Sexual and reproductive healthcare

The House of Lords is scheduled to consider the following question for short debate on 19 March 2024:

Baroness Barker (Liberal Democrat) 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.

Sexual and reproductive healthcare services and advice are available through different routes depending on where a person lives, including through sexual health clinics and GPs. Sexual health clinics may also be called family planning, Genitourinary medicine (GUM) or sexual and reproductive health clinics.^[1] Services and advice may also be available from some pharmacies and young people’s services.

Local authorities are responsible for commissioning “comprehensive open access” to most sexual health services.^[2] Local authorities determine spending priorities based on their assessment of local need and “commission and evaluate the service lines that best suit their population, including online and in-person provision”. Funding is provided from the government through the public health grant, which was £3.5bn in 2023/24.^[3] The public health grant has been set at £3.603bn for 2024/25.^[4]

1. Concerns about service availability and funding

Concern has been expressed by some professional organisations, such as the British Association for Sexual Health and HIV (BASHH) and the Local Government Association (LGA), that increased funding is needed to meet a rising demand for sexual health services.

Using data from the Office for Health Improvement and Disparities, the LGA said:

• Almost all (97 percent) council areas have seen an increase in the diagnoses rate of gonorrhoea, with 10 local authorities seeing rates triple. The biggest increases were seen in Wigan, Dorset, Somerset, Devon and Torbay.
• 71 percent of areas have seen increases in cases of syphilis, with the largest increases being seen in Middlesbrough, the Isle of Wight, Darlington and Redcar and Cleveland.
• More than a third (36 percent) of local authority areas have also seen increases in detections of chlamydia.^[5]

The LGA said that the number of consultations carried out had gone up by a third since 2013 and reached 4.5 million in 2022. It said the number of diagnostic tests carried out had gone up by 13 percent between 2021 and 2022 and stood at 2.2 million in 2022.

The LGA argued that this increased demand was coming alongside real terms reductions in funding:

LGA analysis has found that, between 2015 and 2024, the public health grant received by councils has been reduced in real terms by £880mn (based on 2022/23 prices). This has resulted in a reduction in councils’ ability to spend on STI testing, contraception and treatment.^[6]

The LGA said that councils were calling on the government to publish a new 10-year sexual and reproductive health strategy to address infections in the long term.

An analysis by the Guardian newspaper published in February 2024 found that spending by English councils on sexual health services had reduced by a third since 2013:

A Guardian analysis of English council spending on sexual health services found national cuts of more than a third since 2013, despite a rise in consultations for sexually transmitted infections (STIs). English councils spent £9.58 a head on sexual health services—including STI testing and treatment, contraception, and advice—in 2022/23, compared with £14.41 in 2013/14, after taking inflation into account.^[7]

The Guardian also stated that the funding of advice, prevention and promotion services, and STI testing and treatment spending, had also fallen since 2013:

Advice, prevention and promotion services have had the largest cuts to funding, with net spending down 44% since councils were made responsible for public health in 2013. Meanwhile, STI testing and treatment fell by 33% and contraception spending fell by 30%.^[8]

The Guardian quoted Dr Claire Dewsnap, a GUM consultant in Sheffield and former president of BASHH, arguing that it was costly for people to end up in hospital who could otherwise have been treated through sexual health and reproductive services:

The fact is that it is quite ineffective to be spending money on treating people who have had to be admitted to hospital because they’ve got gonorrhoea joint infections when they could have got into their service really cheaply and treated really quickly. And that goes the same for all of the things that we do.^[9]

Dr Dewsnap expressed concern that the issue of access was particularly impacting disadvantaged people. She said, “this is a story of inequality and how this is really affecting those people who don’t have power and autonomy to push their way into services, because there just isn’t the access there used to be”. The Guardian wrote that Dr Dewsnap was concerned that staff leaving the sector was also a problem:

Dewsnap called for funding to be restored, but warned that such a large number of skilled medical staff had left that “even if we suddenly have a load of money come into the sector tomorrow, which is very unlikely, you cannot replace that workforce overnight”.^[10]

BASHH and the Faculty of Sexual and Reproductive Healthcare (FSRH) issued a joint statement in response to the government’s announcement of the public health grant for 2024/25.^[11] They expressed concern that funding had been cut in real terms over the past 10 years:

We are increasingly concerned by the severe and continuing pressures that have been placed on public health, by the year-on-year real terms reductions in funding over the past decade, which in turn severely impact on the ability to deliver the full range of sexual and reproductive health services.^[12]

The two bodies argued that recent data showing an increase in the prevalence of STIs, an increased uptake in abortion services and rising service demand underlined the requirement for high quality sexual and reproductive health services that were accessible to everyone. They called on the government to deliver “a comprehensive national sexual and reproductive health strategy, that should address current challenges in the sector, with consistent funding”. BASHH and FRSH argued that such a strategy should be supported by a commitment to increase the public health grant year-on-year in real terms “to allow us to not only restore but also to expand services for a growing population”.

2. Government policy

The government has said that it is proud of the UK’s progress on sexual and reproductive health and rights in the last 30 years.^[13] It has referenced the UK being ranked the top performing country in sexual and reproductive health and rights policies according to the European Sexual and Reproductive Health and Rights Ranking Atlas 2020–23.^[14] However, it has also said that “no formal assessment has been made of the quality and availability of sexual health services to meet demand nationally or locally”.^[15]

The government has stated that it is currently considering ways to improve the sexual health of the population. In answer to a recent written question about increases in sexually transmitted infections, the government said:

We are considering the next steps needed to continue improving the sexual health of the whole population. The UK Health Security Agency is undertaking work with partner organisations to identify best use of existing and emerging interventions to address the increase in sexually transmitted infections (STIs).^[16]

The government also referenced its 2021 HIV action plan,^[17] which covers the period 2022 to 2025 and aims to end HIV transmissions, AIDs and HIV-related deaths in England by 2030:

As part of the plan, we are investing £4.5mn in our national HIV prevention programme, which annually runs national HIV testing week as well as summer campaigns. Their aim is to raise awareness of ways to prevent the spread of HIV and other STIs among the most affected communities, with a particular focus on young people and other at-risk populations.^[18]

The government also said that the Department for Education was reviewing its relationships, sex and health education statutory guidance, “which includes reference to STI transmission, testing and prevention methods”. The government added that it would soon launch a public consultation on the guidance.

In answer to a written question about the government’s assessment of the Guardian’s findings that funding for testing and treating sexually transmitted infections had fallen by 33 percent since 2013, the government highlighted the responsibility of local authorities for commissioning most sexual health services:

Local authorities are responsible for commissioning comprehensive open access to most sexual health services. Dedicated sexual health services play a key public health role in diagnosis, early treatment, and management of sexually transmitted infections. Individual local authorities are responsible for making funding and commissioning decisions, working with local partners including the National Health Service via the integrated care systems, about the sexual health services that best meet the needs of their local populations through the public health grant, including online and in-person provision.^[19]

The government said it had increased the public health grant, giving local authorities an average 2.1 percent cash increase for 2024/25 compared with 2023/24:

In 2023/24, we allocated more than £3.5bn to local authorities in England to fund public health services, including sexual health services, through the public health grant. In 2024/25, the total public health grant to local authorities will be £3.603bn. This will provide local authorities with an average 2.1% cash increase compared to 2023/24.^[20]

The government has also launched specific funding programmes on sexual and reproductive health, including the reproductive health, sexual health and HIV innovation fund. The fund was established by Public Health England in 2015 to support voluntary and community sector organisations to reduce the impact of HIV.^[21] The fund has supported seven cohorts, with the scope of cohorts five to seven being widened to include projects offering innovative ways of improving reproductive and sexual health, as well as HIV-specific innovations.^[22] Funding was paused for 2022/23 to allow for the publication of an independent review.^[23] Ipsos was commissioned to undertake the review and it published its report on 30 January 2023.^[24] No funding was provided for 2023/24 and in answer to a written question in January 2024 the government said that no decision had yet been made regarding funding for 2024/25.^[25]

On the sexual and reproductive healthcare workforce in England, the NHS long term workforce plan published in June 2023 said:

The introduction of integrated care partnerships provides a unique opportunity. NHS systems and local authorities will be able to work more effectively together to provide integrated care that meets the health and wellbeing needs of the population they serve. This will include integrated workforce planning to best develop and deploy staff; for example, through opportunities for joint teams, joint training and rotation between NHS and social care settings. This will be important for services like public health, which improve population health and prevent ill health, and are vital as the population becomes sicker and has greater healthcare needs. Workforce planning, development and training for public health areas such as sexual and reproductive health and alcohol and drug treatment should benefit from improved joint working between ICBs and local authorities.^[26]

3. Read more

• House of Commons Women and Equalities Committee, ‘Inquiry: Women’s reproductive health’, accessed 14 March 2024
• House of Commons Women and Equalities Committee, ‘WEC to question chief medical officer and children’s commissioner on the prevalence of STIs among young people’, 24 January 2024
• House of Commons Health and Social Care Committee, ‘Sexual health’, 2 June 2019, HC 1419 of session 2017–19; and ‘Government response’, October 2019
• UK Health Security Agency, ‘Gonorrhoea and syphilis at record levels in 2022’, 6 June 2023
• Denis Campbell, ‘Sexually transmitted infections on the rise among over-65s in England’, Guardian, 15 November 2022

---

Cover image by Arek Socha from Pixabay.