House of Lords video: Sexual and Reproductive Healthcare Debate with Call to Save Sexwise

A strong call to save Sexwise

The following is a rough transcript of the speech by Lord Hunt aka Rt Hon Lord Hunt of Kings Heath PC OBE. Apologies for any errors – if in doubt – watch the video!

Introduction

My Lords,

We are in a crisis in sexual and reproductive healthcare as a result of cuts to public health funding since 2010. Baroness Barker spelt this out in her opening speech.

The scale of the increase in sexually transmitted infections is frightening. In 2022, gonorrhoea diagnoses were the highest on record and syphilis diagnoses were at their highest since 1948.

At the Commons Women and Equalities Committee on 24th January. Dr Claire Dewsnap, President of the British Association for Sexual Health and HIV reported that :

“a lot of the presentations in clinics and potentially in other settings like primary and secondary care, are things that we have not seen for 50 or 60 years”.

Dr Dewsnap has highlighted that access to sexual health services is not good enough and that she has no doubt that this is due to a funding reduction of £150 million over the last 10 years.

At the same session Dame Rachel de Souza highlighted that in the past school children could go to the school nurse with sexual health issues but that there has been a 35% cut in school nurses over the last 10 years.

This makes it significantly harder for young people to access sexual health services, particularly in rural areas. Children and young people are far less likely to wait for appointments, if symptoms go away, they will be ignored, and as with gonorrhoea they will return at a later date with serious and expensive consequences for the individual and the NHS.

Currently only 10% of sexual health services offer a drop in facility, because of budget cuts, according to Dr Dewsnap. This makes it far less likely that young people and children will seek the support they need.

It was also highlighted by Dr Dewsnap that budgets for free condoms have just about halved over the last 10 years, yet this is a cost-effective way to prevent STIs.

Sexwise

A further highly effective resource which has been totally cut is the Sexwise website, which was a highly valued sexual and reproductive health resource for professionals and the general public

FPA developed and launched Sexwise in 2017 on behalf of Public Health England (PHE) precisely because there is a need for a free-to-access national digital sexual and reproductive health resource for both professionals and the public.

Sexwise was handed back to PHE in 2019.

In the 5 years since the website was passed to PHE and then to DHSC, the basic need for accurate and free-to-access sexual and reproductive health information has not gone away.

In a time when resources are extremely limited each GP surgery, sexual health clinic, hospital and NHS Trust must now spend time and money on finding this information. The inefficiency is staggering.

Yet the DHSC has ended the contract to deliver technical maintenance and support for the website from 4 March 2024 and refused to allow FPA to take it over.

Why My Lords?

The reasons given are clearly spurious. The first rejection hides behind Crown Copyright of the Sexwise brand. The second rejection – after FPA clarifies the DHSC/Crown Copyright can keep the ownership of the brand – is nonsensical.

Will the Minister instruct the DHSC to either put out a public tender where the winner is required to provide and maintain a comprehensive range of free-to-access, in-depth sexual and reproductive health guides on Sexwise or accept the kind offer of the FPA to run Sexwise for free?

OHID Dismantling

Sadly, the Sexwise saga reflects the wilful neglect of public health by Ministers and their indifference to the effective dismantling of the Office for Health Improvement and Disparities which took over the administration of the public health grant fund when Public Health England was disestablished in 2021.

Public Health England in turn replaced the Health Protection Agency following the 2012 Health and Care Act.

Now major unannounced changes have taken place to the Office which has been authoritatively reported in the Health Services Journal as having led to its fragmentation and decimation.

So in 12 years through a number of iterations, effectively, the Government has moved from having a separate and largely independent public health agency to a disparate group of people spread thinly across a number of Directorates.

The Department claims it is part of an internal restructure in the Department, with OHID teams integrated into the groups of three Director Generals.

But My Lords, at what cost?

Insiders report that OHID has been reduced by about 60% in staffing terms with no strategic logic to the reductions. According to reports, this includes the loss of several senior and experienced officials. Many are leaving and not replaced, and many functions are being overlooked or downgraded including sexual health and other important public health areas.

Can the Minister dispute this, can he tell me how many qualified public health specialists have left OHID and how many remain within it?

It’s a far cry from the triumphalist tone of the announcement launching the Office to be led by the then incoming Deputy Chief Medical Officer alongside the UK Health Security Agency, consequent on the abolition of Public Health England.

It hardly bears recognition to what in 16 September 2021 the then Health Secretary Sajid Javid said in relation to the three priorities he wanted OHID to work on:

• preventing poor mental and physical health,
• addressing health inequalities, and
• improving access to health services, and working with partners within and outside of government to respond to wider health determinants.

My Noble Friend, Baroness Merron anticipated this in her regret motion on 9 Nov 2021 on the abolition regulations. As she argued, the regulations were marked out by a lack of consultation emphasized by the more than 70 health organisations, who signed a letter of “deep concern” that the plans paid “insufficient attention to the vital health improvement and wider functions of Public Health England”, including necessary measures to target smoking, obesity and alcohol and to improve mental health.

As My Noble Friend put it at the time, it is hard to see how the new bodies could be independent or effective. They were not set up in statute and were created without parliamentary scrutiny or approval.

And as we can see, it has been possible for the Minister’s Department to effectively dismantle the Office without any public or parliamentary scrutiny at all.

Hunter, Littlejohns, and Weale in a forthcoming BMJ Opinion column will argue that:

“Set up in haste with no consultation, OHID lacks any of the… independence PHE had, being an opaque body scattered through the Department of Health and Social Care. Given its low profile and lack of a clear mission, it comes as no surprise that, despite denials from the government, it has been virtually eviscerated.”

Hunter and colleagues went on to say that;

“OHID’s fate is in keeping with the government’s opposition to public health measures and fear of being accused of ‘nanny statism’. True to its neoliberal roots, the government is committed to the rhetoric of individual choice and to shrinking the state.”

Or as Dave West of the HSJ put it:

“…the latest restructure, as well as being damaging to a functioning national public health system, suggests any idea of greater push and support from the centre for ICSs’ long-term agenda – of population health, prevention and inequalities – remains for the birds.

“Hopes of tougher preventative action on alcohol or sugar, for example, equally so.”

Last month, Clare Bambra and Michael Marmot argued in the BMJ that the restructuring is a further cut to our public health systems on top of massive reductions in local public health and related funding over the past decade.

They point to the slowdown in health improvement for the UK overall. Until 2010, life expectancy in the UK had been increasing by about one year every four years. This trend had continued for all of the 20th century, with small deviations. In 2010/11, there was a break in the curve—the rate of improvement slowed dramatically and then stopped improving.

The BMA has said that there are serious questions about whether these changes to OHID will mean a scaling back of vital national public health leadership and functions.

Conclusion

This is on a par with the Government’s tepid approach to public health measures – smoking aside. The shamefully postponed implementation of the Obesity strategy is but one example. It is in this context that we see the problems arising in sexual health.

How else to explain LGA analysis that, between 2015 and 2024, the public health grant received by councils has been reduced in real terms by £880mn which has resulted in a reduction in councils’ ability to spend on STI testing, contraception, and treatment?

As Hunter and colleagues argue revitalising public health in the UK requires changes including a cross-government approach to tackle the social determinants of health alongside restoring the funding cuts to public health funding.

Will the Minister respond?