Sexual and Reproductive Healthcare

Baroness Bennett of Manor Castle Excerpts

Tuesday 19th March 2024 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I sincerely thank the noble Baroness, Lady Barker, for securing this debate. I thank her slightly less for the fact I have had to throw half of my speech out because she has covered it so comprehensively already, but it was a great introduction that set out the issue of work- force that the subject directly addresses but also the true crisis in sexual health. I echo the reflections from the noble Baroness, Lady Barker, about the importance of relationships and sex education. That is the foundation of prevention; it is clearly not being delivered to anything like the standard it should be to our young people. That means we are utterly failing them.

It is a pleasure to follow the noble Lord, Lord Hunt; he and I have had our disagreements in recent times, but I entirely agree with everything he just said. I echo his comments about public health, and that this Government have essentially abandoned public health as a way of ensuring that we have a healthy society that enables the people in it to thrive and live to their full potential. There is the failure to tackle the issue of ultra-processed foods—our broken food system—as well as issues around alcohol; I would add the failure to restrict gambling advertising and allowing the gambling industry to go totally out of control, which presents a great threat to many people.

Returning to the specific issue we are talking about, when I was reading the briefings, I came across the term “neonatal syphilis”. What I knew about neonatal syphilis before this came from reading the history of Georgian and Victorian England. If we read some of the novels of that era, we find some very vivid descriptions—they might not have known the cause, but they could describe the effect. I went and looked, and I came across the website for the Centers for Disease Control and Prevention in America setting out the reality of neonatal syphilis, which is frequently

“stillbirth, miscarriage, or neonatal death”.

If the baby survives, among the effects are

“blindness, deafness, developmental delay, or skeletal abnormalities”.

It is interesting that there is a parallel between what is happening here in the UK, with different structures, and what is happening in the US, because the US, as the CDCP says, has an acute failure in terms of neonatal syphilis—the number of babies born with neonatal syphilis in 2022 was 10 times greater than in 2012. The CDCP says that testing and treatment during pregnancy could have stopped 88% of those cases.

I reflect on those US figures because we are seeing increasingly an Americanisation of our healthcare system: a copy of the US healthcare system’s models; an import of US companies; and an import of people with professional experience, particularly managerial experience, of the US system. This is a system that the CDCP, citing the syphilis figures, says is a total failure. That is something we should really reflect on.

I should probably declare my position as a vice-president of the Local Government Association. I will pick up figures that have already been mentioned, but that have to be highlighted. Among the largest reductions in public health spend since 2015 has been spend on sexual health services—29%—yet at the same time, there has been a significant increase in demand for sexual health services: nearly 4.5 million consultations in 2022, up by a third in a decade.

Of course, we are always hearing elsewhere in your Lordships’ House about rising costs. Sexual health clinics and services are no more immune from the costs of rising energy prices and rising staff costs, et cetera, than anywhere else. The funding is falling and the demand is increasing, so of course the needs are not being met. I reflect back on the debate earlier this week on the Budget. Member after Member of your Lordships’ House got up and spoke about “broken Britain” and our broken services. The noble Baroness, Lady Vere, for the Government, said at the end: “Oh, I think you’re all being too gloomy”. Well, I am afraid that if we look at the state of our sexual health services, we see that the phrase “broken Britain” is sadly appropriate.

I acknowledge having drawn on the excellent briefings we have received, and I now turn to training. We have received demands, which seem perfectly fair and reasonable, that all sexual health medical training posts be 100% funded through the NHSE, in the same way that posts in primary care, oncology and public health are funded, and that the NHSE be accountable for ensuring that some of the recruitment gaps that the noble Lord, Lord Hunt, referred to are filled in. This is important and relates to some of the other debates we have had about the importance of expertise and of proper, full medical expertise being involved at all levels of the health service. No service should be allowed to operate without a genitourinary consultant, and meetings of organisations and commissioners must include them.

I come to two more specific asks. We have a contrast in asks from the briefings. The Terrence Higgins Trust calls for a high-level sexual health commission to address these issues, while the National AIDS Trust calls for a national sexual health strategy. I do not have a particularly strong position on which of those is the right way to approach the crisis, as all these organisations are saying, in different words, are the Government going to take serious, significant action? They may not have very long to go as a Government, but this really cannot wait until we have had an election—whenever that is.

I come back to an issue I have raised a number of times before in the House: the patchy provision of postal STI and HIV testing across England. Only during one special week, the national HIV testing week, can everyone access this testing from a single service. That makes England an outlier. Wales and Scotland already have national HIV postal testing services. In Wales, that also includes STIs, and the Scottish Government are also moving in that direction. It would surely be cost-efficient and cost-effective to make available to everyone in England a national HIV and STI testing service. It would be an extremely good way to spend government money.

I also want briefly to raise the issue of chlamydia testing. We had a full national chlamydia screening programme that included both young men and women, but that was cut back in 2021 from preventing chlamydia infection to reducing the harms of untreated chlamydia. As a result, chlamydia has come to be seen as a women’s issue. Of course, infection occurs in both sexes, but that is not being drawn to the attention young men in particular. Will the Government reverse that change and reinstate the full national chlamydia screening programme service?

The final thing I want to address is people living with HIV who are no longer engaged with services. The Government estimate that some 14,000 people have not been seen at their HIV clinic for at least a year. That is a real risk to the health of people living with HIV and a significant threat to the Government’s goal of ending new HIV cases by 2030. Of course, this issue relates to many other policy areas that the Minister cannot deal with, such as poverty and homelessness, but surely there should be within health a programme to re-engage people with HIV, who should be being cared for not only in their own interests but in the interests of the health of the nation and the whole of society.