with an identifiable purpose for their
residence here which has a sufficient degree of continuity to
be properly described as settled. In this context, neither nationality
nor the past or present payment of UK taxes or National Insurance
contributions have any relevance.
3. The section 121 powers have so far been
used to make regulations only in relation to NHS hospital treatment.
The National Health Service (Charges to Overseas Visitors) Regulations
1989, as amended ("the 1989 Regulations"), place an
obligation on providers of NHS hospital services to establish
whether each patient is an overseas visitor and if so to make
and recover a charge for any hospital treatment provided, unless
the patient is covered by one of the specified exemptions from
charges. The 1989 Regulations define an overseas visitor as "a
person not ordinarily resident in the United Kingdom" (Reg.
4. It is important to understand that S121
of the NHS Act 1977, and the 1989 Regulations made under it, relate
to the power to charge for services that are provided under the
NHS Act 1977. They are not the powers which determine whether
the services are to be provided. Furthermore, overseas visitor
patients who are deemed chargeable under the provisions of the
1989 Regulations remain NHS patients subject to the same clinical
prioritising as any other NHS patients. The fact that they are
required to pay for the treatment received does not allow them,
for example, to bypass waiting times or be treated in any way
NHS Hospital Treatment
5. The conditions relating to exemptions
from charges for overseas visitors contained within the 1989 Regulations
fall into three broad categories:
(i) eligibility for the full range of free
NHS hospital treatment because specified conditions are fulfilled;
(ii) eligibility for treatment the need for
which arises during a temporary visit to the UK, or in relation
to the exceptional humanitarian grounds exemption, because certain
specified conditions are fulfilled; and,
(iii) eligibility for free NHS hospital treatment
because there is a need for certain specified services which are
exempt from charges.
6. The first category covers a considerable
range of circumstances including, for example, people here to
take up employment with a UK-based employer, overseas students
here to study a course of at least six months' duration, and those
who have been living lawfully in the UK for at least 12 months
immediately preceding the treatment being provided. All the exemption
conditions in this category also apply to the exempt person's
spouse and dependent children if they are living in the UK with
the exempt person on a permanent basis.
7. The second category includes people from
other European Economic Area member states or people from other
non-EEA countries with which the UK has bilateral health care
agreements, as set out in Schedule 2 of the 1989 Regulations,
who fall ill or are injured whilst on a temporary visit to the
UK. Some of the conditions in this category can be extended to
the spouse and dependent children of the exempt person in the
same way as for the first category, others cannot. This category
also includes the specific exemption for exceptional humanitarian
8. The third category applies to specific
services which are always free to all. This includes, among other
things, any treatment provided solely in the Accident and Emergency
Department of a hospital, compulsory mental health treatment,
and treatment for certain specified diseases set out in Schedule
1 of the 1989 Regulations. Tuberculosis is one of the diseases
in the Schedule. This category also includes the initial diagnostic
testing for HIV and associated counselling, but not subsequent
treatment if the test proves positive. Thus an overseas visitor
who does not meet any of the other exemption conditions in the
1989 Regulations should be required to pay for any HIV treatment
required beyond the initial testing and counselling. It is important
to appreciate that this is not a new requirement, but has been
in place since the 1989 Regulations first came into force.
9. On 1 April 2004 the National Health Service
(Charges to Overseas Visitors) (Amendment) Regulations 2004 ("the
2004 amendment Regulations") came into force. The amendments
these made to the 1989 Regulations included provisions to close
loopholes that had been identified during a review of the hospital
charging regime. A full public consultation on the proposed changes
took place between 29 July and 31 October 2003. The 2004 amendment
Regulations made no changes to the existing rules on charging
overseas visitors for HIV treatment described in the previous
10. One of the amendments to the 2004 Regulations
was to tighten the 12 months residency exemption, which covers
those overseas visitors who do not meet any of the other exemption
conditions, providing exemption from charges once they have been
living in the UK for 12 months. This exemption now specifies that
in order to qualify for the exemption the person must have been
living in the UK legally for that period. This means that illegal
immigrants, failed asylum seekers, visa overstayers and others
living here without proper authority cannot now take advantage
of free NHS hospital treatment. In order to do so a person must
be able to show that they had been living here legally.
11. During the consultation on the proposed
changes, a number of respondents pointed out that whilst tightening
the 12 months' residency exemption was the right way to go, provision
needed to be made for those who were already undergoing a course
of free treatment because they were exempt from charges at the
time the treatment began but whose status subsequently changed.
(This might include, for example, asylum seekers, who are exempt
from charges as long as their application, and any subsequent
appeals, are being considered. Only once they have finally been
refused do they become chargeable). We accepted the validity of
the argument that requiring such patients to begin paying for
the remainder of their treatment could result in them feeling
unable to complete it. Amendments were, therefore, included in
the 2004 amendment Regulations so that where a patient has begun
a course of treatment free of charge, that course of treatment
remains free until completed, even if their eligibility status
changes. Treatment for a different condition, or starting a new
course of treatment for the same condition, becomes chargeable
when the status of such a patient changes.
12. It is also worth pointing out that guidance
on implementation of the revised charging regime, issued at the
time the 2004 amendment Regulations came into force, makes clear
that where treatment is deemed by a clinician to be immediately
necessary, either to save life or to prevent a condition from
becoming life-threatening, then that treatment must be given without
delay, irrespective of whether the patient is, or may be, chargeable.
If it is subsequently established that the patient is a chargeable
overseas visitor, then they should be advised of this as soon
as is practically possible, and appropriate recovery action taken.
The guidance is also explicit that, because of the potential risks
to both mother and baby, hospital maternity services should always
be considered as immediately necessary treatment. This could include
HIV treatment where it was considered clinically necessary.
Primary Medical Services
13. The current legislation on the eligibility
of overseas visitors for primary medical services (ie GP services)
allows GP practices discretion on whether to accept any application
to join a practice's NHS list of patients. A person may be accepted
onto the list either as a permanent registered patient or as a
temporary resident (ie, where a person is in an area for more
than 24 hours but less than 3 months). Existing guidance HSC 1999/018
"Overseas Visitors' Eligibility to Receive Free Primary Care"
encourages practices to register overseas visitors as temporary
residents, if at all.
14. Where a practice decides not to accept
an application, the person can be offered treatment on a private,
paying basis. As with hospital services, however, where a healthcare
professional believes that treatment is immediately necessary,
it must be provided without delay, even if the patient is not
registered with the GP practice. It must also be provided free
15. The Department of Health has recently
conducted a public consultation on proposals:
(i) to strengthen and clarify the rules on
the eligibility of overseas visitors to free NHS primary medical
services so that they better match, as far as practicable, those
on the eligibility of overseas visitors to receive free NHS secondary
care as set out in the 1989 Regulations; and
(ii) for those overseas visitors who are
not eligible for free NHS primary medical services to be offered
treatment by practices for which they would be charged.
16. Two charging options were considered:
(i) using existing legislative powerssection
121 of the NHS Act 1977to introduce NHS charges; or
(ii) treating overseas visitors who are not
eligible for free NHS care as private patientsthis would
be a private contractual arrangement between the practice and
17. Ministers are currently considering
the responses to the consultation with a view to deciding the
best way forward.
Overseas Visitors and Access to HIV/AIDS Treatment
18. Access to HIV/AIDS treatment remains
as it has been since 1989. It is for individual practices to decide
whether to accept any person, whether or not they are an overseas
visitor, onto the practice's NHS list. For hospital services,
under the 1989 Regulations anyone deemed by the NHS body providing
the treatment to be ordinarily resident, will be automatically
entitled to receive any and all hospital treatment free of charge.
Similarly, the initial diagnostic testing for HIV, and any associated
counselling, is free to all. If, however, the patient is established
as an overseas visitor under the provisions of the 1989 Regulations
then any subsequent hospital treatment will be chargeable unless
they meet one of the exemption criteria.
19. An overseas visitor who does not meet
any of the exemption criteria but is nevertheless living here
lawfully, would be liable to be charged for their hospital treatment
until such time as they accrue 12 months' lawful residence. After
that they would be eligible to receive all future hospital treatment
free of charge as long as the patient's residence here remains
20. If, however, a clinician is satisfied
that the hospital treatment is immediately necessary, then it
will be given without delay, irrespective of whether the patient
is chargeable. Any payment issues will be dealt with as soon as
21. Where an overseas visitor patient has
started a course of HIV treatment free of charge because they
were found to be exempt from charges at that time, that course
of treatment will remain free of charge, even if the patient's
immigration status changes in the meantime so that they are no
longer eligible for free treatment.
22. The Health Select Committee published
the report of its inquiry into sexual health in June 2003, with
51 recommendations (references to recommendations are shown in
footnotes, where applicable, below). The Government's response
to this report was published in September 2003 (command paper
CM 5959) setting out how the recommendations were being addressed,
including a proposed additional investment of £11.4 million.
Since then, the Department of Health (DH) has made considerable
progress in continuing to implement the National Strategy for
Sexual Health and HIV, and additional significant measures to
modernise sexual health services in England have been set out
more recently in the Government's Public Health White Paper: "Choosing
Health, Making Healthy Choices Easier", published on 16 November
The priority for sexual health
23. The Committee recommended that the Government
take urgent steps to ensure that sexual health was prioritised
and resourced. The Government has recognised that, given the scale
of the problem, more action is now needed and has, therefore,
signalled a major step change for sexual health to boost delivery.
The White Paper, sets out a number of commitments, backed by £300
million new funding, which will improve access to services, raise
awareness of risks and boost prevention efforts.
The White Paper on Public Health
24. The White Paper consultation demonstrated
that people wanted to take responsibility for their own health
and that generally people did not want interventions from the
Government "telling them what to do". People do, however,
want the Government to support them in making healthier, informed
choices in life. This principle is at the heart of the key commitments
on sexual health set out in the White Paper. These include:
(i) A new £50m sexual health campaign
over 3 years, targeting young men and women, aimed at getting
the messages through loud and clear about prevention, the use
of condoms and the serious implications of Sexually Transmitted
Infections (STIs) such as Chlamydia and HIV.
(ii) Services, in future, to be delivered
through a flexible, multidisciplinary workforce, in a range of
settings. This includes STI testing in the community, targeted
at those most at risk.
(iii) Modernised Genito Urinary Medicine
(GUM) service provision, including new capital and revenue funding
(£130 million over 3 years), coupled with a goal that by
2008, all patients seeking appointments at GUM clinics to be offered
one within 48 hours, and underpinned in the Local Delivery Plans
being prepared by Primary Care Trusts (PCTs) from April 2005.
A comprehensive service review on GUM is already underway to support
(iv) A new thrust to turn around STI rates,
supported in Local Delivery Plans through measuring the rates
of Gonorrhoea as a proxy indicator for overall STI rates.
(v) Acceleration of the National Chlamydia
Screening Programme, to cover the whole of England by March 2007,
plus new pilots, in partnership with the private sector, to explore
chlamydia screening in pharmacies, backed up by a further £80
million and underpinned in future Local Delivery Plans.
(vi) An audit of contraceptive services in
early 2005, followed by investment of £40 million to meet
gaps in services and strengthen the delivery of the full range
of contraceptive services to better meet patient needs and choice
(vii) DH will pilot health services dedicated
to young people and designed around their needs, including primary
care and specialist services in locations which are convenient
for younger people.
(viii) Ensure a broader reach of information
about sexual health for young people, with increased support for
parents in talking about sex and relationships.
(ix) Renewed support for Teenage Pregnancy
Partnership Boards to strengthen delivery of their strategy in
neighbourhoods with high teenage conception rates.
25. Even before publication of the White
Paper, DH had already taken a number of actions to ensure the
NHS gave a higher priority for sexual health in local services.
The new planning framework for the NHS, "National Standards,
Local Action: Health and Social Care Standards and Planning Framework",
published in July this year, includes the first ever national
Public Service Agreement (PSA) target for sexual health, alongside
the Government's PSA on teenage pregnancy so that the Governments
PSA goals is this area are now "to reduce the under-18 conception
rate by 50% by 2010 as part of a broader strategy to improve sexual
26. This planning framework states that
the NHS, together with Local Authorities, will need to take the
sexual health strategy into account when developing their policies
that will contribute to the delivery of the national target. It
also highlights the sexual health areas which will be particularly
relevant for PCTs and their local authority partners to cover
in their plans, including STI rates, access times and contraceptive
and sexual health service provision.
Links with the Field
27. Every PCT now has an appointed sexual
health lead. DH hosts an annual conference to discuss strategic
development and support them in their role. DH officials also
meet regularly with a network of sexual health co-ordinators,
at Strategic Health Authority (SHA) level, who play a central
role in working with the PCT sexual health leads to take forward
the strategy and service modernisation across the country. And
DH is looking at ways of strengthening regional coordination to
help further improve local delivery.
28. At national level, the Independent Advisory
Group on Sexual Health and HIV, established in 2003, has developed
into a valuable source of expert, independent advice and means
of communicating the importance of sexual health. They published
their first annual report in October 2004, and representatives
of the group have begun a programme of visits to local services
around the country, to spread good practice and feed back issues
of concern to the centre.
Investment and resources
Funding Announced with Government's Response
29. The additional funding announced with
the Government's response to the Health Select Committee in October
2003 is already bearing fruit. For example, £5 million was
added to the budget to introduce the preferred NAATs test for
chlamydia to all parts of the country, providing more reliable
results using a more convenient and less invasive urine test.
GUM Capital Funding
30. The Secretary of State for Health announced
further funding of £15 million to improve GUM in November
2003, to boost the modernisation of premises and facilities within
clinics. Following a bidding process, this funding has been allocated
to those areas which can make best use of the money, including
those who are working towards fully integrated sexual health services.
This has been strengthened by further investment in capital, as
referred to above, through the White Paper.
Modernisation and improvement of sexual health
31. We have acted on the Committee's recommendation
for a maximum waiting time of 48 hours as one of the White Paper's
key commitments, backed by major investment and inclusion in Local
Delivery Plans. The Health Protection Agency's (HPA) recently
published data on the current state of play on waiting times,
which show that SHAs and PCTs have much to do to meet the goal
of 100% being offered an appointment within 48 hours by 2008.
32. Work has also progressed in establishing
10 GUM development pilot sites in areas with little or no GUM
services, or services where there are very limited staff and resources
to cope with demand. The intention is that we will disseminate
findings and learning from these 10 sites to other areas of the
33. In April 2004, the Society of Sexual
Health Advisers published "The Manual for Sexual Health
Advisers", with funding from the Department of Health.
This document provides clear, practical guidance on issues such
as partner notification, counselling, working in community settings
and the legal and professional framework.
34. The DH has commissioned the Medical
Foundation for AIDS and Sexual Health (MedFASH) to undertake a
national review of GUM services which will be led by Prof. Mike
Adler. The review, which started in Summer 2004, will undertake
an assessment of all GUM services, to identify and spread good
practice and help boost modernisation. The review will include
workforce issues, such as difficulties arising for single-handed
consultants, and training.
35. The National Training Working Group
is working in partnership with the Sheffield Centre for Sexual
Health and HIV to look at clinical and non-clinical training,
across a range of health professions, and taking forward the implementation
of the sexual health training plan.
IT, Data and Patient Involvement
36. The DH is also developing a Common Data
Set for Sexual Health to support the implementation and monitoring
of the National Strategy for Sexual Health and HIV. This aims
to provide a single, standard structure for collecting data on
sexual health and will apply to all settings providing sexual
37. A draft specification of the data set
already exists and further detailed work is being undertaken to
complete the specification which must then be formally agreed
by all stakeholders and finally approved by the NHS Information
38. As well as the move towards patient
focused services outlined in the White Paper, the sexual health
standards, currently under development (see below), include a
standard to empower people who use services to have confidence,
personal control and choice in managing their sexual health care
and in making the best use of services. In addition, the Independent
Advisory Group on Sexual Health and HIV, is helping to ensure
user involvement in national policy making, through the inclusion
of service user representatives among its membership. These include
HIV service users, and the group is in the process of recruiting
a young person's representative to join the group.
39. Recommended standards for the treatment
and care of people with HIV were published in November 2003 in
partnership between DH, MedFASH, the British HIV Association and
the National Association of NHS Providers of AIDS Care and Treatment.
MedFASH were then commissioned to produce similar standards for
sexual health services, which are now being finalised, with publication
planned for Spring 2005. These standards will help to drive up
the quality of services and provide a clear benchmark of good
practice. They cover a broad range of issues including the development
of sexual health networks, workforce development, promoting good
sexual health, empowering service users and improving access.
Testing for chlamydia and other STIs
40. Good progress has been made on the roll-out
of the National Chlamydia Screening Programme, now significantly
boosted by the White Paper to accelerate the completion of the
roll-out to March 2007. The White Paper also sets out a commitment
to introduce and evaluate the effectiveness of screening in pharmacies
as part of the national programme. A pilot will be carried out
in pharmacies, in partnership with the independent sector, to
test the effectiveness and acceptability of screening in this
41. The Government is already responding
to the concerns raised about switching as quickly as possible
to the superior Nucleic Acid Amplification Test (NAATs), and £7
million pump-priming money was invested in 2003-04 to ensure that
all major laboratories in each region of England use the most
effective technology. Funding has now been allocated to ensure
that there is access to NAATs in every SHA in England. The DH
has been working closely with the Purchasing And Supply Agency.
NAATs technology should be in place across England by Spring 2005.
42. The first annual report of the programme
for 2003-04 has now been published. Screening in the first year
of the programme, found 1 in 10 sexually active young women and
1 in 8 sexually active young men were infected with Chlamydia.
This data will help us to understand the distribution and determinants
of chlamydia infection, as well as providing lessons which will
enhance the subsequent phases of the roll-out.
43. Joint working between the DH and the
Defence Science and Technology Laboratory on near patient testing
technology is progressing. This new technology will give a chlamydia
result within one hour, and will be piloted in the clinical setting
in the first quarter of 2005.
HIV and AIDS
44. The latest data on HIV was published
by the Health Protection Action in November. This shows that prevalence
of HIV infection in the UK (diagnosed and undiagnosed) in adults
increased by 7% over 12 months. This compares to an increase of
20% reported in HPA's annual report for 2002. For the first time,
heterosexual men and women were the greatest number of patients
seen for HIV care.
45. However the reduction in the proportion
of HIV remaining undiagnosed from almost a third (31%) in 2002
to just over a quarter (27%) for 2003 shows some positive progress.
This is still too high and we remain committed to reducing this
further for example by targeted HIV campaigns encouraging HIV
testing for African communities. In GUM clinic attenders, uptake
of voluntary confidential testing for HIV among men who have sex
with men increased from 47% in 1997 to 64% in 2003. In heterosexuals,
voluntary confidential testing for HIV increased from 27% in 1998
to at least 55% in 2003.
46. Diagnoses rates of HIV in pregnant women
continue to increase since the introduction in 1999 of the universal
offer and recommendation of an HIV test to pregnant women in England
as a routine part of antenatal care. In England in 2003, it is
estimated that at least 92% of HIV-infected women were diagnosed
before delivery. Antenatal diagnosis allows pregnant women to
take advantage of interventions to prevent mother-to-baby transmission,
such as antiretroviral drug therapy, elective caesarian delivery
and avoidance of breast feeding. As a result the proportion of
children exposed to maternal HIV infection is decreasing, eg in
London in 2003, 5% of children exposed to maternal HIV infection
would have been infected, compared to 16% in 1998.
47. Asylum seekers are offered health assessments
and screening for tuberculosis (TB) at Home Office Induction centres
to identify their immediate health needs and to protect public
health. Testing for HIV is offered on request or where medical
history indicates they have been at risk.
48. Following the Committee's recommendations,
the DH is funding the Terrence Higgins Trust, working with GUM
professionals, to undertake a 12 month pilot project aimed at
assessing the feasibility and acceptability of HIV testing and
syphilis screening for the groups most at risk of HIV (gay men
and black Africans) in non-clinical settings, such as clubs, bars
and voluntary organisation's premises. Sigma Research are evaluating
the pilot and if successful, we will look to disseminate the findings
and learning more widely.
49. The recommended standards for NHS HIV
services offer guidance on managed service networks. Each standard
offers an evidence-based rationale; key interventions; implications
for service planning; guidance on practice; and suggested audit
indicators. The recommended standards will serve as a tool for
planning and auditing service development, a framework for commissioning
and a resource for partnership between service users and providers.
50. The DH is funding the Children's HIV
Association and Royal College of Paediatrics and Child Health
to map and develop networks for paediatric HIV services outside
London. This is progressing well and will lead to the publication
of good practice guidance on the development of networks for the
provision of children's HIV services nationwide.
51. The DH has reviewed the formula for
the AIDS Support Grant (£16.5 million) paid to local authorities.
In line with changing social care needs this now prioritises women
and children living with HIV. We have also funded the National
AIDS Trust to produce a guide on the needs of people living with
HIV which was distributed in October.
Commissioning of services
52. The strengthening of performance monitoring
arrangements outlined above will lead to improvements in commissioning
and enable closer monitoring of consortia development and regional
commissioning by SHAs.
Primary care and access to services
53. Since April 2004, we have seen the introduction
of 4 primary medical services contracting routes new General Medical
Services (nGMS), Personal Medical Services (PMS), Alternative
Provider Medical Services (APMS) and Primary Care Trust Medical
Services (PCTMS), in addition to the development of Specialist
PMS and Practice-led Commissioning. They provide flexible frameworks
for multi-professional, interagency statutory, voluntary and commercial
organisations to be creative in delivering a sexual health agenda
to meet local needs and diversity of population. Implementation
of levels 1 and 2 sexual health services through core services
provided in general practice, whichever contracting route is utilised,
requires support from primary care organisations to ensure access
to the appropriate training, education and competency assessments
to ensure sustained quality delivery and positive sexual health
54. Stakeholders from key organisations
are working together to produce national standards for delivering
sexual health services in any setting. These are being compiled
by MedFASH and due for publication at the end of February. National
quality training standards are being developed and a multi-professional
national group is examining the competencies required for delivering
enhanced services in general practice. These two initiatives are
expected to be completed by Spring 2005. Work is also being undertaken
to negotiate sexual health training into pre and post graduation
medical and nursing training programmes.
Contraceptive services and termination of pregnancy
55. The key role played by contraceptive
services in protecting against both unplanned pregnancies and
STIs is highlighted in the White Paper. To support this, the NHS
will also strengthen the infrastructure for sexual health and
contraceptive services in primary care. We will undertake an audit
of contraceptive services in early 2005 to identify current provision
of contraception by GPs and community services, to examine staffing
and training issues and any restrictions in access to services
and methods. We will also be investing centrally to meet gaps
in local services and investment available will total £40
56. A contraceptive services group has been
established and one of the group's key actions is to develop an
action plan for improvements to access services and the full range
of methods. The expert group on contraception has now met 4 times
and is making good progress in drawing up an action plan, which
will help to deliver the White Paper commitments. A NICE guideline
is being developed on long-acting methods of contraception which
should raise awareness and support appropriate prescribing and
usage. To help improve capacity and access, a distance learning
programme for nurses has been developed. We are also supporting
the development of a UK version of the WHO Medical Eligibility
Criteria for evidence based contraceptive prescribing.
57. The £1million for contraceptive
services for 2004-05 was allocated to 162 clinics based on a formula.
Funding can be used for training and improved access to long acting
methods of contraception.
58. On abortion, an audit of waiting times
and commissioning policies has been undertaken and the results
should be available shortly. We are planning to use the results
of the audit to commission development of best practice guidance
for commissioning abortion services.
59. The draft sexual health standards, currently
being developed, highlight the need to include issues of sexual
dysfunction as part of a broader, holistic approach to sexual
health. They set out the need for practitioners to be aware of
the prevalence of sexual problems such as dysfunction and psychosexual
distress, and the difficulty patients may have in seeking help
for these conditions.
Sexual health promotion
60. The Government agrees with the Committee
on the importance, and cost-effectiveness, of prevention to improve
sexual health. The White Paper highlights this and signals a major
new sexual health campaign, targeted particularly at younger men
and women, to ensure they understand the real risk of unprotected
sex, and persuade them of the benefits of using condoms to avoid
the risk of STIs (including HIV) and unplanned pregnancies.
61. Chlamydia screening and targeted HIV
prevention have continued to be supported by DH and have received
additional investment, as set out above.
62. In July 2004, the Department of Health,
jointly with the Department for Education and Skills (DfES), published
"Best practice guidance for doctors and other health professionals
on the provision of advice and treatment to young people under
16 on contraception, sexual and reproductive health".
Sex and relationships education
63. The Government is committed to delivering
high quality sex and relationships education (SRE) within the
framework for PSHE, recognising that young people need more than
simply the facts about human reproduction which are covered in
the science curriculum. Within PSHE, the focus is on managing
relationships and giving young people the knowledge and skills
to: resist pressure to have sex early; practice safe sex if they
do become sexually active; and manage risks, not only in relation
to sexual behaviour, but also drugs and alcohol.
64. The Government continues to review the
evidence on the delivery of PSHE from OfSTED inspections, monitoring
by the Qualifications & Curriculum Authority (QCA) and through
its Regional PSHE advisers, but at this stage is not persuaded
that making PSHE statutory is necessary. It believes that the
key to improvement is through: improving teachers' skills and
confidence in teaching SRE, embedding PSHE as a key component
of the National Healthy Schools Standard (NHSS)for which
there was a further boost in the White Paperby providing
clearer guidance to schools on its expectations for what each
young person should learn through PSHE in each key stage of learning.
65. The Government continues to roll-out
the PSHE certification programme for teachers. In 2003-04, over
500 teachers successfully completed the programme and approximately
2,000 teachers are participating in the programme in 2004-05.
In addition, the Government has begun the roll-out of a linked
certification programme for community nurses who contribute to
the delivery of SRE in schools and other settings. Following a
successful pilot in 2003-04, 325 community nurses are participating
on the programme in 2004-05.
66. Following consultation with the Teacher
Training Agency (TTA) new standards for Initial Teacher Training
(ITT) now ensure trainee teachers are familiar with the PSHE framework.
To support this, the Governments Teenage Pregnancy Unit has commissioned
a "Best Practice Toolkit on PSHE" for ITT providers.
67. DfES and DH are currently reviewing
the NHSS, with the intention of including the requirement that
the school has a high quality PSHE programme as one of the key
qualifying conditions. The White Paper sets out the goal that
all schools will be, or will be working towards, being a healthy
School by 2009. DfES has published a "Healthy Living Blueprint"
for schools, which further emphasizes the priority which the Government
places on healthy Schools.
68. DfES has asked the QCA to develop "end
of key stage statements" for PSHE for Key Stages 1-4, setting
out what students are expected to have learnt by the end of each
Key Stage. This brings PSHE in line with other curriculum subjects.
As part of this work, QCA is also developing assessment guidance
for schools and exemplar classroom materials. This "package"
of materials will be available to schools from April 2005.
69. Specialist SRE teaching resources for
young people with learning difficulties and young people with
physical disabilities are being developed in partnership with
voluntary and community sector groups serving these young people
and their families.
70. DfES has developed a dedicated area
on the PSHE teaching website about doing more to support boys.
It contains specific lesson plans for teachers, training courses
and links to resources. In addition, the Teenage Pregnancy Unit
(TPU) has supported Working with Men to develop the Building Bridges
SRE resource. This is for work with boys in key stage three and
four, and aims to increase their engagement with SRE in schools
and improve their uptake of local advice services.
71. Supported by TPU, Parentline Plus continues
to implement the "Time to Talk" initiative aimed at
helping parents develop confidence and skills in talking to their
children about sex and relationships. The PR work in a range of
national and regional media is supported by the Parentline Plus
free helpline and website. The TPU has also supported the fpa's
"Speakeasy" community-based education project aimed
at enabling parents to talk to their children about sex and relationships.
The main aims of the courses are to encourage parents to provide
positive sex education in the home and encourage parents to take
on the role of "sex educator". In addition, TPU supports
the "Parent to Parent" peer support project pilot, with
Sheffield City Council.
Department of Health
1 Recommendations 1, 6, 13, 47, 48, 49, 50, 51. Back
Recommendations 7 to 12. Back
Recommendations 2, 3, 4, 5, 14. Back
Recommendations 15, 16 and 17. Back
Recommendations 18 to 24. Back
Recommendations 25 and 26. Back
Recommendations 27, 28, 30. Back
Recommendations 29 to 33. Back
Recommendation 34. Back
Recommendations 35 and 36. Back
Recommendations 37 to 46. Back