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Health: Contraceptive Services

Volume 793: debated on Thursday 11 October 2018


Asked by

To ask Her Majesty’s Government what action they intend to take to protect women’s sexual and reproductive health services following the findings of the Advisory Group on Contraception, published in September, that nearly 50 per cent of local authorities have reduced the level of contraceptive services delivered since 2015.

My Lords, the Government have mandated local authorities in England to commission comprehensive open-access sexual health services, including the provision of free contraception. Contraception is also widely available free of charge through general practice. Working with Public Health England we are considering ways to promote increased access to the full range of contraception.

I thank the Minister for his Answer, but it is not good enough to place the responsibility on local councils when there has been a £600 million cut by Public Health England overall over the past few years. Local authority budgets for sexual health services have been reduced by £30 million in the past two years. This is a false economy. Every pound spent on contraception saves £9 in averted costs as well as huge personal and family costs. We are seeing some of the consequences already. According to the Terrence Higgins Trust there has been a 20% increase in the diagnosis of syphilis and gonorrhoea. When will the Government replace the lost funding now that we have learned that austerity is over and make sexual health services a public health priority again?

I concur with the noble Baroness about the importance and benefits of contraception. It is a success of sexual health services that the use of long-acting reversible contraceptives has risen over the past 10 years. She is right that there have been pressures on public health budgets which have affected services, but it is important to note that many outcomes are improving. The annual number of sexually transmitted infections is stable, and the number of teenage pregnancies is down. In fact, it has fallen by 45% since 2010 to its lowest recorded level. I take her point about the importance of these services and that they are under pressure; nevertheless, they are performing admirably.

Given that half our pregnancies are unplanned, and that the department’s policy in respect of limiting neural tube defects is to tell women of child-bearing age to take folic acid supplements, what is the Government’s response to the research published two days ago that shows, once again, a reduction in the use of folic supplements by young women of child-bearing age?

I know the noble Lord is very active on this particular issue. We respect the evidence and are considering what to do about it at the moment.

My Lords, in response to a request for information, nearly 42% of local authorities reported that they had reduced sexual and reproductive health services because of budget cuts. All the directors of public health in local authorities report that services related to contraception have been reduced because of cuts to the public health budget. There has been a rise in the number of abortions for women around the age of 30 and above and a decrease in the uptake of long-acting reversible contraceptives among women over the age of 30. All this points to the cause being the reduction in the public health budget for local authorities. Evidence-based policy would suggest that that needs to stop or be reversed. I am sure that the Minister will say that he will fix it.

I thank the noble Lord for his question and reiterate the point I made; of course public health budgets have been under pressure and we know why that is. Nevertheless, there are some positive outcomes in the changing of services, such as services moving online, as they have done in London with good effect. It is also worth saying that, in the same survey that the noble Lord referred to, more than 50% of local authorities had either kept the same levels of service or increased them. That is also worth focusing on. Nevertheless, I recognise that there are pressures and that there are behaviours that we do not want to see, such as increasing abortions among the over-30s. We are making the case, and will be doing so in the spending review, for the benefits of public health spending on issues such as this.

My Lords, the provision of access to contraception is a part of the GP contract, but there is a growing number of GP practices that neither provide the service nor refer their patients elsewhere. What are the Government doing to stop that unacceptable situation for growing numbers of women?

The noble Baroness is quite right that there is an obligation in the GP contract. We are in the process of renegotiating the contract for the next financial year, and I shall certainly take that issue back and feed it in to the team that is carrying out the negotiation.

My Lords, now that austerity is over, when will local government budgets be restored so that local authorities can address issues such as the one we are hearing about today?

Local authority budgets will of course be a matter for the spending review that will take place at some point during the next year.

My Lords, I have raised this with the Minister on previous occasions as patron of the Terrence Higgins Trust. I share the concerns of my noble friend Lady Thornton that the vulnerable groups who need access to sexual health services are at the moment being denied that very access. Does he agree that a lack of access for these vulnerable groups will impact negatively on the health of the nation?

I agree that there can be a negative impact. Indeed, one of the things that Public Health England has done recently is publish a consensus statement about sexual and reproductive health policy and actions, and it is updating its action plan. Nevertheless, it is important to point out that there were more attendances in clinics in 2017 than in 2013, which shows that it is possible to get appointments to be seen.

My Lords, in how many areas are sexual health clinics now staffed by nurses rather than doctors because it saves money? I know of two. If he does not know the answer, will he write to me and put a copy of his answer in the Library?

I am afraid that I do not have those figures with me, so I will certainly write to the noble Baroness and place a copy in the Library.