Intended for healthcare professionals


Split in commissioning between local authorities and health bodies is reducing access to sexual health services

BMJ 2013; 347 doi: (Published 05 December 2013) Cite this as: BMJ 2013;347:f7311
  1. Matthew Limb
  1. 1London

Sexual health outcomes in England are at risk of deteriorating because of “fragmented” commissioning and lack of leadership in the system, experts told a conference.

Jane Hatfield, chief executive of the Royal College of Obstetricians and Gynaecologists’ Faculty of Sexual and Reproductive Healthcare, said that poor access to contraception services was causing concern and could lead to more unplanned teenage pregnancies and abortions.

She said, “There is a lack of leadership in the current fragmented structures and a lack of a strong patient voice.”

Hatfield said that well supported contraception services were important and offered women a chance to talk to health professionals about wider personal health matters.

She said that her faculty was hearing complaints about local authorities limiting or restricting access to services, and she urged local authority directors of public health to step in to make sure that sexual healthcare did not lose priority.

Hatfield was speaking at a seminar on sexual health policy, education, and commissioning held in London on 3 December and organised by the Westminster Health Forum, a private firm that specialises in organising conferences.

Speakers echoed concerns raised recently by other specialists about how the reorganisation of the NHS and public health structures under the Health and Social Care Act 2013 was affecting services.

Since 1 April local authorities have been responsible for commissioning certain public health services, including contraception, testing and treatment for sexually transmitted infection, and HIV testing. But HIV care remains within the NHS, and clinical commissioning groups and NHS England both have responsibilities for commissioning other sexual health services.

A survey by the British HIV Association released to mark world AIDS day on 1 December found that a majority of HIV specialists thought that splitting HIV care from broader genitourinary medicine was leaving patients worse off.1

Paul Cosford, health protection and medical director for Public Health England, defended the current arrangements. He accepted that there was concern that some 150 potentially different local authority approaches could lead to “widely variable” quality of sexual health services. But he said he did not think that sexual health care was being treated with less priority and said that directors of public health were confident that they could improve outcomes in the new system.

Andrea Duncan, the Department of Health’s programme manager for sexual health and HIV, said that local authorities were facing a tough and “challenging” time. “Organisations need to work together to ensure that care and treatment is of high quality and is not fragmented,” she said.

Etty Martin, Public Health Warwickshire’s commissioner for sexual health, said, “The ‘reforms’ were a bit of a car crash but not really a write-off.” She said that there were still opportunities to improve outcomes through collaboration.

Alison Hadley, director of the Teenage Pregnancy Knowledge Exchange at Bedfordshire University, said that rates of conception among under 18 year olds had fallen by 34% from 1998 to 2011. But she added that local authorities’ progress in reducing teenage pregnancy varied considerably and that nationally England was still far from matching the success of other western European countries.

Hadley said that the latest findings from the British national survey of sexual attitudes and lifestyles, published earlier this month,2 had shown the value of school based sex education in preventing unplanned pregnancies.

But the conference heard concerns that, despite good examples, the overall quality of schools’ sex and relationships education was not good enough.

Hadley said that action to improve sexual health outcomes and to reduce rates of teenage pregnancy required a “whole systems approach” in local communities. “People are trying to keep things going against quite difficult odds,” she said.


Cite this as: BMJ 2013;347:f7311


View Abstract