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Sexual Health (Middlesbrough)

Volume 491: debated on Wednesday 22 April 2009

I thank Mr. Speaker for granting me this debate, which is important to my area. I want to put on record the contribution that health service staff are making in dealing with sexual health matters in Middlesbrough, and to highlight some of the good practices that are being followed. Given that it is Budget day, I will not ask the Minister for any more money—she can put herself at ease on that subject—but I shall demonstrate what good practice is being followed and express one or two concerns that I have for the future.

Securing improvements in sexual health and well-being will continue to present a real challenge to all of those charged with that responsibility nationally, locally and regionally. Sexual health services have been required continually to adapt to changes in the communities that they serve. That was evident in the most recent Department of Health document on the issue, which was entitled “Progress and Priorities—Working for High Quality Sexual Health”.

That document shows us, for example, how the shape of HIV in this country has changed significantly, particularly in relation to increases in the diagnosis of heterosexual people infected overseas and the undiminished levels of newly acquired infections in gay men. Despite the availability of more effective drug treatments and expanded testing opportunities, too many people are still diagnosed too late. Overall, diagnoses of sexually transmitted infections have continued to increase. Other social changes also impact significantly on sexual health, such as the frequent use of alcohol and other drugs.

One subject that has not been well reported or analysed is the need for sexual health services for older people. Sexual behaviour research in that group is minimal, but recently, in a large survey of almost 8,000 people over 50, two thirds said that they were sexually active and more than one in 10 said that they did not use contraception with their current partner. They also did not know about their partner’s sexual history. The document concludes:

“Whilst progress has been encouraging in some areas, overall the picture is one of worsening sexual health”.

That is the case in Middlesbrough and Teesside, too. Middlesbrough, Redcar and Cleveland, and Hartlepool primary care trusts, as well as Stockton-On-Tees teaching PCT, have developed proposals for the improvement of local sexual health services as part of a Teesside-wide investment. That is an example of best practice in collaboration across geographical boundaries. Flowing from that, a Teesside-wide sexual health reorganisation is taking place to help to facilitate a fully integrated sexual health service.

A tendering process is under way in the area to appoint a lead provider, which will be responsible for organising the delivery of an integrated sexual health service. That will include genito-urinary medicine—GUM—contraceptive and sexual health services, and teenage pregnancy. It is intended that such a future pattern of integrated sexual health services will start to address the issues that I have mentioned. Those developments will support the changes needed to take a radical step forward in service delivery on Teesside. That vision of sexual health services sets out an ambition for everyone across Teesside to have access to comprehensive sexual health services, and to promote sexual health and well-being. Our providers say that that

“will be delivered through high quality, fully integrated care pathways, that will be both holistic and client focused”.

That is, and will be, delivered through PCT primary services at street and clinic level, and the James Cook university hospital in my constituency. The South Tees Hospitals NHS Trust GUM services are currently meeting Government targets on the number of patients seen and appointments offered. In fact, South Tees GUM services were recent finalists in the Nursing Times GUM service awards.

On HIV, approximately 300 patients attend South Tees services—the majority attend the department of infection and travel medicine. Patients are usually seen by the department of infection within 48 hours of referral. Medical, nursing, psychological, dietary and social input gives holistic care to patients with HIV.

For too long, our area has had to suffer poverty and health inequalities, and it has long been recognised that there are serious health inequalities in the Cleveland area. More than 16 per cent. of the population have health problems and that is significantly higher than the national figure of 13.1 per cent. Standardised mortality ratios are higher than national averages for all causes of death—for example, standardised mortality ratios for coronary heart disease show that, in some wards, levels of heart disease are more than 50 per cent. higher than national rates.

The same is true of sexually transmitted infections. Across the Tees area, the four primary care trusts have the highest levels of teenage pregnancy and sexually transmitted infections in the country. The evidence collected by the four PCTs shows a clear picture of an increasing trend in sexual risk-taking behaviour, with the resultant increase in sexually transmitted infections. That is often exacerbated by alcohol and drug taking.

The first priority is to deal with these infections at the sharp end, both in clinics and in hospitals, as I have mentioned. However, a longer-term view is also needed. So, alongside the need to manage the growing demand, the PCTs are acutely aware that they must have a better understanding of social causes and provide better education and prevention. The PCTs have recognised that, although they commission a range of sexual health services, there is not a comprehensive approach to the issue. They also acknowledged that strong, strategic leadership was needed to build on a vision and strategy for this delicate but crucial area of service. As a result, there should be a strong, robust, patient-and-public-involvement focus to address the needs of vulnerable groups.

The PCTs also recognised that although there are good informal service links, commissioning is gradual and service developments are generally not well co-ordinated across the Teesside area. That is expressed in a key document entitled “The Shaping of Sexual Health Services Across Teesside”, which is a patient survey conducted in October 2008. The survey ran for four weeks and closed on 26 September 2008. It asked the public to comment on issues such as their understanding of what sexual health services do, where they can go to find information and, if they had received treatment, their opinion of the service.

The survey—an online and paper questionnaire—received 591 responses from members of the public and 24 responses from inmates at the local Kirklevington Grange prison. There was high awareness—over 85 per cent. in all cases—of sexual health services provision, but respondents were not knowledgeable about where to access services, which is a concern.

The internet and GP surgeries are the main sources of information, and, for many members of the public, the GP’s surgery is the preferred location for a check-up. People expressed a strong desire to see a same-sex health professional. In addition, many respondents expressed a desire for the clinic to be located where they were not likely to be known, and in a setting not identified as a dedicated sexual health centre.

The responses were received not from those who might be called serial users of sexual health clinics: over 60 per cent. of respondents were recorded as not having had to use a sexual health service in the past two years. The majority of respondents were female, over 86 per cent. were heterosexual, less than 7 per cent. were gay or lesbian, and 3.4 per cent. were bisexual. Nearly half of respondents were 35 to 64 years old, and 95 per cent. considered themselves to be white British. In summary, the vast majority had not required sexual health services, and there was high awareness of what services were offered but not where to access them.

One aspect of the survey that caused me some concern was the location of respondents by postcode area. I will do my best to spare the Minister the ordeal of my running through a social analysis of all the postcodes in my constituency and the general area, but, in short, the distribution of replies reflected respondents from the wealthier areas of Teesside. Worryingly, some of the more affluent wards in our area seemed to have a higher number of respondents than would be the case if analysis were done on a population basis. I do not intend to accuse those responsible for the survey of producing a distorted picture, but I suspect that the findings indicate that the poorer population of inner Middlesbrough has a pattern of needs even deeper than the survey may indicate. As such, I feel that there is a need for a follow-up survey in areas such as central Middlesbrough.

However, the good news from the survey was that, despite the need to extend the service, there was an appreciation of the services provided and of the people providing them. For instance, one respondent said:

“The Doctor took time to listen to my concerns and gave me a full explanation without being patronising.”

Someone else said:

“I went to the hospital because I’d been in a sexual attack and the doctor worked with me with areas I wasn't comfortable in expressing.”

In June last year, the national support team for sexual health reviewed services on Teesside. The review reflected examples of local good practice but also made several key recommendations, including a move towards much more integration of services. The development of a service specification is an attempt not only to change service delivery but also to try to look more holistically at people’s physical, emotional and social needs. In turn, that will be used to try to implement change through positive attitudes and behaviours. I understand that this is the first such reorganisation in this field in the country.

In conclusion, I hope that the Minister will follow the progress made in the process and outcomes of the reorganisation, given that it provides one of the first standard models for England. I hope that she will keep a close eye on it, given the concerns that I have expressed. However, great progress has been made, given some of the problems and difficulties that we have experienced. I will leave it at that.

I congratulate my hon. Friend the Member for Middlesbrough, South and East Cleveland (Dr. Kumar) on securing this debate.

My hon. Friend and I would agree that there is no doubt that the issues around sexual and reproductive health in the 21st century present us with immense challenges—he touched on some of them—but that we are making some progress. The problems include rising numbers of sexually transmitted infections, waiting times for clinic appointments, the emergence of chlamydia as a major infection, the need for better contraceptive services and the need to inform all sexually active people about how to reduce their risk of infection and maintain their sexual health and that of their partner. Underpinning all those issues is the need for consistent improvement, not just in Middlesbrough but across the whole country, and bringing services up to the best possible standard.

My hon. Friend spoke about health inequalities and the importance of reaching out in particular to members of the population to whom services are still not delivering the kind of response that we would like. I concede that Middlesbrough, in common with many other parts of the country, is very much a work in progress. My hon. Friend touched on that when he discussed improving sexual health. There are stories of real innovation and improvement, which he mentioned but, as he said, the picture is still mixed. It is clear that local services must continue to strive to do better to meet the ambitious national targets that we have set them, as Middlesbrough is doing with its new sexual health strategy. I hope that it will ensure that progress is made. I assure my hon. Friend that I will keep an eye not only on Middlesbrough but on the development of sexual health services in all local health areas across the country.

It is important to focus on a few things in Middlesbrough. The town experienced a fall of nearly 24 per cent. in under-18 conceptions between 1998 and 2006, which was very good. Regrettably, it experienced a substantial rise in such conceptions between 2006 and 2007, which left it lagging behind the trajectory for reaching the 2010 targets. After reflecting on that, I, like my hon. Friend, would urge the organisations in Middlesbrough to ensure that, within the important strategy that they are developing, they examine what they need to do to bring teenage conception rates down again.

On STIs, we have data only at strategic health authority level, which show an upward trend in HIV, syphilis and gonorrhoea in recent years. I realise that some increases result from more people coming forward for testing, which is a good thing, but it is important that Middlesbrough considers other reasons for the trend within the strategy. There are, however, signs of better things to come. For example, I am encouraged that Middlesbrough’s chlamydia screening programme is starting to grow. It is still a little behind where we would like it to be from a national perspective, but it is heading in the right direction. Again, I urge local organisations to commit to faster progress over the next 12 months. My hon. Friend touched on that when he spoke about the need to ensure that there is a proper focus on all communities and on accurate information, and that there is dialogue and partnership not just with the organisations that provide the service but with local communities as well.

It is good to see that last year, Middlesbrough offered 99.9 per cent. of all patients an appointment at a sexual health clinic within 48 hours—a hair’s breadth from the national expectation of 100 per cent.—but consistently, between May 2008 and February 2009, it hit 100 per cent, which is encouraging.

My hon. Friend mentioned the visit of the sexual health national support team in June last year. The team made a number of recommendations to local trusts across Teesside, including the need for stronger strategic leadership, more patient involvement in planning new services and campaigns, better governance and integration across genito-urinary medicine, community and primary care services, and specific improvements in the way in which the chlamydia screening programme was being delivered.

I am encouraged by the fact that the four primary care trusts covering Teesside have joined forces on the new five-year strategy to improve health and well-being, which, as my hon. Friend said, has a particular focus on sexual health for children and young people. Implementation only started this year, but the plans are sensible and they need to pick up on the recommendations of the national support team, as he rightly said. Specific measures include better partnership working between general practitioners, schools and youth workers, facilitated through Children’s Trust arrangements in the area. We know from experience across the country that that is crucial in addressing teenage pregnancy.

The PCTs also launched a series of new information campaigns to get the safe sex message across to targeted groups. Let me stress that it is particularly important that these campaigns are targeted. I echo the points that my hon. Friend made in saying that the campaigns need to reach excluded young people who have been expelled from school, involved in drink and drug abuse or who have entered the criminal justice system. In many cases, young people, particularly young women who are pregnant, or those who catch STIs, have other problems in their lives and unless we reach out to them early on and deliver a joined-up solution, we are not making the difference that my hon. Friend and I would like to see.

Drawing together the sexual health strategy and looking at it over a five-year period, I hope that we will not only shut the door before the horse has bolted—that is important in the provision of these services—but that we will still ensure that there is concentration wherever necessary to make people wise after the event. In respect of the plans routinely delivering contraceptive services, I am particularly encouraged that anyone attending an abortion clinic across Teesside will receive automatic advice, support and counselling, which is a step in the right direction.

Like my hon. Friend, I have focused on the local dimensions and the work on sexual health in the Middlesbrough area, because, ultimately, it is about local services—schools, GPs, youth services and prison services—all working together in this important area. Local action, however, is not a fig leaf for inaction from Westminster. My hon. Friend said that he was not—at least, not today—asking for more money for Middlesbrough, but it is important that we consider the high profile campaigns and the work that is going on.

A significant investment is being made by the Government to improve access to contraceptive services. We have invested some £26.8 million over the last financial year to improve women’s access to contraception, particularly long-acting reversible contraception. We have allocated these substantial resources. I say to my hon. Friend and to organisations in Middlesbrough that it is important that they ensure that that money is spent speedily and efficiently to support and reinforce the important points that my hon. Friend made with regard to the five-year strategy.

A great deal of work is under way to broaden services. I mentioned the national target for everyone who needs one to receive an appointment at a sexual health clinic within 48 hours. We also expect PCTs to look at how they can deliver more choice and a wider range of services, because not everyone feels comfortable going to a GUM clinic. We therefore want more primary care and nurse-led services. I hope that we will see those sorts of things blossoming in Middlesbrough. Many GPs are now broadening their skills by delivering routine sexual health services through locally enhanced services.

Although I have already mentioned it, teenage pregnancy is a key concern, which is why we launched the teenage pregnancy strategy, following a detailed report by the social exclusion unit. My hon. Friend touched on inequality in health, leading to economic inequalities and the impact that that has on people’s quality of life and their general well-being. Although there has been dramatic progress—falls are welcome—we need to recognise that progress is not fast enough: we are behind in our stated objectives and we need to ensure that our ambitious target to halve the under-18 conception rate by 2010 is achieved. To speed up that process, I announced, with my right hon. Friend the Minister for Children, Young People and Families, additional support to help local areas further reduce their rates. That support includes £20.5 million extra funding to improve young people’s access to effective contraception, as well as additional support for parents to talk to their children about sex and relationships, so that young people are able to make those choices and feel empowered with regard to their sexual health, rather than feeling pressurised by their peers.

In October 2008, my right hon. Friend the Minister for Schools and Learners announced that personal, social and health education, which includes sex and relationships education, will become statutory in all schools. This is crucial, added to other policies, including the strategy in Middlesbrough, if we are to ensure that young people have the knowledge and skills to make safe and responsible choices about their sexual health.

We know that where local areas are following the national teenage pregnancy strategy, and where we see strong strategic leadership from PCTs and local authority chiefs, as well as effective partnership working bringing together education, health and youth services to confront the underlying causes of teenage pregnancy, the impact can be significant. We know from experiences across the country, in places such as Hackney and Liverpool, that teenage pregnancy is not inevitable and that if we deliver the services in the right way, fantastic results can be delivered.

I appreciate that Middlesbrough faces particular challenges, with pockets of severe deprivation and disadvantage across the city but, together with my hon. Friend, I urge all local organisations involved with the sexual health strategy in Middlesbrough to make a renewed commitment to the strategy and to tackle speedily the key concerns that he has raised today by ensuring that they have not only the framework and the strategy in place, but that they have ways to deliver it to individuals in the communities across his constituency to make real changes.

Sitting adjourned without Question put (Standing Order No. 10(11)).