The House of Lords debates the state of sexual health today. It is another sign that the nudge-and-wink culture of embarrassment and secrecy surrounding sexual activity could be changing. There was more evidence earlier this month with the news that a government-financed trial in 100 schools had found a new way of curbing teenage pregnancy. Pupils under 16 who were taught to consider other forms of intimacy, such as oral sex, were found less likely to engage in full intercourse.
The first anniversary approaches of the most devastating report produced by the Commons select committee on health. It concluded that, despite the 2001 government strategy on sexual health, the prevalence of sexually transmitted diseases was at its highest level since the inception of the NHS 56 years ago. It concluded that the poorly resourced, under-staffed and demoralised service was in a state of "crisis".
From sex education in schools (too biological, too patchy, too little, too late), through family planning and contraception services (cut back), to sexual infection treatment clinics (facing mounting numbers and increasing waiting times), the sexual health service was, in the words of the committee's chairman, "a shambles".
The problems begin with education. For 18 years, Conservative ministers wrung their hands in dismay over Britain's rising teenage pregnancy rate, but proceeded with policies - restrictions on sex education and cuts to family-planning - that exacerbated the problem. Initially, Labour moved warily on an issue that a moral minority expounded on with much ill-informed noise.
But Labour did set up a teenage pregnancy unit in 1998, and spent three years on a sexual health strategy. Teenage pregnancies are falling (down 9.4% since 1998), although the UK rate, which in the 1970s had a similar rate to other European countries, is still the highest in western Europe and some four times higher than the Netherlands.
Contrary to the claims of rightwing commentators, there are several studies - 33 in the US alone by 1995 - showing that young people given sex education at school start their sex lives later, take fewer partners and are more responsible about contraception. Yet the state of ignorance uncovered by the select committee was shocking: more than a quarter girls aged 14 and 15 thought contraceptive pills protected them from infection.
But it was the state of clinics that caused the MPs most concern. It is not an issue the suffering patients shout about. Given the stigma attached to their condition, they keep silent. Open access is now virtually unknown. Waiting times average 12 days for urgent cases, but up to eight weeks for general check-ups, with serious, spiralling consequences for public health. People don't stop having sex while they wait. Last year, a third of clinics were open only for three days a week.
The dilapidated facilities in which the clinics are based signals just how low a priority the service has been given - 20% housed in temporary buildings and 80% needing refurbishment. At the time of the report, Bristol was using a condemned, flea-ridden temporary cabin and turning away 400 people a week.
The biggest irony is the economies that are being lost by the lack of investment. The government estimated in its sexual health strategy that the prevention of unplanned pregnancies saved the NHS about £2.5bn, yet family-planning and contraceptive services remain at the end of the funding queue. The average lifetime treatment cost for an HIV-positive individual is around £150,000. Add in the cost of social care, welfare, lost taxation, and the cost can be tripled.
There are now at least 50,000 people with HIV. Estimates of the total numbers suffering from chlamydia - which can lead to ectopic pregnancies, infertility and pelvic inflammation, yet often shows no symptoms - range up to 200,000.
Ministers did respond to the report with an extra £11m for clinical services and chlamydia screening (the select committee called for up to £30m), and a further £15m was announced for this year. But field workers complain about the amounts siphoned off for other causes.
The latest health department safe sex campaign - including an online sex lottery - is having a positive response from 18- to 30-year-olds. But something more fundamental is needed. Sex education is still not included in the core of the national school curriculum as the committee wanted. The shortfall in clinical staff has not been made up.
More seriously, sexual health was not included as a priority in the nine performance goals against which primary care trusts are inspected. It has therefore dropped off their agenda. Ditto with respect to the 28 strategic health authorities, only a handful of which included sexual health in their local delivery plans.
But it is ministers who set priorities, not managers. Their duty is clear: to give an unequivocal signal to PCTs that they expect the current epidemic of sexual infections threatening society to be tackled with urgency and vigour.
