Rt Hon Amber Rudd MP Minister for Women and Equalities Sanctuary Buildings 16-20 Great Smith Street London SW1P 3BT
2nd September 2019
Urgent request to intervene: Funding for sexual health services
We are writing to you as sexual health and HIV organisations to express our concern at the current funding situation for sexual health services in England and to ask you to urgently intervene to ensure public health funding is increased in the upcoming Government Spending Round.
As you know, sexually transmitted infections (STIs) and HIV continue to disproportionately affect members of the LGBT+ communities, BAME communities, and young people.
This country has made great progress in tackling new HIV transmissions – with new HIV diagnoses on the decline since 2015. This progress has been down to collective effort to implement HIV combination prevention. Alongside swift access to HIV treatment, facilitating access to PrEP, condoms, HIV testing, and information and advice have been vital in reducing new HIV transmissions. Sexual health services are the bedrock of HIV prevention interventions. The Government has committed to ending new HIV transmissions by 2030, but this will not be possible without full access to sexual health services.
In contrast, England continues to see worrying trends in STIs. There has been a 249% increase in gonorrhoea since 2009, including a 26% rise in the last year. Worryingly, recent years have seen the emergence and spread of antibiotic resistant gonorrhoea, with three cases of extensively drug resistant gonorrhoea identified in 2018. Syphilis rates continue to rise – up 5% from 2017 and are now at the highest number of diagnoses since 1949. Gay and bisexual men and BAME communities disproportionately face the burden of these increases in STIs. Open access sexual health services are essential to prevent, test and treat STIs.
In addition, demand for sexual health services is rising – Public Health England data has indicated a 15% increase in attendance of sexual health services between 2014 and 2018.
Sexual health services are the responsibility of local authorities – funded by the annual ring-fenced public health grant from the Department of Health and Social Care. Local authority public health grant funding is being cut by £700 million in real terms between 2014/15 and 2019/20. This equates to a reduction of almost a quarter in public health spending per person. The cuts to funding have led to sexual health service budgets being reduced by 25% over the same time period. There is no future funding settlement for the local authority public health grant past 2019/20 and no solution from the government to the very urgent demand being seen in sexual health services now.
The upcoming Government spending round will set the local authority public health grant for one year only. The Health Foundation and Kings Fund have called for a £1 billion investment in public health spending in 2020-21 to reverse the impact of the cuts to public health budgets.
These funding cuts are directly having an impact on access to frontline sexual health services. Data collected by South East London sexual health clinics indicated that in a one-month period (November 2017), 1094 people were turned away from sexual health clinics in that area as clinics did not have enough capacity to see everyone who needed their services. Over half (54%) of those turned away reported that they had symptoms of a sexually transmitted infection. Data from the sexual health doctors association British Association for HIV and Sexual Health (BASHH) indicates that a worryingly high proportion of sexual health doctors are having to turn away patients because they don’t have capacity to see them.
In the recent Health and Social Care Select Committee report on sexual health, the Committee called the “severe” cuts to spending on sexual health “a false economy” and were concerned that they “risk widening health inequalities”. The Committee was concerned to hear “real and justifiable concerns that additional cuts will be applied to a sector now at breaking point”. The Committee
added that “looking forward to the Spending Review, the Government must ensure sexual health funding is increased to levels which do not put people’s sexual health at risk.”
Sexual health services are not sustainable at the current level of funding. The inequalities we see in sexual health will continue to widen and LGBT+ and BAME communities will continue to be disproportionately affected by STIs.
We urge you to intervene as a matter of urgency and call for increased funding for public health in the upcoming Government Spending Round .
Ian Green, Chief Executive, Terrence Higgins Trust
Dr Olwen Williams, President, British Association for Sexual Health and HIV
Rob Cookson, Deputy Chief Executive, LGBT Foundation
Karen Skipper, CEO, Spectra
Deborah Gold, CEO, National AIDS Trust (NAT)
Will Nutland, co-founder, PrEPster
Professor Chloe Orkin, Chair, British HIV Association
Matthew Hodson, Executive Director, NAM / aidsmap
Alex Sparrowhawk, Chair, UK-CAB
Marion Wadibia, Chief Executive, NAZ
Ian Howley, Chief Executive, LGBT Hero
Simon Collins, HIV i-Base
Steve Worrall, Deputy Director, Positive East
Dr Greg Ussher, CEO, METRO Charity
Amanda Ely, CEO, CHIVA
Silvia Petretti, CEO, Positively UK
Michelle Ross, Founder, cliniQ
Cc: Rt Hon Matt Hancock MP, Secretary of State for Health and Social Care, Duncan Selbie, Chief Executive, Public Health England