Sexual and Reproductive Healthcare

Baroness Merron Excerpts

Tuesday 19th March 2024 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I start by congratulating the noble Baroness, Lady Barker, on securing this important debate, and on her thorough assessment of what is a very worrying state of affairs. As I am sure the Minister has heard, that assessment has been received with some unanimity of concern across the Chamber.

The Health Foundation estimates that sexual health services will have seen spend lowered by some 39% between 2015-16 and 2024-25, which is far in excess of the already problematic 27% cuts to the public health grant. However, the situation gets even worse as the reductions in the public health grant tend to be largest in the more deprived areas. In Blackpool, for example, ranked as the most deprived upper-tier local authority in England, the per-person cut to the grant has been one of the largest. Perhaps the Minister could address how this disparity in the provision of funding for sexual health services will be put right for people in the most disadvantaged areas. It would also be helpful to hear how we have got to this situation.

My noble friend Lord Hunt raised some key questions about the Office for Health Improvement and Disparities, which I certainly want to echo. I look forward to the Minister’s reply on that, as well as to an explanation about how these cuts, which are more extreme in disadvantaged areas, square with the Government’s levelling-up agenda.

I anticipate that the Minister will give your Lordships’ House a number of statistics to refute the negative impact of the reduced funding that I have referred to on sexual health services. However, a recent Written Question tabled in the other place by Rachael Maskell MP asked what recent assessment had been made of the quality and adequacy of the availability of sexual health services. Minister Leadsom replied:

“No formal assessment has been made of the quality and availability of sexual health services to meet demand nationally or locally”.


As this is the case, how can the Government assure themselves that they are satisfied with the impact of the funding that they provide? How can they address, therefore, the very real questions that have been put in the debate this evening?

I turn to the current state of demand. The Local Government Association, using data from the Office for Health Improvement and Disparities, reports on a number of areas. For example, almost all council areas have seen an increase in the diagnosis rate of gonorrhoea, with 10 local authorities seeing rates triple, while nearly three-quarters of areas have seen an increase in cases of syphilis and more than one-third of local authority areas have seen increases in detections of chlamydia. It is interesting to note that councils, as well as other groups, have called on the Government to publish a new 10-year sexual and reproductive health strategy to address infections in the long term. Perhaps the Minister could advise the House what consideration the Government have given to that proposal.

An analysis by the Guardian just last month found that spending by English councils on sexual health services had reduced by one-third since 2013 despite a rise in the necessity for consultations for sexually transmitted infections. Advice, prevention and promotion services have had the largest cuts to funding, with net spending down some 44% since councils were made responsible for public health in 2013. Meanwhile, STI testing and treatment fell by one-third and contraceptive spending by nearly one-third. Yet we know it is costly for people to end up in hospital who could otherwise have been treated through sexual health and reproductive services. So could the Minister comment on how cuts such as these make sense in terms of value for money, when research shows that each additional year of good health achieved in the population by public health interventions costs £3,800, around three times lower than the costs resulting from the NHS interventions that become necessary in the absence of those preventative measures?

The noble Baroness, Lady Barker, was right to draw attention to the workforce that is necessary to provide these services. There have been many warnings that a large number of skilled medical staff have left the NHS and, even in the unlikely event of a major injection of resources, it would just not be possible to replace that loss of workforce overnight.

I think we in this Chamber all agree that long-term workforce planning is essential to ensure the sustainability of crucial sexual health services. There is currently a retirement cliff edge for all members of multidisciplinary teams. That has been exacerbated by difficulties in recruiting new staff into the specialty, as well as the experience of the pandemic, which saw more healthcare professionals leaving the sector. As we have heard today, there is an urgent need to recruit new trainees by addressing the low number of training posts in GUM and HIV and lower awareness of the specialty. A survey of RCN members reported that sexual and reproductive health is not regarded as attractive to new staff, while concerns were also raised about the diminishing options for education and training. That is borne out by the limited exposure to the specialty that we see in undergraduate training and in the core general training following medical school—something highlighted by the noble Baroness, Lady Barker.

In all this, the failure to plan and invest in a sexual and reproductive workforce only exacerbates pressures elsewhere in the healthcare system. People are being pushed into hospital now due to untreated STIs, with admissions to hospital for syphilis and chlamydia doubling between 2013-14 and 2022-23 while gonorrhoea admissions have tripled.

As the noble Lord, Lord Allan, said, the workforce plan refers to what I would describe as a hope—a hope that there will be benefits from improved joint working between ICBs and local authorities on workforce planning, development and training for public health areas, including sexual and reproductive health services. In answer to a Written Question that I tabled last month, the Minister confirmed that NHS England conducted an annual performance assessment of the ICBs for the 2022-23 financial year. Can the Minister indicate what assessment has been made of those promised improvements through joint working in respect of sexual and reproductive health services; in other words, is the joint working delivering in the way that the workforce plan hoped for?

Importantly, how will the Government address the very real issues that have been highlighted in this debate? They are real, they have been with us for years and they need resolution.