Memorandum by Brook Advisory Centres (WP
08)
1. INTRODUCTION
1.1 Brook, a registered charity, is the
country's leading sexual health organisation for young people,
offering young women and men up to the age of 25 free and confidential
sexual health advice and services.
1.2 Our evidence is therefore restricted
to the plans for improving young people's sexual health outlined
in the Public Health White Paper.
2. Will the Proposals Enable the Government
to Achieve its Public Health Goals?
2.1 Brook welcomes the Government's commitment
to a new sexual health campaign targeted at younger women and
men. It is alarming that awareness of the importance of using
condoms alongside other methods of contraception appears to have
broken down since the mass media HIV campaigns of the 1980's,
particularly amongst young people. We therefore believe that a
more high profile public information campaign is needed to tackle
the lack of awareness about sexually transmitted infections and
HIV.
2.2 The Department of Health's proposals
to ensure a broader reach of information about sexual health for
young people in ways that can be accessed in complete confidence
(such as websites and email) will increase their access to impartial
and accurate information about how to protect their sexual health.
It is evident from Brook's own confidential on-line inquiry service
provided via its website that this is an effective way of reaching
young men and younger age groups who might not use telephone helplines
or face-to-face services because of embarrassment or concerns
about confidentiality.
2.3 However, young people also need access
to confidential services in addition to information. We are particularly
concerned that the Government's proposals for information sharing
databases could constitute a serious threat to young people's
confidential use of sexual health provision. Under the proposals,
details of practitioners such as sexual health workers who are
involved with the young person would be recorded on the database.
This would potentially alert other professionals to the fact that
a young person is in contact with sexual health services. The
vast majority of young people taking part in a Brook consultation
on this issue said that this would make them less likely to use
a service. The proposals could therefore constitute a major deterrent
to young people accessing preventive sexual health and contraceptive
provision, undermining the Government's aim to reduce sexually
transmitted infections and teenage pregnancy rates.
2.4 We are particularly disappointed that
the Government did not take the opportunity presented by the White
Paper to make Sex and Relationships Education a statutory part
of the national curriculum. Research shows that young people who
have received good sex and relationships education, combined with
access to confidential services, start having sex at a later age
and are more likely to use contraception when they do become sexually
active.
2.5 Brook believes that the most effective
way to ensure that young people are enabled to make informed choices
about their sexual health, and to therefore reduce rates of sexually
transmitted infection and teenage pregnancy, is to make Sex and
Relationships Education a statutory entitlement for all children
within the PSHE curriculum.
2.6 There have been welcome improvements
in SRE as a result of the teenage pregnancy strategy but these
are by no means uniform across the country. Ofsted's recent report
on PSHE in secondary schools found some schools did not cover
PSHE at all in order to give more time to subjects within the
national curriculum. We believe that consistency and quality would
be improved by a statutory curriculum instead of leaving it to
the discretion of individual schools to define within their SRE
policy what is taught, if anything.
3. Are the proposals appropriate, will they
be effective and do they represent value for money?
3.1 The Health Development Agency's review
of the effectiveness of interventions aimed at reducing STIs found
that there is good evidence that school-based sex education is
effective in reducing adolescent sexual risk behaviour.
3.2 As long as SRE remains a non-statutory
part of the curriculum, improvement in young people's sexual health
will be patchy at best. Giving young people access to more information
about sexual health will have limited impact if they are not also
helped to develop the skills needed to act on that information.
Brook believes that young people need to be specifically helped
to develop the ability to recognise and resist pressure so that
they can delay intercourse until they are ready for it; to develop
healthy relationships; and to negotiate and practise safer sex.
This is most effectively done through comprehensive sex and relationships
education in schools and other settings.
3.3 The British Association for Sexual Health
and HIV estimates that diagnosing and treating sexually transmitted
infections and their consequences costs the NHS around £1,000
million annually. The announcement of an additional spending of
£300 million over three years to improve sexual health services
and extend the national advertising campaign will clearly represent
value for money if it leads to reduced rates of sexually transmitted
infection. However, whether it will be sufficient to modernise
and improve all services and meet the additional demands for testing
and treatment which could result from the public information campaign
is unclear.
4 Do the necessary public health infrastructure
and mechanisms exist to ensure that the proposals will be implemented
and goals achieved?
4.1 The main mechanism for ensuring that
the proposals will be implemented is the NHS planning framework.
We therefore welcome the Government's commitment in Choosing Health
to issue a "supplementary technical note" to ensure
that NHS Local Delivery Plans address inequalities in sexual health
but it is not clear whether this will provide sufficient leverage
to promote service improvement in all areas.
4.2 Without ring fencing or a strong focus
on sexual health within the planning framework, there must be
concern as to how far local organisations will use the additional
funding earmarked for sexual health for its intended purpose.
4.3 The proposal to deliver sexual health
through a flexible multidisciplinary workforce has considerable
training implications, in particular if non-specialist staff in
primary care or youth work are to deliver high quality services
or information.
4.4 The voluntary sector is well placed
to support implementation of the proposals. Brook already provides
positively evaluated confidential information to young people
via a telephone helpline, website and on-line enquiry service
in addition to providing sexual health services at its Centres,
and producing sex and relationships education publications. We
would welcome the opportunity not only to expand our own services
but to share our expertise with other services through training
and consultancy to improve young people's sexual health services.
January 2005
| 
