Sexual health services are being “cut to the bone”, according to research which has triggered warnings that more sexually transmitted infections and unintended pregnancies will follow.
Analysis by the King’s Fund has found that efforts to promote safe sex among groups most at risk, including young people and gay men, have been hardest hit as local councils in England have spent less as ministers slash their public health grants.
Spending on sexual health, advice and promotion fell by 35% to £47m a year between 2013/14 and 2017/18, found Ruth Robertson, a senior policy fellow at the thinktank. Those budgets pay for initiatives to encourage use of condoms, including pop-up stalls in colleges, nightclubs and shopping centres that give out free contraceptives and STI testing kits.
“The biggest cuts are to upstream, primary prevention services that work to promote safe sexual behaviour. Sexual health prevention services can be the first port of call for commissioners who need to implement cuts,” said Robertson in a blog which outlines her findings. Those areas are particularly at risk because – unlike provision of contraception and tests for STIs, such as herpes and chlamydia – councils are not legally bound to provide them.
“Spending reductions are starting to cut to the bone in some parts of the country. It’s worrying that there have been such deep cuts in spending when gonorrhoea and syphilis are on the rise,” added Robertson. “In some parts of the country clinics are being closed, moved to less convenient locations or operating with reduced opening hours … people with symptoms [of STIs] are being turned away.”
Total spending by councils fell over the period by 14% from £668m to £572m, according to her analysis of spending on sexual health between 2013/14 and 2017/18. Councils took over responsibility for public health from the NHS in 2013 as part of then coalition government health secretary Andrew Lansley’s shake-up of the health service, which experts say was very damaging.
Robertson also learned that: nine out of 10 (88%) councils cut spending on such services, and only a handful (12%) increased it; spending on STI testing and treatment fell 10% to £364m and contraception services are down 15% to £161m. Robertson and Dr Olwen Williams, president of the British Association for Sexual Health and HIV, warned that the cuts contrasted starkly with health secretary Matt Hancock’s pledge to ramp up efforts to prevent illness.
“The health secretary is in his place in wishing improved health prevention but does not seem to have grasped the fact that everyone has a right to good sexual health, and through ignoring this important area he is letting the population down,” said Williams.
“If services are cut, fragmented and delivered ad hoc by a variety of providers there is a potential significant risk that there will be further increases in STIs and rising rates of unplanned pregnancies. There is concern that individuals will not be able to access pre-exposure prophylaxis [the anti-HIV drug] as the services will be ‘limited’, and thus potentially we may see a rise in HIV,” she added.
The most recent data from Public Health England (PHE) shows that the number of STIs every year is steady at around 422,000. However, cases of syphilis have been rising for the past decade and were up 20% between 2016 and 2017, especially among gay and bisexual men. Gonorrhoea cases rose by 22% in that year.
Professor Noel Gill, head of PHE’s STI and HIV department, said it is “not clear” if spending cuts have led to a rise in diseases such as syphilis. “Studies show that factors such as a lack of condom use and people practising more risky sex are likely to be key.” The numbers of attendances at clinics and screenings have gone up since 2013, “which suggests people are still able to access services”, he added.
Labour accused ministers of choosing the day parliament rose for its Christmas break to “sneak out” confirmation it is reducing the public health grant to councils by a further £85m next year. A Department of Health and Social Care spokesperson said: “We are giving £3.5bn this year to local authorities for public health services, as they are best placed to understand and meet the needs of their local communities.”
