Lord Black of Brentwood (Con)
My Lords, in begging leave to ask the Question standing in my name on the Order Paper, I declare an interest as a patron of the Terrence Higgins Trust.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
We remain committed to improving sexual health in England. The UK Health Security Agency conducts comprehensive surveillance of sexually transmitted infections and supports local areas to use this data to inform sexual health services delivery. We are working with it and other key delivery stakeholders to explore options for the best use of both existing and innovative preventive interventions, as well as strengthening messages to the public on how to reduce the transmission of STIs.
Lord Black of Brentwood (Con)
My Lords, PrEP has been a game-changer in the fight against HIV, and making sure that as many people at risk of infection as possible have access to it is fundamental to meeting the target of ending new HIV cases by 2030, but at the moment we are failing to ensure that access because of the immense pressure on sexual health services. Nearly 60% of people are forced to wait more than three months to access PrEP through that route. Does my noble friend agree that one way to deal with this problem is to make PrEP available through pharmacists, as contraception now is—an initiative backed by the Royal Pharmaceutical Society—and does he recognise that such a policy, in line with the ambition of Pharmacy First, would not just relieve pressure on sexual health services but encourage uptake among women, who make up 31% of people accessing HIV care but represent only 2% of PrEP users?
Lord Markham (Con)
I thank my noble friend for all the work he does in this space and absolutely agree that we are world leaders in the use of PrEP. We have 86,000 people currently using it. It is a key prevention tool and something that we want to expand as widely as possible. There is an excellent pilot happening in Brighton at the moment, where you can get PrEP online, and I absolutely agree that we should look at Pharmacy First as a way to expand that even further.
Lord Fowler (CB)
Does the Minister remember reports on the AIDS campaign in the 1980s, which showed not just a reduction in AIDS but a fall in all other sexually transmitted diseases generally? How much is now being spent on such public education campaigns in this area? Is this spending increasing or decreasing?
Lord Markham (Con)
Overall, we spend £3.5 billion on public health. I do not have the breakdown of the advertising within that, but I will happily follow up with that. That is a small increase over the last year. Education is key to all this. Part of the reason for the increase in sexually transmitted diseases is that people used to use condoms because they were scared about two things: pregnancy and HIV infection. As both those risks have gone down, so has the use of condoms, which has resulted in the higher level of sexually transmitted diseases—so education is key.
Baroness Barker (LD)
My Lords, in 2022 the rate of STIs went up by 22% and, at the same time, the public health budget has been reduced by 29%. The strain on those services is now intolerable. Is it not time to have a proper, real increase in that budget?
Lord Markham (Con)
The figures are slightly misleading because, of course, that was in comparison to a Covid year, when there was much less testing. In fact, if you look at it versus pre-pandemic figures, the numbers are 16% down compared with 2019; that is the real comparison we should look at here. At the same time, I think we would all agree that £3.5 billion is a big investment in this space. It has gone up slightly over the past year but, as I mentioned earlier, education is also key in this space.
Lord Hunt of Kings Heath (Lab)
My Lords, can we come back to the issue raised by the noble Lord, Lord Black: whether community pharmacies could play a bigger role in relation to PrEP? Does the Minister accept that, although there is much that community pharmacies could do, they face a fundamental financial crisis at the moment, with many going out of business? Will the Government accept that they are going to have to give more support to community pharmacies for them to do the kind of things that the noble Lord is asking for?
Lord Markham (Con)
Yes. I believe that there is a real win-win possibility here, where we can get more services through Pharmacy First—obviously, that is good for primacy care access—and give further support to pharmacies. I was having this conversation just this morning. We made contraception available through pharmacies in April 2023; we will get the results of that back shortly. Things such as sexual health and PrEP are absolutely what we are looking at.
Lord Bailey of Paddington (Con)
My Lords, in view of the fact that it is often the hardest-to-reach communities that suffer the greatest pain from the uplift in sexually transmitted diseases, can the Minister tell us what work the Government are doing to reach such communities, particularly the young, to educate them so that they can protect themselves?
Lord Markham (Con)
My noble friend is absolutely right: young people—15 to 24 year-olds—represent one of the highest levels of this. In 2020 we made relationships, sex and health education classes available compulsorily in schools. We are currently reviewing that to see the effectiveness of it, with a view to expanding it further.
Baroness McIntosh of Hudnall (Lab)
My Lords, can the Minister tell the House what the current rate of take- up is for vaccination against HPV—human papillomavirus —and what efforts are being made to make sure that all those who should be vaccinated are?
Lord Markham (Con)
I will need to come back with the exact figure for the vaccination rate. I know that it is proving quite effective, which is important. On the measures we are taking, we are investing £25 million in women’s health hubs precisely to enable these sorts of vaccination programmes. I will happily follow up in writing with the detail.
Baroness Cumberlege (Con)
My Lords, does my noble friend the Minister agree that, in this technological age, it is very important that people are able to access everything they need from the NHS via their phone or a laptop? I am working to ensure that all women have access to their maternity record via the NHS app, but only 23% of sexual health clinics currently allow online booking. Can my noble friend tell me how the Government plan to address this issue?
Lord Markham (Con)
I thank my noble friend. As she knows, I am a big advocate of everything that we can do with the app. We are absolutely looking to extend its services, which will include sexual health clinics. In the past year alone, we have increased from around 10% of GPs allowing someone to see their records to around 70% today. Sexual health clinics are clearly an area that we need to look at next.
Baroness Merron (Lab)
My Lords, with a real-terms cut of nearly a third for sexual health services over the past eight years, it is ever more difficult to get an appointment. Given that STIs increased by 24% last year alone, what assessment have the Government made of the potential to improve access to sexual health services through the universal provision of postal STI tests in England—something that Wales already offers?
Lord Markham (Con)
We are leading the world in all these areas. In a recent survey across the European nations, we came out top in sexual and reproductive health services, which I want on the record. Just last week, everything that we are doing in the HIV space was recognised as part of all this. This is another area in which we are looking to widen access as much as possible. I mentioned the examples of an online service in Brighton and, to the noble Lord, Lord Hunt, Pharmacy First. We are looking to make sure that access and testing are as widely available as possible.
Lord Turnberg (Lab)
My Lords, chlamydia is a cause of infertility. A vaccine has been developed and is in use. How far have we got with the programme of vaccination against chlamydia in both boys and girls?
Lord Markham (Con)
The noble Lord is correct: about 50% of all cases are of chlamydia, and it is undetectable in a lot of people. That is why we have started screening programmes of chlamydia in women, so that it can be picked up when it has been undetected, which we know can be done. As the noble Lord mentioned, we have a programme of chlamydia vaccinations for both females and males. From memory, I think the rate of boys vaccinated is about 30%, but I will come back in writing with the exact numbers.
Lord Herbert of South Downs (Con)
My Lords, the biggest single cause of death of people with AIDS globally is tuberculosis. Coinfection is a real issue. Although this problem is not nearly as serious at home, there are still thousands of cases a year and they have started going up again. Will my noble friend confirm that, post Covid, the Government will look again at what more needs to be done to eliminate tuberculosis—an entirely treatable disease—from our shores?
Lord Markham (Con)
Yes, absolutely, as we are in all cases. I want to be clear on this. My noble friend mentioned AIDS: the UN targets are 95%, 95% and 95% for diagnosis, treatment and viral load detection, and we are at 95%, 98% and 98%. We are beating the targets and leading the world on this.