The Government has responded to the Health and Social Care Committee (HASC) report and recommendations on sexual health. It has committed to a much needed sexual and reproductive health strategy for England. Central to its success will be the mechanisms it promotes to see stronger collaboration between NHS and local authorities.
It’s encouraging to see a range of stakeholders across local authorities and the NHS listed by the Government as vital to the development of such a strategy. However, the response is less convincing when it comes to the setting of clear standards and accountability mechanisms. This is a missed opportunity for ensuring there is a consistent quality of provision across the country and all those in the system (including the NHS) have a stake. Current good practice examples of collaboration are highly reliant on local advocates and relationships; in some areas these voluntary initiatives are just not working.
We want to see bolder direction from Government through strategy and shared performance indicators across the system, to ensure the good practice examples we’ve seen in specific areas are replicated. This is not the first time the Government has shied away from setting clear standards for provision that may drive consistency. In 2018 it consulted on the regulatory framework for public health. To date it still hasn’t published a conclusion nor responded to recommendations from NAT and others that the regulations be strengthened.
The Government’s response on funding for sexual and reproductive health services is, in a word, weak. Time and time again we hear that local authorities are, ”responsible for deciding their local health priorities and allocating their resources accordingly”. Yet it stays silent on the sustained disinvestment in public health and the limits this puts on local authorities’ ability to respond to local needs. The Government’s statement that, ”Minimum spend levels in sexual and reproductive health would also risk unintended adverse consequences for other local authority commissioned services” is in itself an admission that local government is underfunded.
Although it was a positive shift to finally see a small uplift in public health funding in this Spending Review after years of cuts it’s nowhere near enough. For local authorities to deliver on prevention then the Government must commit to spending an appropriate proportion of health spend on public health. The Health Foundation showed that public health spending decreased from 2.8% in 2013/14 to 2.1% in 2018/19. In order to meet need based on the recommendations of the Advisory Committee on Resource Allocation (ACRA), investment needs to be higher than either of these figures. NAT supports the Health Foundation’s recommendation that a minimum proportion is agreed with scope to review this up. This is to ensure that this part of the health service is increasing in line with the NHS.