Select Committee on Health Minutes of Evidence

Memorandum by the Department of Health (SH 1)


  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).



  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. 1(2)).

  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 preferentially.

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 reasons.

  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 paragraph.

  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 of charge.

  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 powers—section 121 of the NHS Act 1977—to introduce NHS charges; or

    (ii)  treating overseas visitors who are not eligible for free NHS care as private patients—this would be a private contractual arrangement between the practice and the patient.

  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 lawful.

  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 practicable.

  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 2004.

The priority for sexual health[1]

  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 GUM modernisation.

    (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 health"

  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[2]

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 services[3]

  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 country.

  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 health services.

  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 Authority.

  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.

Recommended Standards

  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[4]

  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 setting.

  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[5]

  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[6]

  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[7]

  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 outcomes.

  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[8]

  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 million.

  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.

Sexual dysfunction[9]

  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[10]

  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[11]

  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 Paper—by 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

2   Recommendations 7 to 12. Back

3   Recommendations 2, 3, 4, 5, 14. Back

4   Recommendations 15, 16 and 17. Back

5   Recommendations 18 to 24. Back

6   Recommendations 25 and 26. Back

7   Recommendations 27, 28, 30. Back

8   Recommendations 29 to 33. Back

9   Recommendation 34. Back

10   Recommendations 35 and 36. Back

11   Recommendations 37 to 46. Back

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