Sexual and Reproductive Healthcare

Lord Markham Excerpts

Tuesday 19th March 2024 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

I start by adding my thanks to the noble Baroness, Lady Barker, for securing this debate and for all the work that she does in this important area. I was grateful for all the contributions, but I admit that it made me smile when the noble Lord, Lord Allan, asked whether the solution to the sexual health debate should be one of a bigger bed. I thought that was a very topical answer to it all, but I will come back to his bigger bed question on the long-term workforce plan later on.

I admit to a bit of surprise when hearing some words used in the debate: the noble Baroness, Lady Barker, used “crisis” and the noble Baroness, Lady Bennett, mentioned “broken Britain”. I can answer the question of the noble Baroness, Lady Merron, about the quality and availability of services for sexual health because, thanks to our very own House of Lords Library briefing, as I am sure all noble Lords saw, some very interesting and extensive research was produced by the European Parliamentary Forum for Sexual and Reproductive Rights in October 2023. It looked at 46 European countries on a whole range of subjects and, for instance, in the area of access to abortion services the UK came third out of 46. On contraception, we came first and on HPV prevention, we came third. On gender-based violence in education, we came first. If we add all those up, what was our overall ranking? First.

I am somewhat surprised because this is a reasoned and balanced place, and this came from the House of Lords Library. In the whole conversation we have had in this debate—in all the things mentioned—I was somewhat surprised that it was not mentioned anywhere that this body had done extensive research on it all and it put us first. It commended us time and again in that.

I was also surprised when HIV was mentioned a couple of times. The UN target is called 95-95-95, which is wanting 95% of cases to be diagnosed, wanting 95% to be treated and wanting to make sure that 95% of people with HIV have an undetectable viral load. The UK, and I think we are alone in this, hit the 95% level on diagnosis. On treatment, we hit 98% and on detectable viral loads, we hit 98%. I will check whether we are alone but we are definitely beating those UN targets.

The action taken by the Government—which was recently applauded during Elton John’s visit, as noble Lords will remember—includes standard things such as opt-out HIV testing in every circumstance where people are going into A&E. This has already detected 1,000 people with HIV who were previously undetected. That is absolutely ground-breaking in the world. We were also applauded for the action taken on HIV through PrEP. Call me old-fashioned, but I would rather look at the results we are achieving than at how much we are spending, and I hope noble Lords would join me in that. On the results, according to this independent source and against the UN HIV target, we undeniably come out very highly.

However, I do not want to appear complacent. Clearly, far fewer people are using condoms—often for very good reasons, because there is not the same fear of sexual disease and HIV. So there are societal changes, but that brings some challenges regarding sexually transmitted diseases—that is understood. We are trying to make our funds go as far as possible, not just in services today but in introducing contraception and those services to pharmacies. Pharmacy First is making this very accessible—we are already seeing good take-up, and we expect about 30% of people to get their contraception through Pharmacy First. That is a real example of how we are massively expanding access to the workforce.

The long-term workforce plan is absolutely a bigger bed strategy, and I take the point of the noble Lord, Lord Allan, that we clearly need to make sure that that provides the individual specialisms that are needed. The Government and I accept that work will need to be done to make sure that those specialisms result from that. But I think all noble Lords will agree that the bigger bed strategy is right, and improvements will come through across the board.

The noble Lord, Lord Hunt, referred to Sexwise. The steps we are trying to take are sensible, and the Government did this well when they consolidated a lot of their different websites into a single source. We want the primary source of information we are pointing people towards to be the NHS websites, and particularly the NHS app, which I think all noble Lords would agree is completely appropriate for younger people. At the same time, I absolutely take the sensible point the noble Lord made about a group being willing take over Sexwise. Funnily enough, I said exactly that: “Why can’t we give it a contract for £1 if it is difficult to give it away? Why can’t we do something pragmatic along those lines?” That is the challenge I have set: if it is a good service and someone is willing to do that, why would we not want to support that? But I hope noble Lords see that, in general, it is a sensible strategy in the digital age to consolidate your assets around the overall NHS umbrella and the NHS app.

In response to the noble Baroness, Lady Barker, we definitely want to build on the women’s health hubs. STI and HIV screenings are part of their specifications. In response to the noble Baroness, Lady Bennett, we have hepatitis B, HIV and syphilis as standard parts of the screening of pregnant women. That is seen as very important. I also absolutely agree about the importance of home testing in all this. As noble Lords will see, we are trying to use the NHS app as a vehicle for people to get home testing as they require.

The noble Baroness, Lady Bennett, asked about the advice behind focusing chlamydia screening on women rather than men. That is based on the scientific advice and evidence we have received that that is the best use of resources in this case.

I will write to the noble Lord, Lord Allan, on his very reasonable question about where young people get their information from in a letter detailing what we know. I accept that, if we do not have that information, we should find it out. Hopefully, we can come back on that. Likewise, I will need to come back further on what evidence we have to date on ICBs and the benefits of joint working. As ever, I will follow up on the detail in writing.

I am grateful for the opportunity for us to debate these things. This is one of those occasions where I can stand here in all honesty and say that, objectively, by a number of measures—looking at the results coming in, not at the funding—including from none other than the European Parliamentary Forum for Sexual & Reproductive Rights, Britain comes out at No. 1. That is something that we can all feel proud of.