HC 1048-III Health CommitteeWritten evidence from Sexual Health organisations (PH 155)

The following written evidence is submitted by a number of individual sexual health organisations who also sit on the Sexual Health Forum, a stakeholder advisory group that provides advice to the Department of Health.

Individuals and Organisations that have contributed to the evidence

Baroness Gould of PotternewtonDr Gabriel Scally, Regional Director of Public Health for the South WestFamily Planning Association (fpa)Terrence Higgins Trust (THT)Sex Education ForumNational Children’s Forum (NCB)Marie Stopes International (MSI)Faculty of Sexual and Reproductive HealthBritish Association for Sexual Health and HIV

Key issues which need to be addressed under the new arrangements are:

The availability within local authorities of sufficient high quality clinical public health skills to support commissioning of a complex range of services across the acute, community and primary care sectors. Also, services in non-traditional settings such as schools, FE colleges, pharmacies and outreach work. It is particularly important to commission against national standards to ensure quality, clinical governance etc and that meet national training standards.

The importance of and promotion of nationally recognised standards for workforce training.

Ensure that all needs, for all age groups are met, including those of vulnerable groups for example sex workers, prisoners etc.

Prevention and education is key to sexual health and is value for money.

Ensures a continuing focus on service modernisation and integration.

Improves sexual health outcomes, including those set out in the draft Public Health Outcomes Framework for sexual health.

Links to issues such as coercion, sexual violence, mental health and wellbeing and gender.

Access to factually and clinically accurate information through a range of mediums including helplines, websites and social media

Improving patient involvement and engagement in service design and delivery.

Our sexual health affects our physical and psychological wellbeing and is an issue that affects the vast majority of the population from adolescence through to old age. There is a strong link between social deprivation, STIs, abortions and teenage conceptions. Some groups have much higher levels of sexual ill-health including young people, men who have sex with men and some black and ethnic minority groups.

The consequences of poor sexual health can be serious. HIV therapies are complex, expensive and can be very demanding on the patient. Untreated chlamydia infection can result in pelvic inflammatory disease, which can lead to ectopic pregnancy and infertility. Unplanned or unwanted pregnancies can have negative impacts on women’s health, social and financial situation. Teenage pregnancy is associated with a range of poor outcomes for the mother and child.

Key public health measures have been in place for many years to protect and improve the public’s sexual health.

It is enshrined in legislation that certain PCT functions must be open to all-comers, these include:

“facilities and services for testing for, and preventing the spread of, genito-urinary infections and diseases and for treating and caring for persons with such infections or diseases” (regulation 3(7)(b)(iii));

“services which the Secretary of State has a duty to provide under section 5(1) (b) of the NHS Act 1977. This section states ‘….it is the Secretary of State’s duty to arrange, to such extent as he considers necessary to meet all reasonable requirements in England and Wales, for the giving of advice on contraception, the medical examination of persons seeking advice on contraception, the treatment of such persons and the supply of contraceptive substances and appliances’.”

Many aspects of sexual health remain stigmatised, which can deter people from accessing treatment services. Self-referral to NHS sexual health services without fear that sensitive and personal information will be disclosed wider than is needed has successfully underpinned UK sexual health services for many years.

Prescribed contraception is provided free of prescription charge

Prescriptions for STI treatment, including HIV treatment, are free of prescription charge when supplied in a hospital

STI (and HIV) services are covered by specific legislation on confidentiality and disclosure of information. While they are not absolute, the Regs/Direction provide that information on STIs/HIV will not be shared with GPs and other healthcare professionals without the explicit agreement of the patient. Ensuring patient confidentiality is recognised as a key component of public health prevention strategies to control the spread of infection and reduce undiagnosed infections.

Considerable progress has been made over the past few years, for example, the continued decline in teenage pregnancy rates, which is at its lowest level for 30 years, in bringing the different elements of sexual health together in a holistic and integrated way. This includes development of integrated sexual health services that provide both STI and contraceptive provision. There is much to be gained from retaining this approach within the new public health system.

The consultation document, Healthy Lives, Healthy People; consultation on the funding and commissioning routes for public health closed on 31 March. We support the proposals in the consultation document that in future local authorities should be responsible for commissioning open-access sexual health (contraception, STIs and termination of pregnancy) services using funds from the ring-fenced grant for public health. This will help to ensure a holistic approach to sexual health in particular the opportunity to join up with some of the drivers of poor sexual health including drugs and alcohol.

We also agree that rapid open access sexual health services should be provided in a universal fashion in all areas limiting any inconsistency in provision.

June 2011

Prepared 28th November 2011