(pt 1)

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Westminster Hall

Thursday 9 February 2006

[Mr. Eric Illsley in the Chair]

Sexual Health (HIV/AIDS)

[Relevant documents: Third Report from the Health Committee, Session 2004–05, HC 252, and the Government's response thereto, Cm 6649.]

Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Cawsey.]

2.30 pm

Mr. Kevin Barron (Rother Valley) (Lab): First, let me say that I was not party to either of the reports that are relevant to this afternoon's debate. My diary has also, to be perfectly honest, been under pressure from other quarters in the past few days. As a result, I shall not speak for too long. I shall, however, deal with some of the general issues that are common to the report that was published in 2003 and the one that followed in February 2005.

The 2003 report was entitled "Sexual Health" and concluded that there was a "crisis" in that area. The subsequent report, which is on the Order Paper, expressed concerns that the crisis was showing no, or very few, "signs of abatement", with rates of sexually transmitted infections, including HIV, still rising and long waits for sexual health services still quite commonplace.

Since the Committee's first report, sexual health has risen up the agenda, and that has been reflected in numerous areas. They include the specific public service agreement targets on improving sexual health by 2010, on which I think the Committee had an influence. Another is the maximum waiting time target of 48 hours for access to sexual health services. That was one of the Committee's recommendations, which the Government said would be implemented by 2008. Given that the first month of 2006 has just ended, there is not that long to go. Funding of £300 million has also been targeted at improving sexual health.

However, despite those renewed efforts, which some people might say are in their early days, the impact of attempts to tackle the crisis in sexual health and to increase capacity in services has not yet been realised, and the number of sexually transmitted infections of all categories continues to rise. Only approximately half the people who contact sexual health services can secure an appointment within 48 hours, and there are serious concerns that primary care trusts are diverting sexual health funding into managing deficits and what they believe are priority areas.

As I suggested, approximately half the people who use sexual health services cannot get an appointment within 48 hours. Access to sexual health services is seen as crucial to halting the spread of sexually transmitted infections, because research suggests that many people remain sexually active while waiting for diagnosis and treatment. The 48-hour target is clearly sensible, but it must be met as soon as practicable if we are to stop the increase in sexually transmitted disease.
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A recent study conducted in a Leeds hospital concluded that there was still a huge volume of unmet need for sexual health services. The hospital's research showed that, in one working week, 72 per cent. of patients could not be offered an appointment. The research concluded that sexual health clinics would need to triple their current capacity before the 48-hour target could be met. Clinics are under tremendous pressure, and we need some thoughts from the Minister and the Department about where things are going. Will clinics be able to increase their capacity to the levels that that research predicts will be needed to meet the 2008 target?

The real question, which many organisations involved in sexual health matters have asked, is where the money is going. The Select Committee on Health warmly welcomed the extra funding earmarked for sexual health last year, but it was a bit concerned when it received evidence that that funding had not reached its destination. Although the evidence is anecdotal, some people believe that PCTs are siphoning the funding off for what they call more pressing priorities. There is increasing evidence that the problem is worsening in line with the worsening financial situation in the national health service. There are anecdotal reports of PCTs forcing sexual health services to cut back services and posts to address deficits.

I have recent research that endorses those anecdotal accounts. My hon. Friend the Member for Calder Valley (Chris McCafferty), who is the chair of the all-party group on population, development and reproductive health, sent me a survey carried out by the Family Planning Association. The survey looked at the   local delivery plans that PCTs had produced in answer to the issue of how to meet the 2008 target. The survey was done in August and September last year and was published last month. It said:

My hon. Friend the Minister will no doubt be aware of that survey. Does she or the Department have any comments on it?

The White Paper "Our health, our care, our say: a new direction for community services", which was published last week, mentions rapid access to sexual health services. It says:

A case study in the White Paper shows the benefit of screening in places outside the normal district general hospital annexe. The thrust of the White Paper is that it is essential that such services move out of designated clinics into community settings so that people can receive screening and advice earlier than they would have in the past. People are likely to feel easier about going to the GP or even into a Boots chemist for certain types of screening than they would about going into a clinic annexed to a district general hospital. Can my
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hon. Friend give us a steer on what GP training is likely to take place to allow services in the community to be expanded in line with the White Paper? As an aside, we all talk about the new GP contract, which has now been   signed and delivered, but did any part of the renegotiation aim to make GPs better at giving advice on sexual health issues?

Sex education in schools is another of the issues that is raised in both Health Committee reports, although it   is not in the White Paper—probably for obvious reasons. It is often said that prevention is better than   cure, and that is true. Both the Committee's reports into sexual health recommended strengthening sex education in schools by making it a statutory element of the national curriculum, but the Government have so far rejected those recommendations. In December, however, press reports suggested that the Government's own advisory bodies were due to recommend such an approach, along with other measures to strengthen sex education. I recognise that sex education is not in my hon. Friend's direct portfolio, but it is clear that such matters flow into one another. The Government claim that they work across the piece—in many areas, they do—and not down the stovepipe in one individual ministerial area. Therefore, I would like to know exactly what discussions she is having with the Department for Education and Skills about sex education.

A brief by the Family Planning Association—now the Family Planning Service—makes an additional point to the debate and to the recommendations that were made by the Health Committee in both of its reports. It states that the Qualifications and Curriculum Authority has launched new teaching and learning materials for personal, social and health education teachers in November 2005. Those materials will help teachers who wish to teach sex and relationship education, but they do not make comprehensive SRE compulsory.

Of course, the teaching of SRE remains patchy across the United Kingdom. As parents have the right to withdraw children from classrooms, it can be patchy even within a school. We are not debating such issues here, but I have firm views about whether that should be allowed.

None the less, that is the current situation in education. Obviously, that patchy provision cannot continue for ever if we are to attack increases in sexually transmitted diseases. The FPA brief states:

Those are the findings of the FPA, the NHS and many organisations that have considered the matter. The constituency of my hon. Friend the Minister, like mine, has high levels of teenage pregnancy. Such issues must be taken on in education. They should not be negotiated on the street corners of the communities that we represent.

I shall briefly open up just one other area. My hon. Friend will have known that I was planning to raise this issue, which was discussed in last year's report. In fact,
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half the report was about HIV treatment—not screening, but treatment—of people who are in this country but not residents of this country. Phrases such as "health tourism" are used. We are all familiar with the fact that behind every case of HIV/AIDS is a potential human tragedy. Many people in this House, from all parties, are as worried as I am about people who are not able to get treatment when they are found to be suffering from HIV/AIDS.

I would like my hon. Friend the Minister to say a few words about the issue, particularly on the basis of the comments in last year's Health Committee report, which discussed not only the human tragedy but the fact that we do not know how many people in this country are in the category that does not get treatment for HIV/AIDS. We know about the people who do, as they are in the system awaiting decisions on asylum claims. It is something that worries me and many other people in this House, and I hope that my hon. Friend can say a few words about it at some point in the debate.

I shall sit down now. I know that I have the right before the end of the debate to ask to say a few words more. That is not my intention, unless I have further questions, but if my copious notes become interesting during the rest of the debate, I may exercise that right at some stage.

2.44 pm

Mr. David Amess (Southend, West) (Con): As the new Chairman of the Health Committee, the right hon. Member for Rother Valley (Mr. Barron), said already, he was not the Chairman at the time when we prepared the report. Indeed, there are very few of us left who contributed to it. Some of our colleagues unfortunately lost their seats. One of them died. One reappointed colleague, the hon. Member for Bristol, North-West (Dr. Naysmith), hoped to speak this afternoon, but he is not well. He was keen to make a contribution to the debate.

If you will allow it, Mr. Illsley, I wish to go into a bit of detail about the report. In one sense, the Minister will not be blamed for anything I say—she was not the Minister at the time when we prepared the report. As far as the Select Committee is concerned, all we want to know from the Minister is what action has been taken on our recommendations.

Perhaps the fact that we are even able to talk about these matters means that some progress has been made, although I did think at one point that members of the Select Committee tired a bit of the constant detail of sexual diseases. There was only so much that we could take. The Government have a big challenge on their hands, as attitudes about sex have changed dramatically, certainly since I became a Member of Parliament. The fact that a programme such as "Big Brother" is no longer a side issue—it seems to be at the heart of everything, and the sexual activities on it are rather important—seems to suggest that we are really living in Roman times. There is a big challenge for the Government in deciding how to address these issues.

My hard-working researcher has included a note that I am to say that I am very interested in the sexual health of my constituents. I will not be putting that in a newsletter. I simply say to the Minister that I and the other Members who drew up the report became
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concerned following visits to various centres throughout the country about the services that are available. We can all make the argument that there has always been a problem, but I am an optimist. There are Members in this room who were not on the Health Committee. I am delighted that they want to speak, and I have no doubt that they will contribute to the solution side of the equation.

The Medical Foundation for AIDS and Sexual Health was commissioned by the Department of Health to conduct a two-year study of genito-urinary medicine services throughout the nation. It was to include a comprehensive questionnaire to extract information about facilities, length of appointment per patient, capacity increases and primary care trust funding. The Select Committee was disappointed with the evidence provided by the then Public Health Minister, who told the Committee in February 2005 that the Department had received the report only "a few days ago". That statement contradicted a memo that the Committee received from MedFASH, which confirmed that it had submitted the report in December 2004.

The Public Health Minister made that statement, which disappointed the Committee, for one of two reasons. Perhaps it took seven weeks for the deputy head of the Department's sexual health policy branch to realise that the Department had received key data from a report that it had itself commissioned. If so, that would indicate that at the time the Government did not have the issue at the top of their priorities, despite the fact that the Health Committee had already done a report on associated matters in 2003.

The other possible reason why the then Minister seemed reluctant to give straight answers to our questions was that the information held by the Department would not have cast the Government's policies in a good light. Perhaps the Minister will come up with a different reason for the way in which that evidence session turned out, but the lack of frankness was disappointing.

I now turn to the waiting period and implementation of the 48-hour timetable. Increasingly, the capacity of clinics is being overrun by the demand of patients. A clinician, Professor Kinghorn, who gave evidence to the Committee inquiry, reported that sexual health clinics were not receiving the funding they had been promised. He also highlighted the fact that as waiting times lengthened, there was a greater likelihood that an infected patient would simply ignore the problem, consequently opening up the chance for continued infection of the sexually active public.

Advocates from the British Association for Sexual Health and HIV also provided evidence suggesting that regions that experienced extended waiting times were also those associated with something that is now common knowledge: increasing rates of chlamydia, gonorrhoea and syphilis. I also received research from the chairman of the all-party parliamentary pro-choice and sexual health group. I am not noted in the House as being a pro-choice MP, but the chairman kindly sent the information and I could not resist using it, particularly as it mentions funding shortfalls in my constituency of Southend, West. The chairman tells me that only 22 per cent. of people in my constituency received an appointment within the GUM clinic appointment target of 48 hours. We are all interested in our own
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constituencies, and I would be grateful if the Minister had a word with the appropriate people with responsibility in Southend, West to see if that situation could be improved, because 22 per cent. is not good at all. Perhaps the Minister will say that it is unusual compared with waiting times in the rest of the country.

GUM clinics are, more often than not, located in portakabins. When the Select Committee went on a visit, we were shocked to learn that such clinics were housed in portakabins. These confined working conditions, according to the consultants we spoke to, are not really conducive to a high-level service, causing increased waiting periods that mean infected individuals may be sexually active in the meantime. Even if one is being fair, the strategic health authority's allocation of £15 million to fund GUM infrastructure has proved not to be enough by any stretch of the imagination.

I now turn to the Government's programme for education of the general public. Education campaigns were necessitated by the increase in the number of people seeking treatment from sexual health services since the Government came to power in 1997, and they are certainly effective in prompting those with symptoms of sexually transmitted diseases to seek advice. It is certainly commendable that the public are demonstrating healthy responsibility, but that has also served to put a heavy burden on the capacity of the sexual health care providers to treat this increasing number of patients. The Government have increased education campaign finances, which has led to more people wanting those services, but somehow funding for education is disproportionate to the amount of money being spent on the facilities. Demand is being stoked up and there is a complete disparity in the physical delivery of the services. I hope the Minister will have something to say about that.

The £300 million allocated for sexual health services is very welcome, but it remains to be seen how effective the breakdown of funding will prove. Will the sexual health care facilities be able to cope with the increase of patients caused by this education campaign? Will funds for dilapidated clinics reach them before some of the buildings literally collapse—and I am not exaggerating? Will PCTs use the money according to their priorities rather than the recommendations given by the Government? I suggest that there is a disparity in this case, too. Are the funds an addition in real terms to the money allocated to sexual health care services?

Evidence suggests that even with the financial allocations thus far, sexual health services will fall short of meeting the Government's targets for 2007. It is vital that sexual health facilities receive the money allocated to them. The Government want PCTs to deliver their priorities, but PCTs must not strip clinics of funding in order to attend to more pressing priorities given by the Government. That was mentioned in the evidence given to the Committee by the British Association for Sexual Health and HIV.

Other than the necessary funding for the basic management of sexual health services, money needs to be allotted for research and development in an attempt to find cures and vaccines for various sexually transmitted infections, which we would all welcome. Sanofi Pasteur MSD has developed a vaccine called Gardasil that would fight HPV—human papilloma virus—preventing cancerous lesions and warts.
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Implementation of such a vaccine would save GUMs copious amounts of time and resources, allowing medical professionals to focus on what they are supposed to.

I come to screening for chlamydia. The Committee was advised that there were 89,431 new diagnoses last year, and the Government must do something to address this very serious situation. Perhaps the Minister will explain what the programme will involve. I urge her to do all she can to eliminate the ubiquitous usage of an unreliable test when the technology exists for a completely accurate methodology. We certainly need to supplement the screening programme with a call-and-recall system targeting specific at-risk groups.

The Government argue that the national chlamydia screening programme is targeting men by offering screening in places such as colleges, sports facilities and offices. However, there need to be more measures to ensure the proactive role of men in testing. As we know, women are the likelier of the two sexes to be tested and treated and they will only be subjected to a further threat of re-infection by the large percentage of sexually active men who do not get tested. There you are, Mr. Illsley: I   am prepared to blame men for something in this part of my address.

The Men's Health Forum, for which the hon. Member for Dartford (Dr. Stoate) does a huge amount of work, has implored the Department of Health to continue striving for better methods and locations to   reach out to young men to get tested for chlamydia. As the Minister knows, there is a huge reluctance among young men to come forward. It has also urged the Government to direct PCTs to assign top-tier priority status for sexual health improvement and chlamydia screening, which is an absolute imperative.

The new general practitioner contract fails to move sexual health to the forefront of general practitioners' work. In reality, there are no incentives offered for general practitioners to address sexual health or to improve the quality of the services currently provided. General practitioners, as we all know, are paid according to a system of quality points. There are no   points available within "essential services" and there is only one "additional service" point for having a written policy on responding to requests for emergency contraception and one for having a policy on pre-conceptual advice. With 1,050 quality points available, is it any wonder that general practitioners are not falling over backwards to provide services that are   worth only two points? There is absolutely no incentive whatever.

The Family Planning Association has entreated the Government to supply a clearer delineation of the   services that general practitioners are to provide and which category they fall into—essential, additional or enhanced. The FPA testified before the Committee that certain general practices were declining to offer sexual health services because it had not been clarified whether they were essential services. Certain services are categorised as essential, while others are additional and still others are enhanced. If the Government are to tackle the sexual health problems faced by the nation, all sexual health services need to be afforded priority status by the Government, primary care trusts and general
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practitioners. There is no sense in the fact that a woman can obtain contraceptives to prevent pregnancy as an additional service, but can receive condoms to prevent sexually transmitted infections only as an enhanced service. I do not understand that. There needs to be not only top priority for sexual services, but widespread co-operation and a combination of services.

At present, there are 86 per cent. fewer GUM consultants than the Royal College of Physicians recommends. Those experts are crucial to the effective running of sexual health clinics to provide the optimal service to patients in need. Preparations need to be made for doctors, nurses and other medical providers to meet the massive projected increase in sexual health patients in the next three years. The Government must develop a      comprehensive training programme for those individuals to cope. That programme should not be exclusive to clinicians, but should also apply to primary care physicians.

The Government need to be more robust in researching and analysing the effects of new policies in sexual health. They also need to exert more pressure on primary care trusts to follow through on sexual health services. More expertise is needed to appreciate the scope of the sexual health crisis that the nation is facing.

I pay tribute to the hon. Member for Walthamstow (Mr. Gerrard), who is not in his place. He has done a huge amount of work on HIV/AIDS policy. I can remember a time—and this was during my time in the House—when most hon. Members had never heard of HIV. Lord Fowler started an advertising campaign that was very effective at the time. Perhaps, as a nation, we have become a little complacent. I have been advised that there is a 20 per cent. annual increase—

Jim Dowd (Lewisham, West) (Lab): On that point, when the Committee considered the matter, some people said that the advertising campaign was a great failure and a waste of money—largely because what it said did not happen—but I think the hon. Gentleman will recall, as will others who were on the Committee at the time, that we took the view that it was, on the contrary, one of the greatest successes of public advertising ever, precisely because people did modify their behaviour. That was particularly true among the   groups most likely to suffer. However, we also discovered that, over time, because the threat did not materialise, people assumed that it had gone away and reverted to dangerous behaviour.

Mr. Amess : The hon. Gentleman makes an excellent point. When we first saw the advertisement—I think it involved tombstones—we were all shocked by them, but gradually attitudes changed. I hope that the Minister will reflect on the Committee's discussions on the effects of advertising.

With a 20 per cent. annual increase—53,000 new cases annually in the UK—preventive measures must be taken urgently. I know that the Government have a very difficult task, but I simply ask again: is this matter a priority for them?

I will try to be brief, but I want to say something about health tourism, about which the Chairman of the Health Committee made a few remarks. The Government have
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provided no substantial evidence of widespread immigration to the UK to obtain the national health care services that we provide. The research that has been provided shows instances of short-term foreign patients, especially pregnant women, seeking the maternity wards and natal services of our hospitals, rather than of people such as HIV and AIDS patients seeking long-term care.

A recent survey of migrants by the Terrence Higgins Trust, which I think everyone respects, showed that 75   per cent. of individuals diagnosed with HIV waited at least nine months before seeking testing or treatment, and a third waited at least 18 months for similar services. I would like to hear from the Minister how the Government will try to address that.

I know that the Government are concerned about the effects on immigration of an open-door policy for people from overseas obtaining health care treatment, but our present policies are much more stringent than those of some of our closest European neighbours. For instance, France allows medical treatments to be obtained by anyone who can prove residence in a territory or dependency for three months or to anyone whose native land does not provide the medical treatment sought. It seems that an individual seeking health care services would prefer to go to France for that reason alone.

The complexity of the regulations that determine which people from overseas are eligible for medical treatment leaves those regulations open to misinterpretation. Treatment is denied to those termed "failed asylum seekers", but that is not a comprehensive term because denials can be subject to appeal, as the Minister knows from her Home Office experience. There is serious cause for concern that those eligibility requirements will negatively affect ethnic minorities and foreign individuals who are seeking legitimate asylum.

The complexities also raise questions about who the onus for implementing the changes lies with: is it primary care trusts, physicians, nurses, overseas patient managers or, dare I say it, receptionists? It would be simply unethical for a doctor to refuse treatment outright to an ill individual who sought assistance. That raises the question of how a medical professional would even be aware of the residential or asylum status of a treatment seeker. Sexual health patients disclose only a   minimal amount of information, because such cases are extremely confidential. The House will recognise that that is an inherent problem with the regulatory practices, because a medical assessment is necessary to ascertain how serious a patient's condition is. Even if they are to be denied treatment because of failed residence status, it is very feasible that, on examination, such an individual could qualify for one of the few   exemptions provided. Overseas patient managers testified to the Health Committee about the reluctance that they have experienced when attempting to attain access to foreign patient information.

Not only have the Government perhaps not delivered the statistical information about the true depth of the problem of health tourism but they have not really provided a comprehensive map of how to implement the regulations that they have imposed. The regulations are intended to ensure that taxpayers' contributions go to rightful patients, yet no cost-benefit analysis has been conducted by the Government to prove the regulations are worth while.
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HIV/AIDS is the only sexually transmitted disease that is left off the list of communicable diseases for which the NHS will provide treatment under the guise of a public health threat. Dr. Evans of the Health Protection Agency told us in evidence that the high cost of HIV treatment was the only reason for that. Should we not aim to protect the public against all threats? I think that we should. By not initially treating people from overseas who have HIV, the Government are leaving themselves open to spending more in the long term on treating people who are unwell. Regulatory practices that deny medical treatment to people from overseas will act as a deterrent to testing.

My final words—to the great relief of the House, no doubt—are as follows. I should not underestimate the challenge that the Government face, but I am an Opposition politician, so I am going to. This was and is an excellent report, and from the Committee's point of view, I simply ask the Minister this. Can we please have an answer to the question about how the Government have delivered so far on our recommendations? There is a problem, and all of us recognise that it needs addressing urgently.

3.12 pm

Chris McCafferty (Calder Valley) (Lab): I congratulate the Health Committee on its timely and comprehensive report on developments in sexual health. As chair of the all-party group on population development and reproductive health, I should like to speak about those aspects of the report that are of interest and importance to my group and to my constituents—STIs, family planning services and abortion services.

In 2001, we welcomed the UK's first national sexual health and HIV strategy. It was the Government's response to the country's declining sexual health, outlining the Government's sexual health agenda for the next decade. It acknowledged for the first time the clear relationship between sexual ill health, poverty and social exclusion. It was expected that the strategy would improve and modernise sexual health and HIV services throughout the country.

Issues of particular concern were the increase in STIs, including HIV infections, high teenage pregnancy and abortion rates, the silent issue of sexual dysfunction, the long waiting times in genito-urinary medicine—GUM—clinics, and the lack of consultation and adequately trained staff to provide comprehensive and high-quality counselling, treatment and care. Targets were set to reduce STIs, HIV-acquired infections and unintended pregnancies, and mechanisms were established to address disparities in abortion services throughout the country.

The importance of open access to GUM services to improve access and offer appointments within 48 hours was stressed, and it was recommended that the work force throughout a range of sexual health and HIV services should be trained to work in integrated sexual health service networks. It was also recommended that contraceptive services should be easily available and provided for all those who needed them. It is of concern that five years later, the Health Committee described the current situation as "a continuing crisis".

STIs continue to rise, with screening for chlamydia missing 30 per cent. of infections, and waiting times for sexual health clinics have, if anything, deteriorated
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further. Research has shown that clinics need to triple their capacity if they are to meet Government targets to see and treat patients within 48 hours by 2008. Access to clinics appears to remain better in London than in most parts of the country, but it varies widely elsewhere. The BBC "Panorama" programme drew our attention in October last year to the fact that only 7 per cent. of clinics in the UK can offer a routine appointment within 48 hours, and that there was an average waiting time of between seven days in the south of England and 28 days in Northern Ireland.

The increase in STIs and the increased waiting times and poor tests cause great distress to many women, men and couples. Long-term infertility and subsequent infertility treatment is of particular concern, with its high cost to the NHS and low success rate. Despite those obvious problems, funding that is earmarked for sexual health services does not always reach its targets, as my right hon. Friend the Member for Rother Valley (Mr.   Barron) has already pointed out.

According to research by the British Association for Sexual Health and HIV, some primary care trusts are using cash that has been allocated for sexual health to pay for their deficits. A Family Planning Association survey of PCT local delivery plans showed that although the majority of plans mentioned the 48-hour GUM access target, only 30 per cent. mention the targeted and planned investment in sexual health services needed to increase capacity. I should be grateful to hear from the Minister what mechanisms the Government may be able to put in place to ensure that that practice is prevented, and that PCTs prioritise sexual health and spend the money necessary to develop proper services.

The Committee noted in its report how much of its evidence emphasised the importance of improving sexual health services, but that once a young person needed to visit a clinic for sexual health problems, we had missed the boat. Therefore, surely the most important issue is relationship and sex education in schools and at home, with information and education provided via television, radio and other modern technologies; information and education to equip young people with knowledge, skills and values for life; and knowledge that can raise their confidence and self-esteem, and enable them to make safe and informed choices and develop strong and positive relationships throughout their lives.

It is critical that we improve our sex and relationship education. It should be a compulsory part of the national curriculum to ensure that it receives adequate priority. We need specialist teachers to teach sex and relationship education, and young people's health services must be integrated in schools.

I was pleased to note the recommendation that the Department for Education and Skills issue specific guidance for schools, stipulating that by 2007 all personal, social and health education—PSHE—and sexual and reproductive health lessons must be taught by specialist accredited PSHE teachers, rather than unqualified form tutors, and that they should build links with sexual health clinicians, including community nurses and GPs. They could contribute usefully to sex
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and relationship education. Perhaps incentives for GPs to promote sexual health services are an option for consideration.

Primary schools that effectively plan and deliver age-appropriate PSHE would be confident of their children moving on to secondary school and young adulthood with the knowledge and skills to fulfil the five national outcomes in the Children Act 2004, which are being healthy, staying safe, enjoying and achieving, making a positive contribution and achieving economic well-being.

Contraceptive and abortion services are largely neglected sexual health services, as one of the Health Committee's reports in 2003 highlighted. I draw hon. Members' attention to my two early-day motions on contraception and information technology, and NICE and contraception, which have both enjoyed wide support in the House.

Better and greater choice need to be offered and made available to all clients, especially young people. I would be interested to know the result of the audit of contraceptive service provision carried out in 2005 according to the health White Paper, as well as information on central investment to meet gaps in local services.

I hope that GPs and family planning contraceptive provisions were included in the audit and I would be interested to know, as would many colleagues, when the long awaited UK sexual health campaign will start its advertising. As my hon. Friend the Member for Lewisham, West (Jim Dowd) said, older Members will remember the very successful campaign that was launched in the early 1980s. It would be great to see something like that but more appropriate to the 21st century.

Integration of services is important so that if a variety of sexual health services is not available under one roof, they must at least be linked. PCTs must recognise the links between contraception, abortion and STIs, including HIV transmission. The all-party group on population, development and reproductive health recently published a report, "The Missing Link", on linking sexual reproductive health and rights and HIV/AIDS services in the developing world. Part of that report may be of interest to the Minister as many of the recommendations apply equally here in the UK.

Abortion is one of the main elements of a modern, comprehensive sexual health system. Even with the best intentions and the most reliable contraceptives, women and girls still face unintended pregnancies. Prompt access to abortion services and counselling is paramount to reduce the distress and complications caused by late abortions. The Government's White Paper does not discuss abortion services, but it is important that access is speeded up.

I agree with the Family Planning Association and the independent advisory group on sexual health in their recommendation that the target to ensure that all women have access to abortion within three weeks of their first appointment with their GP or other referring doctor could be more ambitious. As well as being best practice in quality of care, an average reduction in delay of 10 days from referral to abortion would increase the proportion of all abortions carried out at less than 10 weeks to 71 per cent. In economic terms, that would
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represent a saving of up to £30 million. PCTs should strive for an average reduction in waiting times from three weeks to two weeks from first appointment to termination.

I want to touch on confidentiality for minors in relation to family planning and abortions and the Abortion Act 1967, which was a great gift to the women of Britain. I was pleased to note that Mrs. Axon lost her challenge in court, which would have undermined a competent minor's right to confidentiality and consent to family planning and abortions. However, young girls and women still face many problems and obstacles when they seek an abortion. Under current law, the decision on abortion entitlement rests with a woman's doctors. They have immense powers of discretion, but no one knows better than the woman herself when and if she   is   ready for motherhood. Deciding to terminate a pregnancy is incredibly difficult for anyone and women must have the right to decide that for themselves. They need help and counselling, but the ultimate decision must be theirs, at least in the first three months of a pregnancy.

How much better it would be for everyone, especially women, if universal access to education, information and services, especially for young people, were available in an age-appropriate way from an early age so that every young person was empowered to make choices, had the benefit of being able to make choices, and could protect themselves from unwanted, unplanned pregnancies and sexually transmitted diseases, including AIDS.

I look forward to hearing what the Minister has to say on those issues, which are hugely important to young people in this country.

3.25 pm

Dr. Richard Taylor (Wyre Forest) (Ind): I shall try not   to be too repetitive, but the right hon. and hon. Members who have spoken have covered much of the ground that I intended to cover. However, there remain a number of things to say.

First, the 48-hour target is well worth aiming for and essential. I draw the Minister's attention to a recent report in the Journal of Sexually Transmitted Infections which looked at one particular GUM clinic in, I believe, Leeds. During the week that it quoted, it required 626   appointments when it had only 181 slots. It worked out from other figures that it probably needed about three times the current number of doctors and nurses to cover such demand and to reach the target by 2008.

Reference has already been made to other situations for GUM clinics. I believe that the right hon. Member for Rother Valley (Mr. Barron) mentioned Boots. On the back page of The Sunday Times this week was a tiny cartoon on the Government's idea of having GP surgeries in supermarkets. The doctor was sitting behind his desk near the check-out and above his head a notice said "Six symptoms or less". I thought that was super, but it made me think that the supermarkets would be an   ideal place for GUM clinics. Everyone goes to supermarkets and everyone who needed to could go to   a clinic without it being noticeable. I do not believe in private health care terribly much, but it might help the system out of a crisis if GUM clinics were opened up to private providers as a temporary measure.
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Money has been mentioned and the original White Paper "Choosing Health" stated in heavy type:

I am not decrying the £300 million, which is a splendidly generous offer. What bothers me is how it was divided up and where it has gone to. The Health Committee asked the then Minister about that and were rather suspicious that, as has been done before, the Government were announcing the same money more than once. We asked whether it was entirely new money and the Minister said:

My memory is that the allocations were announced before the £300 million was announced, so it must have been £300 million that was being announced twice.

If that is divided up, one wonders exactly how much was earmarked and actually went to sexual health. There should have been £80 million for the acceleration of national chlamydia screening. Did it go there? There should have been £50 million over three years for the new sexual health campaign and there should have been £130 million over three years for modernisation of GUM services. We know that some PCTs have deficits and there must have been an awful temptation to put some of that money towards deficits. I do not know whether the Minister can give any answers about the scale of that.

We tried to get a little further in our evidence session with the then Minister for Public Health. We wanted to know whether there was any compulsion about what is in a local delivery plan. The Minister said that there is compulsion. She went on to say that

a PCT—

I presume that the Healthcare Commission does the assessing. I wonder whether there have as yet been any assessments that could tell us whether PCTs are getting such coverage in their local delivery plans and whether they are achieving their objectives. That would be helpful.

I shall deal briefly with work force issues. Everyone gets pretty fed up with different specialties of the medical profession saying that they need more neurologists, dermatologists, radiologists, psychiatrists or whatever it is because they do not have enough. The specialty that we are discussing is not one of those cases. There are desperate shortages in this specialty and it must have more help. I was going to say that the Government response was the usual claptrap. That might be unparliamentary language, so I will not say it, but the   response did emphasise that the numbers of consultants and nurses had increased, which is Ministers' usual response. Let us unpick that and talk about full-time equivalents. I understand that the number of   full-time equivalents increased from 458 in 1997 to 662 in 2004. For consultants, the figure went from 222 to 298. That was in the course of seven years. We are only
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just beginning to tickle the surface of the sort of increases that are genuinely needed. This is not a question of specialists shouting for their own specialty; there is a genuine need.

The hon. Member for Southend, West (Mr. Amess) referred to the GP contract and how essential it is to have better rewards for providing those services. They are essential, although I think that they are only called additional services at the moment.

Chlamydia has been mentioned and I would like to know about the uptake of the new test. What proportion of testing does the new test account for as opposed to the old test?

Several hon. Members talked about education. The Select Committee recommended strongly that personal, social and health education and sex and relationship education become a statutory part of the national curriculum. The Government response stated:

It seems to me an entirely false differentiation to separate PSHE and SRE, because they overlap entirely. I cannot see why they are not combined as part of the national curriculum. I would love to know the reasons for and against that.

Perhaps the most crucial part of the report relates to charges for overseas visitors in respect of HIV and AIDS treatment. I was sorry for the Minister because she did not have with her the medical advice and expertise that she needed. She was rather confused about the importance of treating HIV/AIDS early, from the point of view of limiting the risk of spread. She accepted that we treat tuberculosis early because we can cure it and we limit the risk of spread, but she did not seem to understand that that same reason is crucial in respect of HIV/AIDS. If we reduce the viral load, we reduce the infectivity.

I asked the Terrence Higgins Trust for an update on any changes since the report, and the letter that I received began:

about changes—

We heard of cases in which people had started treatment not knowing that they were going to be charged. As soon as they learnt that, they defaulted and disappeared and thus there was a chance of their spreading the infection even further.

The 1987 AIDS campaign has been mentioned. There was the famous advertisement with the slogan "Don't die of ignorance". The phrase used about smoking was that it can "seriously damage your health". The current
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phrase for AIDS publications for the people should be something such as "Delaying your visit to the GUM clinic can seriously damage your health". For the Government, it should be "Delayed access to the GUM clinic can seriously damage the nation's health".

I shall finish with the conclusion of a letter that the Terrence Higgins Trust sent to the Health Committee about HIV/AIDS treatment for asylum seekers and visitors. It stated:

3.38 pm

Dr. Howard Stoate (Dartford) (Lab): In 2003, the Select Committee described a crisis in sexual health. As we have heard, it recommended the introduction of a maximum waiting time of 48 hours to access sexual health services—a target adopted by the Government in the public health White Paper. A 2005 Committee report examining what progress had been made found that rates of sexually transmitted disease had continued to rise and that waiting times for clinics had, if anything, got worse rather than better.

The Committee also discovered, rather disturbingly, that funding earmarked for sexual health services had   not always reached its target. Because of that, it recommended that the Government should monitor closely progress on delivering on the 48-hour target, and conduct an audit to ensure that the extra investment promised for sexual health actually reaches the clinics, which urgently need to increase their capacity, as we have heard.

We heard from the hon. Member for Southend, West (Mr. Amess) that the new GP contract has failed to provide adequate incentives for GPs to promote sexual health services. The Committee recommends that the Government review the GP contract with a view to giving much higher priority to sexual health and that, also, a dedicated sexual health training programme should be established for GPs and practice nurses. The Minister will be aware that the GP contract has had some updates this year, with alteration to the quality and outcomes framework for points. Some welcome changes have been made. However, I believe that an opportunity has been missed. It would, I am sure, have been possible to put sexual health further up the agenda for GPs and practices, to ensure that the epidemic was better controlled.

I am happy with some of the contract changes. Certainly, my past call for points to be available for obesity has been recognised. The availability of points for better mental health care and for management of chronic renal disease is also welcome. I believe, however, that the Government could have gone further and included sexual health strategy within the points, and   that most GPs would have risen to the challenge if the contract had been structured in that way.

Chlamydia has been covered to an extent in the debate already. It is now the commonest sexually transmitted infection in the UK, with nearly 90,000 new cases in 2004.
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It predominantly affects young people; 68 per cent. of diagnoses in 2004 were of people under 25. Data indicate, rather alarmingly, that approximately 10 per cent. of young women and men between 16 and   25 in this country are infected with chlamydia.

It is easily treated once it is diagnosed. In fact, a single dose of antibiotic is effective in nearly 99 per cent. of all cases, and the experts do not even recommend follow-up. Once the one-off dose of the drug of choice for the condition, azithromycin, has been given, eradiation is virtually guaranteed, and there is therefore no need for follow-up. That is obviously very welcome, because it improves compliance and concordance with treatment, but it is worrying that the drug is not being handed out in enough cases.

The problem with chlamydia is that it is asymptomatic in 70 per cent. of women and 50 per cent. of men, so it often goes undiagnosed. It might be thought that if it has no symptoms it cannot be all that serious, but it has significant long-term effects. A problem that may affect women who catch it asymptomatically is that if they catch it more than twice it sets up an auto-immune inflammatory response in the fallopian tubes. Over time that causes irreparable scarring of the fallopian tubes, leading inevitably to infertility. In fact, chlamydial infection is the commonest cause of infertility in the country.

Not only does infertility cause couples significant heartache; it causes significant health problems. Scarring of the tubes increases the risk of ectopic pregnancy, which can be fatal. It certainly leads to major surgery and a lot of hospital admissions. The problems that couples must go through, such as long-term in vitro fertilisation, infertility testing and, sometimes, difficulties in obtaining infertility services and the accompanying drugs, add an enormous burden—not just in the family's distress, but in the cost to the health service.

The Government could save significant money simply on infertility treatment services, by directing money at a much earlier stage to chlamydia screening services. We can save money by transferring it in the right direction. No one wants a reduction in the money available for infertility services, but I believe that the pressure on those services would be reduced. I have seen evidence that a chlamydia screening programme would in five years reduce its incidence to about 10 per cent. of its current level. It is not a long-term project. A relatively short-term approach to screening for chlamydia could reduce the risk of the infection in the community by such a huge margin, in only a five-year period, that at the end of that time it would be possible to reduce the level of screening, because of a falling away of demand and need. What I am describing is one of those situations in which a relatively small amount of money up front can have a beneficial long-term effect. The cost will be contained, not continuing.

It has been suggested that an opportunistic screening programme such as the one that the Government have introduced for chlamydia may pose particular problems in screening young men, as young men generally attend health services far less frequently than young women. People who have been involved in the health services, in particular, will know that young men are a difficult target to reach, and that it is difficult to carry out opportunistic screening of young men.
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The Government's response to the Health Committee report of 2005 argued that the Department did target young men for chlamydia screening. However, the only evidence that the Department could offer to show that the national chlamydia screening programme actively targeted young men was the fact that screening was offered in such places as colleges, sports facilities and workplaces, and that a pilot of chlamydia screening in pharmacies would be implemented. I am pleased that the Government have agreed to roll out the national chlamydia screening programme nationwide by April 2006, but its effectiveness will depend on its success in encouraging men to come forward for testing. It would be unfortunate in the extreme if the programme were to succeed in testing more women, only for them to be reinfected by men shortly afterwards.

I certainly take issue with the hon. Member for Southend, West, who blamed young men for the problem. I do not believe that blame has any place in the matter. Young men are simply not aware of the problem. They are often asymptomatic. I think that blame is the wrong approach. If young men feel blamed, that is more likely to force them away from services than to get them to come forward. We need a no-blame culture. Perhaps we should treat sexually transmitted infection as one of those things that happens—just like catching colds, which are transmitted from person to person. It would be equally pointless to blame someone on the tube for causing your cold. What we need is a service that puts no stigma on the infection and treats it as simply something that can be caught from someone else, just like common warts or any number of other things. We must treat it in that light, removing stigma and blame and all the overtones that go with sexually transmitted infections. Then we are much more likely to encourage the right group of people to come forward.

The early results of the screening programme show that a step change is needed in testing men for chlamydia. The annual report of the national chlamydia screening programme for 2004–05 stated that only 12.5 per cent. of those screened were men—a very small rise from 7 per cent. in 2003–04. Again, we are reaching only a small proportion of the men who potentially are at risk. Part of the reason for the low take-up is the locations at which screening is offered. Last year it was offered at 539 family planning clinics and general practices, but at only 195 young person's clinics, military bases, prisons and universities.

Just as an aside, I want to note a strange fact about the military in this context. Although soldiers are more likely to catch sexually transmitted infections, there is far less stigma attached to that in the military. If a young soldier goes to see his MO he will be told, "Oh, you've got it too, have you?" and be handed the treatment with no stigma at all, whereas the approach is quite different in the general population. Paradoxically, although soldiers' behaviour is not the best in relation to catching such infections, they get treated rather more appropriately, and with less stigma and fewer associated problems.

Much more work needs to be done to increase the types of venue at which screening is offered, particularly to include those where men are likely to be present. We must look hard at how screening is marketed to men. I understand that the Department hoped that making chlamydia testing kits available in pharmacies—initially
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in Boots in London—would increase the number taken by men. The early results are not encouraging. Those from the first few months of the pilot show that 79 per cent. of the kits were given to women and only 21 per cent. to men. A lot more thought needs to go into how the kits are advertised, displayed and made available in pharmacies, to increase the number of men who are tested.

The Men's Health Forum, with which I work closely in my capacity as chair of the all-party group on men's health, is engaged in several projects aimed at increasing the number of men tested for chlamydia. A pilot study in the area covered by the Telford and Wrekin primary care trust, for example, tested 400 people, of whom almost 80 per cent. were male. That result was achieved by partnership working with the NHS and local communities, the use of male-friendly promotional materials, free self-test kits and the availability of treatment at local pharmacies.

The Men's Health Forum believes that if that success is to be repeated throughout the country PCTs need to give chlamydia screening a far higher priority than they do at present. A recent survey of 2005–08 local development plans found that 23 per cent. did not even mention chlamydia. It also suggests that the Health Protection Agency should do more to develop and disseminate examples of best practice on the targeting of men for chlamydia testing.

Although men use services when they are referred and once they feel that they have been given a reason to use them, they are more reluctant to seek ad hoc advice about health concerns from their pharmacists and GPs. Many pharmacies now have space for consultations, but many men take the view that pharmacies are women's places and they are often slow to take advantage of those services. The same is often true of GPs' surgeries. We therefore need to do more to make those services more appealing to men.

That view is supported by the results of a survey on men, run by the Men's Health Forum, to inform its submission to the Government's consultation, "Your health, your care, your say". In response to open questions about health services, men said that receptionists should

They also said that

There is another quote:

Genito-urinary medicine clinics must be made easier to access. Besides ensuring prompt treatment, a speedy service helps minimise onward transmission, reduces complications, and allows quicker tracing and treatment of sexual partners. GUM services must be more effectively and proactively marketed to men so that there is wider knowledge of what is available and a dispelling of myths, particularly about some of the diagnostic tests for sexually transmitted infections.
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It is also important to recognise that the present problem of overstretched services is rooted in the shortages of specialist staff, poor resources and lack of investment. Such structural problems must be addressed without delay. The GUM clinic based at Darent Valley hospital in my constituency has an excellent reputation, but it has been overwhelmed by referrals from patients from across north Kent and south-east London, where the GUM service is not so well developed. Therefore, my hospital, which has a well respected clinic, is the victim of its own success. Because it is popular and accessible, it does far more work than it should, as it takes on people from far and wide outside its immediate area.

I suggested to the chief executive of my trust that he should send the bill for treating people from outside the   area covered by the primary care trust to other PCTs. Can the Minister tell us whether that is a practical proposition? I think it would be quite easy to collect patients' postcodes and send on the bill for the services they receive. My hospital could expand its services if it had the money to do so, but it is impractical for it to provide these services to people across south London and north Kent from within its current budget, and its clinic suffers as a result.

Consideration should also be given to a change of name: "genito-urinary medicine" is a medical term that is not understood by many. We used to call GUM clinics "clap clinics" when I was a medical student, and I am not sure that things have moved on much since then. A survey in 2000 by the Men's Health Forum and the Doctor Patient Partnership found that only half of adult men knew that a GUM clinic provides sexual health advice and treatment. Other sexual health services, such   as family planning clinics, should be made more male-friendly, and we should investigate new ways of delivering information to men, particularly utilising media that men are more likely to use, such as telephone services and websites. There is also a role for outreach services to places where men often feel more comfortable, such as workplaces, pubs, barbers' shops and working men's clubs.

We also need new training for health professionals. There is mounting evidence that many men are discouraged from making best use of health services by a generalised feeling that their needs are not understood. That difficulty could be especially marked in respect of sexual health, which is a sensitive subject that touches to the very heart of many men's sense of their masculine identity. It is therefore essential that training programmes for doctors, nurses and other health professionals include components that encourage the development of skills specific to working with men and encompass the respectful treatment of all sexual orientations and cultural values—something else that is often lacking.

There have undoubtedly been improvements in sex education in recent years, as a consequence of the national healthy school standard and other initiatives. However, school sex and relationships education—SRE—is still undervalued, and in some parts of the country teachers still receive inadequate training or support. Although young men have been identified in   official policy as needing a new approach, the SRE that is delivered is still generally too biological, and too   biased towards female reproduction, and it rarely
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targets young men's needs. It too often fails to provide young men with the information they require, or to explore what it means to be a man. There is also insufficient support in schools for adolescent boys struggling to come to terms with a sexual identity other than heterosexuality; the bullying of gay adolescents remains common.

As a consequence, many men grow up without basic knowledge, awareness or skills in respect of sex and sexual relationships, or any acceptance of diversity. Much of the information that is available to young men is from less than reliable sources, including friends, the media and pornography. Consequently, many young men still adhere to what could be called the traditional male model of sex, believing, for example, that "men should always be ready for it", or that sex is about performance rather than fun and pleasure, that contraception is a women's issue, and that only straight sex is normal sex.

However, there have been some successful health promotion projects targeted at young men. I should like to talk briefly about the Health of Men project in Bradford. Professor Alan White of Leeds Metropolitan university has been evaluating its work. That lottery-funded healthy living centre takes a public health approach to work that it delivers in barbers' shops, community centres, pubs and other places where men of different ages from the different groups in Bradford spend their time. The primary aim of Health of Men is to be a network of individuals and groups that encourages and facilitates the development of health-promoting and illness-prevention services that are accessible and attractive to boys and men.

As a result, the team sees a mix of races that broadly reflects that of Bradford. In 2004, Health of Men saw more than 6,000 boys aged 0 to 15 years, nearly 4,000 men aged 16 to 64, and more than 400 men over 65 years of age. One place it visits is a youth centre, and it takes a different approach to working with the boys about health. That is reflected in the comments from those at the youth centre about their Health of Men worker:

Another comment was:

Someone else said, "He's different" from teachers. And another quote is:

Health of Men also works with older men at a dominoes club, and with working-age men, including refuse collectors.

Mr. Barron : Before my hon. Friend became an MP, he spent most of his time as a health professional in the primary sector. In view of the comments he has just made about a mismatch in sex education—it involves not just young men, but young women as well—does he agree that we ought to make the case for health professionals to go into schools to teach sex and relationships, rather than leave that to teachers who also have to cover the broad span of education? Perhaps
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health education should be taught by health professionals, and not be an add-on to somebody else's profession.

Dr. Stoate : I could not agree more with my right hon. Friend. That is the right approach. Teachers are not necessarily experts on all issues. Health issues are predominantly the province of health professionals.

I have strongly argued for a long time that we need far more school nurses. I would like there to be one full-time school nurse for each secondary school, and one full-time school nurse for at least every three or four primary schools. At present, we have one full-time school nurse for each 14 schools—and in some places there are none at all. That is unacceptable. I have visited different parts of the world, and I was particularly impressed with one place in America; there was a secondary school in a difficult and deprived area which had a health clinic that was staffed full-time by nurses. Students could drop in at any time they wanted during the day—they were even allowed time off lessons to go and see the nurses. There was a far more rigorous approach to health education for young people, and there was a noticeable reduction in unwanted pregnancies and sexually transmitted infections. The young people were far better equipped to deal with such problems. My right hon. Friend raises an important point: teachers are not necessarily the right people to discuss these issues, particularly in respect of health and sexuality. Such matters are better left to trained professionals.

I wish to finish by referring to another successful men's health project. It is in Preston, and it has been run by the PCT's men's health development manager, Carol   Kubicki. The project is largely funded by neighbourhood renewal fund money and single regeneration budget money. Its part-time team of nurses and outreach workers engage with different groups including the homeless, Asian men and African- Caribbean men. They go into pubs, places of worship and community centres. In Preston, the PCT also commissions voluntary sector organisations to provide group work with different communities of men, to give the men involved an opportunity to improve their skills and confidence around health issues and to discuss topics in a secure environment. Some of the men have even produced their own information resources, including a calendar. Unfortunately, projects such as these, which are properly funded and staffed, are few and far between. Most public health professionals in PCTs simply do not have sufficient resources or manpower to implement comparable schemes in their areas. In most cases, they are only able to fund small, time-limited, projects involving only a few staff.

I have given this topic a good run around. I have tried to point out that different models could be used. What is required is a co-ordinated approach with—I hate to say this to the Minister—more resources specifically targeted at what I believe is a very important area of health. However, I also believe—this is better news—that if we invest money up front in these services, and create a better climate with more openness and a greater likelihood that people will come forward for testing and treatment, the long-term results could be significantly better, with great savings for health care and significant
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reductions in heartache and anxiety for people with long-term health problems, particularly those to do with infertility.

3.59 pm

Laura Moffatt (Crawley) (Lab): It is a great pleasure to follow my hon. Friend the Member for Dartford (Dr.   Stoate), with his particular expertise and his focus on men's health. That subject is often forgotten in this House, so it is important that we have heard about it this afternoon.

I have taken an interest in sexual health and HIV for many years. That interest first started when I was a nurse on an isolation unit. When we looked after the very first people who were able to give a name to their condition, we did so in isolation. That is a measure of how far we have come on sexual health issues and HIV attitudes and treatments. I suspect that I looked after many people who died with a collection of conditions that we did not have a name for, but who none the less died of full-blown AIDS. We kept them away from everybody. We all thought that we would be infected, and so they were treated in a way that would be unacceptable in today's NHS, and in a way that we would rail against.

My interest continued when I became a Crawley borough councillor and chaired the environmental services committee. We wanted people in Crawley to have a real view of the threats, and looked into how best to educate people about the real meaning of HIV, and how they could protect themselves from infection. It was good to have the debate about the advertisements and the widespread screening, in cinemas and on TV, of the campaigns that were run at the time. However, although they had a dramatic effect, pulled us all up and made us think carefully about our behaviour, it was unlikely that my 79-year-old father, who has been married to my mum for 60 years, needed to be told how to protect himself against HIV—at least I hope so.

It is true that we have moved on enormously on many of the issues, including education and treatment. I was so pleased that the hon. Member for Southend, West (Mr. Amess) mentioned the work that my hon. Friend the Member for Walthamstow (Mr. Gerrard) has done as chair of the all-party group on AIDS. I am its finance officer and have worked closely with my hon. Friend for many years. His determination and commitment to tackling issues around HIV and AIDS is something that the House can really be proud of. The subject is often difficult, and few Members take a close interest, although others dip in from time to time, so my hon. Friend's tenacity should be applauded. It has truly been a pleasure to be finance officer for the whole time that my hon. Friend has been chair.

Listening to a debate such as ours—it has been enormously wide-ranging, and many aspects of improving sexual health have been mentioned—it would be easy to think that there have not been enormous improvements, but of course there have been, in all our communities. There are alarming rates of infection, particularly for chlamydia. However, we must understand that since the early reports, and right through to the 2004 report and the White Paper, there have been tremendous moves to bring services closer to
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people in a way that is sensitive—culturally sensitive, and sensitive to gender and sexual orientation. The professionalism of those working in the sphere of improving sexual health is truly amazing. At times, we could get bogged down and think that there has been no progress, but I am convinced that much has gone on that is to be applauded.

Of course, there has been increased spending, too. We can have a debate on whether we think that the spending is getting through—and it is right and proper that we keep our eye closely on the ball in that regard—but we   should understand that there is increased spending, and it is getting to the places where we need it.

A few months ago, I had the pleasure of visiting a centre for young people in Harlow. I met the nurse who ran the unit, which brought very good services straight to young people. The unit was called into a youth centre, and it was able to offer a full range of counselling services and contraception. People at the unit had time to sit down with young people and help young women to understand that there are methods of preventing them from becoming pregnant or infected by common sexually transmitted infections. The unit showed that those services can be available in the heart of a community.

We went through a time of thinking that the best way to offer sexual health services was through the back door, so that no one knew where we were visiting. It was all a bit shady. I honestly believe—and hope—that we have moved beyond that. Although confidentiality is crucial, having those services at the heart of our communities will make a real difference; they will really make sure that people keep themselves safe, and will prevent infection in the first place. The best way to make sure that sexual health services take their proper place among all the other important things that the NHS offers is to make sure that they do not have that seedy feel. It is a service that is important for the sexual health of all of us, and there is no reason to be ashamed to visit those clinics.

That brings me to the issue of screening for chlamydia. My hon. Friend the Member for Dartford was right to say that the condition is easy to treat. I firmly believe that that has led young people to think that it is a risk-free condition. Often, just a single dose is required to cure it, and the young person is told, "Please don't come back to the clinic; we don't need to see you again." It feels like nothing more than a bit of a cold that has been cleared up. That is proving extremely difficult. We need to make sure that information on the great sadness and tragedy that can occur in later life, when infertility may become a major problem, is clearly imparted to young people. It is a tragedy for men as well as women, when they are in a partnership and desperately want a child. It is important that that information is given freely at an early stage, preferably long before infection.

I mentioned health education programmes that are effective and can help. Many hon. Members talked about things happening in schools. Soon after I first met my right hon. Friend the Secretary of State for Culture, Media and Sport, I remember her saying that the best contraceptive for young women was good predicted A-levels. We should hold that dear, because although it is important to talk about the direct issues around keeping oneself safe, making sure that sexual activity is
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within safe confines, and not putting oneself at risk, it is important that young women in particular have aspirations for their future. That could form as much a part of good health care and promotion as direct health advice. I hope that the Minister will say a few words about the joined-up work that needs to be done in matching aspiration with ensuring that young women are safe.

I firmly believe that abortion services should very much be offered as part of the panoply of services to promote sexual health. It is often said that the decision to terminate a pregnancy must be extremely difficult to make, and I completely agree, but for some women it is a very easy decision, as they absolutely know that they are not ready for motherhood. Therefore those services must be offered as quickly as possible. The one thing that unites all of us here—and I am a member of the all-party pro-choice and sexual health group—is that we all want a reduction in the number of abortions, full stop. We very seriously want more of those abortions to be carried out before 10 weeks. Providing those services sensitively alongside everything else, with equal value, plays an enormous role. My right hon. Friend the Member for Rother Valley (Mr. Barron) said clearly that it is important that we do not lose that service among all the other work that is going on. I hope that we do not. I should like the Minister to say a few words about that.

We have heard a lot about the difficulty of delivering good quality services in our communities and about waiting times for GUM's unique services. I am utterly convinced that it is still difficult to recruit clinicians to the clinical area of sexual health. We need to be honest about that and accept that people, including doctors in training, may not immediately think they want to spend the rest of their lives in that area. I have suggestions for the Minister about how she may consider who else is fit to deliver those services.

The people I have met who work in sexual health services are the most committed and motivated people in the health service that it is possible to meet. I believe that we should be using nurses much more in this service, because they have the skills to do the counselling work and the ongoing review, and they certainly have the skills to do the prescribing that is often needed. I should welcome the expansion of the nurse's role within sexual health services, because it would have a direct impact on waiting times for GUM clinic services. I hope that the Minister is able to say a few words about that.

We cannot get away from the fact that HIV remains controversial. Much of the report is dedicated to how we   treat people. Nowadays, the issue is falling into a two-sided debate. In the UK many of our support services for people who are HIV-positive are now chronic disease support services supporting people who have access to the drugs they so rightly need and deserve, but who require extra support in the community to ensure that they remain fit and well. The   all-party group on AIDS has commissioned several reports congratulating the Government on the response in the UK. However, we still have controversy over those who have been deemed not eligible to remain in the UK and the treatment that they receive. This is a difficult argument, because we as a House have to instil confidence in taxpayers that the money—the hard-earned cash—that goes to the health service is spent on
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services that they want. Of course, we must do that. However, another argument says that if we invest in treating people who are currently in the UK, despite their status, that may be an efficient way of spending NHS money.

I take issue with just one point. We know that there are frequent reports about this matter and we have more information about it. I have just been talking about how the issue moves on almost weekly. We know that viral loads influence peoples' infectivity; there is no doubt about that. I believe that the treatment of HIV-positive people is a public health issue. I ask the Minister to say a few words about that. Having spent time reading lots of reports, looking at the evidence and taking evidence, as hon. Members have said, the case for treating those who do not have leave to remain in the UK, for whatever reason, may be of advantage.

A lot has been happening and we in the UK have a lot to be proud of. So much work is going on in the realm of sexual health. Fantastic work is happening in our communities, which makes us believe that we can conquer sexual health problems and promote sexual health in our community. We can see an end to wholly preventable conditions.

4.15 pm

Stephen Williams (Bristol, West) (LD): We have had an excellent discussion this afternoon. I have learned a lot just by listening to some of the contributions. I am aware that there are many medically qualified hon. Members in the room, and I will be followed by one later on. The contribution from the hon. Member for Wyre Forest (Dr. Taylor) was particularly thoughtful, as was the tour de force from the hon. Member for Dartford (Dr. Stoate). The thoughtful contribution of the hon. Member for Crawley (Laura Moffatt) was interesting as well.

By coincidence, yesterday the Office for National Statistics released its latest statistics on sexually transmitted infections throughout the United Kingdom, which once again show a worrying rise. First, the incidence of syphilis in England rose from 1 per 100,000 of the population in 2000 to just over 7 per 100,000 in 2004. For women—these statistics can be somewhat bizarre—the figure rose from 0.3 women per 100,000 to 1 woman per 100,000. That is a seven-fold increase for men and a three-fold increase for women.

Increases in chlamydia have been experienced, as has already been mentioned, and there has also been an increase in warts. I do not want to tread on the sensibilities of the hon. Member for Southend, West (Mr. Amess), who said earlier that sometimes he did not want to hear all about the various infections. However, I recently met a consultant from the Westminster and Chelsea hospital, a representative of the British Association for Sexual Health and HIV, who told me about a new infection called LGV, which may sound like a road traffic vehicle to a layman like me, but stands for lymphogranuloma venereum, a horrible-sounding bacterial infection of the anus that is increasingly being detected in gay men and has been found in women's vaginas in Holland, too. That disease is particularly difficult to detect and is another worrying facet of sexually transmitted infections.

I shall talk about HIV later. I want to start by mentioning sexual health and young people, to which hon. Members referred earlier. Primary care trusts have,
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as part of their public service agreement, to meet a target identified on page 70 of the Department of Health's annual report 2005; they must reduce the number of under-18 conceptions

In my preparations for this debate, I was sent some statistics by Schering Healthcare Ltd., a manufacturer of the contraceptive pill, which confirmed the impression that we have already gleaned this afternoon that the UK has one of the highest teenage pregnancy rates in the world—it is the highest in Europe and the second highest in the developed world, after the United States. The most recent figures show that there are around 806,600 pregnancies throughout the UK. In England and Wales, there were, according to Schering, 487,934 unintended pregnancies in 2004, of which a quarter went on to result in live births. However, 185,415 of those pregnancies were terminated and the balance sadly resulted in a miscarriage. In 2004, roughly 36,000 of those abortions were among teenage girls. Those are worrying statistics.

For my first point on joined-up government, I refer to the remarks made earlier by a couple of hon. Members about the advice given to young people. In 2004, the Department of Health confirmed that its guidelines for doctors, and others involved in giving sexual advice to young people, were that such advice should remain confidential. However, in 2005 the Department for Education and Skills began consulting on whether that confidentiality should be breached, even when there was no suspicion of abuse. That seems a clear example of a lack of joined-up government between the Department of Health and the DFES. I shall be interested to know what representations the Minister has made on that issue to her colleagues. I tabled early-day motion 829 on this subject; so far, it has the signatures of 71 Members who believe that advice given to young people should remain confidential so that there is no further increase in the number of unintended, and perhaps unwanted, pregnancies.

My second point on advice to young people has already been well made by many; it is about whether specifically qualified people should give sex and personal relationship advice to young people in schools. The Chairman of the Select Committee made an interesting observation when he asked whether teachers were the correct people on whom to place the burden of giving that advice, or whether it would be better for a designated, medically qualified person visited schools to give it. Will the Minister reply to that point as well?

The major topic addressed in the report is HIV and migrants. The incidence of HIV is rising again in this country, and in some parts of Africa it is of truly terrible proportions. We know of 58,000 cases of HIV in this country. Several references have been made to the early public information films and adverts broadcast in the mid-1980s that featured falling tombstones and so on. At that time, I was coming up to my A-levels; the adverts created a difficult climate for gay men such as me who were struggling with their sexuality in their teenage years. At that time, young gay people certainly got abuse because of their sexuality, and to some extent they still do.
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Recently, we have made enormous advances on people's attitudes to homosexuality, but there is still some way to go. The hon. Member for Dartford made some interesting points on homophobic bullying. I am a member of the Education Committee, and the hon. Gentleman will be pleased to know that I asked my Committee colleagues whether we could have a short look at the issue of bullying in schools. Well before Christmas, they agreed that we would, and I intend to ensure that the charities and helplines that help people suffering from homophobic bullying are able to give evidence.

Although the stigma is not so bad in this country, we must recognise that among African men it is still pretty strong. Their attitude to gay sex is still pretty awful, and that means that African men infected by HIV can be reluctant to come forward and report their infection because they fear it will lead to stigma in the wider community. The stigma definitely needs to be addressed, although it has not been mentioned so far in this debate.

I have statistics on the rise in HIV infection in my home city of Bristol. In the 10 years following 1989, hospitals and clinics in Bristol saw cumulatively just over 100 cases. However, in each of the last two years for which statistics are available, they have seen more than 100 cases; recently, there has been a significant increase. The demographic analysis is illustrative: 43 per cent. of current HIV cases in Bristol are among black African men, and 10 per cent. are among black men of Afro-Caribbean origin.

The ethnic population of Bristol is small for a major English city: 8 per cent., and many are of Asian, not African, origin. People of African origin, whether they are Afro-Caribbean or from Africa itself, make up only about 3 or 4 per cent. Those figures clearly show that the major growth of HIV infection in Bristol is among black Africans. There are some important issues on that to be addressed. I do not have the figures for other cities, but it would be useful to find them out.

The HIV test is free, whatever one's immigration status. Anybody can go for a test; at that point, one has only to give a number, not a name or nationality. However, if the test should give bad news, the person is captured by the charging mechanism. If they are still in the asylum process, their treatment is free. However, if they are outside it because they have exhausted their appeal rights or overstayed their visa for whatever reason, they will fall within the charging mechanism.

That raises another point about joined-up government. How do we balance the needs of the Home Office, which quite rightly wants a rigorous asylum and immigration process, with the need to make sure that that process does not damage public health outcomes in this country?

The National Audit Office recently had a look at this country's record of returning failed asylum seekers to their country of origin; those statistics are stark as well. A large part of my work as a constituency MP in Bristol is to do with asylum cases. Many people have exhausted their appeal rights for whatever reason and therefore no longer qualify for free treatment. None the less, they are still in this country. In my constituency, they will typically live in the St. Paul's area. If they have HIV status—the statistics for Bristol suggest that there is an increasing risk
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of HIV infection among black African men in the city—and are not offered free treatment, they will become a public health risk.

As I understand it—perhaps the Minister could confirm this—another funding pressure is to do with primary care trust budgets. We welcome the increased resources that PCTs have been given to deal with sexual health issues. However, a PCT's budget is based largely on the number of GP registrations in the area covered by the PCT, and a lot of new arrivals in this country, whatever their immigration status, are not registered with a GP.

Are we sure that the funding given to PCTs that have large immigrant populations matches the public health need? If someone comes forward, has their test and does not qualify for free treatment, clinicians are put in a moral dilemma. I understand from the clinicians to whom I have talked that they offer treatment, and I am sure that the medical oath requires them to do that. However, I have recently also picked up evidence of acute or primary care trusts chasing people for bills.

An anti-retroviral drugs programme can be very expensive. It starts at about £5,000 and at the later stages can run to £25,000-plus. We could be talking about significant amounts of money. Recently, I have tabled parliamentary questions to the Minister to ask whether there is evidence of trusts around the country sending bailiffs to knock on people's doors and ask them to pay bills for HIV treatment, and what effect she thinks that that has on people complying with their treatment programmes. It is essential that once people start on such programmes, they stick to them and take their tablets on a regular basis, otherwise the treatment will not work.

The other risk is that people may not come forward because they know that they will be exposed to a charge. Not only stigma but financial pressure may stop people coming forward for HIV treatment. [Interruption.] Well, the Minister is sighing, but such issues are important and need to be addressed.

Perhaps the solution is either to examine the funding mechanism in respect of HIV and say that anyone with HIV in this country should qualify for treatment or to recategorise HIV as an STI on public health grounds, so that it can qualify for free treatment as an infectious disease in much the same way as tuberculosis is treated.

We welcome the extra resources that the Government have given, but are we sure that primary care trusts are using them for the purpose for which they are intended? We are well aware of the budgetary pressure that PCTs are under, especially those with deficits. There is evidence throughout the country that PCTs are using resources that are delegated to them for whatever purpose, whether dentistry or sexual health, to sort out their finances, rather than to deal with health needs. Will the Minister comment on that?

Genito-urinary medicine clinics are in a poor state. The hon. Member for Crawley referred to going to a clinic through the back door. Whether it is through the back door or the front door, the clinics should be fit for purpose. The report that we are discussing refers to the Sheffield GUM clinic, which is in a poor state. The Milne clinic at the centre of the Bristol Royal infirmary in my constituency is also in a poor state and should
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have investment put into it. I wish to put it on the record that major investment has been put into the student health service.

It is right that we are discussing such issues this afternoon, but perhaps we should discuss them more often and perhaps in the main Chamber rather than in Westminster Hall. The report refers to the sexual health service as an unglamorous and under-funded part of the national health service, so we need much more debate and joined-up government to deal with it. People, wherever they come from, have a right to expect world-class public services that can deal with some of the shaming statistics in respect of sexual health in this country.

4.32 pm

Dr. Andrew Murrison (Westbury) (Con): We have had a great debate. I shall rattle through my comments because the Minister has said that she would like some time to deal with the serious issues that have been raised. I congratulate the Health Committee on the report. It is a good piece of work. I hope that it has more effect than its predecessor report in 2003. We shall wait to hear what the hon. Lady has to say.

I take issue with some comments that have been made. The matter is regarded as unglamorous or something to which people should not aspire. That certainly used to be the case. I recall that when I was a medical student in Bristol the status of genito-urinary medicine was, without a shadow of doubt, very low. I cannot remember whether the so-called clap clinic was literally or only metaphorically in the basement, but I recall going there because I was learning about GU medicine. The message that was given subliminally was that it was not a speciality to which to aspire.

The sad events of the past couple of decades have increased the prominence of genito-urinary medicine, and it is an area in which health care professionals want to work. When I come into contact with professionals in that field, I am always struck by their high calibre. There is no doubt, however, that they are struggling. They are under-resourced. In response to that, I know that the Minister will say, "Ah, but you vote against rises in the health budget." We can take issue with that. It is all very well spending money if it is spent efficiently. We have heard some thoughtful comments about how might be done, in particular spending on screening for chlamydia and saving money down the line in spending on infertility treatment. The area needs to be prioritised because, obviously, it is about treating people. It is also a big public health issue and one that has been neglected for some time. I make no bones about saying that. It is an area that has been let down during the past few years.

The Government started well. In 2001, there was the national strategy for sexual health and HIV. The Health Committee has published two reports, but nothing seems to have been achieved. The Government's White Paper, "Our health, our care, our say", runs into 209   pages. Oh, it is even more than that. On page 91, there is a short piece about rapid access to sexual health   services; that is about the only bit I can find in the White Paper that relates directly to sexual health. It is a missed opportunity. The White Paper reiterates the undertaking that by 2008

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That seems to be a shifting target. We need to be a little more ambitious than that. When people want to use GUM clinics, by and large, they want to use them now. Surely there is far more scope for walk-in clinics. The danger is that, if people have to wait for long periods to access GU medicine, they will give up. We know that if they give up, they will continue to be a risk to not only themselves, but others. It becomes a public health issue.

I counsel caution about 48-hour targets. We have had them in relation to general practice and they have caused some difficulty. We should be looking more towards walk-in clinics. That seems to be the way ahead. We are dealing predominantly with young people. They want things right now and to offer them waits, particularly long waits, will not be helpful.

I shall not rattle off statistics. We are grateful to the hon. Member for Bristol, West (Stephen Williams) for giving us up-to-the-minute figures. Most of us are struggling with last year's figures, and I was interested to hear that the new figures confirm the trend in all the common sexually transmitted diseases. That the incidence of such conditions is on the up is a point well made. More worryingly, the predicted incidence is up, too, especially for HIV/AIDS. We are grateful to Professor Kinghorn for drawing attention in his evidence in the report to the poor state of many clinics. They need to be improved in many respects. I do not know the position of the GU medicine department at the Bristol Royal infirmary at the moment, but I should hate to return there in the not-too-distant future and find the same place and facilities as were there 25 years ago when I was a student.

We have heard much about the screening programme for chlamydia. The Minister needs to explain why it is restricted to women—indeed, young women—and tell us about her plans for how it could be extended to men in a more meaningful way than has been the case. We also need to know what impact screening will have on GU medicine clinics. The hon. Lady must have an idea about that. I hope that it will put pressure on GUM clinics because, if it does not, it might suggest that it is not being effective. We must budget for that and allow for the increased pressure on those clinics and others that provide health care in such areas because we expect chlamydia to be picked up and to be treatable. As the hon. Member for Dartford (Dr. Stoate) said, it can be treated extraordinarily easily.

It is important to say that traditionally few people have spoken up for such a range of conditions. We must allow for policy making. It is easy for a Minister to listen to the latest lobby group, of which there are many excellent ones in health care generally, but the users do not tend to speak up for the conditions that we are discussing. There is considerable stigma attached to such conditions, some of which are chronic, and it is unlikely that many sufferers will make a big song and dance about them in the way that, fortunately, those in other areas of health care do—they stand up for what they want and, rightly, lobby for it. That is far less likely to happen in the areas that we are discussing. When we are apportioning priority we need to make an allowance for the fact that that group of people is less likely to bang the drum for their conditions.
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We have heard a lot about sex education programmes. The Government committed to funding a campaign to raise awareness on sexually transmitted disease in a public health White Paper of November 2004. We now understand that there has been a delay until spring 2006. It would be nice if the Minister would tell us why.

I have talked briefly about funding, but I would like to make a couple more remarks in the time available to me. Concerns have been expressed that the money designated for some primary care trusts has been used to plug holes in their deficits rather than to deliver the badly-needed service improvements in sexual health clinics. We share the Committee's concerns that were expressed along those lines. The British Association for Sexual Health and HIV found that a large proportion of money allotted to PCTs for genito-urinary medicine was not finding its mark and was not being delivered to the front line. We are also concerned about that.

We understand, by way of example, that there is a particular problem in the Oxford City primary care trust, which is redesigning GUM services in Oxford. There is an issue about whether the PCT is spending the money on the services that are needed in the city. That is a difficulty that the Minister might like to examine. The British Association for Sexual Health and HIV raised that specific concern in earlier discussions.

It is worth making the point that the median waiting time to secure a first appointment at a GUM clinic increased quite a lot between 2000 and 2003. That is at a time when, according to the strategy published in 2001, GUM targeting was going to be prioritised. That situation needs to be addressed, for the reasons that I have stated.

The statistics potentially underestimate the problem that people are experiencing on the ground. A study done in Leeds, which came to our attention today, identified that in a given week 181 slots were available for people to access GUM services, and more than 700 people tried to access them. That represents a worse statistic than if we were to ask people who did attend how long they had to wait for their treatment, because a great number of people will not turn up if they cannot get a slot that is immediately available or convenient to them. I can think of no other area of health care where that is more likely to apply. There is a strong possibility that we have underestimated need and that people are effectively being turned away from services because they are not sufficiently immediately available.

The Committee heard from Professor Kinghorn about his experience in his Sheffield clinic. He considered that there has been

Only one in five of his patients accessed his clinic within the target 48-hour period, and the average wait was about three weeks. The Minister must agree that that is simply not acceptable.

The hon. Member for Dartford will know this far better than I, but we are potentially missing an opportunity by not using general practitioners as effectively as we might. He rightly highlighted the use of the quality and outcomes framework and quality points, and the missed opportunity in the recent revision to the contract because we failed to target sexual health. He
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has far more experience as a GP than I, but when I was in general practice I found that GPs were keen to be involved in that area.

There is a danger in our balkanising this matter to GUM clinics and assuming that GPs are not interested in the work or not able to take it on. That is not the case, particularly in relation to things such as chlamydia where the treatment is relatively straightforward. There has been a missed opportunity and I hope that the Minister will address that.

I am conscious of the time and will try to rattle through things as quickly as possible so that the Minister has a chance to address the remarks that have been made. I think that she is fairly clear about my concerns that funding is not getting through. A number of independent witnesses would make that point.

I have two specific points for the Minister, one of which she may be able to answer immediately and another that she may not. On post-exposure prophylaxis for HIV, I am not aware of any updated guidance following the previous briefing note that I saw in May 1998 on the provision of PEP following sexual exposure. I do not expect her to be able to answer this now, but I hope she will update me in writing about when the latest guidance was issued by the Department or its agencies.

Secondly, I am concerned about co-morbidity from tuberculosis in relation to HIV. I am concerned about the lack of public information that has been given recently on the policy change on BCG. Clearly, TB and HIV are associated, and the Minister needs to address the situation. I would be grateful if she would comment on how she will dispel much of the confusion about that issue.

4.46 pm

The Parliamentary Under-Secretary of State for Health (Caroline Flint) : Today's discussion has been interesting and helpful, but something might be missing from it. We have talked a lot about the sexual health consequences of STIs and abortion, but we have not talked about that fact that this is about people having sex, relationships and personal responsibility.

Hand on heart, I can say that there is plenty that Government, doctors, schools, hospitals and other organisations can do, but if we are to tackle the problems and challenges that we face in the 21st century—it is not that the problems never existed before; there have always been issues around STIs—part of the engagement must also be with individuals. There needs to be an understanding of their personal responsibilities. That means that when someone has sex with a partner, they must recognise that they are having sex with every person with whom that person has previously had sex.

If someone in a relationship strays and has sex with other people, they must be conscious of the consequences for their partner who thinks that they are in a faithful relationship. People who have a number of   different relationships, are not in a confirmed relationship with one person and are having sexual activity need to be aware that the more frequent the change of sexual partner, the higher their risk of getting an STI. Women in such circumstances have a higher risk of becoming pregnant if they are not taking adequate precautions to look after themselves.
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We live in a changing world. People have more sexual partners and therefore there is a greater risk of contracting an STI. Although people often enter into a relationship with the hope that it will last a lifetime, it does not always do so. Co-habiting couples, whether same-sex or involving men and women, and married relationships can break up. So there are issues to face up to about how, throughout the sexually active part of our lives, we ensure that we continue to have discussions about how sex will affect us in the future.

I have had some interesting discussions with members of the independent advisory group on sexual health and   HIV, and others, about people who have been in long-term relationships. Such a relationship might last for 20 years, for example, but the last time the people involved discussed contraception issues and STIs might have been a long time ago. They might suddenly find themselves active again and going into an arena with a mindset based on the situation 20 years previously, not on what it needs to be based on today.

It is important that such things are thought about in this general context; otherwise, the sorts of services that people need cannot be delivered and the sorts of communication campaigns and material that meet the needs of very different groups cannot be developed. We need people to respond and, hopefully, to take on board their personal challenges and personal responsibilities in this area.

It is important that we have such debates—I think that the hon. Member for Westbury (Dr. Murrison) mentioned this. The important thing about sexual health is that often there is no voice in the community knocking on the PCT's door, demanding better services, modernisation and reform, because of the stigma that is still attached to sexually transmitted infections and people's inability to speak openly about such issues. That is clearly not a problem for some of the other health lobbies that write to MPs, knock on the PCT's door and organise groups in the community to get the best drugs and the best services for their interest groups. That is why it is important to take a lead on sexual health by ensuring that we provide space to discuss such issues, voice concerns about what is not happening and consider what could be done to tackle the challenges that have been raised this afternoon.

I am pleased that the Health Committee undertook the inquiry, which is an important and timely one. However, the report is also timely in that it was announced only recently that sexual health is one of the six top priorities for the NHS in 2006–07, along with health inequality—no one mentioned that in the entire debate, which surprises me a little. As Minister with responsibility for public health, I feel that we in the Department have done quite well, with two out of six of those priorities. When I came to the Department I was told about the top priorities and I asked, "Well yes, but what does that really mean?" I have been assured that the fact that sexual health is one of the priorities will bring the issue of targets into much clearer focus for those who commission and deliver services on the ground.

I was pleased to receive a letter from my noble Friend Baroness Gould of Potternewton, who wrote to me as the chair of the independent advisory group on sexual
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health and HIV about the fact that sexual health is one of the top priorities:

I hope that that is the case; indeed, in meetings with individuals and organisations with which we work there has, in recent weeks, been a smile on people's faces. However, that is not to diminish the challenges that have been raised this afternoon, which I shall try to deal with as best I can.

As all hon. Members have mentioned in one way or another, sexual health was a key part of the White Paper, "Choosing Health". I link that to what the Government can provide and what people have to decide for themselves, because the issue is about choosing health. Some important points have been made this afternoon about how better to connect sexual health with other health issues. The point that my hon. Friend the Member for Dartford (Dr. Stoate) made about the links between chlamydia and fertility seems an obvious one. When we talk about PCTs and funding services, I think—as in other public health areas in my brief—that the important challenge for those of us who advocate better services is to make a good, sound economic case.

I receive many letters from hon. Members, some of whom are in the Chamber, about constituents who cannot access IVF treatment. We know that chlamydia is one of the major sources of infertility problems further down the line.

Dr. Stoate : The commonest.

Caroline Flint : Indeed. If we could get ahead of that, so that people did not get chlamydia in the first place—through safer sex and by treating the condition as quickly as possible—that should reduce the pressure down the road on those who need IVF treatment, particularly on those who could have done nothing to prevent an infertility problem. I am talking not about a blame game, but about having an economic argument, so that commissioners can see that the money that they invest in social health has added benefits that can affect how they plan their services. There are a number of other equally valid examples of that in sexual health.

We have provided additional money both to modernise and to transform sexual health services in England. I should stress that I am not interested in   throwing money at services that are not really meeting the needs of today's communities. The challenge must be about service delivery and outcomes, because it has been clear from all the contributions this afternoon that some groups are not accessing the services as they have traditionally been provided. I have seen some innovative work in Sheffield, in the hospital and in the community, and only this week I was at the Bloomsbury centre just off Tottenham Court road, meeting some people in the STIs and HIV clinic. They had half a dozen examples of how they could save money by running the service in a different way. The issue is about resourcing, but resourcing that will make a difference and create a step change.

I hope that I can reassure the hon. Member for Wyre Forest (Dr. Taylor) that we have not counted up the money twice. Most of the new money will go in over the
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next two years, and we have been helping those in the field to prepare so that the money arrives when they have developed the plans and ideas that will use it best. That is an important part of that process. People are concerned—I am concerned—about the money that is over and above what we provide being used properly. Part of that means ensuring that the services develop their plans, so that when we release the money we can see more clearly that it is going to something that has been thought out, rather than throwing it out before people have thought about how they are going to plan and develop the services. Capacity is, of course, important in that. There is £130 million in 2006–07 and 2007–08 for GUM, £40 million in the same period for contraception and £70 million for chlamydia—£10   million was issued in this financial year to get things going—so I am conscious of the need for the money to be used properly.

As with other aspects of health care, we rightly decided that we could not micro-manage the health service from the centre. We have to take some risks in devolving money to localities, where it can be best planned for. Different parts of the country face different issues in dealing with STIs and HIV. We know that the highest rates of HIV are in London and the south-east, and that ethnic communities face different issues, so we cannot plan all those services from the centre.

However, sexual health is now included in local delivery plans, which must be overseen by the strategic health authorities. In partnership with them, officials from my Department have been following up those authorities that we feel do not fulfil the need and do not address the targets for access and for reducing gonorrhoea rates, for example, and we have been challenging them. "National Standards, Local Action" highlights the fact that the PCTs should include all areas of sexual health in their local plans, and we will be monitoring that.

On 3 October, Kevin Orford, deputy director of finance at the Department, wrote to all SHA finance directors and chief executives, explaining that SHAs and PCTs should not identify those posts working on "Choosing Health" for savings. He went on to say that any savings may be made in administrative posts or other back-office functions supporting the public health function, where merger or other opportunities for economies of scale and efficiency savings were appropriate, but that any such savings should not detract from the delivery of "Choosing Health".

I hope that I can assure all hon. Members here that we are using all the levers that we think are appropriate to ensure that we can deliver on our targets in sexual health. That is now greatly enhanced by the fact that sexual health is one of the top priorities. That means that our delivery unit, which deals with delivery across the NHS, has sexual health as one of the key focus areas next year, and it provides an opportunity to bear down on the matter and ensure that the outcomes are what we want.

My right hon. Friend the Member for Rother Valley (Mr. Barron) and my hon. Friend the Member for Dartford both mentioned the GP contract and how it   works. It is a maze. As everybody knows, sexual health does not feature in its incentives, but nor do other   important health issues that are among the Government's priorities. It is difficult: treatments
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concerned with sexual health do not necessarily lend themselves to the contract's incentives; for example, defining a measurable, outcome-based intervention. Equally, PCTs do have the flexibility to design and deliver services over and above those provided by traditional general practice contracts, in order better to meet local need. We have not lost sight of the issue, and will continue to work on it. GP commissioning, in conjunction with PCTs, offers a further opportunity to consider the sort of services that would assist GPs in their work and would play an effective role in developing better services for patients.

My hon. Friend the Member for Dartford asked about the problem of patients who attend GU clinics in neighbouring PCTs. The Bloomsbury centre, which I visited this week, has a particular problem in that the majority of its clients are commuters who come to work in central London. Payment by results, which will be introduced for all GU clinics provided by acute trusts from April this year, will allow PCTs to recoup the cost of providing services to people from neighbouring PCTs. Again, when that is up and running, PCTs, particularly those responsible for delivering services, will be better able to plan the development of their services without having to worry so much about the cost that they incur in providing a service that is taken up by many people from other areas.

The hon. Member for Wyre Forest talked about staffing, as did my hon. Friend the Member for Crawley (Laura Moffatt). There has been an increase of 225   GUM consultants in England since 1997, but we are also looking at ways of making better use of other health professionals, such as nurses, pharmacists and health visitors, in the delivery of modern services. The Bloomsbury centre—I am afraid that I am going to praise it to the skies, because it was so impressive this week—is really using its nurses and their skills, including for prescribing, as my hon. Friend the Member for Dartford outlined.

The centre's staff also talked about the future use of health care assistants. They took me through the activities carried out in the clinic, and it was clear that nurses were not required for all of them. They were considering using health care assistants to relieve nurses, particularly those with prescribing status, so that they could play a larger role in complex treatments and patient services. They were considering the whole work force, analysing in a very productive way how the team worked.

The White Paper, "Our health, our care, our say: a new direction for community services", which we published on 30 January, highlights the fact that in future we will need to be radical about the way we deliver services, particularly those that are not provided in hospitals. It would be fair to say that discussions are going on among different groups of sexual health professionals about what is best. Some of those who provide hospital services think that their service is the   be-all and end-all, and others, who work in the community, say the same about theirs. It should not be a question of one or the other, but when we consider investing money, particularly in buildings, we have to ensure that it will produce a step change in relation to   access.
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There are many views, and we have to challenge all professionals to justify their plans and explain how they will deliver. For many of the reasons that have been stated this afternoon, hospital-based clinics are not necessarily the places where many people want to go. In the months ahead, I shall bring together people from the voluntary sector and elsewhere with those currently working in the field to discuss with me how we might design services for the future. What is most usefully done at the centre is the design of best practice overview models that will help local commissioners to see what has been tried and tested—what can be shown to work—so that they do not have to constantly reinvent the wheel and can get on track sooner rather than later.

I agree that we have to vary the settings. I am not against siting mobile units in supermarkets, Boots or football clubs. We are working with the Football Association and the authorities in rugby and other sports on the best ways to use the places where many people—particularly men—go, to get them to think about their health. Sexual health is just one part of it; obesity and drinking should also be considered. Just before Christmas, I attended a seminar at Elland Road in Leeds, and another series of seminars involving sports clubs, health professionals and others will take place later this year. It is important to think outside the box about where we provide services.

Almost half the patients seeking appointments now receive one within 48 hours, but there are still differences between areas. I will ask officials to look into the situation in Southend, West. Part of our work is to monitor progress. A national support team has been created to address poor performance and support delivery, so we will be able to investigate individual cases in which there has been a problem obtaining access within 48 hours. There might be good reasons why only 22 per cent. of patients are seen within that time in some areas, so we will not rely on national averages. We will hone in on areas that do poorly and on those that do well, to find out the reasons in each case.

Let me put the hon. Member for Westbury right: the chlamydia screening programme is a service for men and women. In fact, this is one of the few countries that screen both men and women. My hon. Friend the Member for Dartford raised the issue of whether the   access points are places in which men feel comfortable. It will be interesting to check whether, in Boots—I have to say that the Boots project has been very good—the access point is next to the cosmetics counter, whereas it should be by the aftershave. My hon. Friend is right to say that we should consider the gender take-up, in case we are not catching men. The problem, which I have heard many times, is that women go for treatment, receive it and then go out and have sex with the guys who infected them in the first place. That does not make sense, and that is why we have decided that men should be included in the programme as well.

The hon. Members for Southend, West (Mr. Amess) and for Wyre Forest were concerned about the technology and the test that is used. The national chlamydia screening programme uses nucleic acid tests, a DNA technology, because they are more sensitive. They also allow patients to collect their own specimens, whether urine or self-taken vulvo-vaginal swabs. That is important, too. Not only is the technology the most up
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to date, but the tests are changing. I had a discussion about that this week; the process is much faster if people do not need a health professional standing over them.

We have already put £7 million of pump-priming money into that development, and I am pleased to say that NATs is now available in every strategic health authority area. We will monitor the situation in order to ensure that no area continues to use the older enzyme immunoassay test. We are talking about a major, long-term public health programme, which is important in respect of infertility and other issues. Two thirds of the new programmes will be ready to start screening in April. I am pleased to say that that is way ahead of target. I have already mentioned Boots, as have other speakers. So far, so good. It is going well. More than 10,000 kits were given out in the first 12 weeks of the pilot, so we are clearly meeting a need that might not have been met by more conventional delivery of the service.

In discussing sexual health, we should not confine ourselves to sexually transmitted infections. Contraception is also important. I think that there is a language issue. When we talk about sexual health there is a tendency for people, even some of those who work in the profession, to think that we are talking only about STIs and HIV, but contraception is an important part of all that.

As part of my ambition to get the best people possible to help me to redesign sexual health services, I hope to involve the Family Planning Association and others, so that we can think about integrated services. That is important for resource and staffing reasons and in terms of reducing stigma; this is a common aspect of people's lives. I shall give a plug to my own area, where I was pleased to visit a clinic in the middle of Doncaster which offers a podiatry service, a smoking cessation service and a sexual health service, so one can have one's feet done, get a nicotine patch and get something for the weekend. That is a positive, open way to provide services, rather than hiding them around the corner. Several hon. Members talked about that.

We are undertaking a national audit of contraceptive services, because we want to be clear about where the gaps are and how to deal with them. We want to ensure that the full range of methods is available and that best practice is shared. Last year's report by the National Institute for Health and Clinical Excellence was helpful regarding the many different types of contraception that are available. It is important that people have choice. For many women who have been in long-term relationships, it may be a long time since they discussed such issues, and much may have changed in that time. I recently wrote to all PCT leads to highlight the importance of this subject and to ask them to work with us to complete the audit. Having done so, we have earmarked £40 million to address the issue over the next two years. As I said, I am interested in how we can bring these issues together.

The hon. Member for Southend, West talked about access to condoms. There is free provision for men and women through community contraceptive clinics, youth clinics, GUM clinics and some GPs. Many PCTs
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provide condom distribution schemes and target the most at-risk groups, such as gay men, young people and people in black and ethnic minority communities.

I, too, thank my hon. Friend the Member for Walthamstow (Mr. Gerrard) for his work over many years on HIV/AIDS. I thought that he might be here this afternoon because he sent me a letter asking for something, but I shall talk to him about that at another time. I also thank my hon. Friend the Member for Crawley for her work and support for the all-party group.

I am pleased to say that the prospects for people with   HIV are a hell of a lot better now. The number of AIDS deaths has fallen dramatically since effective drug therapies were introduced in the 1990s. The UK remains a relatively low-prevalence country for HIV infections as a result of sustained public campaigns, targeted campaigns, open-access confidential services and tremendous support from the voluntary sector organisations that work with us and with PCTs around the country.

Our health promotion work aims to target those most at risk of infection, and we continue to work with national HIV voluntary organisations in taking that forward. However, as has been pointed out this afternoon, rates of HIV diagnoses are increasing. The increasing trend in new HIV diagnoses reflects the fact that more people are coming forward for testing, which is a good thing, but it also reflects the ongoing HIV transmission. That underlines the need to give sexual health and HIV a high priority, which we are doing. Recent large increases in new HIV diagnoses have been attributed to infections in the heterosexual community, including infections that were acquired abroad—mainly in sub-Saharan Africa. Transmissions continue to occur in the UK amongst gay men and, to a lesser extent, heterosexuals.

The Health Protection Agency report, "Mapping the Issues", is a timely reminder to those commissioning and providing services that prevention remains the cornerstone of our fight against HIV, and the "Choosing Health" White Paper highlighted the importance of improving sexual health and preventing STIs, including HIV. Our proposed new campaign would complement that and support existing HIV awareness campaigns. We are asking why there are unsafe sexual practices in particularly high-risk groups. That is why we work with organisations such as the Terrence Higgins Trust.

We must also compare the position today with that in the 1980s. I remember not only the advertising campaign with the tombstones, but that people were dying. At that time, we saw on our TV screens people who got HIV for whom there was no hope. If one got it, one's life span was going to be pretty short. We all remember harrowing footage such as that of Princess Diana supporting various organisations to give public recognition and support to those working with people who were HIV-positive and who developed AIDS.

The situation is different today. Thankfully, because of the drugs, more HIV-positive people are living. Therefore, one issue that we must grapple with is whether we need to find a different way in which to talk to young people about the dangers that they face, regardless of the advances in medicine for which we are
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all thankful. They might not die if they contract AIDS, but they will have a life sentence. It will be with them for the rest of their lives. They will be able to manage it and live normal lives, but it will be part of who they are and will affect how they think about their relationships. We need to think about that.

More work needs to be done, and is being done, to engage with the African communities. We work with various organisations on that front, but I am interested to see what we can learn from the positive work that we have done in relation to HIV with communities in Africa, and whether we can bring something back from those projects to help here, particularly regarding engagement with those communities. As I said, we had some interesting discussions about that at the Bloomsbury centre this week.

It would be interesting to involve patients in designing and planning services, as they could make a huge contribution. There is an expert patient programme at the Bloomsbury csentre, whereby patients are very much allowed to lead the agenda in terms of how their health care is provided. The centre employs a full-time patient representative for people who go there wanting to talk to someone who is in the same boat as them rather than a health professional.

I shall write to the hon. Member for Westbury about post-exposure prophylactics and TB if I may, as I want to discuss overseas visitors and charging. There are safeguards to protect overseas visitors and individuals who are in genuine need. Guidance on implementation of the charging regime is explicit. Immediately necessary treatment must never be denied because of uncertainty about eligibility. That does not mean that treatment is free, but charging considerations take second place. Whether treatment is immediately necessary will always be a clinical decision, not an administrative one. The same applies to maternity services. Our guidance makes it clear that such treatment should always be considered immediately necessary because of the risks to mothers and babies. That was reiterated to overseas visitors managers last month.

Successive Governments have never required NHS trusts to submit data on the number of overseas visitors treated, the type or cost of treatment provided or the revenue derived from charging. This is not about numbers. It is not a numbers game; it is about principles and about how our NHS should be run. Consultants at two of London's largest HIV treatment centres told us that they saw no evidence of a significant increase in the number of people being charged or in patients withdrawing from treatment because they had been told that they would have to pay for it. In their experience, the vast majority are either exempt from charges or covered by the easement clause that guarantees that a course of treatment must remain free of charge until completed if it is was originally provided free of charge.

As far as we are concerned, a course of treatment for HIV means anything that is considered to be clinically appropriate by the doctor in charge of a patient's care, responding to changes in the patient's condition over time. We accept entirely that that might mean that free treatment has to continue until a patient leaves the UK or is deported. I think that that deals with a point that the hon. Member for Bristol, West (Stephen Williams) made about failed asylum seekers.
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I discussed the issue of pregnant HIV-positive women with my right hon. Friend the Member for Rother Valley the other day. The Department's guidance on implementing the charging routine says explicitly that maternity services must not be delayed or withheld because the patient is a chargeable overseas visitor who is unable to pay in advance. Treatment to prevent mother-to-child transmission of HIV can be included if it is considered clinically appropriate. As I said, the Department of Health has reiterated that twice since the guidance document was issued in 2004—once last May in response to the Health Committee's recommendation and again only last month.

My hon. Friends the Members for Calder Valley (Chris McCafferty) and for Crawley spoke about abortion. I absolutely agree with them. We want to do as much as we possibly can through better sexual health services, which include contraceptive services, to ensure that abortion is not a choice that many women have to face up to. I do not think that it is something that women face up to easily. We have invested £7 million to improve early access and have set a standard maximum waiting time of three weeks, although I appreciate that my hon. Friend the Member for Calder Valley would like it to be better than that. It was quite a challenge, however, to set that standard, as I am sure she will appreciate. PCTs are now measured against that three-week maximum as part of their NHS performance ratings. I am pleased to say that we have seen some improvements. Now, 88 per cent. of abortions take place at under 13 weeks gestation and 60 per cent. at under 10 weeks. That is to be welcomed.

My right hon. Friend the Member for Rother Valley and my hon. Friends the Members for Calder Valley, for Dartford and for Crawley, as well as other hon. Members, mentioned sex and relationships education. Aspects of sex and relationships education, including education about HIV/AIDS and other STIs, are a statutory requirement for secondary schools. A national curriculum science order in 2000 provides the statutory basis for that.

Schools are further encouraged to deliver broader aspects of SRE, in particular to give young people the skills and knowledge to manage positive relationships through the non-statutory framework for personal, social and health education. That is an important aspect of the subject, which is not only about biology and the facts of life, but includes personal confidence in handling relationships. My hon. Friend the Member for Crawley made an important point. Teenage girls who are most at risk of becoming involved in early sexual activity and getting pregnant are those who are not succeeding at school, for whatever reason, who do not have goals set for them and are therefore vulnerable to different pressures.

When I was a Home Office Minister, I was very much involved in preparing "Paying the Price: a consultation paper on prostitution". We found that a number of prostitutes had, from primary school age, lost their way. They were isolated, and were not supported, and one could see their journey to the day that they ended up on the streets selling their bodies for drugs. That is an important issue that we have to face up to, alongside providing the necessary access to advice about sex and contraception. It is why I believe passionately that our White Paper is so important in ensuring that in every
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community—particularly in our poorest—we do not give up on any child, regardless of their family background, and that we demand the most excellent education for every one of them. That will help us in the fields of sexual health, public health, employment and so on. It is absolutely key.

As I share responsibility for the healthy schools programme with the Department for Education and Skills, I am pleased to say that we have now ensured that for schools to attain the healthy schools programme kitemark they have to meet criteria in four areas, one of which is PSHE. That is a step forward from the days when they could just pick and mix. Meeting the criteria for PSHE is a core part of achieving healthy schools status. Last September, a new inspection process for schools was introduced, with greater emphasis on the school's contribution to helping children and young people to achieve the five "Every Child Matters" outcomes.

The hon. Member for Bristol, West and my hon. Friend the Member for Calder Valley raised the issue of the confidentiality of advice given to those under 16. My hon. Friend cited the Axon case. There is a balance to be struck between maintaining confidentiality and protecting young people from harm and abuse. Although confidentiality is included in the guidance and was upheld in the courts only recently, it is not absolute. In some cases, or on some issues, professionals will want to talk to others in the interests of the child.

When the subject of access to abortion for those under 16 came to the fore last year, I asked for a snapshot survey of some of our providers. We wished to know about parental involvement. The guidance states that every effort should be made to encourage a parent, or another adult, to be present. The snapshot survey, for what it was worth, showed that in 65 per cent. of cases a parent was involved and in 95 per cent. of cases another adult was. That is important. Not only should the discussion take place at the first meeting with the young person, but the door should be left open through the whole process so that they can involve a parent. Most of the time, that is done and it is understood by those who provide the services.

The other important aspect of the discussion is the question whether, as parents, we talk to our children about relationships and sex. My right hon. Friend the Secretary of State for Education and Skills is considering some more work that we could do to give confidence to parents to have those important conversations with their children, at different stages of childhood and in a way that is most appropriate to the age of the child.

Dr. Murrison : The Minister is telling us what she is doing, and it is all very nice, but can she tell us why waiting times for GUM clinics have got worse since 1997, why incidents of sexually transmitted diseases have gone up and are rising, and why we compare so badly with comparable European countries?

Caroline Flint : I thought that we were having a thoughtful and reflective discussion this afternoon, and
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I was trying to have an honest discussion with all members of the Committee. I do not want to rehash what I said before about the changes in the way in which we live our lives, but we could spend a whole day talking about that and the cultural differences between us and France, Sweden or Spain. Interestingly, the rates of gonorrhoea have gone down and although the rates of chlamydia and other problems have increased, they seem to be levelling off and slowing down. However, that is at the heart of why we are here today. I am afraid to say that your party was in power for 18 years—

Mr. Eric Illsley (in the Chair): Not my party, his party.

Caroline Flint : I apologise, Mr. Illsley. Your party is my party, and long may it be so.

The party of which the hon. Member for Westbury is a member was in power for 18 years, and, as I said to one of his hon. Friends in the debate on mental health services the other day, it is interesting to listen to Conservative Members bemoaning the state of things today. They had 18 years to start making a difference, and they did not. We have a legacy of no investment and little attention, and, quite frankly, many people on his Back Benches do not even believe that sex education should be provided in schools.

Dr. Murrison : Name them.

Caroline Flint : I would be happy to do so.

Dr. Murrison : Will the Minister give way?

Caroline Flint : No, I will not.

Dr. Murrison : On a point of order, Mr. Illsley. The Minister has made an allegation that she should substantiate. She should give us the names that she has in mind.

Mr. Eric Illsley (in the Chair): That is not a point of order but a point of debate.

Caroline Flint : I am sure that I can rely on my colleagues, but I recall that in a debate not so long ago, which I think was on abortion, the hon. Member for Shipley (Philip Davies) suggested that sex education should not be provided in schools, but that parents should be left to carry out that function. That is one example, but I am sure that there are a number of others as well. Every time we talk about sex education in schools, you can bet your bottom dollar that there will be Conservative Members of Parliament arguing against it. We are in a new era of providing services. We have made tremendous progress, there is more to be done, and I congratulate the Select Committee on its report.

Question put and agreed to.

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