Memorandum by the Family Planning Association
(fpa) (WP 53)
SUMMARY OF
SUBMISSION
fpa (Family Planning Association) is the UK's
leading sexual health charity working to improve the sexual health
and reproductive rights of all people throughout the UK. fpa welcomes
the sexual health proposals in the Public Health White Paper,
and the £300 million funding that has been allocated to implement
these proposals.
NB This submission only relates to the sexual
health proposals in the Public Health White Paper.
Will the proposals enable the Government to achieve
its public health goals?
— The proposals should enable the Government
to address current problems in sexual health and thereby achieve
short-term public health goals.
— The absence of proposals to introduce
sex and relationships education (SRE) as statutory within the
National Curriculum means that there is little to ensure that
the Government achieves public health goals over the long-term.
Are the proposals appropriate, will they be effective,
and do they represent value for money?
— It is encouraging that the sexual
health proposals are so wide-ranging.
— However, it is disappointing that
both SRE and abortion services have been missed out of the proposals.
— We are unable to comment on the effectiveness
or value for money of these proposals as the detailed implementation
plan has not yet been published, nor have audits of need (such
as the contraceptive audit) yet taken place.
Do the necessary public health infrastructure
and mechanisms exist to ensure that proposals will be implemented
and goals achieved?
— Again, we await the publication of
the detailed implementation plan in order to comment fully on
this question. However, we highlight the following five areas
as key in ensuring implementation:
— Expanding workforce capacity to ensure
that services are able to meet demand.
— Providing adequate and appropriate
training to all professionals involved in delivery.
— Integrating STI testing and treatment
across sexual health services.
— Ensuring that there are sufficient
local levers for prioritisation and resourcing.
— Retaining central funding for key
areas such as training and information provision.
SUBMISSION
About fpa
1. fpa welcomes the opportunity to contribute
to the Health Select Committee's inquiry into The Government's
Public Health White Paper. fpa welcomes the inclusion of sexual
health as a central theme in the Public Health White Paper, and
the injection of £300 million for sexual health services
over the next three years. We are encouraged by the comprehensive
proposals within the White Paper and the serious commitment to
delivering these.
2. fpa (Family Planning Association) is
the UK's leading sexual health charity working to improve the
sexual health and reproductive rights of all people throughout
the UK. fpa wants to see a society with positive and open attitudes
to sex, in which everybody enjoys sexual health and where sexual
and reproductive rights are respected. fpa's purpose is to enable
people in the UK to make informed choices about sex and to enjoy
sexual health free from exploitation, oppression and harm.
3. fpa runs a comprehensive information
service, including a national telephone helpline, which responds
to over 100,000 queries each year on a wide range of sexual health
issues. We also produce a variety of publications to support professionals
and the public, and provide resources including training courses
for those involved in delivering sexual health services and sex
and relationships education (SRE). We also contribute to SRE through
our series of publications aimed at young people which schools
can use as part of their SRE programme.
NB Please note that in this submission we only
comment on the Public Health White Paper as it relates to sexual
health.
Will the proposals enable the Government to achieve
its public health goals?
4. The sexual health proposals in the Public
Health White Paper should enable the Government to address some
of the current problems in sexual health, and thereby to achieve
short-term public health goals in this area. Specifically, the
proposals should enable the Government to start to tackle:
— High and rising rates of sexually
transmitted infections (STIs).
— Rates of unwanted pregnancy.
— Current gaps in contraceptive services.
— Current lack of sufficient workforce.
— Specialist needs of young people.
5. However, the fact that the Public Health
White Paper does not propose introducing comprehensive sex and
relationships education (SRE) as statutory within the National
Curriculum means that there is little to ensure that the Government
will achieve public health goals over the long-term. The single
most important means of ensuring that current and future generations
benefit from sexual health and wellbeing is to enable all children
and young people to access comprehensive SRE. Without addressing
this, the Public Health White Paper can only achieve limited goals
over the short to medium-term.
6. In the interim, and particularly in the
context of the recent Ofsted report which was highly critical
of current provision of PSHE (including SRE) in schools, we feel
it would be immensely useful to conduct a thorough audit of SRE
and PSHE provision to establish a clear picture of what is currently
being delivered. This would then serve as the basis for ensuring
that all schools deliver a quality programme of comprehensive
PSHE, including SRE, in the future.
Are the proposals appropriate, will they be effective,
and do they represent value for money?
7. It is encouraging to see that the sexual
health proposals in the Public Health White Paper are thorough
and wide-ranging. fpa is particularly pleased that the proposals
encompass contraceptive services, health promotion, young people's
services and STI testing and treatment.
8. The two areas we are disappointed to
see missed out of the proposals are:
— SRE in the Curriculum (see points
5 and 6 above).
— Abortion services—these should
form an integral part of proposals to improve sexual health in
its entirety, and in this context the White Paper proposals have
missed an opportunity to be truly appropriate for all sexual health
needs.
9. At this point, it is very difficult to
assess whether the sexual health proposals will be effective and
whether they represent value for money, as the detailed implementation
and delivery plan has not yet been published. Moreover, the proposals
include an audit of contraceptive services to assess current provision
and future needs, and we will not know whether the funding allocated
to improve these services will be enough until this audit has
been carried out. fpa is therefore unable to comment on these
questions until further detail has been issued about how the proposals
are to be implemented, and about the results of the contraceptive
audit.
Do the necessary public health infrastructure
and mechanisms exist to ensure that proposals will be implemented
and goals achieved?
10. Again, we await the detail of the White
Paper implementation plans for further information about ensuring
that the public health infrastructure and mechanisms exist to
ensure that the proposals will be implemented and goals achieved.
There must be clear and unequivocal national government leadership
to champion these plans, and we highlight the following areas
as key to ensuring that the proposals can be delivered:
11. Workforce capacity:
— GUM—it is clear that many sexual
health services currently struggle to cope with their workload,
and there is a particular problem with workforce capacity in GUM
services. In this context, it is vitally important that plans
are put in place to increase the workforce as a priority, particularly
given the increased demand in sexual health services likely to
be generated by the forthcoming national advertising campaign.
— Contraceptive services—there
is also a significant difficulty in attracting professionals to
contraceptive services, particularly because of the poor career
structures, status and remuneration levels within this field.
These issues must be addressed in order to ensure that there is
sufficient expert capacity in the future to deliver these specialist
services.
12. Training:
— Multi-disciplinary workforce—the
White Paper proposals outline a broad group of professionals who
will be expected to deliver sexual health services, including
nurses, youth workers, community workers and pharmacists. While
this expansion of the sexual health workforce is to be encouraged,
it is crucial that all those expected to cover sexual health within
their remit are adequately trained and supported in delivering
this work. In addition, all those who work in a sexual health
service should have a basic knowledge of all aspects of sexual
health, and of local services to which they can refer people who
need services that they do not provide.
— Training content—Training must
include not only factual knowledge and information, but also training
in attitudes, values and communication skills to ensure that these
professionals are fully equipped to deliver such a sensitive service.
In the long-term, sexual health must be included as a core component
of qualifications for both medical and other relevant professionals.
— Health trainers—Similarly,
the proposed NHS-accredited health trainers must have adequate
training in sexual health as well as other aspects of public health,
in order to be able deliver effective support and advice to all
groups in communities as envisaged by the White Paper.
13. Integrated GUM services—it is
clear that the 48 hour waiting time target for GUM services will
only be achieved if there is an adequate network of high quality
sexual health services, including general practice and contraceptive
services, which are providing STI testing and treatment as well
as that provided in designated GUM clinics.
14. Local levers—in order to ensure
that the sexual health proposals are implemented, there must be
a series of levers at local level to ensure that these proposals
are given sufficient priority and resourcing. To date, despite
the national prioritisation of sexual health through the National
Strategy for Sexual Health and HIV, we have seen very few incentives
for this prioritisation to be translated into action at local
level. In order to achieve its goals, the White Paper must mark
a real shift in health priorities not only at national but also
at regional and local levels. This should include a significant
role both for Strategic Health Authorities and the Healthcare
Commission in monitoring and performance management.
15. Central funding—it is vital that
sufficient resources are retained at central level within the
Department of Health in order to support a national training programme,
the provision of information for the public, and professional
practice. It is much more cost-effective for the Department of
Health to do this at a national level; to replicate this work
within each PCT would be both wasteful and would inevitably result
in poorer quality of training and information.
February 2005
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