Intended for healthcare professionals

Feature Investigation

Sexual health services on the brink

BMJ 2017; 359 doi: (Published 30 November 2017) Cite this as: BMJ 2017;359:j5395
  1. Caroline White, journalist, London, UK
  1. carolinew_health{at}

Public health funding is experiencing sustained cuts while demand keeps rising. The BMJ asked local authorities how sexual health services are being affected. Caroline White reports

Unlike the NHS, local authorities, which have been responsible for public health in England since 2013, are not allowed to run into debt. Sexual health services, including contraceptives and testing and treatment for infections, account for about £600m (€680m; $790m)—almost a fifth of their public health spend (£3.4bn in 2017-18). But a succession of cuts in funding from central government have squeezed budgets, forcing councils to work smarter to avoid reducing services.

The BMJ sent freedom of information (FoI) requests about sexual health service provision and spending over the past three years to all 152 commissioning local authorities, 147 of which (97%) responded. Only 33 said that they had not reduced spending in any given year, whether by making efficiencies, through direct cuts to services, or because of natural variations in demand; 50 had done so in one year, 37 in two, and 27 in all three years.

Most of these annual reductions in spend were between 5% and 10%, but they ranged from 0.4% to 23%, the FoI responses show. And it’s likely that councils have now explored all viable options to contain costs.

The government public health grant, out of which sexual services are funded, has been steadily cut since 2015. It had an unscheduled 6% cut (£200m) in 2015-16. Scheduled annual cuts will amount to 9.6% by 2020-21.

Rising demand

These financial pressures have accompanied rising demand. Visits to open access genitourinary medicine (GUM) clinics that councils are mandated to provide rose by a third, from 1.6 million to 2.1 million, between 2011 and 2015,1 with some local authorities reporting 6% increases a year.

Although official data show 4% fewer new cases …

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