Sexual and Reproductive Healthcare

Lord Hunt of Kings Heath Excerpts

Tuesday 19th March 2024 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I congratulate the noble Baroness on her contribution and fully endorse what she has to say. We clearly have a crisis in sexual and reproductive healthcare.

I refer the Minister to evidence given to the Commons Women and Equalities Committee only in January by Dr Claire Dewsnap, president of the British Association for Sexual Health and HIV. She said that

“a lot of the presentations in clinics and potentially in other settings like primary and secondary care, are things that we have not seen for 50 or 60 years”.

In the same session, Dame Rachel de Souza highlighted that in the past, schoolchildren could go to the school nurse with sexual health issues but there has been a 35% cut in school nurses over the last 10 years. This issue of access means that it is significantly harder for young people to access sexual health services, particularly in rural areas. According to Dr Dewsnap, because of budget cuts only 10% of sexual health services offer a drop-in facility. That makes it far less likely that young people and children will seek the support they need.

A further, highly effective resource that has been totally cut is the Sexwise website. This highly valued sexual health resource for professionals and the general public was developed by the FPA in 2017 on behalf of Public Health England and handed to PHE to run in 2019. But, alarmingly, the Minister’s department ended the contract to deliver maintenance support for the website from 4 March this year. Twice, the department has refused an offer from the FPA to take it over, and the reasons given are clearly spurious. The first rejection was based on Crown copyright considerations of the Sexwise brand—a ridiculous argument. The second rejection, after the FPA clarified that the Crown could keep ownership of the brand, was, quite frankly, nonsensical.

The basic need for what Sexwise gave, which was accurate and free-to-access sexual and reproductive health information, has not gone away. I hope the Minister will instruct the DHSC either to put Sexwise out to a public tender—we are talking about tens of thousands of pounds of cost—or to accept the generous offer from the FPA to run it on the department’s behalf. I am afraid that the Sexwise saga just reflects the Government’s attitude towards public health, perhaps apart from smoking.

I would like the Minister to reflect on the effective dismantling of the Office for Health Improvement and Disparities. It took over the funding of the public health grant when Public Health England was disestablished in 2021, which in turn, of course, replaced the Health Protection Agency following the Health and Social Care Act 2012. It has now been authoritatively reported in the Health Service Journal that unannounced changes to the office have led to its fragmentation and decimation.

So over 12 years we have seen, through a number of iterations, the Government essentially move from having a large, mainly independent public health agency to a disparate group of people spread thinly across a number of directorates in the Department of Health. At what cost? I have seen reports that OHID has been reduced by about 60% in staffing terms, with a loss of several senior and experienced officials and the downgrading of many functions, including sexual health. Can the Minister tell me how many qualified public health specialists have left OHID and how many remain within his department? It is a far cry from the triumphal tone of the announcement launching the office, followed by the September 2021 statement by the then Health Secretary, Sajid Javid, who said he wanted OHID to work on preventing poor mental and physical health, addressing health inequalities and improving access to health services, and to work with partners within and outside government to respond to wider health determinants. That ended well, didn’t it?

My noble friend Lady Merron anticipated this in her regret Motion of 9 November 2021. As she put it, it is hard to see how the UK Health Security Agency or the OHID could be “independent or effective”. They were not set up in statute and were created

“without parliamentary scrutiny or approval”.—[Official Report, 9/11/21; col. 1675.]

As we can see, it is very easy then virtually to dismantle OHID without any public or parliamentary scrutiny whatever. Hunter, Littlejohns and Weale, in a forthcoming BMJ opinion column, will argue:

“Set up in haste with no consultation, OHID lacks any of the … independence PHE had, being an opaque body scattered through the Department of Health and Social Care. Given its low profile and lack of a clear mission, it comes as no surprise that, despite denials from the government, it has been virtually eviscerated”.


Or, as Dave West from the HSJ has put it,

“the latest restructure, as well as being damaging to a functioning national public health system, suggests any idea of greater push and support from the centre for independent for ICSs’ long-term agenda—of population health, prevention inequalities—remains for the birds. Hopes of tougher preventative action on alcohol or sugar, for example, equally so”.

That has to be on a par with the Government’s tepid approach to public health measures, smoking aside. The shamefully postponed implementation of the obesity strategy is but one example, and it is in this context, of course, that we see the problems arising in sexual health. How else can we explain the LGA’s analysis that, between 2015 and 2024, the public health grant received by local authorities has been reduced in real terms by £880 million, which has resulted in a reduction in councils’ ability to spend on STI testing, contraception and treatment? As David Hunter and his colleagues argue, revitalising public health in the UK requires changes, including a cross-government approach to tackle the social determinants of health alongside restoring the funding cuts to public health funding. Will the Minister effect that change, including restoring the real-terms value of the public health grant, the cut to which has so decimated sexual health services in the way described by the noble Baroness, Lady Barker?