HC 1048-III Health CommitteeWritten evidence from Brook (PH 43)

1. Executive Summary

1.1 Brook is the UK’s leading provider of sexual health services and advice for young people under 25. The charity has over 45 years of experience working with young people and currently has services in England, Scotland, Northern Ireland and Jersey.

1.2 Brook services provide free and confidential sexual health information, contraception, pregnancy testing, advice and counselling, testing and treatment for sexually transmitted infections and outreach and education work, reaching over 260,000 young people every year.

1.3 Brook warmly welcomes the inclusion of sexual health services in public health as it recognises the major public health role that sexual health services play in young people’s health and wellbeing.

1.4 In principle we welcome the proposal that local authorities will commission public health services, but have some concerns around the execution and mechanisms of localised commissioning for young people’s sexual health services.

1.5 We welcome the ring-fenced public health budget but are concerned over whether the budget allocation will be sufficient to fund the full range of public health services proposed.

1.6 We think that it is important that the indicators on under-18 conceptions, rates of Chlamydia diagnosis for 15 to 24 year olds and late diagnosis of HIV are retained in the Public Health Outcomes Framework.

2. Creation of Public Health England

2.1 Brook welcomes the creation of Public Health England as a body to focus specifically on public health.

2.2 We welcome the inclusion of sexual health services in public health as it recognises the important public health role that these services have in treating and preventing the spread of infection and enabling young people to maintain their sexual health and wellbeing. We also welcome the inclusion of contraception services, sexually transmitted infection (STI) services, abortion services and health promotion and prevention services in the definition of sexual health services contained in Healthy Lives, Healthy People.

2.3 We welcome the commitment that these services will be easy to access and delivered in a confidential and non-judgemental way as these are important considerations for young people when they access sexual health services.

3. Future role of local government in public health

3.1 Brook welcomes the commissioning of public health services by local authorities in principle. However, we are concerned that there is a risk that certain elements of sexual health service delivery could become politicised given the involvement of locally elected representatives. For example, we know that confidentiality for young people when they access sexual health services is one of their key concerns. We fear that some people seeking elected office may wish to make a political issue out of young people accessing sexual health services without their parents’ knowledge. It must be clear to local authorities that the public health services they commission must meet the needs of the local population including young people.

3.2 We are concerned that local authorities may not have the knowledge or expertise to commission appropriate sexual health services for young people. Furthermore, the stigma associated with accessing these services may mean that local young people are reluctant to talk about the services they need. We think that accurate local Joint Strategic Needs Assessments and clear commissioning guidance and support from Public Health England will help ensure that local sexual health services meet the needs of young people.

4. Commissioning of public health services

4.1 Brook welcomes the inclusion of sexual health services in public health. We think that it should be mandatory for local authorities to commission comprehensive, open access sexual health services for young people, including STI testing services, contraception services and abortion services.

4.2 Key considerations for young people when they access sexual health services are that they must be confidential and free; open at times convenient to them; in locations they can easily reach; provided by friendly, non-judgemental staff; and well publicised. It is vital that local commissioning of sexual health services ensure that these needs are met for young people.

4.3 Brook believes that it is vital that local commissioning arrangements continue to ensure choice of services for young people. We know that some young people access sexual health services through central locations such as Brook Centres; and some young people access them through community venues that they feel confident using. It is crucial that this choice is retained and services are offered in a variety of locations to make them more accessible to young people.

4.4 We also think that horizontal integration across all public health services delivered for young people will lead to a creation of a holistic public health service for young people and enable them to make healthy and informed choices throughout their lives.

4.5 We believe that all sexual health services commissioned for young people should follow the Department of Health’s You’re Welcome criteria for making health services young people friendly. We also think that young people should be involved in development of sexual health services and feedback on sexual health services. We would be keen to see mechanisms to ensure that young peoples’ voices are represented on bodies such as local Health and Wellbeing Boards.

5. Public Health Outcomes Framework

5.1 Brook broadly welcomes the overall framework for public health outcomes and the proposed domains. We particularly welcome the inclusion of indicators specific to young peoples’ sexual health issues.

5.2 We warmly welcome the inclusion of indicators on under-18 conceptions, rates of Chlamydia diagnosis for 15 to 24 year olds and late diagnosis of HIV and believe it is vital that these proposed indicators are all retained in the Public Health Outcomes Framework. There is strong evidence that national leadership and robust data collection on sexual health outcomes leads to improved services and demonstrable improvements in sexual health for young people.

6. Funding of public health services

6.1 Brook welcomes the ring-fenced public health budget, as funding for public health has previously been an easy target for cuts when budgets are squeezed. However, we fear that the funds allocated to local authorities as part of the public health ring-fenced budget will not be sufficient to fund the range of services proposed. Current expenditure on the full range of sexual health services is estimated to be around £700 to £750 million. Healthy Lives, Healthy People estimated that current spend on areas likely to be the responsibility of Public Health England is around £4 billion. With sexual health just one part of public health we are concerned that the ring-fenced budget will not be enough to meet the local needs for public health services.

6.2 It should be made clear that the ring-fenced public health funding is only to be spent on public health services and that it is not acceptable to re-define other services as contributing to public health to get around the ring-fencing. We are aware that local authority budgets are likely to be under significant pressure over the next few years and this must not have an adverse impact on the funding for sexual health services. Cuts to young people’s sexual health services may appear to be cost-saving in the shorter term but are actually more costly over the medium and long-term as the costs of increased rates of STIs and unplanned pregnancies have to be met. We urge the government to take steps to avoid reductions in services which would lead to a deterioration in young people’s sexual health.

7. Future of the public health workforce

7.1 Brook welcomes the intention of the Government to develop and consult on a public health workforce development strategy in 2011. We believe that a workforce development strategy for public health must recognise the role that non-health professionals like teachers and youth workers have in supporting young people’s public health.

7.2 We would like to see a strategy that proposes a training and education framework that enables all professionals that work with young people to deal with all young people’s issues including sexual health.

8. Abolition of the Health Protection Agency and future of Public Health Observatories

8.1 Brook believes that national data on sexual health services is vital in assessing the sexual health and wellbeing of young people as well as access that young people have to sexual health services.

8.2 We think that Public Health England should, at the very least, continue to deliver the functions that it will take on from the Health Protection Agency (HPA). The data collection and analysis that the HPA currently carries out into STIs is crucial to informing service provision and assessing progress in improving young people’s sexual health. We also believe that access to the sexual health data collected by Public Health Observatories and its regular updating should be retained.

June 2011

Prepared 28th November 2011