Sexual and Reproductive Healthcare

Baroness Barker Excerpts

Tuesday 19th March 2024 Lords Chamber

Asked by

[Baroness Barker]

To ask His Majesty’s Government what assessment they have made of the current level of provision for sexual and reproductive healthcare in England and the case for a workforce plan in this sector.

[Baroness Barker (LD)]

My Lords, I thank all noble Lords and the Minister. Their participation at this late stage is very much appreciated. I also thank the British Association for Sexual Health and HIV, the British HIV Association, the Terrence Higgins Trust and the National AIDS Trust for their briefings for this debate. I draw the House’s attention to my role as co-chair of the All-Party Parliamentary Group on HIV/AIDS and the All-Party Parliamentary Group on Sexual and Reproductive Health. My ongoing involvement in those APPGs reflects my very strongly held belief since I was a young woman that giving people, particularly young people, scientifically correct and fully inclusive sex and relationship education information not only protects them and enables them to study, work and live their lives to their full potential but benefits the whole of society in terms of health and economics.

I want to have this debate because sexual and reproductive healthcare in the UK is in a crisis. That is not me saying that but the Local Government Association, the British HIV Association and the British Association for Sexual Health and HIV—that is, those on the front line trying to hold these services together and make them work. Data from the UK Health Security Agency shows that demand for SRH services has been increasing year on year and hit a record high in 2023, with no signs of abating this year. That increasing demand has not been mirrored in an increase in resources and staffing. The recent Local Government Association report showed that services throughout the UK are at breaking point, with people being turned away from services, which are often open for very minimal times due to a lack of capacity.

Due to the deterioration in numbers of people trying to be genitourinary medicine physicians in the UK, there is a real possibility that very soon we will be without adequately trained experts in out-patient management of complex and complicated STIs. That is worrying for us all. There are huge issues about recruitment, training and staff that can be traced back to commissioning changes that were made under the Health and Social Care Act 2012. Those reforms, which put public health back into local government, were right in principle; public health and prevention and surveillance of disease should start not in the NHS but in communities, where people live. The problem was that this reform coincided with a plummeting of local government finance and, consequently, the commissioning of services has been so severely depleted that services have deteriorated to the point where we have reached the highest levels of cases of gonorrhoea since the 1920s and the highest rates of syphilis since 1948.

The high rate of those diseases, and the lack of capacity for people to be seen in SRH services, has resulted in people presenting late and with levels of infection so high that they may have irreversible harm that could have been treated properly had they been seen earlier.

There has also been a resurgence in neonatal syphilis in the UK—something that we thought was history is now back. We have significant neonatal morbidity. In addition, reduced NHS service capacity has reduced the access to preventive SRH services, including vaccinations and the provision of HIV PrEP, both of which are critical to reducing future transmissions of STIs. In some areas of the UK, particularly outside London, there has been a disproportionate effect, as small clinics have been hit more than others.

It is important to understand in this debate that there are two types of specialists who deliver the majority of SRH and out-patient HIV care in the UK: first, GUM clinics, and HIV physicians who are trained in medicine and specialise in STI and HIV diagnosis and management; and, secondly, community sexual and reproductive health specialists, who train predominantly in women’s healthcare and who specialise in the gynaecological and reproductive care of women across their life course. Most provision of specialist contraception and training of other healthcare workers in contraception, and the leadership of systems across secondary and primary care, is done by community SRH consultants.

Dame Lesley Regan has done tremendous work in the development of the women’s hubs. I ask the Minister whether the Government plan to build on that work to make those into one-stop shops for women, where they can have their reproductive and sexual health issues dealt with all at once.

HIV treatment is different—HIV services are open-access and anybody can come into them—but there is a huge problem in the HIV workforce. Not only is there huge demand; there are so few consultant specialists around to help other staff to train and develop that we are now having a real problem recruiting trainees into genitourinary medicine. That means that those services are becoming ever more fractured, and there is a knock- on effect back to general practice and to pharmacies, which simply do not have the specialist knowledge and training to deal with those more complex cases.

Nurses and allied healthcare professionals are doing much more than they did a year ago, but they cannot deal with the sorts of complex cases that are now being presented to them. We have an inadequate number of consultant specialists working in the field and that is having an adverse effect on training.

Commissioning arrangements are at the root of the problem in all of this. No one is taking responsibility for ensuring that the next generation of doctors and nurses in sexual health services are being trained. No local authority has a training plan and there is no cohesion nationally to drive accountability where it fails. Services that offer no training and education are inherently cheaper and those are the ones being commissioned more and more—for short-term gain for cash-strapped councils, but with long-term harm to public health.

I ask the Minister to address three critical issues: first, making sure that all sexual health medical training posts are 100% funded through NHS England in the same way that posts in primary care oncology and public healthcare are funded; secondly, that NHS England is accountable on its plan to ensure improved recruitment, with the publication of a corresponding action plan to deliver improved recruitment in sex and reproductive health; and, thirdly, that no service is allowed to operate without a GUM consultant within it, no matter how much it depends on lesser-qualified staff.

It is worrying that we are going back to levels of sexually transmitted diseases that we thought were a thing of the past. It is deeply frustrating, because we now have the medicines to deal with these cases, and we know there are new technologies and ways of delivering services that could make the system so much more efficient. If we had nationwide home testing kits for HIV, if we had a greater use of pharmacies for the management of people with HIV in their local areas, rather than them having to go to specialist clinics for ongoing treatment, we could be making great progress. In this field, as in many other parts of medicine, were staff to have the time to sit and think through the ethics and potential of the use of AI, we could make huge strides forward in these public health matters. As it is, these services are stretched to breaking point.

I want the Minister to answer two simple questions. First, what are the Government going to do to stop the crisis and the downward spiral of stretched services relying on staff who are not sufficiently well trained? Secondly, what have the Government made of the lessons that can be learned from the GP recruitment crisis and the opportunities to apply those to increasing recruitment and retention in urinary medicine and HIV, including fully funding training posts? We need to get this workforce back up to the levels we know we can manage in order to deal with a crisis which need not have occurred in the first place.