‘Significant cuts’ to public health funding have left local authorities unable to maintain sexual health services at a time when sexually transmitted infections are on the rise and demand is soaring.
The Commons health and social care select committee has collected more than 80 written pieces of evidence on the state of services locally and nationally since launching its first ever sexual health inquiry in August last year.
The probe was launched in reaction to service providers arguing that increases in STI diagnoses, against a backdrop of significant financial pressures, have left sexual health services at ‘tipping point’.
The written submissions paint a bleak picture of a services struggling to cope with demand soaring at a time of devastating funding cuts, and marginalised groups being most likely to be affected.
Responsibility for sexual health was taken away from NHS England and handed to councils in 2013, which means that since then STI testing and most contraceptive services have been overseen by local authorities.
According to the British Association for Sexual Health and HIV (BASHH) councils last year spent £30m less on sexual health compared to year before, representing a 5% reduction, with recent data indicating a further 3% cut in 2018/19. Over the past four years, planned spending on sexual health services has fallen by £64m, equivalent to 10%.
Local authorities were delivered a further blow in December when the government announced it would cut the public health budget by £85m.
Health policy think tank The King’s Fund summed up the impact the cuts were having in its written submission to the inquiry – the first evidence session for which will be held by MPs on Tuesday afternoon.
“Staffing levels are lower and services are reduced and in some cases closed altogether. Although there is evidence of services innovating to maintain or improve quality, the extent of cuts goes beyond what can be addressed through productivity improvements alone.
“To avoid further funding restrictions and their impact on service provisions, cuts to the central government public health grant must be reversed,” the think tank said.
In its own written submission, the British Medical Association (BMA) warned of the risks of service fragmentation, as well as the disparity between reductions in spending on sexual health services and increasing demand.
The association said: “For example, there have been significant cuts to testing and treatment services for STIs in areas of high population-need.”
Lambeth, in south London, the author said, has the highest level of new sexually transmitted infections of all local authorities in England, according to recent data.
Yet, between 2016/17 and 2017/18, Lambeth Council cut its funding for sexual health services providing promotion, prevention and advice by more than 85%.
The BMA added that in 2017, three out of six sexual health clinics across Lambeth and Southwark closed.
“The variability in commissioning arrangements for sexual health services in England, and the fragmentation of services as a result of this, must be addressed,” it went on.
“The BMA is concerned that cuts to public health services mean that local authorities cannot maintain their levels of sexual and reproductive health provision. The consequence of which is that fewer people are able to access the services they need locally.”
Last month HuffPost UK examined the impact of the loss of such services on local communities – a more common occurrence since more services were centralised.
A record 3.3 million visits were made to clinics in England last year, up 13% from 2013, which is the equivalent of an extra 210 a day, or 1,471 a week, according to figures released last year.
The total number of sexual health screens – the tests for sexually transmitted diseases such as chlamydia, gonorrhoea, syphilis as well as HIV – has risen 18% during this time period, from 1,513,288 in 2013 to 1,778,306 in 2017.
GPs have raised voiced concerns that cuts in sexual health service provision and the lack of accessibility, which means patients are now having to travel further, will result in more patients turning to GP surgeries for help.
Many written submissions raised the issue of certain diseases being on the rise, and with depleting resources, these spikes are difficult to control.
The Association of Directors of Public Health (ADPH) said the rates of syphilis are at their highest since 1949, with 7,137 diagnoses of the disease in 2017 – a 20% increase on the previous year.
There were 44,676 diagnoses of gonorrhoea reported in 2017, a 22% increase relative to 2016.
“This is of concern given the recent emergence of extensively drug resistant Neisseria gonorrhoeae,” the ADPH said.
The problem of sexual health inequalities was also a recurring theme.
Sexual health is not equally distributed within the population; the impact of STIs remains greatest in young heterosexuals 15 to 24 years, black and minority ethnic (BAME) and gay, bisexual and other men who have sex with men.
“While overall prevalence of STIs remain stable, levels of transmission remain high and there are marked increases in bacterial STIs amongst these high-risk groups,” the ADPH said.
Naz Project London raised the issue of funding cuts disproportionately affecting BAME communities.
The sexual health charity said: “The work we do is made urgent by a sobering reality: there is a significant gap in the sexual health outcomes of BAME communities compared to the general population.”
The organisation said cuts to the public health grant imposed on local authorities by national government had already resulted in “significant financial pressures that have directly negatively affected frontline integrated sexual and reproductive health and HIV services”.
“There has been a continued decline in the number and volume of services local authorities are providing despite a clear rise in the demand,” it went on.
“In a context in which BAME communities are already negatively disproportionately affected, this decline in opportunities for access only compounds the health inequalities of these marginalised communities further.”
The inquiry will examine recent trends, the commissioning and delivery of sexual health services, including contraception services and workforce issues.
On Tuesday, MPs will begin hearing oral evidence from national organisations representing providers and commissioners, and a range of charities working in sexual health.