1 Introduction
1. Data published in October 2023 by the UK Health Security Agency (UKHSA) on sexually transmitted infections (STIs) and the chlamydia screening programme demonstrate that 2022 saw substantial increases in diagnoses and record levels of some STIs, including gonorrhoea and syphilis.1 Alongside socioeconomic and geographic variations in prevalence, the data revealed a disproportionate prevalence of STIs among young people, including children, some Black ethnic groups and gay, bi-sexual, and other men who have sex with men (GBMSM). Against this backdrop of rising infections, the Local Government Association has warned that sexual health services (SHSs), which have seen substantial funding reductions over recent years, are “grappling with unprecedented increases in demand” and “at breaking point”.2
2. In response to concerns expressed by the LGA, the British Association for Sexual Health and HIV (BASSH) and others, we heard oral evidence, primarily on STI prevalence in young people, from Professor Sir Chris Whitty, Chief Medical Officer for England, Dame Rachel de Souza, Children’s Commissioner for England, and Dr Claire Dewsnap, President of BASSH. We are grateful to them for contributing to our work.
2 Trends in STI infections
Health risks of STIs
3. STIs are not trivial infections, if left untreated common STIs may cause complications and long term health problems.3 Professor Whitty described syphilis as a “very dangerous disease with multiple complications” and, while gonorrhoea does not have “quite the same level of risk”, he told us that it can have serious risks if left untreated, including “pelvic inflammatory disease in women”, which can cause severe illness.4 Dr Dewsnap further explained:
People can die of gonorrhoea. Babies can be born with blindness. People get long-term consequences from heart infections. They can get encephalitis, a brain infection. Syphilis [ … ] is very damaging. If you are born with syphilis, you are likely to go on to have a life of disability [ … ]. There are major consequences and also lots of impacts on pregnancy.5
4. Health risks specific to men include urethral strictures (scarring of the tube that carries urine out of the body, creating risk of infection) and epididymitis (painful swelling at the back of the testicles), and genital malignancies (including penile cancer), proctitis (inflammation of the rectum lining), colitis (inflammation of the large colon), and enteritis (swelling in the small intestine) in men who have sex with men (MSM).6
Overall trends
5. There were 392,453 reported new STIs in 2022 and 4,394,404 consultations at SHSs.7 While these were increases on 2021 levels, to some extent they reflected a return to normal behaviour and delivery of services since the end of Covid-19 restrictions. However, the data revealed large increases in gonorrhoea and syphilis diagnoses which were “in line with the increasing trend over the last decade”. Cases of these STIs exceeded the already high levels reported in 2019, before the pandemic, by 16.1% and 8.1% respectively. The number of new gonorrhoea diagnoses reported in 2022 was the largest in any year since records began in 1918. New syphilis cases were the highest reported since 1948.8
6. Among gay, bisexual, and other men who have sex with men (GBMSM) rates are also increasing of rarer STIs, including an 82% increase in 2022 of lymphogranuloma venereum (LGV), a strain of chlamydia bacteria that effects lymph nodes in the groin, and outbreaks of shigella, an intestinal STI.9
7. There is some good news in the data. In 2022, the rate of first episode genital warts diagnoses among young women aged 15 to 17 years attending SHSs was 67.9% lower than the rate in this age band in 2018—2018 was the first year that all young women aged 15 to 17 years attending SHSs would have been offered the quadrivalent vaccine when aged 12 to 13 years in the National Human papillomavirus (HPV) Vaccination Programme. A decline of 71.5% was seen in heterosexual young men of the same age over the same period, suggesting a combination of substantial herd and direct protection within this age group overall. Declines were also seen in both men and women aged 18 to 20 years and 21 to 24 years. These are all age groups with direct or indirect protection from the quadrivalent HPV vaccine. Professor Whitty explained:
Alongside that, and slightly later in time, we’ll see, and will continue to see, a substantial reduction in women who get cervical cancer, in men who get penile and anal cancers, and some throat cancers. That is an astonishing improvement.10
8. Professor Whitty also reported that the trend in HIV infections was also “broadly good news”, with significant progress made over decades, albeit with some recent “levelling off”.11 Dr Dewsnap emphasised that there had been many “incredible programmes” for gay and bisexual men, with access to PrEP and other highly effective HIV medicines. She noted, however, that the focus on men had created inequality; for example, the 2022 data showed a 26% increase in HIV diagnoses among heterosexual women. She told us:
Women are now really disadvantaged, and not only do they have higher rates of new diagnosis of HIV, but they are also presenting significantly later, meaning we are not testing them early enough. That is really critical and there is massive inequality. You see this both geographically but also socioeconomically and in terms of racially minoritised communities.12
At risk communities
9. Public health data in England show that young people, people of Black Caribbean ethnicity, men who have sex with men and people from socially deprived backgrounds experience poorer sexual health outcomes, with disproportionately high rates of certain STIs. People who live in more densely populated parts of the country are also more at risk.
Young people
10. Young people in the age group 15 to 24 years are the most likely to be diagnosed with the most common types of STI. This may be due to higher rates of sexual partner change among younger people compared to older age groups.13 The substantial increase in overall STI infections in this age group (a 26.5% annual increase, from 129,938 in 2021 to 164,337 in 2022) was largely due to a sharp rise in gonorrhoea diagnoses. The rising trend in gonorrhoea diagnoses was reflected across all age groups in this period but rates almost doubled for 15-to-24-years-olds (a 91.7% increase, from 16,191 to 31,037):14
Figure 1: Number of gonorrhoea diagnoses by age group, 2013 to 2022
Source: Data from routine returns to the GUMCAD STI and CTAD Chlamydia Surveillance Systems. See, UKHSA, ‘Sexually transmitted infections and screening for chlamydia in England: 2022 report’ (October 2023), figure 5. Note 1: Figures reported in 2020 and 2021 are notably lower than previous years due to the disruption to SHSs during the national response to the COVID-19 pandemic.
11. Chlamydia diagnoses in young women aged 15 to 24 years also increased substantially, rising 21.8% from 56,562 in 2021 to 68,882 in 2022. The detection rate per 100,000 population increased by 22.2%, from 1,733 to 2,110 and the rate of positive chlamydia test results rose from 8.1% to 10%. The UKHSA notes that data from the chlamydia screening programme in 2022 reflect a change of approach implemented in June 2021, since when the explicit policy intention has been on “reducing reproductive harm of untreated infection in younger women”. The data for 2022 therefore represent the first full calendar year in which the approach has been a “proactive, opportunistic offer of chlamydia screening [ … ] for young women and other people with a womb or ovaries aged 15 to 24 years only.” The UKHSA states that, “As chlamydia is a largely asymptomatic infection, increases in the number of infections detected and treated is an indication of improved chlamydia control.”15 As we discuss later, the change in approach by the screening programme away from testing both men and women has been subject to criticism.16 In terms of syphilis, Dr Dewsnap noted, “We see more of an increase in the 20-somethings than in younger women, but younger women are still getting it, and that in itself is a relatively new thing.”17
Ethnicity
12. People of Black Caribbean ethnicity have the highest diagnosis rates of chlamydia, gonorrhoea, infectious syphilis, trichomoniasis, and genital herpes. In London, for example, analysis of 2021 data shows that although only 10% of new STIs were in the Black Caribbean ethnic group, it had the highest rate (2,542 per 100,000), which was twice the rate seen in the White ethnic group. Women of Black Caribbean ethnic origin are also more likely to be diagnosed with HIV.18
13. The UKHSA reports that there are “no unique clinical or behavioural factors” to explain the disproportionately high rates of STIs in this group. It notes that the disparities are therefore “likely influenced by underlying socio-economic factors and the role they play in the structural determinants of the health of this community.”19
Figure 2: Rates of selected STI diagnoses among England residents accessing sexual health services by ethnicity and STI, 2022
Source: Data from routine sexual health services’ returns to the GUMCAD STI Surveillance System. See, UKHSA, ‘Sexually transmitted infections and screening for chlamydia in England: 2022 report’ (October 2023), figure 3. Note 1: Primary, secondary, and early latent stages. Note 2: First episode.
Gay, bisexual and other men who have sex with men
14. The third group with greater needs is gay, bisexual, and other men who have sex with men (GBMSM). The UKHSA notes that bacterial STI diagnoses in this group were increasing between 2013 and 2019 before falling in 2020. This was followed by increases in 2021 and 2022: including a 41.3% increase in gonorrhoea diagnoses, from 27,545 in 2021 to 38,923 in 2022; chlamydia increased by 25.3%, from 15,267 to 19,129; and infectious syphilis increased 12.9%, from 5,316 to 6,003. The UKHSA reports that these increases are “in keeping with the recovery of sexual health service provision and increased STI testing”, and that evidence of a “rebound in sexual mixing among GBMSM” was “likely to have contributed to the rise in STIs within this population in 2022.”20 As noted above, there were also significant rises in reported cases of rarer STIs, such as LGV and shigella. Dr Dewsnap observed that more frequent testing may also play a role in increased diagnoses within this group:
One of the caveats with the rates of gonorrhoea in GBMSM going up is that, because a lot of those groups are on PrEP, they are actually doing more frequent testing. We are also testing pharyngeal samples, which we did not routinely always do. Basically, we are doing a lot more throat samples and you can carry gonorrhoea in the throat. We are probably picking up more infections than we did before because we are doing more testing and we are testing different sites.21
Regional analysis
15. Local Government Association analysis of Office of Health Improvement and Disparities’ (OHID) data on gonorrhoea, syphilis, and chlamydia diagnoses by local authority in England and Wales found that since 2017 almost all councils (97%) had seen an increase in the diagnosis rate for gonorrhoea—the rate had tripled in 10 local authority areas; 71% had seen the syphilis rate increase; and the chlamydia rate had risen in more than a third (36%) of areas.22
16. There were substantial geographical variations in the data. In general, areas of dense populations mean more sexual partners and higher rates of infection. The top ten rates of gonorrhoea diagnoses by local authority area were all in inner London boroughs.23 In March last year, the UKHSA published analysis of 2021 data on STIs in London. It showed that London’s diagnosis rate (1,127 per 100,000 population) was double that of England (551). Around a third of new STIs in England were in London. There were very substantial variations within London with rates ranging from 393 in suburban Sutton to 2,980 in the inner London borough of Lambeth. The highest rates by gender and age group were among young women and men aged 20 to 24 years. Rates were also high in men aged 25 to 34 and girls and young women aged 15 to 19 years.24
17. While STI rates remain highest in London, they were rising faster in some other places. The greatest increases in rates of gonorrhoea in 2022 were in Wigan, Dorset, Somerset, Devon, and Torbay. Middlesbrough, the Isle of Wight, Darlington, and Redcar and Cleveland saw the greatest increases of syphilis diagnosis rates.25
Figure 3: New STI diagnosis rates by UKHSA region of residence, England, 2021
Source: GUMCAD (previously known as Genitourinary Medicine Clinic Activity Dataset) STI surveillance system, CTAD. See, UKHSA, ‘Spotlight on sexually transmitted infections in London: 2021 data’ (March 2023), figure 1, accessed 8 February 2024
Figure 4: Rates of new STIs per 100,000 residents by age group (for those aged 15 to 64 years only) and gender in London, 2021
Source: GUMCAD, CTAD. See, UKHSA, ‘Spotlight on sexually transmitted infections in London: 2021 data’ (March 2023), figure 1, accessed 8 February 2024
3 Screening and treatment
Pressures on sexual health services
18. Demand for sexual health services has grown since local authorities assumed responsibility for SHSs in 2013. Around 4.5 million consultations were carried out in 2022, a third more than in 2013; 2.2 million diagnostic tests were also carried out, an annual increase of 13%.26 Professor Whitty outlined the importance of seeking treatment:
First, it stops or substantially reduces the chances of going on to get genital complications or fertility issues. There might be general complications—for example, syphilis can cause very serious disease. Secondly, it protects. If someone is treated early, it protects their partner but also other people they may have sexual relationships with and the wider community. So it is really important that people are treated—ideally, they do not get infections in the first place, but if they do—to stop onward transmission.27
19. While demand has increased substantially, funding for local authority-commissioned SHSs has reduced. Between 2015 and 2024, the central government public health grant, via which SHSs are funded, reduced by £880 million.28 In 2019, the Local Government Association described sexual health services as “at a tipping point.”29 The LGA argued:
Unless greater recognition and funding is given to councils to invest in prevention services, a reversal in the encouraging and continuing fall in some STIs is now a real risk.30
Since the LGA’s warning in 2019, funding for SHSs has reduced further while rates of STIs such as gonorrhoea and syphilis have reached troubling levels. While not wishing to get drawn into a debate on funding, Professor Whitty told us, “the resources have gone down in this area—that is a statement of fact—and rates have gone up.”31
20. The Local Government Association has modernised its approach to public health, with the use of online consultations, use of apps, and home testing. However, it has warned that the “capacity of councils to further innovate and create greater efficiencies is now limited.”32 Dr Dewsnap told us, “I do not like to use the word ‘crisis’, [but] we are very close to a crisis.” She emphasised that pressures on SHSs had substantially affected staffing capacities and the ability of services to offer face-to-face consultations. A recent mystery shopper exercise conducted by the Terrence Higgins Trust found that young people (aged 16 to 24) faced the most difficulties in accessing sexual healthcare.33 It also found that only 50% of SHSs were able to offer consultations face-to-face when contacted and not all offered postal STI testing.34
21. Dr Dewsnap and the Children’s Commissioner for England, Dame Rachel de Souza, were particularly concerned about the effects of the lack of appointments on children and young people and the trend towards directing people to online testing. Dr Dewsnap told us:
[ … ] there is a lot of evidence showing that young people have more difficulty accessing online testing, not least because, for example, if you order an online test, it has to come to your home address, most of the time. If you do not want a parent to know that you are testing, or someone you are living with—for example, someone you are already in a relationship with—you would not want the test to come to your home address.35
Dr Dewsnap also noted “digital disparities”, with younger people from socio-economically deprived groups and in rural areas who seek support being less able to access it, both in person and online. She emphasised that:
What needs to be remembered is that online tests are great, and we want more people to have them, but that cannot be at the expense of a face-to-face service, because young people will always lose out.36
The last thing I would say, and this worries me a lot, is that only 50% of young people online identified as safeguarding risks are eventually able to be contacted. So if you go online as a young person and put something in your screening questionnaire that says, “I am a safeguarding risk,” there is only a 50% chance you will ever be contacted about that safeguarding risk. That is extremely worrying.37
22. Dame Rachel de Souza also observed that access to SHSs for children had declined substantially over the last decade:
One of the ways we were so successful in the past in these areas was that children could just walk in. Often, they would be signposted by a school nurse, who was a trusted adult in the school and would send them off for a test. We now have 35% fewer school nurses than 10 years ago, and you cannot just walk in. Children are telling me all the time that they are not able to get access, they are not able to get appointments.38
23. Dame Rachel told us she was “deeply worried” that the children most in need of face-to-face support, including children with disabilities and SEND, asylum-seeking children, and those from certain minority ethnic groups, were least able to access it.39 She explained, “Children do not access services in the same way as adults. They are not going to sit and wait and take something two weeks later. They need instant access; that is what does it.”40 The mystery shopper exercise conducted by the Terrence Higgins Trust found that very few SHSs (11%) offered drop in services that were available to everyone, while waiting times for face-to-face appointments booked by telephone averaged 13 days, or 19 days in rural parts of England in those SHSs that offered them.41
24. There is widespread smartphone use among young people yet the mystery shopper exercise found that in England just 1 in 10 clinics had appointments that could be booked online, while no clinics in Wales offered online booking.42 The Terrence Higgins Trust has called for the Government to commit “to a 48-hour target for access to sexual health appointments, year-round access to free postal STI testing, and for appointments to be booked quickly and easily via an NHS app.”43
25. In the absence of access to sexual health services young people are likely to turn to online sources of information, particularly on social media.44 This risks young people accessing substandard services. Research undertaken by the London School of Hygiene & Tropical Medicine (LSHTM), UK Health Security Agency (UKHSA) and University of Bristol, found that few UK online sexually transmitted infection test services met national recommended standards, with independent sector providers the least likely to be compliant.45 We note that BASHH has previously expressed concern that testing and treatment practice that deviates from national clinical guidelines contributes to the rising problem of antimicrobial resistance.46
26. Challenges in accessing SHSs are being felt in secondary care. NHS Digital data show that hospital admissions for chlamydia have increased from 167 in 2013–14 to 300 in 2022–23, admissions for gonorrhoea have tripled from 96 to 297, while those for syphilis have increased from 325 to 540. Dr Dewsnap told the Guardian:
The fact is that it is quite ineffective to be spending money on treating people who have had to be admitted to hospital because they’ve got gonorrhoea joint infections when they could have got into their service really cheaply and treated really quickly.47
27. We note that in 2019 our colleagues on the Health and Social Care Committee concluded:
Sexual health must be sufficiently funded to deliver high quality sexual health services. Cuts to spending on sexual health, as with other areas of public health expenditure, are a false economy [ … ] the Government must ensure sexual health funding is increased to levels which do not jeopardise people’s sexual health. Inadequate prevention and early intervention increase overall costs to the NHS.48
28. UK Health Security Agency data on sexually transmitted infections (STIs) in 2022 are deeply concerning. For particular STIs they show a return to, and acceleration of, pre-Covid-19 trends of rising rates of new infections. Rates of gonorrhoea, which almost doubled among people aged 15 to 24 years, were the highest since records began in 1918. Syphilis cases reached a peak not seen since 1948. Both infections carry substantial risks of severe illness for individuals and to public health. The data should be a wake-up call to the Government, local authorities, sexual health services, reproductive health professionals and others in the NHS, and those delivering Relationships, Sex and Health Education in schools.
29. The public health grant to local authorities for the commissioning of sexual health services (SHSs) has been reduced substantially during a period of increasing demand. This is not sustainable and an obvious false economy. It has left many SHSs unable to maintain sufficient staff to provide an adequate level of service. It is unacceptable that around half of SHSs have been unable to offer face-to-face consultations when contacted. This has equality impacts, for young people who need face-to-face advice and support from trusted adults, but also for other groups likely to struggle to access support online.
30. The Government must radically increase the public health grant to local authorities to a level that allows sexual health services to operate effectively and meet local need. This must include the provision of face-to-face consultations to those who need them, within 48 hours, and universal access to free postal STI testing. Booking appointments and access to online testing should be made available via smartphone app.
31. Online providers of STI tests and treatment should be accredited by the relevant regulatory body, and regularly monitored on their performance against national clinical guidelines. In response to this Report, the Government should set out the steps it will take to ensure that all children who identify online as a safeguarding risk receive the support they need.
Fragmentation of services
32. In addition to the funding pressures discussed above, Dr Dewsnap explained that fragmentation across the broader health system was a barrier to delivery of effective services. She gave the example of abortion rates and advice on contraception:
[ … ] Sexual health services and most contraception are commissioned by local authorities. Women’s termination care and gynae services are commissioned by the CCG, and now the ICBs, and other bits of care are commissioned by NHS England, but those bits of the system are not currently speaking to each other, which is quite worrying.49
Dr Dewsnap also observed that people with shigella tended to present at hospitals rather than SHSs. She emphasised that these infections were consequently not recorded in the data, and that:
If people do not present to us and are not referred directly to a sexual health service, we would not necessarily be aware that they have had the infection. Importantly, we cannot then implement prevention messages for the future. They are often just identified as an infection, treated [in hospital], and then it is, “On your way,” whereas we would implement other practices like talking to them about safe sex and perhaps advising more condom sex, giving them a way into PrEP, HIV testing and generally education around regular testing for STIs. That is an important part of what we do to prevent other infections.50
33. There are signs that some of the problems caused by fragmentation identified by Dr Dewsnap are being addressed. For example, the LGA report that in Derbyshire, local government, the NHS and voluntary sector organisations have set up a partnership to encourage innovation and new ways of working in sexual health and to help tackle some of the problems caused by the fragmentation of the system. Part of that work includes “looking at cross-system support for the under 25s responding to the change in guidance for chlamydia screening and a teenage pregnancy partnership with relationships and sex education as a key focus for action”.51
34. Our attention was also drawn to inefficiencies arising from local tendering processes, which have become a requirement following the move of responsibility for SHSs from the NHS to local authorities. Dr Dewsnap told us:
Every time a service is tendered, we lose experienced nurses and doctors and support workers, and we have to then retrain. We effectively go back in our effectiveness and productivity for 18 months while we retrain. Then, two years later, we go back out to tender again. We are constantly having to retrain staff, and these are not skills that you learn overnight.52
35. Competition for contracts can lead to improved service provision, however repeated tendering and short-term contracts can also be destabilising and lead to the loss of experienced workers. The Government should make an assessment of the effect of repeated tendering of sexual health services on the adequacy of local SHS provision and its impact on the sexual health workforce. As part of that assessment the Government should consider whether public health grant settlements over a longer term would better support strategic service delivery.
36. The provision of sexual health services is fragmented across the health system and can be complex to navigate. The Government should work with providers and commissioners to improve collaboration across reproductive and sexual healthcare to ensure effective cross-system support for young people and other groups at greatest risk of contracting an STI. These measures should be underpinned by a wider national strategy on sexual health.
Antibiotic resistance
37. Treatment of some STIs, particularly gonorrhoea, is becoming much more challenging because of increasing resistance to antibiotics.53 Professor Whitty described gonorrhoea as “one of the most highly drug-resistant organisms we have”, with very few effective antibiotics now available. He told us that in relation to gonorrhoea “we are in deep trouble at the moment, and we need some new antibiotics or some new way of approaching it.”54 Dr Dewsnap observed that resistance is seen in people of Black African or Black Caribbean ethnic origin, young people and MSM, “So the three groups that we are most worried about being able to tackle infections in are more likely to have drug resistance on board.”55
38. Dr Dewsnap noted that shigella—which is transmitted via a variety of routes, not just sexually—was also “multi-drug resistant” and could be problematic if it took hold in a particular community; and that mycoplasma genitalia, an infection affecting the urinary and genital tracts of men and women, had “very high rates of antibiotic resistance”.56 She reported that SHSs were finding it “very difficult to access resistance testing for mycoplasma genitalia”. In her view:
The system itself is not set up as well as it could be for us to monitor that resistance and to act appropriately. We also need research trials to develop new drugs, because we are on our last antibiotic for gonorrhoea, and if it suddenly starts becoming more resistant to that antibiotic, we are going to have a real problem.57
Dr Dewsnap also drew attention to the potential for DoxyPEP, an antibiotic taken after sex, to reduce chlamydia and syphilis infections. DoxyPEP is available in some parts of the US but is not yet available under prescription in the UK.
39. It is worrying that we are seeing antibiotic resistance to some STIs—particularly gonorrhoea, where the rate of diagnoses has reached record levels, and for which young people and other communities at greatest risk are most likely to experience drug resistance. In response to this Report the Government should set out the steps it is taking to develop new antibiotics for the treatment of gonorrhoea, shigella and mycoplasma genitalia, and other relevant STIs, including the level of funding it is providing to support that research.
4 Prevention
Condoms
40. The UKHSA lists the main preventative steps people should take to ensure safer sex and sets out a range of support available from SHSs and the NHS and how to access it. It emphasises that consistent and correct use of condoms protects against STIs and HIV, as well as preventing unplanned pregnancies. However, condom use is falling, due to a range of factors including cost, personal choice and a lack of awareness of their benefits. Dame Rachel de Souza explained:
if you are learning about sex from TikTok and you are watching porn, nobody uses a condom. Young people are getting inaccurate information from unreliable sources rather than from where they should be getting it, which is really excellent RSE teaching.58
Dr Dewsnap observed that “condoms used to be a really key part of our prevention mechanisms, but condom budgets have gone down [ … ] Obviously, condoms are not super-cheap, especially for young people who do not have much disposable cash.”59 Dr Dewsnap explained that SHSs were rationing the provision of condoms due to funding restraints. In Professor Whitty’s view there was a “need to go back to re-promoting condom use, making sure that is available to people via multiple routes.”60
41. We note that a 2022 study explored whether there was a “missed opportunity” in promoting condom use when young people obtain STI self-testing kits online.61 Researchers at the University of Hertfordshire worked with young people in England to develop the website ‘Wrapped’ to which people were directed once they ordered an STI testing kit online. Wrapped asked users to identify their main barriers to condom use and offered them six options, including a condom sample pack, access to a free monthly condom ordering service, a free condom carrier, a condom demonstration video, videos of young people giving tips on communicating about condoms, and videos of real couples discussing and using condoms. Following randomised control trials, a March 2023 update reported that “the intervention was acceptable to young people and reportedly changed their condom related beliefs and behaviours.”62
42. We note also that in September 2021 a South East England remote sexual health testing service began providing condom kits to those over 25 who had requested STI screening. A separate scheme ran for those aged 16 to 24 who could request condoms directly.63 An analysis of orders by Preventx, the UK’s largest provider of STI screening, found that 83.6% of orders were from heterosexual people, with women requesting 65.4%. 25% of orders were placed by those in the two most deprived populations. Focusing on chlamydia positivity rates, it found that the rate among those who requested condoms was lower than those who did not (4.71% versus 5.38%).
43. Condomless sex is a key risk factor for STI acquisition, and changes in condom use have been widely reported. The Government must increase its promotion of the benefits of condom use, using a tailored approach to those groups at greatest risk of STI infection. There are innovative approaches being used to promote uptake in condom use such as the inclusion of condoms with STI testing kits. The Government should review the effectiveness of these schemes and consider the merits of supporting their rollout nationally.
Public health campaigns and stigma
44. Most public health campaigning is now done at a local level and through schools. The most recent national campaign on STIs was Public Health England’s 2017 campaign ‘Protect against STIs’, a campaign that aimed to reduce the rates of sexually transmitted infections (STIs) among 16 to 24-year-olds through condom usage. Professor Whitty explained, “There is still a place for national services, but the great majority of the information is done locally, except when there is a major thing like, for example, when the Mpox outbreak happened, and that will be led nationally.”64 He emphasised the importance for any campaign or messaging to avoid stigmatising those at risk of infection. He told us:
These are very common diseases. They spread around very easily. Lots of people get them who have incredibly conventional sexual and romantic lives, and this should simply be seen as one of the routes of transmission, just like oral or respiratory, by which people can get potentially very serious infections.65
[ … ] if you make it sound as if STIs are always things that happen to other people, then don’t be surprised if people aren’t worried about them, don’t take precautions, and don’t recognise them when they occur. You have to make people understand this can happen to anybody. It is a normal thing that can happen to anybody.66
45. We asked the witnesses whether the record levels of certain STIs merited a new national campaign. Professor Whitty agreed that a campaign to target young people was necessary but cautioned against a national approach because the drivers of the increases “are very different in different communities.” He argued that a national approach would likely miss the key groups; instead “we need [ … ] to work out how we get to the communities who are the biggest risk, and target messages to those”67. In Dr Dewsnap’s view this meant “co-produced, person-designed messages”68 and delivered in spaces where young people spend their time such as TikTok. She told us “we want young black women to be designing the messages they want. We want young gay men to be designing the messages they want. We want all young people engaged in sex and relationships education to be designing the messages.”69 Professor Whitty agreed, “To think a single set of messages is going to work for all the communities is clearly incorrect, and schools have a huge part to play.”70
46. The Government should make funding available for public awareness campaigns focused on STI prevention among young people and other groups at high risk of infection in areas with the highest rates of sexually transmitted infections and where rates of diagnosis are rising fastest. The campaigns should be co-designed by those communities, should normalise discussion of sexual behaviour and be promoted in the online spaces where young people are currently turning to for advice.
Relationships and Sex Education
47. In 2021, the Department for Education published evidence following a study of young people’s views on RSE and patterns of sexual risk-taking in England. This was the second study of this type and reflects attitudes in 2018. It found that:
- “Young people who did not receive any RSE in schools were more likely to go on to take more sexual risks, including intercourse before the legal age of consent, unprotected sex and contraction of a sexually transmitted infection (STI).
- Just under half of young people described the RSE they received at school as either ‘fairly useful’ or ‘very useful’. However, nearly 1 in 5 young people described the RSE received in school as ‘not at all useful’.
- Young people of minority sexual orientations (gay, lesbian, bisexual or other), those with disabilities, and those who participated in other risky behaviours were significantly more likely to say that their school RSE was ‘not at all useful’.
- One in 10 free school meal-eligible young people did not learn about STIs, consent, LGBT relationships or relationships in general in their school RSE. This is higher than for young people who were not eligible for free school meals (nearly one in 20).”71
48. In 2020, relationship and sex education became mandatory in schools. The statutory guidance for schools, published by the Department for Education (DfE) in June 2019, requires that students at secondary level learn about:
- the prevalence of some STIs and the impact they can have on those who acquire them
- how the different STIs, including HIV and AIDs, are transmitted
- how risk can be reduced through safer sex (including through condom use)
- the importance of and facts about testing and treatment
- how to get further advice, including how and where to access confidential sexual and reproductive health advice and treatment.72
A 2022 survey by the Sex Education Forum found that RSE lessons were being inconsistently delivered, often with few opportunities for pupils to ask questions or influence the lessons. Of the 1,002 young people aged 16 to 17 in England who were surveyed, one in three (33%) said they didn’t learn about how to access local sexual health services.73
49. Dame Rachel de Souza told us she was concerned about the quality and relevance of children’s relationships and sex education. She reported results from a survey conducted by the Office of the Children’s Commissioner in 2022 that found that “only 55% of children said they had learned about relationships” at school. She told us that these children:
[ … ] were all worried that they had not learned enough about adult sexual relationships, enough about STIs, and they were also worried about unplanned teenage pregnancies. Many of them said their PSHE teaching at school was so poor that they learned most of it online.74
50. Dame Rachel described both the provision of education on contraception and contraception itself, in terms of free condoms, as “a postcode lottery”. She explained that among children “there was an absolute desire for better advice”.75 We heard that the more comprehensive sex and relationships education [SRE] children receive the later their sexual debut is.76 Dr Dewsnap explained that “there is prevention in delivering SRE at the right age and there is no wrong age to be delivering the right age sex education.”77 Professor Whitty emphasised the importance of also educating parents in this space,
In the context of schools, the second thing we need to do is help parents to see sexually transmitted infection information not as something which is a threat, and which will make it more likely their children and their peers will behave in ways they do not want them to, but rather as a safeguard against them being exploited by people who are not caring for them, and it is an opportunity really to talk things through. We really need to make that positive case for people who are understandably nervous on this.78
51. Asked why the quality of RSHE was so variable, Dame Rachel suggested that Ofsted needed to take it seriously for headteachers to do so.
Over the last seven years, the last Ofsted chief did an in-depth curriculum review, a deep evaluation with recommendations for every single subject, but not RSE. [ … ] It is almost as if there was no consideration that RSE has domain-specific knowledge that children need to learn, like about STIs. It is often seen as a discussion class.79
She added:
the subject has not been prioritised or taught as well as it could be, partly because of accountability issues, partly because of what you are judged on as a headteacher, partly because of curriculum crowding—am I going to have a history teacher or a PSHE teacher?—and partly because of a nervousness about teaching it.80
52. Dame Rachel explained that students wanted to be able to approach trusted adults with queries and that school nurses were a “godsend” in this area but “there has been a 35% drop in school nurses over the last 10 years. It is a real tragedy; they are gold dust. Anything we could do about increasing the number of school nurses would be amazing.”81
53. We asked witnesses whether there was merit in extending the teaching of RSE to 18. They all agreed. Dr Dewsnap told us “It should definitely go on to 18. Also, the variation in people maturing is so huge [ … ]. Some kids will not be receptive at 15.”82 In our 2023 report on Attitudes to women and girls in educational settings we recommended that RSE be extended to 18.83 The Government replied that it was “considering this recommendation.”84
54. There is compelling evidence that Relationships and Sex Education (RSE) in schools is inadequate, including in relation to contraception and sexually transmitted infections (STIs), with nearly half of children saying education in this area is so poor they rely on finding information for themselves online. This exposes children to an unacceptable risk of harm. The 2022 data on STIs are a red flag and should encourage everyone to do better.
55. The Government, Oak National Academy—the public body established in 2020 to provide teachers with online lesson plans and other resources—headteachers and Ofsted must place greater priority on RSE and ensuring it delivers the information and guidance that children need. The Government also needs to do more to make the positive case for sex education in schools, to help parents to see that sexually transmitted infection information is a safeguard rather than a threat.
56. The Government should work with the NHS and Oak National Academy to improve the teaching of sex education, and the materials available to support it, to ensure it provides an effective response to the troubling increases in the prevalence of STIs among young people. The benefits of condom use should be a key part of the curriculum. As we have previously recommended, RSE should be taught up to the age of 18.
57. School nurses are a valuable resource. They are a trusted adult who children can turn to, they can pick up on safeguarding concerns, and trends in problems such as STI prevalence in a community. They can also direct children to sexual health services, reducing potential demand on hospital services and risks to long term health. In response to this Report the Government should set out plans to reverse the recent substantial and damaging reductions in the number of school nurses.
Vaccination
58. Human papillomavirus (HPV) increases the risk of developing some cancers later in life including cervical cancer, mouth and throat cancer and some cancers of the anus and genital areas.85 Vaccination against HPV has been offered to all girls in school year 8 since September 2008 and to all boys since September 2019. Since the start of the vaccination programme in the UK, there has been a big decline in HPV infections and in the number of young people with genital warts. Professor Whitty explained that the vaccine was “extraordinarily effective”:
We know that if all girls, and now boys, are vaccinated at a young enough age—around the age of 12 or 13—then 97-ish per cent will be individually protected, and at a population level this will probably be just shy of 90%. They protect one another by the fact that both sexes are included, and this will, in due course, get rid of almost all the herpes-driven cancers that go this way, which are principally cervical cancer but a number of others, and genital warts. HPV vaccination is the most important one we really must get on top of.86
59. Delivery of the HPV vaccine was affected by the Covid-19 pandemic and while take-up is increasing in most regions it remains significantly below 2019 levels. In 2022–23, 71.3% of year 8 females received dose 1 of the vaccine, 16.7% lower than the pre-pandemic coverage. Professor Whitty told us:
We need to work hard to get that back up again because we have the potential to almost eliminate cervical cancer in this country. It would be tragic to let that slip through our fingers because of operational problems or because people have concerns. We really need to make clear that this is an incredibly effective vaccine against a very unpleasant set of diseases—not just one disease—and with a very good side effect profile. It is something that any girl and boy should be encouraged to take up.87
Figure 5: Dose 1 HPV vaccine coverage by NHS commissioning region for the routine female cohort (year 8) academic year 2018 to 2019 up to academic year 2022 to 2023 in England88
Figure 6: Dose 1 HPV vaccine coverage by NHS commissioning region for the routine male cohort (year 8) academic year 2019 to 2020 up to academic year 2022 to 2023 in England89
60. Dr Dewsnap reported that SHSs would like to be able to provide catch up vaccination to those who had missed out or who had arrived in the UK from countries without an HPV vaccination programme but that they were not able to provide that service:
We are currently only commissioned to deliver the vaccine for MSM, and we have been doing that for five or six years. [ … ] We see many women who have missed out on the vaccine, and we cannot give it to them. If you could change that, it would be a really great thing we could do.90
Although not as effective when administered in later years, the vaccine still offers a degree of protection against HPV, additionally, Dr Dewsnap explained, there is early evidence coming out showing that vaccination may effectively treat people who have already acquired HPV.91
61. We asked Professor Whitty about the development of other vaccines. He told us a gonorrhoea-specific vaccine is being trialled at the moment and for other STIs “there are lots of things in research stages, but [ … ] I would say we are five to 10 years away from widespread deployments. Gonorrhoea is the one where the biggest potential for vaccination lies in the short term.”92
62. The HPV vaccine is a remarkable step forwards in preventing HPV infection and the serious consequences that can result from it. It is a tragedy that not all children are receiving this vaccine. The Government must step up its efforts to increase take up of the HPV vaccine, including as a first step, by targeting the cohort of children who may have missed out on vaccination during the Covid-19 pandemic. Given the significant proportion of children who have not received the vaccine and the potential benefits the vaccine can have in treating HPV, we recommend that sexual health services be able to deliver the vaccine to all those who would benefit from receiving it.
National Chlamydia Screening Programme
63. Since 2021, the National Chlamydia Screening Programme has provided screening to sexually active young women aged 15 to 24 years. Previously, it was recommended that all sexually active men and women aged 15 to 24 be tested for chlamydia annually or on change of sexual partner (whichever is more frequent). The changes were framed as a strategic re-focus, from preventing transmission of chlamydia and early detection, to reducing the reproductive harm of untreated infection in young women.93
64. The Royal College of Obstetricians and Gynaecologists (RCOG) and the Faculty of Sexual and Reproductive Healthcare (FSRH) were both critical of the change in approach, arguing that it risked shifting responsibility away from men and could bias public perception that chlamydia is a sexually transmitted infection primarily affecting and transmitted by women.94 Echoing those comments, the Terrence Higgins Trust has since called for the return to proactive screening of all young people. It argues:
Given 70% of women and 50% of men with chlamydia show no symptoms, opportunistic screening of all young adults is an essential approach to early diagnosis and preventing onward transmission. The new approach to NCSP does not seem to have increased the number of chlamydia tests carried out among young women: last year there was a small decrease compared to 2021. Emphasis on preventing pelvic inflammatory disease and infertility that results from some untreated chlamydia infections is important, but only testing women and girls is not the answer.95
65. In light of the increases in chlamydia diagnoses, the Government should review whether the shift in focus of the National Chlamydia Screening Programme to restricting the offer of opportunistic screening to young women has been effective.
A new strategy
66. Some of the concerns we have outlined in this Report, for example around improving collaboration across the multiple agencies responsible for delivering sexual health services, could be addressed by a new national strategy on sexual health. Dr Dewsnap told us that sexual healthcare needed to be “underpinned” by a new strategy. She explained:
If we are in a setting of tight resources, you have to make decisions about what you are going to spend money on and that can only really come from a strategy. We are not expecting you to suddenly lavish us with all the funds that we would ever need, but we do need more funding, and we actually need a strategy that decides where we are going to put our resources.96
67. Professor Whitty was “very sympathetic” to the idea of a new sexual health strategy because “a lot of things have changed” over the last decade. He therefore supported a “proper rethink” about sexual health. He noted that, despite it having a respiratory rather than sexual route for transmission, there had been important learnings from the handling of the Covid-19 pandemic. Lessons could also be taken from the approach to the Mpox outbreak in 2022.97
68. Professor Whitty reiterated that the data suggested parts of the system were effective and argued that the development of a new strategy must “not throw out stuff that’s good.” He believed that part of the strategy should involve “doubling down on what we are doing well”, for example through the rollout of new HIV medicines and ensuring effective delivery of the HPV vaccination. While he believed it would be important to innovate in areas such as developing new vaccines and antibiotics, there was also a need to “go back” to some of the straightforward prevention messages, for example around condom use.98
69. In response to the Health and Social Care Committee’s 2019 report on Sexual Health, the Government pledged to bring forward a sexual and reproductive health strategy. It told that Committee:
We agree with the recommendation and the development of an updated sexual and reproductive health strategy will be led by the Department for Health and Social Care (DHSC) working in partnership with Public Health England (PHE), NHS England and Improvement (NHS E&I), local government and other partners. [ … ]
Our priority for an updated strategy is to work with all partners to achieve our ambition that sexual and reproductive health services are more holistic and that system mechanisms support co-commissioning and joined up patient pathways.99
The Government has yet to publish such a strategy.
70. The Government must ensure that the sexual healthcare system works more efficiently and effectively to arrest and reverse the trend in sexually transmitted infections. This will require longer term work to carefully consider how the different parts of the system can work together to achieve this. The Government should work with the British Association for Sexual Health and HIV, the Faculty of Sexual and Reproductive Health, NHS leaders, the Local Government Association and education bodies to develop the coherent, cross-sector strategy on sexual health it committed to in 2019. It is unacceptable that five years on, no progress has been made. Young people are at the start of their sexual journey. Such a strategy should begin by meeting their needs.
Conclusions and recommendations
Screening and Treatment
1. UK Health Security Agency data on sexually transmitted infections (STIs) in 2022 are deeply concerning. For particular STIs they show a return to, and acceleration of, pre-Covid-19 trends of rising rates of new infections. Rates of gonorrhoea, which almost doubled among people aged 15 to 24 years, were the highest since records began in 1918. Syphilis cases reached a peak not seen since 1948. Both infections carry substantial risks of severe illness for individuals and to public health. The data should be a wake-up call to the Government, local authorities, sexual health services, reproductive health professionals and others in the NHS, and those delivering Relationships, Sex and Health Education in schools. (Paragraph 28)
2. The public health grant to local authorities for the commissioning of sexual health services (SHSs) has been reduced substantially during a period of increasing demand. This is not sustainable and an obvious false economy. It has left many SHSs unable to maintain sufficient staff to provide an adequate level of service. It is unacceptable that around half of SHSs have been unable to offer face-to-face consultations when contacted. This has equality impacts, for young people who need face-to-face advice and support from trusted adults, but also for other groups likely to struggle to access support online. (Paragraph 29)
3. The Government must radically increase the public health grant to local authorities to a level that allows sexual health services to operate effectively and meet local need. This must include the provision of face-to-face consultations to those who need them, within 48 hours, and universal access to free postal STI testing. Booking appointments and access to online testing should be made available via smartphone app. (Paragraph 30)
4. Online providers of STI tests and treatment should be accredited by the relevant regulatory body, and regularly monitored on their performance against national clinical guidelines. In response to this Report, the Government should set out the steps it will take to ensure that all children who identify online as a safeguarding risk receive the support they need. (Paragraph 31)
5. Competition for contracts can lead to improved service provision, however repeated tendering and short-term contracts can also be destabilising and lead to the loss of experienced workers. The Government should make an assessment of the effect of repeated tendering of sexual health services on the adequacy of local SHS provision and its impact on the sexual health workforce. As part of that assessment the Government should consider whether public health grant settlements over a longer term would better support strategic service delivery. (Paragraph 35)
6. The provision of sexual health services is fragmented across the health system and can be complex to navigate. The Government should work with providers and commissioners to improve collaboration across reproductive and sexual healthcare to ensure effective cross-system support for young people and other groups at greatest risk of contracting an STI. These measures should be underpinned by a wider national strategy on sexual health. (Paragraph 36)
7. It is worrying that we are seeing antibiotic resistance to some STIs—particularly gonorrhoea, where the rate of diagnoses has reached record levels, and for which young people and other communities at greatest risk are most likely to experience drug resistance. In response to this Report the Government should set out the steps it is taking to develop new antibiotics for the treatment of gonorrhoea, shigella and mycoplasma genitalia, and other relevant STIs, including the level of funding it is providing to support that research. (Paragraph 39)
Prevention
8. Condomless sex is a key risk factor for STI acquisition, and changes in condom use have been widely reported. The Government must increase its promotion of the benefits of condom use, using a tailored approach to those groups at greatest risk of STI infection. There are innovative approaches being used to promote uptake in condom use such as the inclusion of condoms with STI testing kits. The Government should review the effectiveness of these schemes and consider the merits of supporting their rollout nationally. (Paragraph 43)
9. The Government should make funding available for public awareness campaigns focused on STI prevention among young people and other groups at high risk of infection in areas with the highest rates of sexually transmitted infections and where rates of diagnosis are rising fastest. The campaigns should be co-designed by those communities, should normalise discussion of sexual behaviour and be promoted in the online spaces where young people are currently turning to for advice. (Paragraph 46)
10. There is compelling evidence that Relationships and Sex Education (RSE) in schools is inadequate, including in relation to contraception and sexually transmitted infections (STIs), with nearly half of children saying education in this area is so poor they rely on finding information for themselves online. This exposes children to an unacceptable risk of harm. The 2022 data on STIs are a red flag and should encourage everyone to do better. (Paragraph 54)
11. The Government, Oak National Academy—the public body established in 2020 to provide teachers with online lesson plans and other resources—headteachers and Ofsted must place greater priority on RSE and ensuring it delivers the information and guidance that children need. The Government also needs to do more to make the positive case for sex education in schools, to help parents to see that sexually transmitted infection information is a safeguard rather than a threat. (Paragraph 55)
12. The Government should work with the NHS and Oak National Academy to improve the teaching of sex education, and the materials available to support it, to ensure it provides an effective response to the troubling increases in the prevalence of STIs among young people. The benefits of condom use should be a key part of the curriculum. As we have previously recommended, RSE should be taught up to the age of 18. (Paragraph 56)
13. School nurses are a valuable resource. They are a trusted adult who children can turn to, they can pick up on safeguarding concerns, and trends in problems such as STI prevalence in a community. They can also direct children to sexual health services, reducing potential demand on hospital services and risks to long term health. In response to this Report the Government should set out plans to reverse the recent substantial and damaging reductions in the number of school nurses. (Paragraph 57)
14. The HPV vaccine is a remarkable step forwards in preventing HPV infection and the serious consequences that can result from it. It is a tragedy that not all children are receiving this vaccine. The Government must step up its efforts to increase take up of the HPV vaccine, including as a first step, by targeting the cohort of children who may have missed out on vaccination during the Covid-19 pandemic. Given the significant proportion of children who have not received the vaccine and the potential benefits the vaccine can have in treating HPV, we recommend that sexual health services be able to deliver the vaccine to all those who would benefit from receiving it. (Paragraph 62)
15. In light of the increases in chlamydia diagnoses, the Government should review whether the shift in focus of the National Chlamydia Screening Programme to restricting the offer of opportunistic screening to young women has been effective. (Paragraph 65)
16. The Government must ensure that the sexual healthcare system works more efficiently and effectively to arrest and reverse the trend in sexually transmitted infections. This will require longer term work to carefully consider how the different parts of the system can work together to achieve this. The Government should work with the British Association for Sexual Health and HIV, the Faculty of Sexual and Reproductive Health, NHS leaders, the Local Government Association and education bodies to develop the coherent, cross-sector strategy on sexual health it committed to in 2019. It is unacceptable that five years on, no progress has been made. Young people are at the start of their sexual journey. Such a strategy should begin by meeting their needs. (Paragraph 70)
Formal minutes
Members present
Caroline Nokes, in the Chair
Carolyn Harris
Kim Johnson
Kirsten Oswald
Prevalence of sexually transmitted infections in young people and other high risk groups
Draft Report (Prevalence of sexually transmitted infections in young people and other high risk groups), proposed by the Chair, brought up and read.
Ordered, That the Report be read a second time, paragraph by paragraph. Paragraphs 1 to 70 read and agreed to.
Summary agreed to.
Resolved, That the Report be the Fifth Report of the Committee to the House.
Ordered, That the Chair make the Report to the House.
Ordered, That embargoed copies of the Report be made available, in accordance with the provisions of Standing Order No. 134.
Adjournment
Adjourned till Wednesday 17 April at 2.00pm
Witnesses
The following witnesses gave evidence. Transcripts can be viewed on the inquiry publications page of the Committee’s website.
Wednesday 24 January 2024
Dame Rachel de Souza, Children’s Commissioner for England; Professor Sir Chris Whitty, Chief Medical Officer for England, Department of Health and Social Care; Dr Claire Dewsnap, President, British Association for Sexual Health and HIV (BASHH)Q1–61
List of Reports from the Committee during the current Parliament
All publications from the Committee are available on the publications page of the Committee’s website.
Session 2023–24
|
Number |
Title |
Reference |
|
1st |
The National Disability Strategy |
HC 34 |
|
2nd |
Misogyny in music |
HC 129 |
|
3rd |
Health barriers for girls and women in sport |
HC 130 |
|
4th |
Accessibility of products and services to disabled people |
HC 605 |
|
1st Special |
Attitudes towards women and girls in educational settings: Government, Ofsted and Office for Students responses to the Committee’s Fifth Report of Session 2022–23 |
HC 258 |
|
2nd Special |
The National Disability Strategy: Government Response to the Committee’s First Report |
HC 563 |
Session 2022–23
|
Number |
Title |
Reference |
|
1st |
Menopause and the Workplace |
HC 91 |
|
2nd |
The rights of cohabiting partners |
HC 92 |
|
3rd |
Black maternal health |
HC 94 |
|
4th |
Equality and the UK asylum process |
HC 998 |
|
5th |
Attitudes towards women and girls in educational settings |
HC 331 |
|
6th |
So-called honour-based abuse |
HC 831 |
|
1st Special |
Ethnicity pay gap reporting: Government response to the Committee’s fourth report of session 2021–22 |
HC 110 |
|
2nd Special |
Equality in the heart of democracy: A gender sensitive House of Commons: responses to the Committee’s fifth report of session 2021–22 |
HC 417 |
|
3rd Special |
The rights of cohabiting partners: Government response to the Committee’s second report |
HC 766 |
|
4th Special |
Menopause and the workplace: Government response to the Committee’s first report |
HC 1060 |
|
5th Special |
Black maternal health: Government Response to the Committee’s Third Report |
HC 1611 |
|
6th Special |
So-called honour-based abuse: Government response to the Committee’s Sixth Report |
HC 1821 |
|
7th Special |
Equality and the UK asylum process: Government response to the Committee’s Fourth Report |
HC 1825 |
Session 2021–22
|
Number |
Title |
Reference |
|
1st |
Levelling Up and equality: a new framework for change |
HC 702 |
|
2nd |
Appointment of the Chair of the Social Mobility Commission: Katharine Birbalsingh CBE |
HC 782 |
|
3rd |
Reform of the Gender Recognition Act |
HC 977 |
|
4th |
Ethnicity pay gap reporting |
HC 998 |
|
5th |
Equality in the heart of democracy: A gender sensitive House of Commons |
HC 131 |
Session 2019–21
|
Number |
Title |
Reference |
|
1st |
Unequal impact? Coronavirus, disability and access to services: interim Report on temporary provisions in the Coronavirus Act |
HC 386 |
|
2nd |
Appointment of the Chair of the Equality and Human Rights Commission |
HC 966 |
|
3rd |
Unequal impact? Coronavirus and BAME people |
HC 384 |
|
4th |
Unequal impact? Coronavirus, disability and access to services: full Report |
HC 1050 |
|
5th |
Unequal impact? Coronavirus and the gendered economic impact |
HC 385 |
|
6th |
Changing the perfect picture: an inquiry into body image |
HC 274 |
Footnotes
1 UK Health Security Agency, ‘Official Statistics: Sexually transmitted infections and screening for chlamydia in England: 2022 report’ (October 2023), accessed 5 February 2024
2 “STI surge: Sexual health services at breaking point due to rising demand”, Local Government Association press release, 19 January 2024
3 Q8; Public Health England, Guidance: Health matters: preventing STIs, August 2019
4 Q8; see, NHS, ‘Overview: Pelvic inflammatory disease’, accessed 5 February 2023
5 Q8
6 NHS, ‘Sexually transmitted infections (STIs)’, accessed 6 February 2024
7 UK Health Security Agency, ‘Official Statistics: Sexually transmitted infections and screening for chlamydia in England: 2022 report’ (October 2023), accessed 5 February 2024
8 UK Health Security Agency, ‘Official Statistics: Sexually transmitted infections and screening for chlamydia in England: 2022 report’ (October 2023), accessed 5 February 2024
9 Q9
10 Q1
11 Q1
12 Q2
13 UK Health Security Agency, ‘Official Statistics: Sexually transmitted infections and screening for chlamydia in England: 2022 report’ (October 2023), accessed 5 February 2024
14 UK Health Security Agency, ‘Official Statistics: Sexually transmitted infections and screening for chlamydia in England: 2022 report’ (October 2023), accessed 7 February 2024
15 UK Health Security Agency, ‘Official Statistics: Sexually transmitted infections and screening for chlamydia in England: 2022 report’ (October 2023), accessed 5 February 2024
16 Terrence Higgins Trust (WRH0042)
17 Q11
18 Gov.uk, Spotlight on sexually transmitted infections in London: 2021 data, updated 5 March 2024
19 UK Health Security Agency, ‘Official Statistics: Sexually transmitted infections and screening for chlamydia in England: 2022 report’ (October 2023), accessed 5 February 2024
20 UK Health Security Agency, ‘Official Statistics: Sexually transmitted infections and screening for chlamydia in England: 2022 report’ (October 2023), accessed 7 February 2024
21 Q35
22 “STI surge: Sexual health services at breaking point due to rising demand”, LGA press release, 19 January 2024
23 “STI surge: Sexual health services at breaking point due to rising demand”, LGA press release, 19 January 2024
24 UKHSA, ‘Spotlight on sexually transmitted infections in London: 2021 data’ (March 2023), accessed 9 February 2024
25 “STI surge: Sexual health services at breaking point due to rising demand”, LGA press release, 19 January 2024
26 “STI surge: Sexual health services at breaking point due to rising demand”, LGA press release, 19 January 2024
27 Q1
28 “STI surge: Sexual health services at breaking point due to rising demand”, LGA press release, 19 January 2024
29 Written evidence submitted by the Local Government Association to the Health and Social Care Committee’s inquiry on Sexual health (SLH0050)
30 Ibid
31 Q49
32 Local Government Association, Breaking point: securing the future of sexual health services, November 2022
33 Terrence Higgins Trust (WRH0042)
34 Q16
35 Q17
36 Q17
37 Q17
38 Q18
39 Q18
40 Q18
41 Terrence Higgins Trust, Over-stretched and under strain: A mystery shopper approach to access to sexual health services in England, Scotland and Wales, 2023
42 Terrence Higgins Trust, Over-stretched and under strain: A mystery shopper approach to access to sexual health services in England, Scotland and Wales, 2023
43 Terrence Higgins Trust, Over-stretched and under strain: A mystery shopper approach to access to sexual health services in England, Scotland and Wales, 2023
44 Q25
45 London School of Hygiene and Tropical Medicine, Few UK online sexually transmitted infection test services meet national standards, 13 April 2022
46 British Association for Sexual Health and HIV, BASHH position statement on the inappropriate use of multiplex testing platforms, and suboptimal antibiotic treatment regimens for bacterial sexually transmitted infections, 23 March 2021
47 Guardian, Hospital admissions for easily treatable STIs rise amid funding cuts in England, 16 February 2024
48 Health and Social Care Committee, Sexual Health, Fourteenth Report of 2017–19, HC 1419, para 52
49 Q4
50 Q9
51 Local Government Association, Derby and Derbyshire: Tackling the fragmentation of the sexual health system, 2 June 2023
52 Q49
53 See, for example, “More cases of antibiotic resistant gonorrhoea identified in England”, UKHSA press release, 7 February 2022
54 Q7
55 Q7
56 Q7 and Q10
57 Q7
58 Q26
59 Q32
60 Q49
61 Newby K, Kwah K, Schumacher L, Crutzen R, Bailey JV, Jackson LJ, Bremner S, Brown KE
An Intervention to Increase Condom Use Among Users of Sexually Transmitted Infection Self-sampling Websites (Wrapped): Protocol for a Randomized Controlled Feasibility Trial
JMIR Res Protocol, Vol12, 2023
62 University of Hertfordshire, Wrapped: update, March 2023
63 PreventX, An analysis of orders through an online condom distribution scheme, June 2023
64 Q33
65 Q1
66 Q36
67 Q56
68 Q59
69 Q36
70 Q36
71 Department for Education, Research and analysis Experiences of relationships and sex education (RSE), November 2021
72 Department for Education, Statutory Guidance: Relationships and Sex Education (RSE)(Secondary), June 2019
73 Sex Education Forum, New polling shows young people are being failed by poor Relationships and Sex Education in schools and at home, January 2022
74 Q26
75 Q27
76 Q35 [Dr Dewsnap]
77 Q35
78 Q34
79 Q41
80 Q41
81 Q48
82 Q46
83 Women and Equalities Committee, Attitudes towards women and girls in educational settings, Fifth Report of Session 2022–23, HC331
84 Women and Equalities Committee, Attitudes towards women and girls in educational settings: Government, Ofsted and Office for Students responses to the Committee’s Fifth Report of Session 2022–23, First Special Report of Session 2023–24, HC258
85 UKHSA, Guidance: Information on the HPV vaccination from September 2023
86 Q12
87 Q13
88 UKHSA, Human papillomavirus (HPV) vaccination coverage in adolescents in England: 2022 to 2023, January 2024
89 UKHSA, Human papillomavirus (HPV) vaccination coverage in adolescents in England: 2022 to 2023, January 2024
90 Q14
91 Q15
92 Q12
93 Public Health England, Policy paper: Changes to the National Chlamydia Screening Programme (NCSP), June 2021
94 Faculty of Sexual and Reproductive Healthcare, FSRH and RCOG statement on changes to the National Chlamydia Screening Programme (NCSP), June 2021
95 Written evidence submitted by the Terrence Higgins Trust to the Committee’s inquiry into Women’s reproductive health (WRH0042)
96 Q20
97 Q49
98 Q49
99 HM Government, Government response to the Health and Social Care Committee report on sexual health, CP186, October 2019