12.Sexual health services are part of public health services, and therefore funding and commissioning falls within the remit of local authorities’ public health departments, rather than the NHS. However some aspects of sexual health (including, for example, contraceptive services provided by GPs, which is where the majority of women access this type of care) are commissioned differently, by CCGs; and other aspects (such as cervical screening) are subject to still different funding and provision arrangements.
13.An enduring theme in evidence to our inquiry was geographical variation in access to the highest standard of sexual health services. Variation is not an issue which is unique to sexual health, but is a problem shared by many services which are commissioned locally, as highlighted by a number of our previous reports, including Public Health Post-2013, Suicide Prevention, and the First 1000 Days. Local authorities have experienced large budget reductions in recent years; also in common with other services funded by local authorities, sexual health services have therefore faced significant funding cuts - of up to 40% in some areas - in the face of rising demand for their services.
14.Many stakeholders have told us that a new, national strategy is needed for sexual health, to help both providers and commissioners in their attempts to deliver sexual health services to a high quality and consistent level, in the face of the challenges of fragmented structures and reduced funding. The British Association of Sexual Health and the British HIV Association both call for “a new long-term strategy”, with the National AIDS Trust describing the need for ‘a comprehensive strategy for sexual health and HIV that links up stakeholders across the system’. Similarly, the Royal College of Nursing argue that “an updated Strategic Framework, with action and funding behind it and prevention at the core is necessary”. Jim McManus of the Association of Directors of Public Health put a national sexual health strategy as one of his top policy recommendations in oral evidence to us, and the Terrence Higgins Trust add further detail on why this is needed:
What I think we are lacking, and this is a responsibility of Public Health England, is an overarching piece of work around a sexual health strategy for England. The last document came out from the Department of Health was in 2013. It was just for the Department of Health, but what we need is a systems approach with Public Health England having a responsibility to lead, with the Department, clinicians and third sector organisations, so that we have a clear and ambitious sexual health strategy that will respond to some of the issues as to why we are seeing an awful increase in gonorrhoea and syphilis. We have the highest rates of syphilis since 1949, which is shocking. We have to make sure that leadership is provided, because currently we are operating in a bit of a vacuum.
15.We recommend that Public Health England, in collaboration with a broad-based working group of representatives drawn from all sectors involved in commissioning and providing sexual health services, should develop a new sexual health strategy, to provide clear national leadership in this area. The rest of this report—covering funding, commissioning, services, prevention, and the sexual health workforce—sets out the key areas that this strategy should focus on.
21 British Association for Sexual Health and HIV / British HIV Association (); NAT (National AIDS Trust) (); Royal College of Nursing ()
Published: 2 June 2019