We have an important debate this afternoon on the subject of sexual health. At three hours, the debate is fairly lengthy, and I want the Opposition Front-Bench spokesmen and the Government spokesman to have adequate time. I hope that that will be borne in mind by all hon. Members who wish to participate. I call the Chairman of the Select Committee on Health to open the debate.
Welcome to the Chair, Sir Nicholas. I know that you have long taken an interest in sexual health and health matters in general. I have a concern that I wish to place on the record. You heard my comments in the Liaison Committee this morning about the fact that, unfortunately, our debate has clashed with the Second Reading of a health Bill. That is unsatisfactory, and I hope that note will be taken of the concerns of a number of my colleagues who found themselves having to choose between attending this debate and the one in the main Chamber.
I thank the hon. Gentleman for drawing attention to that matter. In response, I can say only that his comments were noted in the Liaison Committee, and that a Minister is present who will, I am sure, take the message back to those who organise the business of the House. The able Clerk who is sitting on my left has indicated that the matter will be taken up. I hope that we can prevent this from occurring again.
I am grateful for that. I do not hold the Minister responsible. I know that she shares my concern about this matter.
I welcome the opportunity to discuss the report and the Government's response to it. No area of public health in England has suffered a more dramatic and widespread decline in recent years than sexual health, yet that vital area of health care has not yet featured in any significant way in spending programmes or in the Government targets that dictate priorities. The Health Committee welcomed the publication of the Government's national strategy for sexual health and HIV as a foundation for tackling poor sexual health. However, its members swiftly became aware of considerable concern that the problem of sexual ill health had reached crisis proportions and was outgrowing the scope of commitments made in the national strategy. We announced our intention to hold an inquiry into sexual health based on an analysis of the strategy at the end of April 2002.
As written evidence began to arrive we prepared for the inquiry by appointing three specialist advisors—Professor Mike Adler from University College medical school, Dr. Anton Pozniak from the Chelsea and Westminster hospital, and Helen Christophers, an independent consultant in sexual health promotion. I want to place on record the Committee's sincere thanks to them for their expert advice, which helped it to negotiate the technical demands of the inquiry and to appreciate more fully the sensitivities involved in these emotive issues. They were not only advisers; they were deeply concerned about the suffering of the many people who have infections and diseases of a sexual nature.
I wish also to thank the Health Committee staff. We are fortunate in being helped by an excellent group of people. They supported us through our inquiry. I pay particular tribute to Jenny McCullough. The second Clerk of the Committee when we held the inquiry, she was primarily responsible for much of the work that we have done. She has moved to another position and we wish her well and thank her for the work that she did on our inquiry.
Tribute is not normally paid to Committee members, but I want to mention three members who were party to this inquiry and have subsequently left the Committee. My hon. Friend Andy Burnham had a particular interest—I was going to say expertise [Laughter.] Perhaps that would have been the wrong word. He was an excellent Committee member and we wish him well in his new role as a Parliamentary Private Secretary. I pay particular tribute to my hon. Friend Ms Drown, who is here today—I was not aware that she would participate. I had intended to say that, having taken this policy area seriously, she had left the Committee and gone on maternity leave. We are pleased to see her and to know that Ottilie is doing well and making good progress. I am also pleased to see Sandra Gidley, who was a first-class member of the Committee and one of the key figures in pressing it to undertake the investigation. I thank her for the excellent work that she did.
Turning to the evidence, during our inquiry we received more than 160 written submissions from a wide range of sources, including genito-urinary medicine consultants, academic institutions, charities, members of the public, lobbying groups, royal colleges and pharmaceutical companies. They indicated the widespread nature of the problem and its profound impact on the lives of the many thousands of individuals affected. In addition, between June 2002 and January 2003, we heard from 67 witnesses during 10 evidence sessions.
In the opening sessions, evidence from experts in the epidemiology of sexually transmitted infections and HIV/AIDS—including scientists based at the Public Health Laboratory Service communicable disease surveillance centre—helped to place on record the worrying trends in sexual health. Seeking clarification on the implementation of strategy, we took evidence from Department of Health officials. We heard from clinicians with specialist knowledge of sexual health in primary and secondary care, family planning service providers, patient groups, charities, campaigning organisations, and experts on sex and relationships education. In one of our most memorable evidence sessions, we heard from a group of young people aged 15 to 21.
We are grateful to all those who gave evidence, particularly the scientists and clinicians who gave of their time to speak to us. In specialising in this area of health, they embrace a role in disease prevention and in health promotion, and may even act as advocates for those who are affected by poor sexual health. We were struck by their commitment to the work, which was often given at the expense of their own professional development and private time.
Perhaps we are most indebted to the young people, drawn from peer research and support groups in our own constituencies, who gave evidence in January last year. They answered our questions in a full and frank way and approached with enthusiasm and poise what might have been a daunting experience in front of the Committee. We were disappointed that newspaper accounts of that session failed to reflect the thoughtful and articulate nature of the contributions made by those young people to the debate. One witness from the Wakefield area struck me with the strength of her arguments and the articulate way in which she put them over. She disclosed to the Committee that she has a picture of me in her bedroom, so I have great affection for her. She was described in one newspaper article as
That denigrated her—all who heard that witness recognised that she had a great deal to say. The contribution of those young people was remarkable. Many of us learned that we in Parliament ought to listen formally to children and young people more often, because we get a great deal from doing so.
I fully concur with my hon. Friend's description of the value of the evidence that we had from consumers and users of services—particularly the young people. Does he share my view that one reason why sexual health services in this country have been allowed to fall to such a low level is that there is not much lobbying in support of those services?
I have been a Member of Parliament for fewer years than my hon. Friend, but in those 11 years, although I have had letters about almost every aspect of the health services, I have had no lobbying from constituents complaining about sexual health services, apart from HIV services. There has been no lobbying about the local clap clinic, or the time that constituents may have had to wait for such services, or the conditions that they may have endured. Does my hon. Friend agree that it is important that Committees such as the Health Committee take on such issues, about which the consumer's voice is often silent?
I concur entirely with my hon. Friend. I made the point, as did other members of the Committee, that I could not recall receiving one letter about GUM in my time as a Member of Parliament. It is not an issue that constituents feel able to raise with Members of Parliament. The worrying situation found in some GUM clinics reinforces the need to ensure that the public and patient involvement aspects of the health service reflect the needs of groups that are not able to articulate their views on sensitive and difficult issues.
When the then Minister for Public Health, Ms Blears, and the Parliamentary Under-Secretary of State for Education and Skills, Mr. Twigg, came to the Select Committee, I was gratified to find that both of them had clearly taken note of the merits of the evidence that young people had given to the Committee. I welcome that.
I appreciate the hon. Gentleman's point. Does he agree that a patient, especially a young person, who is afraid to see their MP to lobby for services is just as afraid to see their GP, who is often a family friend and well known in the community? Indeed, they are more embarrassed about going to see their GP than they would be about seeing one of us. I hope that he agrees that one of the chief problems is the demise of community health services and family planning clinics, which often acted as a point of referral to sexual health clinics in hospitals.
I was about to come on to that point, on which I concur with the hon. Lady. I appreciate the comments that she has made when I have talked to her about these issues. Her knowledge and experience are highly respected in the House. Later, I shall mention one idea that reflects her concerns that we have followed up: in one part of the country an encouraging development has taken place that offers a model that could be followed.
We made several helpful visits during the inquiry, and both in the United Kingdom and abroad we saw for ourselves what was being done to tackle sexual ill health and the conditions in which individuals receive advice and treatment. We came away from each visit with a great deal of new information about different approaches to sexual health care provision, as well as a vivid impression of the sometimes shocking epidemiological and behavioural trends that underlie the problem.
At Manchester Royal infirmary, we met GUM consultants, clinical staff and public health authority and strategic health authority representatives. We were given a detailed presentation on the numbers presenting themselves for treatment. I recall querying the figures on what was termed "anonymous sex"—I asked whether it referred to the number of patients who were unwilling to disclose partners for tracing. The answer confirmed that in some instances it was, but in most it was patients who did not know who their partners had been. That issue was obviously of concern to the Committee: we must consider the question of personal responsibility.
We also visited the Brook advisory centre in Manchester, where we heard about sexual health services for young people and about the financial difficulties encountered by those who are trying to provide such services in the voluntary sector. We met representatives from the Manchester young people's council, and we were all impressed by the maturity of their contributions. They talked to us about sex and relationships education in schools and their concerns about the ambivalent and confusing approach to sex in the media.
In Bolton, we met a health worker who was in contact with sex workers in local saunas. Hearing what she had to say about her work was interesting. We visited the Lighthouse Kings centre in Camberwell, London to hear about the model of HIV care developed by the Caldecot centre and the Terence Higgins trust to provide sexual health services and a wide range of other support services to those living with and affected by HIV.
We heard from staff at the south Bristol walk-in centre and met clinical and managerial leads at the premises of the Milne centre for sexual health. Our visit to the Milne centre was one of the most memorable experiences of the inquiry. We saw for ourselves a situation that had been described to us by many clinicians in formal submissions to the inquiry. The state of the premises in which people were diagnosed and treated and in which clinicians worked was nothing short of appalling. Members of staff told us that they wore extra pairs of socks to protect them from the fleas that infested the clinic. In Exeter during the same visit we heard from clinicians working single-handedly to provide services for large populations in rural areas, which is a stark indication of the severe capacity problem in sexual health services in that area.
On the point made by Dr. Tonge, at Paignton community college the Committee saw the Teenage Information Centre-Teenage Advice Centre—known as the Tic Tac project—of which many hon. Members will be aware. The centre is housed in a self-contained bungalow on the site of the college. We met the health and youth work professionals who staff the centre, representatives of the college management, and students at the college. That was an important visit for the Committee. The ease with which the young people could get access to confidential advice on sexual health and other matters, and the appreciation they showed for the service, made a deep impression and helped us to frame some of our recommendations when we were considering our report. Picking up the point that was made about the reluctance, particularly of young people, to go to the family GP, the centre seemed to offer a possible model that could be replicated elsewhere. It is a successful experiment that people in other parts of the country are considering.
In Brussels we learned more about the European context of our inquiry in discussions with the Health Commissioner, David Byrne. With the help of the International Planned Parenthood Foundation network, we came to appreciate the rapid rise in the incidence of STIs across Europe—in particular, the increased incidence of HIV/AIDS in central and eastern Europe. I should like to place on the record the Committee's thanks to Commissioner David Byrne, who is retiring later this year. He has always been willing to meet the Health Committee to discuss various subjects. We appreciate his co-operation on this and other policy areas.
In December 2002 we travelled to Sweden to visit youth health centres that provide comprehensive sexual and reproductive health care for young people. We also spoke to teaching staff in a secondary school about provision for relationships and sex education, and about the links between schools and colleges and local youth health centres. We visited staff at the sexual health clinic at the South Stockholm general hospital before travelling on to learn about sexual health services in the Netherlands, which are delivered through municipal health centres as well as through specialist and voluntary services, such as those provided by the HIV Foundation.
Those meetings, and the ones hosted by Government officials, clinicians and epidemiologists working in the field, provided opportunities for us to see at first hand the different approaches to sexual health taken by two socio-economically comparable countries. In particular, it enabled us to see examples of good practice in sexual health services for young people and infectious disease control. We saw the benefits of a more open discussion of sexual health, compared with the culture of embarrassment and secrecy that still surrounds sexual health in this country.
Has my hon. Friend seen the FPA report showing that most parents support school-based sex and relationships education, and that 60 per cent. believe that children should be taught aged eight to 10, or even younger? Does he agree that if we are to change the attitudes he describes, we need to start in primary schools?
That is a difficult matter for me as a parent, and for all of us who are parents, although most of us have had to deal with it at some point. During the course of the inquiry, I was struck by the message that despite the arguments advanced by some people, there is clear evidence that if children are given good sex education at quite a young age—and I would argue for that in primary education—it is likely that their first involvement in sexual activity will occur later in life, rather than earlier. The perceived wisdom among some people—some witnesses advanced the argument—is that if people are told about it, they do it. That is not true. The evidence shows the opposite is true. I concur with my hon. Friend's point.
Before my hon. Friend leaves the subject of the youth clinics that we visited in Sweden, does he share my view that part of their strength lay in the fact that they operated in a quasi-formal framework? They seemed to be productive and to achieve many of the targets on which we in this country have tried to make progress. Part of the strength of their operation is that they focus on all aspects of youth health and do not pigeonhole sexual health as a separate consideration. Such a separation may be what gives rise to much of the stigma and embarrassment encountered in this country.
I concur entirely with my hon. Friend. The same message came out of the Tic Tac project. If a youngster was seen going into the Tic Tac project building, it was not automatically assumed that they would come out with a packet of condoms. They could have gone in for advice on all sorts of issues. It is important to recognise that advice, assistance and support should be given more widely and not only on sexual health. Although we were struck by the positive approaches in Sweden and the Netherlands, we realise that for a variety of reasons public health problems caused by sexual ill health are increasing rapidly even in countries where good practice is to be found.
We published our report on
When gathering evidence for the inquiry, we saw a picture even more bleak that that which convinced us to undertake the inquiry in the first place. In the first part of our report, we sought to place on record the extent of the decline in sexual health in England. The facts spoke for themselves: at the time of our inquiry, about one in 10 sexually active young women, and a great many young men, were infected with chlamydia; syphilis rates had increased by 500 per cent. in the previous six years and the rates for gonorrhoea had doubled; HIV remained the most important communicable disease in the UK, with an estimated 6,500 new diagnoses in 2002; and rates of teenage pregnancy in this country were still the highest in Europe.
Our report also set out to show how sexual health services were fighting to cope with the crisis and how patients and staff were suffering as a result. It was striking that although we received a great many representations from clinicians and health professionals, we had little evidence from patients. We accepted that the reason for that is that people are not prepared to come forward and talk about that area of ill health. Given the stigma attached to sexual health problems, and given that sexual ill health tends to follow the fault lines of social exclusion, we understood that patients might be reluctant or unable to complain. We felt strongly that the Committee should therefore complain on their behalf and call for a greater awareness of patients' experiences of sexual health services.
We heard of and saw for ourselves clinics where waiting times for an appointment were 10 days or more, and where hundreds of people were turned away every week. It was obvious to us that suspected STIs should be diagnosed and treated as soon as possible to prevent onward transmission. We recommended a target of a maximum 48-hour wait for patients who wanted to access sexual health services. Confronted by the compelling evidence that we heard from consultants working single-handedly in large areas, and from those working in clinics that resemble accident and emergency units or, as they put it, war zones, we also recommended that the Government urgently review staffing levels and increase capacity to make that target feasible. We asked trusts to give priority to improving the material conditions of clinics such as the one that we saw in Bristol, so that the most basic standards of dignity, confidentiality and hygiene could be maintained.
In their response to the report, the Government agreed that additional investment was needed to reduce waiting times and improve capacity in sexual health services, and pledged an extra £5 million to GUM services over and above the funds allocated to implementation of the strategy. The Government also accepted our recommendation of a 48-hour waiting time in GUM. That is perhaps the single most important step taken in response to our report, and I very much welcome it. We are convinced that implementation of the maximum waiting time will go some way towards limiting the public health consequences of sexually transmitted infection, and that it will vastly improve patients' experience of the service.
The Government's response on capacity did not meet our expectations, although we welcome the additional resources that have been invested in modernising the NHS estate as a whole, in particular the extra funds to deal with capacity issues. We are not convinced that the 55 additional trained specialists available in the current year will be enough to meet the expected demand. Genito-urinary services have been marginalised in the past and, without targeted funding for specialist posts as well as training places, capacity will remain a problem.
We took much evidence on screening and testing for chlamydia. Given that screening for chlamydia is important because it is asymptomatic in the majority of cases, we were shocked to find that the most widely used test for chlamydia is one that produces false negative results in an estimated 30 per cent. of women and 46 per cent. of men. We urged the immediate abandonment of the test. The results of screening pilots using a more sophisticated test were so worrying that we recommended the immediate introduction of a national chlamydia screening programme.
In response, the Government undertook to address the use of the sub-optimal test for chlamydia as a matter of priority. We were relieved to have the Government's acknowledgment of the necessity for rapid implementation of a national screening programme. We were also pleased to hear that £8 million, which includes a new allocation of £5 million, will be invested this financial year to enable laboratories to switch to the preferred molecular amplification test, and that the chief medical officer has written to all primary care trust chief executives to underline concerns about the use of the sub-optimal test. However, I am aware of the Minister's announcement today, and although we welcome the Government's commitment to extend the pilot screening programme to more areas, we hope that that phased introduction of the screening programme will not delay action to halt the increasing prevalence of chlamydia.
During our inquiry, we reported evidence of new trends in the transmission of HIV and of the spiralling cost of treatment. As in other areas of GUM, service providers were overstretched in their attempts to meet increasing demand for counselling, testing and treatment. We were concerned that treatment costs would continue to deplete the resources needed by clinical and support services for sexual health. We also placed on the record of our report the concerns of clinicians and other service providers that the transition to PCT-led commissioning, as well as the end of ring-fenced funding, might endanger vital prevention, health promotion and evidence-gathering work undertaken in the community and voluntary sector.
We welcome the additional £400,000 from the Government for targeted HIV health promotion and the news that the Government regard studies on the prevention of HIV and other STIs as a research priority. Without the availability of sound advice on health promotion and prevention of STIs, much of the money invested in diagnosing and treating infection will be wasted. The publication of recommended standards for the treatment of HIV, based on the model used by the national service frameworks, is a significant development. However, that does not fully answer the worries summed up by a clinician who told us that he and his colleagues found it difficult to prescribe appropriate treatments for their patients
"without a stamp on the front saying that this is what must be supported"— a stamp such as that relating to NSF or National Institute for Clinical Excellence guidance.
While we acknowledge the clear progress achieved through the Government's teenage pregnancy strategy, we heard evidence that health and education services are still failing young people, and young men in particular. Our young witnesses confirmed our suspicions that the education system in this country persistently delivers too little, too late, often placing a mistaken emphasis on sex at the expense of a wider discussion of self-awareness and relationships. To that end, we urged the Government to incorporate sex and relationships education into the national curriculum and to ensure that it is delivered by appropriately trained teachers. Having seen evidence of the success of the specialist advice facilities both in Sweden and at the Tic Tac centre in Paignton, we also recommended that the Government should examine them as a way in which to improve services for young people.
The Government's response to those aspects of our report has not allayed our concerns. We were pleased to hear that clinics and GP practices have been audited against teenage pregnancy guidance to identify gaps in service provision, but we remain concerned about the standard of SRE that is delivered in schools throughout the country. Although we welcome the news that the quality of SRE will be monitored and that Ofsted will inspect personal, social and health education, including SRE, in secondary schools later this year, we are disappointed by the negative response to our recommendation that sex and relationships education—or relationships and sex education, as we felt it would be more appropriately termed, because our members felt that it was helpful to have a relationship before indulging in sex—be made a compulsory part of the national curriculum. It remains our strong conviction that dedicated SRE teachers should be appointed. As one young witness told us:
"We have English teachers to teach English, but we do not have sex education teachers to teach sex education . . . so it is really not doing the job properly to have an English or geography teacher teaching sex education."
We concur with that obvious point.
The evidence that we heard during our inquiry pointed to persistent deprioritisation of contraceptive services. Witnesses told us that contraception seemed to have disappeared from the Government's plans to tackle poor sexual health and that it was
"progressively becoming the 'poor cousin' in terms of health care provision".
Our report reflected the belief that that imbalance should be rectified, and that family planning services should form part of an integrated and comprehensive sexual health service that offered advice on STI prevention and health promotion, as well as on contraception. We welcome the news that the Government will provide a small boost of £1 million to contraceptive services and that they plan to gather evidence on disinvestment in services at PCT level, but we had hoped to see a firmer commitment to action than merely the publication of guidance on commissioning to PCTs and "consideration" of a performance indicator for contraception services to be included in PCTs' star ratings.
We also recommended that, within the current legal framework, practical steps should be taken to improve access to safe, early abortions on the NHS for those who met the legal criteria. We felt that the national standard of a three-week maximum waiting time from the date of referral for an abortion was too long. The Government agreed with the Committee that in "most" circumstances three weeks was too long to wait. However, they argued that because many PCTs were not meeting the three-week target, it should not be reduced further. They also rejected our recommendation that a national telephone helpline to facilitate self-referral should be considered. However, we take on board the Government's commitment to improve services relating to abortion and their pledge to build on the progress achieved through the teenage pregnancy strategy on preventing unintended pregnancies, which, as the strategy stated, represent one of the consequences of poor sexual health.
Our report concluded that the crisis in sexual health had arisen from a range of factors that cut across all areas of our inquiry. We felt that NHS organisations had failed to deal with sexual ill health as a public health problem and that it had been neglected because of a lack of political leadership and pressure to keep it on the agenda. That lack of central direction, compounded by historical underfunding, marginalised sexual health compared with other areas that received priority because they had NSF status or Government targets attached to them. We welcome the Government's acknowledgement of our assessment of the grave situation and we are encouraged by Ministers' statements that they will take every opportunity to underline the importance of sexual health. However, we also expect to see evidence of other steps taken at the highest level to ensure that sexual health is regarded as a key priority.
We welcome the prospect of a new indicator for sexual health in PCT star ratings and the development of standards along the lines of those adopted for treatment of HIV/AIDS in other areas of sexual health. We hope that guidance measures such as the commissioning toolkit will be adopted at PCT level. However, we concluded that a dedicated national service framework was the best way to ensure that commissioners and trusts allocate appropriate resources and support to patients and health professionals. The Government rejected that recommendation, along with our request that the planning and priorities framework be adapted to include sexual health. We remain concerned about commissioning arrangements for sexual health. We also have reservations about the level of training and support currently offered to GPs to enable them to deliver sexual health services to a high standard. We believe that the primary care sector has the potential effectively to deliver locally commissioned and managed sexual health services, but we are not yet convinced that the mechanisms to support delivery are in place.
The Government tell us that their "clear message" to PCTs is that they are expected to address issues around waiting times and to make appropriate investments in the service. Our clear message is that we expect the Government, in conjunction with SHAs, to ensure that such investment is made and sustained to prevent further escalation of the crisis in public health. We also expect the Government to work not only towards better standards of physical health, but towards a healthier culture in which individuals are aware of their personal responsibility to make choices that will protect them and others from poor sexual health.
Sex has not suddenly been invented or discovered, but one would think that it had, given the way in which some parts of the media seem to be obsessed with it at the moment. In addition, sex has been entirely trivialised, which I shall say more about later.
I concur with almost everything said by the Chairman of the Health Committee, Mr. Hinchliffe. I congratulate Sandra Gidley in particular, as I recall that it was her idea that we embark on this investigation. I shall not enlarge on this point, but shall say simply that the hon. Lady excelled herself in Amsterdam, and we were all the better for that.
I echo the tribute paid by the Chairman to our expert advisers, who were far more knowledgeable about the subject than we were. I understand that Professor Adler, who attended a seminar to which members of the Committee were invited, was reported as saying that MPs said:
"We never knew it was like this. We've never had a letter from a patient complaining about STIs", to which the obvious response is, "Well, you wouldn't, would you?"
A year later, we held our inquiry, which lasted seven months. MPs were eager to reveal just how much they had learned. We said in our report:
"We have been appalled by the crisis in sexual health we have heard about and witnessed during our inquiry. We do not use the word 'crisis' lightly but in this case it is appropriate. This is a major public health issue and the problems identified in this Report must be addressed immediately."
As our Chairman said, our report described waiting lists of two months in Manchester and absolutely appalling services in Bristol. We visited a condemned portakabin with fleas in the carpet from which, apparently, 400 people were being turned away each week. A week after our visit, I was told that that facility was closed down when rats were discovered in the area. The hon. Member for Romsey was right to suggest that the Health Committee should embark on the inquiry. There can be no argument about that.
The report states that the sexual health of our nation is not at all good. How have the Government reacted to that fact? They have produced a wonderful strategy, on which I shall comment in some detail. I wonder, however, whether the strategy is simply a reaction to the crisis, or whether it offers a failsafe solution on which we will all be able to work. I have my doubts. Even today, a headline in the Evening Standard reads, "Sex disease 'timebomb'" Everyone is more than aware of the seriousness of the situation.
I said that sex had been trivialised, and it has been. All the taboos have been broken down and we talk freely about sex. Everyone talks about sex—we are obsessed with it—but what has all that achieved? Every time one turns on the television, one finds that there is no 9 pm watershed and that sex is depicted on every channel. It is extraordinary what I see being shown on some digital channels, before quickly moving on to the next one. Sex is everywhere—even the lyrics of some music contain sexual references. We can dismiss all that as irrelevant, but I do not think that it is irrelevant; it is germane to the mess in which we find ourselves. The media, just as they have changed the mother of all Parliaments, have changed the sexual behaviour of the country.
Paragraph 1 of the report states:
"No area of public health in England has suffered a more dramatic and widespread decline in recent years than sexual health."
The statistics that I obtained from the House of Commons Library show that the number of people contracting sexually transmitted diseases has increased dramatically: new episodes of chlamydia have increased from 32,000 to 67,000; of gonorrhoea from 11,000 to 22,000; and of syphilis from 116 to 696. Those are shocking facts. The rising trend in the number of sexually transmitted infections does not look as if it will even slow down, and it certainly does not look as if it will be reversed. The situation is very worrying, so the Government were right to produce their strategy in 2001.
The Chairman of the Committee touched on the issue of sex education, which is very important. Not every human being is comfortable talking publicly, or even privately, about sex. The sex education of young people, and children in particular, is a personal matter. For my part, I am nervous and cautious about sex education at a young age. One of the tragedies of today's society is that the age of innocence is decreasing all the time. Our reaction to that sad development is to say that because very young children know all about it, we must prepare them for what lies ahead and make them wary of trusting others. I understand all that, but let there be no doubt: in the past two or three years there have been dreadful national cases of things going terribly wrong after people have been trusted with the care of children and young people. That is the nature of humanity and there is a limit to how we can control, conduct and monitor the way in which such knowledge is imparted.
I am nervous about the issue and I do not have an easy answer. However, I feel strongly that it is not for any one of us to lay down the law to parents. Parents have a huge responsibility when they bring children into the world. Decisions about sex education must be theirs and theirs alone. I understand entirely the difficulties if little Johnny is withdrawn from a sex education class: it can be embarrassing and his life may be made hell in school break. Nevertheless, the issue is important and sensitive for parents.
I understand where the hon. Gentleman is coming from. I do not always agree with him, but I share some of his concerns. However, does he recall that during the inquiry we were told and given some fairly strong evidence to show that one in 10 girls knows nothing about menstruation when she starts her periods? That is unacceptable in this day and age, and I am sure that the hon. Gentleman shares my view. If the parents do not go along with his suggestion that it is their duty to deal with this issue—many parents still do nothing about it—who is responsible? Who should deal with that worrying situation?
The hon. Gentleman has touched on an excellent point. Many of us have children and this is not a matter that I want to personalise. However, on the specific issue that he mentioned, I would very much hope that if there was a mother and a father, the mother would take the responsibility of preparing her daughter.
The hon. Gentleman challenges me to say what would happen if there was no lady to share information with the child. I understand his point—someone must take responsibility. If there was no mother, the task would, I hope, fall to someone who had responsibility for caring for the child.
I appreciate the hon. Gentleman's sensitivity, but menstruation in girls is part of human reproduction. Should we not simply learn about it? Why is human reproduction divided from the rest of education? No one is embarrassed about teaching us how the heart works or how our eyes focus. Why should we not teach children how the reproductive system works and about the events around that?
Does the hon. Gentleman not agree with the Chairman of the Committee that children have a right to know? Parents should not be entitled to deny them that knowledge. That was certainly what we were told by the young people who gave evidence to us.
I say again that it is for the parents or the individuals responsible for the child to make the decision. I hope that they would do what the hon. Member for Wakefield said and prepare their children.
Does the hon. Gentleman not accept that many parents are themselves deficient in the knowledge that they need to impart to their children? Many have problems with their own relationships and many have hang-ups about sex, so they are not necessarily the best people to communicate the necessary information to their children.
I say to the hon. Gentleman that it is not for Members of Parliament to patronise other human beings—parents—by saying that we know best, that they are ignorant or daft, and that we have all the answers. We should listen to everyone.
I say again that deciding what to tell children is a personal matter. I would be totally against legislation that made telling a child about menstruation an absolute duty. Not every human being is the same, and such an approach would be wrong and totally undemocratic. We should be not too prescriptive in such matters, but a little more sensitive to individuals' feelings.
I think that the hon. Gentleman fails to hear the points that colleagues are making. Even if we totally agreed that responsibility should lie with the female adult who had care of the child, we know from experience and from statistics that some parents will not and, indeed, cannot accept and execute the responsibility to pass on such information. When that happens, the consequences for the child, as the report shows, can be really dreadful. I ask the hon. Gentleman to consider whether in this respect society should take responsibility when parental responsibility is not exercised.
I am listening—I am just not agreeing. I say to the hon. Lady that none of the three or four hon. Members who have intervened on me has come up with an acceptable solution. They have raised a point, and I agree with them, but they are have not come up with an acceptable solution to the problem of how to impart information to individuals. Their solution is that children should know everything very early on—I think that the age of six or eight was mentioned.
Hon. Members might grimace, but Dr. Tonge said that it is a mere matter of biology and should be taught in schools. I disagree. I am listening and I understand the issues, but I do not agree with the views that hon. Members have expressed.
The way in which sexual health is bandied about on television is unfortunate. I do not mind admitting that although I used to like "Coronation Street" a great deal, I am not up to speed with the present plot. However, I am advised that in the modern show young people are depicted as having sex freely. There is a character called Sarah Louise who is 16; she already has one child, and another by a different father is on the way. Some people might ask, "What does it matter?"
As my hon. Friend has not seen the programme recently, perhaps I can help by explaining that Sarah Louise is in a stable, loving relationship with the father-to-be of her second child.
Would the hon. Gentleman be more comfortable with the depiction of sex on television—which I deplore just as much as he does, and if I get the chance I shall tell him why—if the characters were shown to use condoms properly before having sexual intercourse, just to get the proper message over?
I am not sure about that, but some of the story lines are increasingly ridiculous. One has only to look at "EastEnders" to see that it is all happening. People might laugh, but such programmes have an impact on the way in which people behave. The wrong message is being sent, and I have to say to my hon. Friend Mr. Burns that it is not cool for a sixteen-year-old to behave in the way that Sarah Louise does, although I am happy that she is now in a loving relationship.
The report concluded that the crisis in the sexual health of the United Kingdom arises from
"A failure of local NHS organisations to recognise and deal with this major public health problem . . . A lack of political pressure and leadership over many years . . . The absence of a patient voice . . . A lack of resources . . . A lack of central direction to suggest that this is a key priority . . . An absence of performance management."
The Government are very keen on targets—an enthusiasm that I do not share—and seem to think that they are the answer to anything and everything. Their national strategy for sexual health and HIV is divided into four broad themes: better prevention, better services, better commissioning and supporting change. The themes relating to better provision and better services seize on the words "targeted" and "targets", but targets are not the answer to such difficult problems. Problems can be solved only by sound policies.
The strategy includes four targets. They are, first,
"To reduce by 25 per cent. the number of newly acquired HIV infections and gonorrhoea infections by 2007"; secondly,
"By the end of 2004, all GUM clinic attendees should be offered an HIV test on their first screening for sexually transmitted infections (and subsequently according to risk) with a view to" taking the matter further; thirdly,
"By the end of 2003 all homosexual and bisexual men attending GUM clinics should be offered hepatitis B immunisation at their first visit;" and, finally,
"From 2005, commissioners should ensure that women who meet the legal requirements have access to an abortion within 3 weeks of the first appointment with the GP or other referring doctor."
Those targets can be implemented only when the Government provide a coherent way forward. Simply stating that there is to be a 25 per cent. reduction in the number of newly acquired HIV and gonorrhoea infections by 2007 is absolutely ridiculous. Who said that that will happen? How will it happen? Yet there is the statement that it will happen, as though that were an answer to the serious situation in which we find ourselves.
Recommendations 6 and 7 of the report are crucial. I feel very strongly about recommendation 6, which is:
"Although we support the Government's drive to improve sexual health services via the Strategy, without wholesale advances in sexual health provision these targets will be tokenistic."
I shall not dwell on recommendation 7, which deals with abortion. I hope that in most circumstances, if not all, abortion can be avoided, and that given the marvellous education that we now have, no one will ever have to have one in future.
I agree with the hon. Members who intervened that better education is essential, but we badly need to do something—perhaps through a Department other than the Department of Health—about how sex in general is depicted. It is being trivialised and that damages the health of the nation. The sooner we tackle that problem, the better. Despite that, the Health Committee has, as ever, produced a wonderful and valuable report.
I agree with Mr. Amess that the report is important and worth while, and I congratulate the Government on their largely positive response.
The hon. Gentleman mentioned targets, about which there are lessons from the inquiry that we should learn in respect of other parts of the health service. Many people in and around the health service would probably say that there were too many targets, but when we asked people coming before the Committee what they wanted, the first thing for which they asked was often Government targets. They did so partly because they know the culture and know that that approach will help them in negotiation. However, I think that such people find it genuinely helpful when the Government set out nationally something that they would like for their service and on which they can work at a local level. Target bashing should be restrained slightly, because practitioners seem to welcome targets. That point has come through in both our inquiry and others, which has surprised me.
I wanted the Committee to call our report "It's not sexy", because I was struck by the extent to which the inquiry revealed deep failings in the system—in trust, in health authorities and in government—that have allowed a service that affects public health across the board to reach such a state. Decision makers at those levels have obviously all failed in their duty to protect public health. The situation in Swindon is just the same as that in other areas. Since 1998, there has been a 50 per cent. increase in the number of new patients attending the STI clinic, which is higher than the national rate, and there has been an exponential rise in the number with STIs, which is a concern. In subsequent years, waiting times have increased from two to four days, which is a reasonable time scale, to up to three or four weeks, which is too long for someone with serious concerns.
My area is one of the many places across the country that have only one full-time consultant. Our consultant is supposed to spend one day a week at the clinic in Oxford, is the clinical lead for Chippenham and elsewhere and also tries to help at other clinics. For example, when the consultant at Bath had to be away for a few months, our consultant tried to help out with cover. To do all that while dealing with the Swindon clinic as well is impossible. One can try to get locum consultants, but it is almost impossible to do so. When our consultant was ill recently, the service was really dodgy. That shows how vulnerable such services are in Swindon, as I am sure they are throughout the country.
In the light of the vulnerability of the service, we welcome the Government response and the fact that the Department of Health has given Swindon £30,000 to pump-prime the initiatives that have been set up. However, bearing in mind the wider pressures on the health service in the local trust and in the Avon, Gloucestershire and Wiltshire strategic health authority, that figure seems small in comparison with the real needs. I congratulate those working in the sexual health services in Swindon on their commitment to those services and on raising their concerns professionally and responsibly. I am pleased that they, along with the PCT, have produced a three-year expansion plan to deal with the massive increase in work load.
May I draw my hon. Friend's attention to the case of my constituency, where the opposite is true? Under what was the health authority and is now the primary care trust in Lewisham, the issue has been a priority for a long time because of the enormous explosion of sexually transmitted diseases and complications in the area, and because of our vulnerable population. Where sexual health services are prioritised, a huge distortion is produced in the budget. There is concern that funding cannot be found for other services that ought to be funded equally. There is an overall need for greater resources.
I agree. Part of the reason for that explosion is that genito-urinary medicine services are rightly often open-access services and attract demand from outside the area. Given that this issue is such a public health concern and will cost the health service and people in general more in the long run, the problem must be addressed. I am pleased that the Government have gone at least part of the way in their response to the report.
In Swindon, we estimate that we will need an additional 14 clinics over the next three years. The £30,000 pump priming is merely a drop in the ocean with regard to the cost of creating those further 14 clinics. I am pleased that the strategy is there, but I am concerned about whether the issue will stay on the agenda both locally and nationally. Will the funding to meet such obvious needs really be available?
The Government could do one thing that would help Swindon and the other areas that are bidding. Funds are available to set up pilot services to develop GUM services and clinics. We should pick some of the hard-pressed clinics in areas such as Swindon, which has higher than average rates of teenage pregnancy and sexually transmitted diseases, and fund the pilots in those areas. We need to learn from the lessons that we are given. A move from a vulnerable service with a single-handed consultant to a strong, quality service giving people the public health support that we need would be welcomed. I hope that the Government will respond positively to Swindon's request to become one of the pilot sites, as that would be good for the people of Swindon and beyond.
If we were to gain such Government support, we could have some confidence that the issues were being addressed. It is depressing to think about how we have reached this point. I would like us to see where lessons can be learned. Why has Lewisham dealt with the matter responsibly and made a priority of it? Why have trust and health authority non-executive directors allowed it to slip by?
I can tell my hon. Friend why Lewisham has made the issue a priority. In Lewisham, as in most of south-east London, the problem has reached epidemic proportions. The decision to prioritise has largely been forced on the area; it was not a far-sighted decision taken a long time ago. Following the publication of the report, it is important that we deal with the problem across the country before it becomes an epidemic.
That is exactly the point, and we should all try to learn something from it. Things should not have to reach this stage before action is taken.
I shall touch on some of the issues that the Committee highlighted in its report and which featured in the Government response. The first issue that we looked at was how the service should be expanded, if that is to happen. Should it be expanded at a general level across GP services or in the GUM clinics? Many would welcome GPs becoming more involved in sexual health services—Swindon certainly would—but there is a danger that that might not work if there is no central specialist support. For example, GPs cannot be more involved in tracing partners if they do not have proper communication with the partner-tracing system. We must ensure that the infrastructure is adequate, so GUM clinics have to be the priority. We cannot immediately train every GP to have specialist GUM knowledge without backing from the specialist clinics. The first priority must be at specialist clinic level, otherwise the training needs will be enormous.
I was concerned by some of the evidence that the Family Planning Association gave to the Committee. It made me look into the issues surrounding unwanted pregnancy, which is particularly relevant in Swindon because we have more teenage mums than elsewhere. I am pleased that, among the young people who gave evidence to the Committee, there were a couple of teenage mums from Swindon. They were not naturally assertive and were the last people whom one might expect to see addressing a House of Commons Committee, but they got their points across. In particular, they said that relationship and sex education in schools is not good enough. They said that they had found electronic babies useful and thought that if they had had them earlier, they could have helped them and others, and might have helped them to delay the decision to have their families.
I share hon. Members' concerns that the Committee's findings were written up like a diary piece rather than a write-up of the real issue, which is that without better relationship and sex education, people's lives will continue to be fundamentally changed. We should be doing something about that. When people tell me about the good and innovative work that is being done in Swindon to prevent teenage pregnancy, I am concerned to hear how frustrating it is to try to start new projects. In Swindon, we have a good project working with young dads, which people want to expand more widely in Wiltshire, but the task of getting the money for it has become a huge mountain to overcome—people cannot do it. We need quicker methods of getting funding to people so that we can build on the good practice in those projects. That does not happen at the moment.
We are also concerned about child protection issues. We know that teenage mums are often vulnerable and that people who abuse children or even adults are good at picking on vulnerable people. That is why those working with teenage pregnancy need to have particular training in child protection issues, so that they can pick up on any warning signs of people floating in—possibly new partners—and trying to impose themselves on teenage mums. We need to make sure that those child protection issues are addressed.
This issue is not only about relationship and sex education in schools. If we are to avoid unplanned pregnancies, we need to do more with regard to contraceptive services. I am glad that the Government have partly acknowledged that need in their response. Contraceptive services are needed at different locations, because some people will want to go to GPs and some will want to go elsewhere. We need the contraceptive services to be available.
The Committee urged the Government to do more for those who end up with an unwanted pregnancy because their contraception failed or for another reason. I have never met anyone who wanted to have an abortion. It is unpleasant even at an early stage, and it is painful and involves huge emotions. It is unpleasant to have to think about abortion, and people almost always treat it as the worst of two options. We should therefore not be so nervous about speaking about it.
I know that Committee members were nervous about making a recommendation, but we did so. For example, we said that we should not be so restrictive about where terminations take place. At the moment, they have to be carried out in licensed premises, so they tend to happen only in hospitals, but it would be better if more early medical abortions were made available in community clinics. I welcome the Government's recognition of that point, and I know that some pilot sites will be set up. Will the Minister say how quickly we could get a response on those pilot schemes and how soon the project could be rolled out nationwide? It would certainly give us more flexibility.
Some people may be worried that such an approach will suddenly make abortion easier and that more abortions will be wanted, but I doubt whether that will happen. Instead, many women will avoid the huge trauma that results from terminations being delayed. Women have been having terminations for centuries; if they are not available, safe and easy, those women will go to the back streets, where they will be dangerous. We should be realistic. We should ensure that counselling is available and that women are certain of their decision, but afterwards we should make the process as easy as possible, because terminations are still painful and traumatic.
I urge the Government to decide on the pilots as quickly as possible. We could then have a community setting for early abortions, and nurses could become more involved. Only then shall we be able to get the services quickly to the women who need them.
I want to talk briefly about chlamydia—a problem that greatly exercised the Committee. The Chairman rightly pointed out the Committee's concern about the test, and I am glad that the Government recognise that a better test is needed. Indeed, I am pleased to say that the Government have gone further than the Committee. I tried to get the Committee to agree that we should suggest a pee-in-the-pot day, and that rather than screening people in one clinic or another, we should try to wipe out chlamydia just as we wiped out polio. I think that we should try to reach all the young people in an area by getting pharmacists and everyone else on board, although the work load for laboratory staff would be huge. If the approach was taken a region at a time, we would eventually spread the testing across the country, and the laboratory staff would know that if they could get on top of chlamydia, it would reduce their work load in the long run.
The Committee was reticent and said, "No Julia; that is too dramatic. We can't talk about the pee in a pot." However, I am delighted that the Government said that pee-in-the-pot tests had already been done in Cornwall—well done Cornwall—and that if they were successful, there would be more tests nationally. It can be done with a good fun message. Getting rid of chlamydia from a major part of the population would prevent infertility problems for women, save the NHS money and save people a lot of trauma.
In conclusion, the Committee has produced a very good report. It took the Committee ages to get to the end of the process, but it was worth while and we have contributed to the Government's decision to take some really good steps. I urge them to do more, particularly to ensure that we have the funding to deliver locally. In particular, I hope that the needs of Swindon will be addressed and that we will be selected as a pilot site for developing GUM services. I know that that will make a big difference to public health in Swindon.
As a member of the Committee, I take this opportunity to thank the advisers, Clerks and Committee members for making this inquiry so good natured. Inquiries often become politically bogged down, as on foundation hospitals, and Members can take entrenched political positions, which means that there is not always enough give and take. As we have heard, people hold deeply personal views on sexual health, but even though not everyone agreed with some of the views that were expressed in Committee, there was a lot of respect and give and take.
I was delighted when the Committee decided to undertake its investigation into a neglected subject on which an extremely dedicated group of people are working—and they are doing so very much against the odds. No one wants to talk about the problem. Unusually, this was the first inquiry that I can remember where the panel of officials was 100 per cent. female.
So much made me angry as we were undertaking the inquiry and so much still does that the challenge for me today was choosing which bits of the report to highlight. I start by mentioning what was omitted. Some people might look at the size of the report, which is huge, and think that it could be regarded as a modern version of "Everything you wanted to know about sexual health but were afraid to ask", but that is not the case. We learned about disease states, lack of resources, the shocking and dilapidated state of some of the services, what young people think about their sex education and ways in which that education could be tackled.
The emphasis was very much on the physical, practical and obvious aspects of the problem. We scarcely touched on psycho-sexual aspects, for example, and we had a token hour on erectile dysfunction. I want to touch on the wider issues that, in many ways, we hardly referred to. The Family Planning Association highlighted some of those problems and stated in its report to the Committee:
"More recent preventative work has advocated a highly medical model, focusing largely on reducing infections."
I would not say that that was a bad thing, but the FPA believes that sexual health
"should be underpinned by a holistic ethos, which positively promotes human sexuality . . . as normal and life enhancing. A useful model is the Teenage Pregnancy Strategy, which takes an integrated approach to the contributing factors and examines the diverse range of influences surrounding young people and sex."
The FPA went on to talk in its evidence about the importance of sex and relationships education:
"Sexual health needs to be better integrated with teenage pregnancy programmes, community development projects and within education and local government to avoid services becoming isolated, and subjected to stigma and downgrading."
That theme was touched on in the evidence session, but the root cause of most of the problems is the peculiar attitude that the British seem to have about sex. It is not prudish, but schizophrenic. On the one hand, there are parents who are reluctant to talk with their children about sex for fear of somehow ruining their innocence, but on the other hand, statistics show that those children are likely to have a TV that they use unsupervised in their room.
That issue has been mentioned by a number of hon. Members. It is quite horrifying to think of some of the messages that are sent out, even on the soaps. Later at night, not long after the watershed, there are programmes that delight in showing young Brits at play abroad, displaying promiscuous behaviour. Production staff on reality TV shows fuel the bored young people with alcohol in the hope that they might get some on-screen sex. We live in a completely bizarre world. No wonder our young people are confused. That point was mentioned by our panel of young witnesses, and it is a matter of much regret that the coverage of that witness session poked fun at those witnesses. I still get quite upset about that.
Those young people also spoke eloquently about strong peer pressure and, sadly, the existence of mixed standards, which I thought had disappeared years ago—the attitude that if someone does not have sex, there is something wrong with them, but that if a girl has sex, she is a bit of a slapper, to use modern parlance. There is no middle way. The young people also spoke quite a lot about alcohol and how it was often a contributory factor or made sex easier. That is the oldest excuse in the book, but I hope that when the long-awaited alcohol strategy appears it will address some of those issues. Significant problems are associated with under-age drinking and drinking generally.
I turn now to slightly alternative themes. I will talk about erectile dysfunction, as I do not think that anyone else will. It was left to me to do all the questioning in Committee during our token session on the issue. During that session, one of the problems that was highlighted was equity of access to products that can help if a man has a problem. The report recommended that the Department review the current provision, but the Government have refused to carry out such a review. I should remind hon. Members that male impotence preparations are currently mostly covered by the schedule 11 or selected list scheme and can be prescribed only if the patient is also suffering from a specified clinical condition such as diabetes.
Schedule 11 is part of the general medical services regulations, which are being revised as a result of the Health and Social Care (Community Health and Standards) Act 2003. However, the selected list scheme does not form part of the new GMS regulations. Although the Government have assured us that there will be no additions, deletions or amendments to the medicines listed in that scheme, the provisions for it are to be covered by a separate set of regulations. I am not sure why that is so. Concerns have been raised about the continuation of a slightly different scheme, known as the severe distress provision, whereby a GP can refer a patient to a consultant urologist if he is suffering from unreasonable severe distress. If the consultant agrees that prescribing is appropriate, the patient can receive his medication on the NHS. Can the Minister reassure us that that scheme will continue, and that people who are currently accessing medication for that reason will continue to be able to do so?
I have dealt with British attitudes to sex—including talking about it—and I have reached one unshakeable conclusion: we are failing to prepare our young people for life. There is no point trying to educate them about the finer points of algebra or even about how their heart works if they are not equipped to deal with and negotiate sexual relationships, including learning how not to succumb to pressure and how to handle such situations, so that they can go on to have a healthy sex life when they decide to do so.
The Committee travelled to Sweden, where I was struck by the sexual health clinics for under-25s. The clinics were bright, clean and airy, and they welcomed both sexes and employed a range of staff, including nurses, doctors and social workers, who had a holistic approach to the subject and talked to the young people who accessed services. If the staff thought that a girl was coming in for the pill and was being promiscuous, they would encourage her to speak to a social worker or psychologist, because in their view such behaviour indicated some other problem. That is very grown up. What struck me was that a visit to the clinic formed part of the curriculum. Every child of a certain age was shown their local youth sexual health clinic and nobody batted an eyelid. If we tried to introduce something similar in this country, the tabloid press would have a field day. They would probably say that we were encouraging young people to have sex and so on. In fact, young people are having sex anyway, and we must ensure that if they are doing so, they are properly equipped to do so safely and healthily.
The nearest thing to those centres in this country is the excellent Tic Tac project at Paignton, which is an information and support centre based on a school premises. It is not just about sex, but about all aspects of social care. Similar projects should be encouraged in schools around the country. The project is responsible and has been well received by parents, and it seemed to be achieving its purpose of reducing the teenage pregnancy rate.
It was evident that the approach of Sweden and the Netherlands to sex education was heavily focused on the relationships aspect. Our system is based on the form teacher, who may or may not have received some training in sex education, teaching the subject. It always used to be the geography teacher who got the most flak. No account is made of how comfortable teachers are with educating children in such sensitive subjects. Not everybody can do it; people have to be comfortable with the subject and with themselves before approaching it in a realistic way with young people. The level of ignorance was described very adequately by our young witnesses, who were damning about the education that they had received. There is a particular problem with targeting education at young men. Although I welcome some of the attempts to tackle that problem, they do not seem to have gone far.
We have produced generations of sexual ignoramuses. Those on the Select Committee will probably be able to name the 12 methods of contraception that I have written down, although I looked at that number again before this debate, and found that there were actually 13 methods. Not many people can name them all, and I tested the matter out at the Liberal Democrat conference. We had a debate on sex education, and I challenged the audience to name 12 methods of contraception. Three people put their hands up; all of them were MPs and two were medically qualified, although we are not sure about my hon. Friend Mr. Willis. That evening, I could not move around the conference or the fringe events for people stopping me saying, "We've got up to nine. Can you tell us what the others are?" It was a good opportunity to provide public education, particularly as it was the last night of conference.
I wholeheartedly support one of the Select Committee's key recommendations: SRE in schools should become a core part of the national curriculum. I firmly believe that we have a moral duty to make such education compulsory from key stage 2, although I know that not everyone agrees. These days, a large majority of girls start menstruating before they leave primary school. Years ago, there was no provision for the few who started their periods before they started secondary school. Now, we see the bins and the machines in the girls' toilets at junior school. It is a dereliction of duty not to educate young girls about what is happening to their bodies.
Parents are vital, but when it comes to sex education, we are often given the alternative of parents or schools. We must not take an either/or approach, but consider ways in which parents can become more relaxed and happier about what is happening in school. They could be involved in developing ideas that encourage children to talk to their parents, because the younger children are when that happens, the easier it is. If parents wait until they have an embarrassed 14-year-old boy on their hands, they will not have a chance of raising the subject and being open and honest with him.
I shall finish by concentrating on the Government's response. Our report was so powerful that I thought that things could change only for the better. Perhaps I was naive. I do not see enough evidence that the Government are taking the problem more seriously. For example, they talk about GU services becoming a part of the indicators for star ratings. However, they also say that the local development plans will identify demand for additional GU consultants. The Family Planning Association has surveyed the strategic health authorities and has taken a look at local delivery plans. From the plans of 24 SHAs came the following results: HIV was mentioned in just seven plans; sexual health was mentioned, but only briefly, in 10, with no service improvement or investment targets identified; STIs were mentioned in just two plans; teenage pregnancy was mentioned in 15, but that might feature more heavily because it is an indicator for primary care trusts; and abortion and contraception services were not mentioned at all.
The only indicator that is used for PCTs takes the percentage of NHS-funded abortions into account, and it was mentioned in the Government's response. That is regarded as a good indicator of access to services. After all that we have heard today, would not a better indicator be whether people are able to see a GU specialist or access a walk-in clinic within 48 hours? That would do far more than a perverse indicator about abortion to tackle the wide-ranging problems that we have identified.
I hope that the Minister will convince me otherwise, but I get the impression that the Government are just talking the talk. Who are they are talking to? Clearly, SHAs have not heard the message. It is not good enough to put the blame on the PCTs, using the same old mantra that the money is there and it is up to them to ensure that there is adequate investment in services. Although we do not like it, we all know that, rightly or wrongly, PCTs prioritise according to what the Government have identified as targets. There do not appear to be any such targets here. I am usually the last person to ask for a target, but where there appears to be no interest something must happen to generate an improvement. It is the hanging offences—"If you do not do this, you will not get your three stars"—that get the resources.
The report expressed a certain amount of disappointment that the HIV ring-fencing had gone, although there have been reassurances that the money is still there. The all-party group on AIDS has identified something. There is a pattern to the dispersal of asylum seekers, some of whom are likely to be HIV-positive. They are often dispersed to places where there is no historic record and expertise in dealing with HIV/AIDS, and they might not be dispersed to the main centres of population that have traditionally had large clinics and high throughputs. If the Minister can say what is being done to ensure that adequate resources are available in the areas to which such people are being dispersed, that will go some way to reassure the Committee that the system will not collapse.
Many answers refer to something called the sexual health commissioning toolkit, which gives advice and provides ideas on all manner of worthy topics. However, there is a problem with any sort of toolkit. To draw an analogy with a toolbox for a car, there will be those who tinker all weekend so that everything is finely tuned and hunky-dory, and there will be others who use it only as a last resort. Sadly, an excellent piece of work has probably not been utilised as much as it might have been.
It appears that nobody is providing leadership. We have heard about the lack of the patients' voice. Patients are not making demands or highlighting problems—with the exception, perhaps, of HIV services, for which there is a particular lobby group. The administrators are not providing a lead to ensure that priority is given. As for the politicians, the Health Committee has made a stand, but one of the worst things that could happen would be to move on to something else and forget all about this.
On chlamydia testing, apart from the welcome news about the pee-in-the-pot pilot, the Government seem to be happy to trundle out the implementation of the screening pilots by 2008. By that time, a lot of women will have contracted chlamydia, and some of them may have reached the stage where they are infertile because of it. Looking ahead to when they want to have children, they are now rightly allowed to have in vitro fertilisation, but if the Government put a few more resources into dealing with the chlamydia problem they will not have to spend so much in the long term on dealing with infertility. We must put the horse before the cart, rather than the cart before the horse. This is a classic example of lying back and not thinking of England, and there are many more examples of this head-in-the-sand approach.
There were many parts of the report that individual members wanted to beef up. However, we were all conscious that if we went overboard on abortion services or hyped up the pee-in-the-pot day, as Ms Drown mentioned, there would be only one story. We wanted the media to focus on every aspect, and I think that we achieved that.
The worst thing that we can now do is let this report gather dust and forget about it. We must carry on trying to press for the adoption of some of the Committee's recommendations and monitoring the Government's progress on their commitments.
In view of your exhortation to be brief, Sir Nicholas, I shall speak only for a couple of minutes. Much of what I wanted to say has already been said, and I shall cut the repetition to a minimum except where I want to offer strong support to what other Members—those who are present and Committee members—have said.
I wish to join members of the Committee in congratulating our advisers and support staff on producing the document. Clearly, it was our magnum opus for the previous Session. It seems so long ago now that, given the glacial pace at which business moves in the House, its impact tends to be lost and we have to try to remember furiously what we were dealing with at the time. However, the import of much of what we learned during the inquiry both in the United Kingdom and wider afield has certainly not left me. I am a south-east London MP, as I said in an intervention on my hon. Friend Ms Drown, and the issue is of great importance and urgency for us in my part of London. One observation in the report is that sexual health and dysfunction disproportionately affect disadvantaged communities, and south-east London is one of the most disadvantaged communities in the country.
I too welcome the Government's moves in response to the 48-hour target and the revisions to chlamydia-testing suggestions that were set out in the report. To some degree, they were the more simple suggestions that we set out. I wish briefly to refer to the national service framework. I understand the Government's reluctance in the matter and agree that if everything is important, nothing is important. Decisions have to be made and, throughout the House, hon. Members say almost every day that the issue they want to draw attention to is the most important that is confronting us and that it must be given priority.
The reason I ask the Minister and Department to reflect further on matters is that, as others have said, this is an issue where the picture is becoming worse, almost by the hour. Everyone recognises that, but it is an issue on which there is far less broad agreement about the strategy for reversing the trend. I understand that it competes with other issues. If everything achieves such a status, it diminishes the efforts that are being made elsewhere. I ask my hon. Friend the Minister whether the scale of the response is proportionate to the scale of the problem.
Others have mentioned the importance of early education in such matters. As I said to the Committee Chairman, my hon. Friend Mr. Hinchliffe, I was most impressed by the youth clinics that we visited in Sweden because they addressed all issues relating to health and young people, including responsible diets and introducing many people to a healthy lifestyle, as well as matters concerning sexual health. They play an important role. We have suffered in this country over the years because of the way in which the problem has become compartmentalised and stigmatised.
Reference has been made to the lack of public representation to us, as Members of Parliament, about such matters. My hon. Friend John Austin said that he had received no letters about the subject over the past 12 years. I think that I have received one. The reason for that is not only the embarrassment and stigma associated with sexual health services in this country. They have traditionally been such Cinderella services that there is a lack of ambition for those using them and a poor level of service has become the norm; ergo if those using them receive a poor level of service, it is felt that there is nothing particularly wrong about that.
In part, the problems that we are facing—the "crisis" as the report puts is—is a product of the approach that has been adopted over several years. There is also a parallel in the area of sexual health with our current major inquiry into obesity. Part of people's attitude towards that condition is due to the notion of blame. Somehow it is thought that the condition is in part self-inflicted and therefore not as deserving of public action and public money as cancer, heart disease or other conditions about which people feel strongly. There is an idea that those things happen to a person, who is just the victim, whereas with STIs, or obesity for that matter, the person concerned is somehow complicit in their condition.
As a reflection on poor services, I cite the clinic that we saw at the Manchester Royal infirmary, which made me think that we had been teleported to a third-world country grappling with the issue for the first time. The conditions in which the staff had to work were appalling. That was true of the décor and the whole tenor of the place. Incidentally, we managed to lose Dr. Taylor in a ladies' lavatory at the Manchester Royal infirmary, but that is another story, which needs to be taken up with the Clerk, who could not count up to eight.
I want to take up some of what Mr. Amess said. I accept that we cannot take the issue out of a social context, although I do not necessarily agree with his analysis of it. I agree that we cannot see the issue aside from the climate in which it exists. One issue is the greater freedom that people have enjoyed since the 1960s. Is not sex supposed to have been invented
"Between the end of the Chatterley ban
And the Beatles' first LP"?
Sex is with us now in a way that it has not been before. In many ways that is liberating. People feel freer and more able to express themselves than at any time in the past. I prefer that to what many previous generations have had to tolerate. However, with that freedom comes a responsibility. The individual has a responsibility—I readily accept that idea—but so do the rest of us and the broader society. Where we fail, we will all pay the consequences. We will certainly all die of something some day, but let it not be ignorance.
Thank you, Sir Nicholas, for allowing me to air a few of the bees in my bonnet. Sadly, I was not on the Select Committee that conducted the investigation, but I am glad that it was done. I congratulate the Chairman and the Committee for their work and the report that they produced. However, I wonder how many more Committees, reports, targets, reviews, strategies and announcements we shall have before we take the bull by the horns and do something about the problem.
I am sorry if Mr. Amess felt that I was teasing him. I have much sympathy with what he says. I am old enough now to think that there was a rather nice time when children were innocent and people did not have sex promiscuously as they do now. However, as Jim Dowd said, there was also a downside to that time. People were restricted and repressed, and if they did the wrong thing they were often accused.
Every age has its problems—sexual freedom is certainly one of ours—but there is something that I do not think that the hon. Member for Southend, West realises. As he mentioned, young people are surrounded by television programmes showing sex every night, and advertisements that use sexual imagery for everything one can think of, such as cars, deodorants or chocolate. I do not know whether the hon. Gentleman owns any shares, but if he does, has he ever been to a shareholders' meeting and complained that the products that he supports or profits from are advertised in that way? Individuals should think about that and say, "We object to that line of advertising. Why cannot we have something different?"
Children and young people are surrounded by such material, but we never see an advertisement or television programme in which a character uses a condom. We never see antidotes advertised. There is never a sexy advertisement for a condom on television. The only things that we see are those that force people into sexual activity—never the antidotes. We are guilty of encouraging that culture, by not saying anything about it.
The hon. Gentleman also said that sex is talked about everywhere. It is. It is the hot topic in any pub or club. Everywhere, people talk quite freely about sex. However, it is not talked about freely in schools, which is the problem. Children do not feel that they can talk about it freely. Again, we are sending young people double messages. They are surrounded by this thing called sex and by people engaging in sexual activity, yet they cannot talk about it or find out very much about it, except from their friends, who may be misinformed. We must therefore consider antidotes.
I am glad that someone mentioned alcohol. As Mr Hinchliffe said, many respondents to a questionnaire on sexual contacts could not say with whom they had had sex. I suggest that that may be because of the amount of alcohol that is consumed, especially by young women. They simply cannot remember. They get drunk and have sex. Sadly, the traditional effect that alcohol has had of giving young men the droop does not seem to occur very much nowadays, so sexual activity carries on. I do not know whether they put something in the booze; it certainly does not seem to have the required effect.
I was glad that Ms Drown and my hon. Friend Sandra Gidley said a great deal about chlamydia. The rise in the number of cases of chlamydia is horrific. Seven years ago, which is not a very long time ago, I practised medicine before I became an MP. We hardly dealt with it. It was just beginning to be talked about. Now, it is a countrywide epidemic. As my hon. Friend the Member for Romsey said, do we know how many people with chlamydia become infertile as a result, especially if they must wait two or three weeks for an appointment at their local clinic? As she also said, chlamydia blocks the fallopian tubes, and women will become infertile and need in vitro fertilisation in adult life. Has anyone costed all this? Will we really be able to afford to offer everyone who is infertile because of blocked fallopian tubes two free IVF treatments on the NHS? The cost will be colossal. For once, the Evening Standard is right to talk about a time bomb. It is a time bomb, and a very expensive one.
My main point, and the loudest-buzzing bee in my bonnet, is my frustration that so much emphasis is placed on treatment in the NHS. As a result of sexual activity, we must treat severe infections ranging from AIDS down to thrush infections, which make people more likely to pick up the more serious infections. We must treat unwanted pregnancies and infertility, at huge expense. I read somewhere that even in 2003, 50 per cent. of pregnancies are unplanned. That is here in the UK, in 2003. The cost to the health service is enormous. The SHAs and primary care trusts must place an emphasis on these things because, when they occur, they demand urgent treatment.
Please let us remember the old adage that prevention is better than cure. Where is the public health message? What are the Government doing? If we continue to have free health care at the point of delivery, we must do something about prevention, otherwise we will run out of money. We must stop people becoming ill in the first place. A beautiful thing about this topic is that the message of safe sex, which prevents people from getting pregnant and catching infections, will cover a host of ills that prove to be so expensive for the NHS. Where are those messages?
As some hon. Members know, I have worked in international development ever since I was elected to Parliament. Anyone who travels in Africa will come across the AIDS problem by the barrel load. It is a terrible pandemic, which is raging throughout Africa. Uganda is a very poor, underdeveloped country. It has no sophisticated health service, no infrastructure and very few roads. Yet it has reduced the incidence of AIDS in leaps and bounds. It has done that by means of a strong publicity message and by having public health advertisements everywhere, including on television and radio, for those who have them. Bands of specialists, some of whom are AIDS sufferers themselves, go round schools, selling the safe-sex message.
If Uganda can do that for AIDS, we can do it in this country for all the other things—unwanted pregnancies, chlamydia and syphilis, which is horrific, although I have never seen any of the many cases that we now have. If we can only get to grips with producing a few simple publicity measures, we could tackle all those things. We have television, which is a major asset. We also have advertisement hoardings throughout the country. At the moment, there is a brilliant British Heart Foundation advert showing a cigarette stuffed with fat, which is a brilliant image of what cigarettes do to smokers. We can do the same or similar with other public health messages.
Education in schools is essential and should be compulsory. The messages should start at primary school level, be appropriate to the age of the children and be repeated every year. However, we also need a massive publicity campaign to sell public health messages. If we do not have one, the health service will run out of money. Of course, such messages can be frightening. I remember the AIDS campaign 10 years ago, which was the only one of its kind. It was Lord Fowler who pushed for it, and I understand from talking to him that there was terrific opposition in the Cabinet to having that series of advertisements on television and to spending the money—but, boy, did they make people sit up and think. Young members of my family really sat up, watched and took in the message. Sadly, it was never repeated. We must do something like that.
The key to preventive health and public health is to be entirely honest with people. We must tell them, "We don't mind you doing what you do, but if you don't do it safely, you'll become ill and, if there's not enough treatment around, you'll die." That is the message that we must get over.
Before I call the Front-Bench spokesmen, I should tell hon. Members that we are not as pushed for time as I expected and that I want the Minister to be able to rise at 5 o'clock. The spokesmen for the Liberal Democrat party and the Conservative and Unionist party can divide the remaining time between themselves, but I hope that they understand that I will call the Minister by 5 o'clock at the latest.
I thank you for your guidance on timing, Sir Nicholas. As ever, it was very clear. As you will be aware, I have been in need of such guidance from time to time.
This tremendously important debate follows on from a tremendously important report. In reading the report and the Government's response, all parties concerned will recognise that we face a crisis and that action must to be taken. I would be the first to agree that there are no quick fixes, and, in their response to a point in the report, the Government said that they did not believe that either. However, there are things that can be done and some have, indeed, already been put in train. Some measures may produce results more quickly than others.
I shall deal first with the evidence that has come forward. I know that we have heard this two, three or four times already today, but it cannot be said often enough that, according to surveys, one in 10 young people are infected with chlamydia. Yet studies show that 75 per cent. of young people in about the same age group have never heard of chlamydia. Chlamydia can result in infections, infertility and ectopic pregnancies, which are potentially life-threatening to the mother. The fact that the disease is so prevalent and that so little is known about it gives a clear indication about the procedures that need to be implemented—to try at least to ensure that it is brought to the forefront not just of our attention, but that of the public, particularly young people.
We have already heard about the 500 per cent. increase in syphilis infections, which I hope is because the figures started from a very low base. However, that increase, the doubling of gonorrhoea infections and the 6,500 diagnoses of HIV, all indicate the sorts of problem that we face. That must be put together with the information from the Committee about long waiting times and the fact that people are turned away from genito-urinary medicine clinics. Not only do we have a big problem—we have a problem about how to treat that big problem.
It is worth considering how we got to this situation. I was a science teacher in the 1980s, and I remember the impact made by the legislation that made clear that science teachers were no longer to talk about relationships during sex education. At my school, we were given written instructions not to talk about sexually transmitted infections or contraception. That gave away an opportunity for young people to be taught daily about such things by people whom they knew, respected and trusted.
There was a gap for a while, and then personal social and health education came in. Although I agree that sex education should be taught within relationship education, I would pose this question: if young people are taught PSHE once a week, will they see a teacher qualified—or allowed, or who feels competent or whatever—to teach that subject? If they happen to be off sick or on a trip that day, they will miss that lesson. Three or four months may pass before another part of that education is offered. However, children were able to approach their science teachers, whom they saw perhaps five times a week—enough to know whether they could trust that teacher or not.
I read with interest the comments made by the young people who gave evidence to the Select Committee. I worry that the reason why young people can get through all of their secondary education and reach 16 or 17 without any sex education is because they happened to be off on the few days that it was offered, and because such education is not there as a constant, open part of general education.
Does the hon. Lady agree with those working with teenage mums in Swindon, who say that the message needs to be reinforced in the spring term, just before young people leave school? They are going off into the world, such issues pose a danger and they need to be aware of them.
I agree. One problem is that the subject has not been sufficiently returned to—it is taught once a year, and perhaps the teacher is off sick that day. PSHE lessons tend to be timetabled on the basis that the pupils who attend them are withdrawn from something else. If the teacher is not there, they go to the normal lesson and that part of the curriculum is not covered as well as it would have been if they had received regular teaching. I speak from experience of a school that was and is highly regarded. I think that it is the same for many other schools.
As well as worrying about those aspects, I am concerned about the culture that other hon. Members have described—the sort of culture in which it is all right to put page 3 nakedness into a newspaper, but in the same newspaper there will be smutty little jokes and holier-than-thou articles about what is and is not permissible. Until all of us exercise our freedom to refuse to buy newspapers that operate those double standards, that sort of nonsense will continue. It does not bode well when politicians join in with that. We have heard about the need for leadership. Leadership sometimes requires that one does not go with the crowd; politicians should stand up for what they believe in, and if that is proper education to enable young people to gain a proper understanding, they must say so. It is not sufficient to go along with the tut-tutting brigade who, nevertheless, think that it is acceptable to expose women's breasts on page 3.
Our culture makes it extremely difficult for young people. One of the bodies that has supplied me with information suggests that young people believe that they are odd if they have not had sex by a certain age, although the reality is that most young people of the same age have not done so. They are then, as my hon. Friend Dr. Tonge said, made to feel bad if they have had sex. We have got ourselves into the ridiculous situation in which, far from talking about sex in an honest way, we tend to talk about it in the pub and behind the bike sheds, rather than openly so that young people can obtain real, honest information of the type that they need.
The Government have focused particularly on reducing teenage pregnancy. That is a laudable aim. Undoubtedly it has influenced many young people—about 8,000 pregnancies have been avoided. Stockport, within which my Cheadle constituency is located, has experienced one of the greatest reductions in teenage pregnancy, so I absolutely support that aim. However, there is the problem that more unwanted pregnancies now involve women in their 20s. We need to worry a great deal about what is causing an increase in unwanted pregnancies in that age group. What is it about our society that produces so many unwanted pregnancies? Earlier, we heard that 50 per cent. of pregnancies are unwanted. That is an appalling statistic. Perhaps it has something to do with the fact that our contraceptive services are not getting the support that they need.
Forgive me. I might well have produced the wrong term—unplanned, certainly. I thank my hon. Friend. I suspect that she is correct, and I shall go back to my figures to check the terminology.
We have heard about chlamydia, and about the huge number of young people who do not know anything about the disease. The fact that 70 per cent. of women and 50 per cent. of men do not know that they are carrying the infection is a great worry. Part of the reason why people do not know about it is that it is a hidden infection. I am delighted that screening programmes are being rolled out and that the chief medical officer is recommending the new test. Will the Minister monitor the roll-out of that chlamydia screening and tell us, perhaps in a year's time, how far it has progressed? Will she tell us, perhaps also within a year, the extent to which the new test has been adopted as a result of the CMO's requests to strategic health authorities?
I have talked at some length on education and my concerns about changes in the 1980s and 1990s that were due partly to how legislation that affected sex education and relationship education, which were linked, could be followed through. There are some good initiatives, such as peer education. For instance, I have seen training that young people give in drugs education first hand, and it was first class—it worked extremely well. There is much to be learned from peer education, which should be supported. Community initiatives and outreach programmes are also important, so I was pleased to hear about the Tic Tac centre in Paignton. We have our own programme in Stockport called Central Youth, on Grand Central square. The scheme was introduced by the local authority, the health authority and others, and has given free access and a great deal of assistance to young people. The programme has been particularly helpful for young men, who have been prepared to go to a location such as a shopping centre, rather than somewhere where they might be known.
My hon. Friend the Member for Richmond Park said that local development plans make no mention of HIV, sexual health or other issues. That is not necessarily an indication that those things are of a low priority, but because we have developed a target-driven culture—whatever is not a target does not get followed. We must seek a balance, but, according to a Family Planning Association survey—I thank the association for its briefing—not one local development plan from the strategic health authority mentioned abortion or contraception services, which is a real problem. I hope that the Minister will ensure that that does not happen in future.
We hear that a great deal of funding is coming in. I have read the Minister's responses to the various requests that have been made. The additional investment is welcome, but I should like some reassurance that it will end up where it should end up. Money announced for other services has not always reached where it was supposed to reach, so what tracking exercise will the Government undertake to ensure that that does not happen?
I have asked for reports on a number of issues in a year's time. It would be immensely helpful for either the Committee or Parliament to be told what has been achieved. The Minister's response is dated September 2003, so it would be good to aim for another report in a year's time in September 2004, but if that is too soon, some information by the end of the year about the report's impact would be welcome. We all recognise that there is a problem and that funding should go where it is needed, but after today it is possible that, unless Parliament asks for a report every year, everyone will forget, and we cannot afford to allow that to happen. The issue is far too important to allow it to go by the wayside, and for us to say that we have done all that we could. It is my firm belief that we could do a great deal more by ensuring that Parliament is kept regularly informed.
I, too, thank the Committee's advisers and staff for their help and guidance, and for their work in producing the report. I am sure that all hon. Members—I include Ministers—will agree that it makes an important, positive contribution to the debate on sexual health.
I noted with interest—but it was not unexpected—that the Committee Chairman quoted from the report at the beginning of his speech. The report stated:
"We have been appalled by the crisis in sexual health we have heard about and witnessed during our inquiry. We do not use the word 'crisis' lightly but in this case it is appropriate. This is a major public health issue and the problems identified in this report must be addressed immediately."
I wholeheartedly stand by that statement; it is probably the most important statement in the report, as it sets the scene.
We are talking about a burgeoning epidemic. At the beginning of section 3, the report shows the bald statistics of the incidence of each sexually transmitted infection from 1996 to 2001. The latest figures, taking us up to 2002, show the sad fact that there has been no diminution in the increase in infections but an escalation out of all proportion to previous increases. Between 1996 and 2002, there was an increase in primary and secondary syphilis of 933 per cent.—a staggering and frightening figure. For gonorrhoea, the increase was 105 per cent.; for chlamydia, it was 141 per cent.; herpes showed an increase of 15 per cent.; and genital warts had increased by 17 per cent.
The report did not look into it—that makes it no less important—but other STIs are developing that do not come within the well known categories. For instance, and rather nerve-rackingly, I was talking to a colleague who had visited his local district hospital last week. He wanted to talk to hospital staff about sexual health matters, and was told some stark facts. For instance, three years ago, the main problem that the hospital had to deal with was chlamydia. One year ago, it was chlamydia and the results of date rape from spiked drinks.
Horrifyingly, this year, the hospital found that young girls, who had learned the message about not allowing themselves to get pregnant, were going out clubbing and thinking it safe to engage in oral sex with multiple partners. The trouble is that many of their partners, and they themselves, had body piercings. One result of that was an increase in the incidence of cancer on the tongue, as well as other infections, caught from the skin around the piercing. That is happening as a direct result of infections caught during sexual activity; and, according to the hospital, it has led to cancer and other STIs not found in the statistics under the conventional definitions. There must be other aspects that suggest that there is still more to this state of affairs than we can see from the already stark and horrifying figures.
The future is not at all good either. Many hon. Members have discussed in different ways the question of social attitudes and social changes. During work on the report it became clear from the statistics on the changes in social behaviour that the number of young men and women engaging in unsafe and unprotected sex is increasing.
I do not know whether the hon. Gentleman will agree about this, but he probably knows that I used to work as a pharmacist, and I frequently dispensed the morning-after pill to young girls who had been out clubbing. Often they arrived in twos and threes, which was most alarming. Does he agree that an ideal opportunity exists, which is probably being missed by health professionals and drug companies alike, to get a safe sex message across so that such incidents are not repeated?
I am grateful to the hon. Lady. If she will forgive me, I shall come to the question of safe sex campaigns shortly.
The statistics are worrying, because those for 1990 showed that 13.6 per cent. of men had engaged in unsafe sex in the previous year. By 2000 the figure had, incredibly, increased to 15.4 per cent. The figures for women had gone from 7.1 per cent. to 10.1 per cent. That is frightening, because it suggests one of two things: either that people have learned nothing, or that they are entirely ignorant. It may be both.
I now come to the point raised by Sandra Gidley. What we saw with the emergence of HIV/AIDS in the mid-1980s was a high-profile educational campaign, using television and other media outlets, written and visual. It was hard-hitting, and was criticised from the top levels of government down to certain sectors of the general public who were queasy and worried about a hard-hitting campaign. However, it went ahead and, as Dr. Tonge said, it hit home. It made people at home in front of their televisions sit up, watch and take in the message.
The campaign was significant in leading people to understand that the nearest thing to safe sex in this country was the use of condoms. Of course, the spin-off benefit of that approach was to protect individuals—it was hoped—against not only HIV, but the entire range of STIs. That campaign lasted for a period and was not repeated in the same way. There was a view that there were other, possibly more sophisticated and successful, ways of getting the message across, through targeting in specialist magazines and other outlets. I am not convinced of the accuracy of that view.
Of course there is an important role for such targeting in advertising and conveying public messages. I do not deny that. However, in addition, a hard-hitting message is needed for the entire population, preferably—because it is the easiest way to do it—through national television as a supplement to other forms of advertising. After the initial campaign there was a noticeable decrease in the incidence of STIs. The figures then began to rise again, in the mid to late 1990s. The fact was that we had—and we certainly have now, in 2003–04—a new generation oblivious of the advertising and the public information of the late 1980s. They are unaware, or not properly aware, of the danger and the threat of STIs. There is then the problem with chlamydia: many people who are infected are unaware of that, in the same way that the latest HIV statistics suggest that there remains a significant proportion of people who are unaware that they are HIV-positive.
I pay tribute to the Government for their "sex lottery" campaign and their use of the internet to set up their "Playing safely" website. In addition, however, I urge them to re-examine the pros and cons of having a more high-profile, hard-hitting campaign that will get across to the whole country through the most obvious medium—television. That is needed so that we can bring home the message that we are not crying wolf and that this is not a game; it is a deadly serious and deeply worrying matter.
The trends are unacceptable and the Minister would accept that were deaths from cancer, flu or pneumonia to increase in the way that the incidence of STIs has increased over the past six years, there would be even more of a public outcry. Ministers and Members of Parliament—I am not blaming Ministers—would be running around far more, saying, "This is dreadful", and they would be coming up with what they believed were solutions, even if they were short-term ones, to try to lower the death rate.
My other point relates to the issues that the report highlighted about access to sexual heath services. There is a serious problem, and Governments—I use the term in the plural—have been able to get away with a level of service that would not be tolerated for the treatment of cancer or heart disease. That is because far too many people—for a variety of reasons that have been mentioned in the debate—are shy, ashamed or embarrassed by their medical condition, and most are not prepared to campaign for improved quality of service. They are not prepared to campaign for more services and for more public attention to be focused on those services because they fear that people will judge them adversely, because they are infected by whichever medical condition they have. Over a long period—this did not start on
Some hon. Members have said that during their time as MPs they had received only one letter, or not even one, about STIs suffered by individual constituents. Apart from one area, and I do not know why this should be unique to my constituency, I have not received any such letters. On a number of occasions, I have received letters from people on the subject of sexual dysfunction, mostly about their not being able to get Viagra on a NHS prescription and believing that they should be able to do so. That is a surprise in many ways, as I thought that it would be easier to write to me about chlamydia or genital warts.
Would the hon. Gentleman agree that we discovered from the witnesses who were party to the inquiry that no one is pretending that there was ever a golden age, when everything was fine? They said that things had deteriorated over time and, more often than not, that the service had never been anything more than barely adequate. Given the pressure that it is under, it is now completely incapable of responding.
The hon. Gentleman is absolutely right, although to be fair to myself, I have been trying to make the same point, however inadequately. I specifically said that the problems with treatment and the quality of care did not arise on
The time when we should have started concentrating on bringing the quality of service up to the expected standard has long since passed. As the Committee's report said, we had quote after quote about the poor condition of buildings in which services and care were provided. More often than not, rooms are tucked away in a corner somewhere on the far side of a hospital site; they are not in a prime position. We heard about the example from Bristol, where services had to be closed down, and about the problems in Manchester.
The Committee also heard about the time that it takes to see a consultant and to get treatment. According to the evidence provided by the Public Health Laboratory Service, the median waiting time for the first appointment in genito-urinary clinics is 12 days for men and 10 days for women. The figures from as recently as 2000 were six days and five days If those figures are accurate, they suggest that there has been a deterioration. The Government's response says that the maximum waiting time to see someone and embark on treatment should be 48 hours by 2005–06 or, if possible, earlier. That is good news, and I welcome it. There is a self-evident danger in people having to wait to see someone, and we came across people who had had to wait three weeks plus. The problem—this is true of all conditions, but particularly of chlamydia, which most people are unaware that they have—is that people will probably still be engaging in sexual activity. If they have more than one partner, they will be compounding the problem by spreading the infection. Therefore, it is crucial that they are seen as quickly as possible. There is not only the obvious benefit that they will be able to embark on a course of treatment, but the fact that, while they wait for treatment, they will be prevented from spreading the epidemic further through their activities.
The report's recommendations in that regard are therefore important, and the Government have made great steps forward in their response. However, if there is any way in which the suggested timetable can be brought forward so that the 48-hour waiting period can be implemented before 2005–06—let us not forget that the commitment on waiting times was given last September, which was four months ago—that would be more than welcome, because 2005–06 is a long time to wait. Bringing the implementation forward would mean that we could start getting on with the important task of improving the quality of care.
Finally, the Minister will no doubt say—with some justification, because it is factually correct—that the Government have recently made £35 million, and possibly a little more, available to deal with the problem. That is a good step forward, but, given the catch-up involved, it may be a drop in the ocean. It is crucial not only for public education but for the public treatment of STIs that more priority is given to breaking down the barriers of embarrassment that inhibit people from treating this area of health care in the same way as other, more mainstream areas of health care.
I welcome the work done by the Health Committee and I am pleased to respond to such a thoughtful and constructive debate on an issue that now has a higher profile. The Health Committee should take its share of the praise for that higher profile attention and for recognising that the Government attach importance to the issue. I thank my hon. Friend Mr. Hinchliffe and the Committee for the thought provoking, timely and comprehensive report. I am also grateful for the additional comments from the independent advisory group, which responded to issues raised by the Select Committee.
The Government share the deep concerns expressed by the Committee about the poor state of sexual health. It is a significant problem and a priority for the Government, which is why we are committed to making improvements through the sexual health and HIV strategy—the UK's first sexual health strategy. We strongly believe that the aims, principles and interventions detailed in the strategy provide the best basis for improving sexual health.
Although I agree that the strategy has an important role to play, I discovered from the Minister's civil servants before Christmas that a national strategy is the Department of Health stating what it wants the NHS to do, whereas a national service framework is the Department instructing the NHS precisely what to do. Would not an NSF, in which instruction is given, be better than a strategy, which is simply a Department of Health wish list?
I am grateful for the hon. Gentleman's remarks and I shall come on to the question of a national service framework later. However, I stress that the strategy sets the foundations for implementing progress. That progress has included establishing a sexual health lead in every primary care trust; the roll-out of the chlamydia screening programme; the publication of health promotion and commissioning of toolkits and HIV standards to support local implementation; the development of the "sex lottery" campaign; and the establishment of the first Independent Advisory Group on Sexual Health and HIV. We have also strengthened the national team, run conferences across the country to support ongoing work, and made additional investment in services. The strategy has helped us to drive forward important national developments that have supported local implementation. I do not think that the strategy should be viewed in isolation from the practical activity that is designed to deliver the strategy.
Many hon. Members have expressed concerns about the priority the Government have given to improving sexual health. We have acknowledged that sexual health services have suffered from under-investment and a lack of priority for many decades under different Administrations. I am grateful for the comments in acknowledgment of that from Mr. Burns. However, the Labour Government were the first to develop a comprehensive strategy to tackle sexual ill health. We started that process in 2001 and it was completed in 2002. The Committee's report acknowledges that the strategy is an excellent starting point and a foundation that can be developed in partnership with the key stakeholders including, most importantly, service users. We expect our additional pump-priming money to support the sexual health strategy implementation locally.
The Government's response highlighted that Ministers would
"take every opportunity to underline the importance of sexual health".
We are determined to do that today and in the future. In response to the most recent sexual health statistics, my right hon. Friend the Secretary of State for Health said:
"it is vitally important that we address the nation's poor sexual health".
We are therefore working with strategic health authorities to raise the priority of sexual health within the priorities and planning framework and local delivery plans. The chief medical officer recently met chief executives of all of the strategic health authorities to highlight the importance that we attach to improving sexual health, and suggested ways in which they could better performance-manage implementation of the strategy to mirror good practice in areas such as Manchester and north-east London, where sexual health already features in local delivery plans.
I am delighted that this meeting has happened, but, as I said earlier, I received a briefing from the FPA, which had audited local delivery plans and found that sexual health was not evident in any way. Can the Minister tell us when we will see a difference and when the FPA will be able to write to hon. Members who are likely to speak in debates such as this to say that the situation has improved?
I hope that the next round of local delivery plans will show a changed picture from the one that the hon. Lady has sketched out.
Let me make it clear that we do not propose to develop a national service framework for sexual health, because a strategy is already in place. The strategy is focused on driving up standards and reducing unacceptable variations in services. We have recently published standards based on the NSF model for HIV treatment that provide clear evidence-based recommendations and interventions. Sexual health standards—which cover STIs, reproductive health and signposting to psychosexual services—are under development. We expect that primary care trusts will use those standards to drive service provision.
The Minister has said more than once that the Government are determined to improve the quality of care and services. I do not dispute that, but I do not understand, given the Government's determination, why they are content to have a strategy, the definition of which, according to the Minister's own civil servants, is related to what the Department of Health says it would like the NHS to do, rather than have something such as an NSF, which the Department of Health says would instruct the NHS what to do and which would reinforce its determination. Surely, the latter would be a more powerful weapon to achieve what the Minister wants?
The hon. Gentleman has reiterated a point that he made a moment ago. The answer lies partly in the point made by my hon. Friend Jim Dowd. If everything is a target or a top priority, nothing is a priority. Despite hon. Members' claims about the demand for more targets, work on targets has shown that those who are given them say that there are problems associated with them, and those who are not given them say, "Give us a target." Sandra Gidley was generous enough to acknowledge that she did not normally stand up and demand targets, but it is tempting when trying to focus on something to say, "Let's have a target." Imagine the national implications if we responded to every demand. I am not saying that sexual health has been given a low priority—or, indeed, that it is not being given a high priority. However, there are factors such as the time that the chief medical officer spends talking with strategic health authorities. That, and the emphasising of priorities, is not something that is done about everything across the board.
I am well aware of that too, and I am sure that my hon. Friend does not dispute that. I simply referred to his point about how many targets we can have and the implication of having targets and frameworks and issuing instructions. There is a limit to how effective that is past a certain point.
I thought that one of the ideas behind national service frameworks was to give patients an idea of what they might expect from a particular service. If so, would not the Government want NSFs for many conditions? Ultimately—perhaps in many years' time—the aim might be to have NSFs for everything. Is there real reluctance to adopt an NSF for sexual health because the Government do not want to have NSFs for everything, or because there is a strategy and, as we cannot do everything at once, we should focus first on an NSF for something that does not have a strategy?
The answer to that is both. We do not intend to have NSFs for everything; there is a limited number of subjects on which NSFs seem appropriate. Because there is a strategy leading to the development of standards, we argue that those standards will exist anyway. In a sense, that part of the debate is largely about labelling.
In making a wider point about targets, I shall deal with that subject on which many hon. Members touched. Of course, there is a national standard for HIV testing and abortion services, and there is a national goal to reduce newly acquired HIV and gonorrhoea infections. As a result, there is also a commissioning toolkit, a training strategy and other measures that have been put in place in addition to the standards. The abortion access point is included in the star ratings. As hon. Members know, we are working towards the inclusion of a 48-hour waiting time indicator.
My hon. Friend the Member for Wakefield and others mentioned work force and capacity—an important subject if we are to deliver more services better to more people. Locally, it is for trusts to determine how the services are configured and to provide quality services to patients. They need to decide the grade and skill mix in their area because they need to judge what will work there. Consultant numbers in genito-urinary medicine increased by 15 per cent. between September 1997 and March 2002. Further growth in consultant numbers will be supported by increases in training places.
The Committee also talked about training. The sexual health training mapping exercise report has been compiled and recommendations have been published on a website. The conference for training has been arranged for
I agree with hon. Members that additional investment in sexual health is valuable and is needed if we are to reduce waiting times and modernise premises. The Government have provided a clear lead by investing an additional £47.5 million in implementing the strategy, and we have given a commitment to provide a further £20 million in each of the next two financial years. We have also announced a further investment of £11.4 million in response to the Committee's report, and in November my right hon. Friend the Secretary of State announced additional capital investment to the tune of £15 million to improve GUM services by modernising premises and facilities in clinics. The funding will be available from April and will be carefully targeted at those clinics in need. Strategic health authorities are already making plans for the improvements that they want and where the money should be spent. The improvements to clinics and other facilities should have a major and immediate impact on the overall quality of service for patients at many of those sites.
I must make it clear that central investment represents only a small proportion of the resources that are available for service development. Shifting the balance of power means that most resources are held locally, as is the power to decide how they are used. There has been a radical transformation of the NHS. We are working towards greater local accountability and flexibility. Considerable new resources are being given to primary care trusts to enable resources to closely match local needs. As well as taking sexual health issues up nationally through the Select Committee and in debates such as this one, hon. Members who are aware of these issues in their own constituencies and areas will be discussing them with the local commissioners.
What the Minister is saying is welcome, but it is all in the future. While these things are being put in place—if that is ever to happen—more cases will arise and more young people will be infected. When will she tell us something about what is happening now and speak about the immediate impact, the publicity campaigns and all the preventive measures that can be taken to stop young people catching diseases?
I appreciate the hon. Lady's impatience. One of the problems that I have not yet cracked in responding to debates is how to answer all the strands of questions simultaneously, so I ask her to forgive me if my reply is ordered in a sequence. If she would like me to deal with that point now, I should be happy to do so. Of course, it is important and I accept what she said. There must be a national, as well as a local, dimension to public health. It is for that reason that we have already invested substantial sums in national campaigns on sexual health. The "sex lottery" adult sexual health campaign, which is aimed at people in their late teens and early 20s, has been running for about a year. So far we have spent some £4 million on that campaign, which complements the one on teenage pregnancy.
I welcome the "sex lottery" campaign, but the Minister may not have had a chance to read all the evidence in the report. A young lady powerfully made the point that the campaign was very good and in your face, but said that the information was in the small print, so it was hard to get at what was being said. What assessment has been made of the effectiveness of that campaign, particularly in reaching its target audience?
Order. Before I allow the Minister to respond, I should say that I have some sympathy with her in trying to deal with all the questions that she was asked during the speeches made earlier in the debate. I hope that from now on interventions will be kept brief or will be non-existent.
Thank you, Sir Nicholas.
There is a clear strapline on the campaign: "Use a condom". I am sure that that will please all hon. Members, and particularly Dr. Tonge, who has been strong on that issue throughout the debate. Many hon. Members will not have come across the campaign. With regard to what the hon. Member for West Chelmsford said about national campaigns, these days "national" often means focusing on particular TV channels—and there are no longer just three or four of them. We have to target the channels and commercial breaks when we believe that the target audience will be best represented. We can target the magazines that those people read and the radio stations that they listen to, but—surprise, surprise—MPs are not the target audience, so we will not often see such things. We are assessing the "sex lottery" campaign and its work is being constantly monitored and evaluated to see whether it is effective.
I will not speak in detail about the sums used for campaigns. They are, however, broken down into sub-categories. This year, some £2.2 million was spent on HIV, a total of almost £5 million was spent on "sex lottery" campaign leaflets, helplines and Sexual Health Direct, and some £3 million was spent on the teenage pregnancy campaign. This year, the overall total was £10.25 million. An impressive amount of work has been done. The campaigns are targeted, but hon. Members are not the target audience, so the fact that they may not have seen them very often is no indication of whether we are reaching our target.
On the mainstreaming of HIV budgets, I know that the Committee and others had concerns about the transfer of the budgets to main NHS allocations. However, record increases in the budgets and the inclusion of the numbers of people receiving HIV treatment as one of the primary care trust budget weightings will address those concerns. Despite an increase in patient numbers, a recent audit of the use made of the British HIV Association treatment guidelines found hardly any evidence that costs were affecting the prescription of optimum drug treatments for those with clinical need. The evidence is therefore that the provision, although mainstreamed, is still effective and is being used for that purpose.
On reproductive health, we made it clear that sexual health is not only about disease and that improving reproductive health is also important, as is reducing the number of unintended pregnancies—a key aim of the strategy. Easy access to the full range of contraception advice is a fundamental health service. The cost-effectiveness of providing a good range of contraceptive services is well documented, and poor provision of services results in higher costs to the NHS due to abortions and unintended pregnancies.
We therefore established a group of key experts to develop and publish a work programme to support improvements to contraceptive services. The group is advising us on how best to target the additional £1 million that we announced for contraceptive services. I strongly endorse the investment in such services, which is simply good sense. It is, in effect, spending to save, as well as a very important part of the solution in providing better sexual health for all. It also brings considerable benefits by helping to reduce the number of teenage pregnancies. The Government are making good progress in this area. We have seen significant drops in teenage pregnancies as a result of that work, which shows that we are succeeding in getting our messages across through the campaign and our support work on teenage pregnancy.
My hon. Friend Ms Drown asked about the role of medical abortion and what we were doing about early medical abortion in a wider range of health care settings. I listened carefully to her comments, and I can tell her that we have identified two pilot sites. We expect to be able to report on the matter in about a year's time, and we will examine the results. We must ensure that any class of place that the Government approve will be approved only if we are content that a woman's safety is not at risk.
The Minister's penultimate point was very important. The fall in teenage pregnancy rates is excellent and very welcome. However, the rise in the number chlamydia cases, for example, shows that the real message is not getting across. People are not having safe sex. They may be preventing pregnancy, but they are not preventing infection. We need to try to find strategies—she loves that word—to get that double message across. One gets more than a baby from having unprotected sex.
I would like to make it clear that I do not love strategies; I love to see action on the ground. That is the only real criterion for success. However, strategies play a role, and we have to recognise that.
In the next few minutes, I want to talk about chlamydia and GUM. The Health Protection Agency is working in partnership with the Department to roll out the chlamydia programme. It is collecting data on the programme and monitoring implementation, the numbers screened and so on. That is an important part of the roll-out.
I announced today that a further 50 primary care trusts will join the chlamydia screening programme, in addition to those in the 10 areas in which it is already up and running. That will mean that a quarter of primary care trusts will be covered by the programme. We will announce the third phase shortly. We have made rapid progress on the issue in two years.
In the light of my hon. Friend's constituency, that was clearly a mistake that we will have to look into. I am sure that we focused on areas that we thought should take priority for health reasons.
England is not alone in facing GUM problems. Since 1995, STIs have increased and there are complex reasons for that. I was interested by the debate raised by many hon. Members about rights and responsibilities, and I am sorry that I do not have time to comment on it. That issue is an important part of the debate, and we should have much more discussion about it. None the less, we must be realistic. Sustained changes in sexual behaviour will not happen overnight, as a number of hon. Members have acknowledged. The process will take time.
We are not merely taking measures to improve access to genito-urinary services. I have mentioned the "sex lottery" campaign, and the chlamydia screening programme is also being rolled out. We are focusing on other initiatives to help increase the priority of GUM services at local level. As we stated in our response to the report, we strongly support the introduction of the 48-hour GUM waiting time indicator for primary care trusts. We are working with the Health Protection Agency to undertake pilot surveys in a number of GUM clinics to seek information on waiting times from patients. Data will be collected on postcodes, making it possible to calculate waiting times for the residents of individual primary care trusts. That will be a first.
If the pilots are successful, the first main survey of clinics will be undertaken in May this year and it should be possible for a waiting times indicator to be put in place for the year 2005–06 at the latest. We will work with the Commission for Healthcare Audit and Inspection on that matter. If we can bring the programme forward, we will do so.
I am sorry that I have not been able to deal at any considerable length with the interesting discussion on the importance of sex and relationships education and the provision for personal social and health education in schools. That is an enormously important part of our work. Ofsted is undertaking a survey in some 80 secondary schools and is planning to issue a series of expected learning actions for key stages 3 and 4. I accept that points can be made about sex education—and relationships education in particular—in primary schools. We will consider that issue.
I congratulate the Minister on endeavouring to deal with all the questions. I know that she was not quite able to do so, and I am sure that she will reply to hon. Members whose questions were not dealt with.
Question put and agreed to.
Adjourned accordingly at half-past Five o'clock.