Sexual health plans undermined as trusts keep cash (original) (raw)

A £300m programme to tackle England's epidemic of sexually transmitted infections is in danger of collapse because the money has been siphoned off by NHS trusts to reduce their financial deficits, government advisers warn today.

The Independent Advisory Group on Sexual Health and HIV (IAG) said it surveyed 191 primary care trusts - the local bodies that hold the NHS purse strings -and found only 30 were spending the money as ministers intended. The rest have diverted some or all of it to cut overspending on hospitals, drugs and GP services.

Two years ago, a public health white paper entitled Choosing Health promised £300m to improve contraceptive services, sexual health clinics and chlamydia screening. But ministers did not ring-fence the money to ensure it was used to implement the policy.

The IAG is funded by the Department of Health, but is independent of it. Its chairwoman, Lady Gould, an influential Labour party figure, said last night that the extra money should have allowed sexual health and contraceptive services to expand, but instead clinics are closing.

"The IAG believes that it is essential that strategic health authorities and PCTs recognise that investment in frontline sexual health services will save them a great deal of money in the future. Better sexual health services bring benefits for patients as well as delivering cost savings for the NHS by reducing the number of sexually transmitted infections and unwanted pregnancies."

The survey found 51 PCTs had absorbed the entire allocation into the general budget this year, and 33 withheld some or most of the sexual health funding. Forty PCTs said the funding had not reached contraception services, 31 admitted withholding cash earmarked for chlamydia screening and 40 said genito-urinary medicine (GUM) services were being affected by funding problems, resulting in recruitment freezes and understaffing.

Lady Gould said ministers should have ringfenced the £300m. "When they allocate a one-off sum of money for a particular purpose and when they publicise the fact, they have to find ways of making sure it is used for that purpose," she said.

The government promised to make sexual health one of the NHS's top six priorities in 2006-07. Recent figures show a rise in cases of most sexually transmitted infections. Chlamydia remained the most common, with 109,832 new cases in 2005, a 5% increase on 2004.

Colm O'Mahony, consultant in sexual health at the Countess of Chester hospital, an NHS foundation trust in Chester, said it had expected an extra £200,000 and submitted an expansion plan to West Cheshire PCT. "I was told categorically by the PCT's finance director that none of the extra sexual health money could be spent on sexual health. It all had to go towards paying off the PCT's £42m debt."

Dr O'Mahony said the £300m was the first substantial investment in sexual health after 20 years of neglect. "It was naive of the government to expect PCTs with big debts to use this money as intended. They should have ringfenced it."

A Department of Health spokeswoman said: "We have provided PCTs with more sexual health funding than ever before, but it is up to local NHS organisations to decide how to manage their budgets to deliver services to best meet local needs."

She said the extra investment was already having an impact, with gonorrhoea rates falling and more people receiving a GUM appointment within 48 hours.

But Anne Weyman, chief executive of the FPA, formerly the Family Planning Association, said: "The promise to make sexual health a priority has been fatally compromised. Without the investment, rates of unplanned pregnancy, sexually transmitted infections and abortions will only increase."

Nick Partridge, chief executive of the Terrence Higgins Trust, said: "It would be a great disappointment if the nation's sexual health were sacrificed on the altar of financial balance in the NHS."

Facts and figures

Sexually transmitted infections have increased by 3% over the last year, to 790,387. While chlamydia is the most commonly diagnosed STI, the most dramatic rise - 23% last year - has been in cases of syphilis which experts say has been fuelled by unprotected gay sex and an outbreak among mature women who are suspected of "swinging". New cases of gonorrhoea bucked the trend by falling by 13% - a substantial drop for the second successive year - although they still rose in the gay community. The figures indicate the total workload in genitourinary medicine clinics has risen by 9%, at a time when 46% of patients are still unable to gain access within the government's 48-hour target.