Good sexual health is a vital aspect of overall health and wellbeing. That is helped by easy access to high quality information and sexual health services. Although the top line figures for sexual health appear positive at first glance—overall sexually transmitted infections and teenage pregnancies are falling—they mask a number of seriously concerning underlying trends and inequalities as poor sexual health outcomes fall disproportionately on certain groups.
An enduring theme in evidence to this inquiry was geographical variation in access to the highest standard of sexual health services, worsened by the impact of greatly reduced funding and increased fragmentation of services.
Sexual health must be sufficiently funded to deliver high quality sexual health services and information. Cuts to spending on sexual health, as with other areas of public health expenditure, are a false economy because they lead to higher financial costs for the wider health system. Inadequate sexual health services may also lead to serious personal long-term health consequences for individuals and jeopardise other public health campaigns such as the fight against antimicrobial resistance.
Looking forward to the Spending Review, the Government must ensure sexual health funding is increased to levels which do not put people’s sexual health at risk. We are concerned that cuts have fallen particularly heavily in the area of prevention. The message to this inquiry was clear: inadequate prevention and failure to ensure early intervention increases overall costs to the NHS.
We welcome the Minister’s indication that prevention as part of sexual health will be a central part of the prevention Green Paper, and we expect the Government to set out in the response to this report how that commitment will be followed through into action, including the funding required to put it into practice.
A recurring theme in evidence to this inquiry was the complexity caused by fragmentation of both commissioning and provision, as well as the variation in the level of services available to patients. We also heard evidence of the considerable time, energy and money that can be wasted through repeated procurement and tendering processes. We were given examples of how this complexity and variation is having a direct and unacceptable impact on patient care in some areas, for example women being denied cervical screening and having to undergo a separate examination elsewhere for a test that could and should have been completed in a single visit.
Some areas have managed to negotiate their way around the bureaucratic obstacles and work more effectively together. This needs to happen everywhere in order to put patients first, and more should be done to make joint working easier.
Witnesses to this inquiry told us that a new, national strategy is needed for sexual health, to help both providers and commissioners to deliver sexual health services to a high quality and consistent level, in the face of the challenge of fragmented structures.
We recommend that Public Health England should provide clear national leadership in this area. The strategy should set out one clear set of national quality standards for commissioners to adhere to, encompassing all aspects of sexual health.
Recognising the complexity of the provider and commissioner landscape in sexual health, we recommend the establishment of a broad-based working group of representatives drawn from all sectors involved in commissioning and providing sexual health services to help draw up the strategy. This national sexual health working group should include senior representation from PHE, NHS England, local government, CCGs, as well as different provider and patient representative groups.
The working group should bring new impetus to work to drive forward change and improve services for patients, delivering effective, joined up sexual health commissioning. That means both identifying and disseminating best practice, and working supportively but robustly with services where improvement is needed. The national sexual health strategy should set out a clear framework through which local areas will be assessed against the quality standards, with the findings made public both to ensure best practice is widely shared, and to increase public accountability.
Based on the evidence we have received in the course of this inquiry, we identify a number of priority areas which the national strategy must address, including access, the provision of services which meet the needs of vulnerable populations, cervical screening, testing for the full range of sexually transmitted infections, access to long-acting reversible contraception (LARC), access to pre-exposure prophylaxis (PrEP) for those at risk of contracting HIV, and preventative interventions within all aspects of sexual health. We call for immediate action on the provision of cervical screening and the availability of PrEP.
The Government must take a strong line on participation in Relationships and Sex Education (RSE). Public health arguments are overwhelmingly in favour of ensuring that all children have age appropriate RSE. Relationships and sex education should be high quality, delivered by appropriately qualified people, and linked appropriately and usefully to local health priorities and local services.
Fragmented arrangements for the commissioning and provision of services have meant that workforce planning, development and training have suffered. There are very serious concerns about the pipeline of future specialists in sexual health. The Harding review should set out a deliverable plan for the workforce needed to deliver sexual health services across England in the next 10 years. Meanwhile, the national sexual health strategy should include a clear programme of further action to re-establish training and development for both the current and future sexual health workforce at the heart of commissioning and provision arrangements.
Published: 2 June 2019