Fragmented sexual health service caused by spending cuts
Author: Jo Carlowe
Sexual health must be properly funded to tackle health inequalities and worrying trends.
This is the message from the Health and Social Care Committee, in its newly published report on sexual health*.
Despite top line figures for sexual health appearing positive, the Committee warns they hide serious concerning underlying trends and inequalities as poor sexual health outcomes fall disproportionately on certain groups.
An enduring theme throughout the Committee's inquiry is 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.
The report concludes that sexual health must be sufficiently funded on a national level to deliver high-quality sexual health services and information.
It warns that 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 which is becoming a major issue in the treatment of gonorrhoea.
The Committee describes recent cuts to sexual health funding as a false economy, and calls on Public Health England, in collaboration with a working group of representatives from all sectors involved in commissioning and providing sexual health services, to develop a new sexual health strategy, to provide clear national leadership in this area. In its recommendations, the Committee says these groups should set out the minimum levels of spending required to ensure all local areas are able to deliver high-quality services.
In its inquiry, the Committee heard from staff about pressures around demand, and the impact on morale, retention and recruitment. The report says a clear plan is required for the workforce to deliver sexual health services across England over the next decade. Meanwhile, the national sexual health strategy should include a programme of further action to re-establish training and development for current and future sexual health workforce at the heart of commissioning and service provision arrangements.
Dr Sarah Wollaston MP, chair of the Health and Social Care Committee, said: "High-quality sexual health treatment should be accessible to all. However, it is clear that the current approach this country has to treatment varies massively depending on where you happen to live. This is unfair and threatens the long-term health of individuals seeking a high-quality service and access to vital information on their sexual health.
“We need to develop a new, national strategy in order to tackle the very real threat of increased levels of poor sexual health and to support a workforce that delivers the best service possible, despite growing demands.
“As part of the Spending Review, the government must ensure sexual health funding is increased to levels which do not put people's sexual and long-term health at risk."
Commenting, Dr Peter English, the British Medical Association’s (BMA) public health medicine committee chair said: “The BMA believes that decreasing spending and reducing the provision of sexual health services will lead to poorer health in the population. This report rightly identifies some important areas for improvement in relation to the delivery of sexual health services and, as the BMA has previously acknowledged, the need for these services to be properly funded across the country.
“The fragmented and uncoordinated way in which these services are currently commissioned means that across the country people, many of whom are vulnerable and disadvantaged, are not getting access to the care they need. The recent issue surrounding Capita and letters to patients about cervical smear tests is a good example of this.”
He added: “The BMA is clear that there should be national quality standards that give a consistent standard and provision of care throughout the country so that people are not disadvantaged by where they live.
“We urge the government to reverse cuts to public health funding, and to make sufficient funding available to ensure that sexual health services can meet the health needs of local populations.
“There should be greater recognition of the evidence that prevention and early intervention is cost-effective. As the committee has importantly highlighted, inadequate prevention and a lack of early intervention can come at a huge price to the NHS. The BMA has repeatedly urged the government to heed such concerns and make a commitment to increased and sustained funding for public health services.
“We welcome the minister’s indication that prevention in sexual health will be a central part of the prevention Green Paper and expect this commitment to be followed through with tangible action.”
A Department of Health and Social Care spokesperson said: “We have a strong track record on sexual health with teenage pregnancies at an all-time low and sexually transmitted infections continuing to fall. Sexual health services and tests are now more widely available online – over 11,000 diagnoses from online tests were reported last year.
“Prevention is at the heart of the NHS Long Term Plan, and comes alongside the £3 billion we are giving to councils to fund public health services this year, including sexual health services.”
*Sexual health. Health and Social Care Committee report, 2 June 2019.