Sexual and Reproductive Healthcare

Lord Allan of Hallam Excerpts

Tuesday 19th March 2024 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, I am very grateful to my noble friend Lady Barker for setting out so clearly the challenges and some of the potential solutions. The noble Baroness, Lady Bennett, has just reinforced why this issue is so pressing and urgent, as we see levels and types of sexually transmitted diseases that go back to an era we thought we had moved past.

I first want to pick up on what the noble Lord, Lord Hunt, said about access, which was really important. Particularly for teenagers and younger people, in many cases access to the school nurse has gone, and the general GP access crisis may have a particularly negative effect on this group. As I think we have all experienced, access to your GP is really something for pushy parents. It is not something that reserved teenagers find at all easy, so the general crisis in GP access may have a particularly negative effect on a group that we want to be able to see their GP. There is no school nurse, and they are too shy to see the GP—call it as it is—or find it too difficult, so where are they getting their information?

My first suggestion for the Minister is that it is really important that we understand that, and that the Government commission some work. My instinct is that those people are probably going to TikTok or Instagram. Those might be useful sources of information, but they are not the same as a nurse or a GP. One of the things that TikTok and Instagram might do is provide initial information and, if it is done well, refer you on to a health professional, but we really need to understand that journey by talking to 14 to 17 year-olds and finding out what they do when they have a concern. When they are doing the right thing and they are worried, where are they going? What is their experience? What kind of information are they getting, and are they seeing the professionals that they need to see? That in itself could really help. Again, I hope that the Minister is going to say that this kind of work is under way. I know it is very difficult and sensitive; particularly when you are surveying teenagers about sexual issues, there are all sorts of legal and safeguarding questions, but I do not think that should hold us back, given the urgency of understanding their experience.

In terms of the broader questions around the workforce, there are three structural questions that I really wanted to put to the Minister. First, can he, hand on heart, say that the Government are taking sexual health seriously when we see the kind of cuts that we have heard about to public health budgets? Those are compounded by crises in local government funding, so the bodies that we need to respond and provide the information—public health services and local government writ large—are seeing significant cuts. I hope the Minister can offer something. We have often brought funding crises to him, and pots of money have been found and dished out for various reasons, but I have not heard of one in this space. I hope that he will think about that. It is really hard to take the Government seriously on this issue when the people who have to deliver the service are seeing their budgets cut year on year.

My second question is one that the noble Lord, Lord Hunt, raises around the role of integrated care boards and integrated care services. I was interested to read the briefing from our friends in the Library, which says that the workforce plan tells us that:

“Workforce planning, development and training for public health areas such as sexual and reproductive health and alcohol and drug treatment should benefit from improved joint working between ICBs and local authorities”.


I emphasise “should”; I do not think that “should” is good enough. I would really like to hear the Minister give any examples the Government can point to that say they “are” benefiting from this ICB structure. I know it is early days; we have been talking about it being early days for about a year, but at some point we should see the benefits that the ICBs should deliver. This is one of those critical areas, where it is joined-up working and the pooling of resources between the two services—local authority-delivered services and traditional acute community and primary healthcare services—that will deliver the benefit.

The third question is on workforce planning—the really interesting question of how all the different pieces are working together, underneath the headline which the Government have talked about. We on all sides of the House have praised the fact that we have these headlines. Again, it is time to dig into some of that detail. There are really two key issues. One is to say how the different pieces fit together because, as the noble Lord, Lord Hunt, has pointed out, there have been experiences where a push to recruit in one bit of the health service has led to that bit of the health service that now has the money hiring people from some other part of the health service that then, a year later, finds itself in crisis. We really need to understand for all these services how these pieces are being meshed together. It is like a waterbed: you push down on one point and another point pops up. The pressure needs to be applied very thoughtfully. There needs to be a bigger bed, for a start, but once you have that, you need to be really thoughtful about how it works to push down in one place and push up in another. It would be helpful to hear more from the Minister about how specific services like these—where you can imagine the recruitment for one service could come from another form of nursing or public health—can be knitted together.

The second issue is thinking about how people behave in their careers; they behave quite rationally. My noble friend Lady Barker referred to the shortage of GUM specialists. As people go through their training and build their career, they will respond to signals about where the opportunities lie. If they see that the funding has been cut in a particular area and the jobs are not going to be there, they will make rational choices.

Again, we need to hear from the Minister—and perhaps also, in an election year, from the Opposition—what signals the Government can send out to make sure that somebody going through the early stages of their career, who is interested in delivering sexual and reproductive health services, will that feel it is worth doing the training because the jobs are going to be there at the end of it. They are going to make a rational choice; that is what we are seeing. Some of the suggestions that my noble friend made are precisely around the fact that we are not getting the specialists that we need in this area coming through because people are choosing to get trained in other specialties instead.

I hope the Minister will be able to respond on these key areas around workforce planning, as well as to the excellent suggestions made by my noble friend. Again, I thank her for giving us this opportunity to talk about an area that is critical, particularly—though not exclusively —for younger people. When mistakes are made at that stage and they do not get the help they need, they can end up with conditions that will affect them for the rest of their lives. We need to do all we can to prevent that from happening.