Prophylactic measures

As both a public health doctor and a member of the health and social care select committee, I am fortunate in being able to examine in detail the various aspects of our UK health service. Unfortunately, we are all too often presented with services that are struggling to flourish due to years of underfunding and one too many restructures.

A recent session looking at sexual health services was a particularly stark example. The expert witnesses described a system with funding split between health and local government as well as both national and local commissioning structures. Unsurprisingly, this has led to confusion, inefficiencies and a fragmentation of patientcare. One example stood out as particularly shocking: a woman who was unable to receive a hormonal coil fitting in a sexual health clinic due to commissioning limitations, despite the clinic having the capacity and expertise to deliver the service. Instead, she was passed between providers and left facing potential delays of up to two years.

Another example of the disjointed and inequitable current system is in the use of postal testing kits, which are made available in some parts of the country in order to plug gaps in the system. Given chronic underfunding and resource pressures, this can be an effective way to meet demand, but ultimately remains a postcode lottery. Supplies of postal tests run out on a daily basis, while the lack of online options, such as click-and-collect, only serves to exacerbate health inequalities, particularly among those for whom home delivery may not be viable due to privacy concerns.

There has also been a worrying decline in condom use, a rise in sexually transmitted infections, reduced uptake of hormonal contraceptive methods and an increased reliance on emergency contraception. Social media may have influenced these trends, where young people encounter misinformation and can struggle to discern factual content. Negative narratives from social media influencers significantly affect young people’s choices, particularly regarding hormonal contraception.

National sexual health campaigns need to be rooted in lived experience, cultural relevance and sensitivity to their target demographic. A recent example of a national campaign which fell well short of those criteria had photos with faces obscured by emojis, which only served to contribute to stigma surrounding sexual health. The sexual health workforce is coming under increasing strain, with one-third of specialists expected to retire by 2028. There are also recruitment and training challenges. The training pathway for sexual and reproductive healthcare specialists is six years post-foundation, and sees intense competition: the committee heard that there were1,400 applicants for just 14 posts this year.

This picture is clearly appalling and unacceptable. Workforce requirements need to be modelled and accounted for in the upcoming health workforce strategy and communication and campaigns must be prioritised to counter the large amount of misinformation being spread across digital platforms.

The unanimous call from the experts who gave evidence was for a national strategy to clearly determine commissioning responsibilities and provide fair, evenly distributed and sustainable funding. This call was in fact already made by the health select committee – in 2019 –but was entirely ignored by the government of the day. We cannot afford to make the same mistake.

As a Labour MP and a public health doctor, hearing the depth of malfunction in an area as critical as sexual health is concerning and galvanising in equal measure. Reducing health inequalities and improving the overall health of our population is a cornerstone of ensuring this country can thrive and future generations can reach their potential. Along with my colleagues on the committee, I will be pressing the government hard to achieve just that.

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