Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 120-136)



  120. And is there any guidance, if you have got a partnership between several PCTs, and one of those PCTs is taking the lead on sexual health, will that one lead work across the three PCTs, or will each PCT have their own?
  (Ms Hamlyn) We think it is perfectly acceptable for there to be one PCT leading, if that is the local arrangement. Who gets involved in our training and development, I think, is for them to tell us about who they would want us to communicate with, involving their training. But we would find it acceptable if one PCT were to take the lead and identified a collaborative arrangement; it is equally acceptable for each PCT to have a lead.

  121. And what is the role of the Strategic Health Authority?
  (Ms Hamlyn) The Strategic Health Authority has a performance management role over PCTs, so they will be discussing with each PCT about progress to meeting the standards and guidelines that we will be producing, and the development of a local strategy. So really it is a performance management role.

Julia Drown

  122. Can I just pick up some of the issues that were brought to our attention from the Family Planning Association's evidence to our Committee, which is what you are going to see, and just first of all picking up some of their issues on abortion. You said earlier that you are doing these pilots, and have seen the Action Plan in other settings, where it is legal; would those include family planning and community clinics?
  (Ms Hamlyn) We are talking about in the context of the law, and I do not know whether Andrea would like to comment.
  (Ms Duncan) The law currently says that abortions can only be performed in an NHS hospital vested in a PCT, or what used to be a health authority, or in a place approved by the Secretary of State for Health.

  123. So the Secretary of State for Health could approve any area, if they wanted to?
  (Ms Duncan) But, at the moment, the only places approved by the Secretary of State are in the independent sector, that is (BPS, MSI ?) type.

  124. But, presumably, it would not be a big, it is not primary legislation to change it?
  (Ms Hamlyn) What we want to do is to pilot, there could be examples where you have what is regarded still as a hospital site, but actually is now, because of the development in that particular area, it is actually more a community setting, where we can actually pilot it to see how it works, and then we can actually consider whether that will inform us about the issue about any changes the Secretary of State might wish to make.

  125. So we are not yet dealing in family planning or community clinics, probably?
  (Ms Duncan) There is a facility in the Human Fertilisation and Embryology Act that the Secretary of State can approve a class of place[7], so we do not have to take applications from individual places, and so these pilots will inform what we can describe as a class of place.

  126. The other thing they suggested was that nurses should be able to undertake abortions; are you looking at that?
  (Ms Duncan) That would require a change in the current law, because the law says that abortions can only be undertaken by a registered medical practitioner.

  127. Any views on that though, is that something that is being raised with the Department?
  (Ms Hamlyn) I do not think it has, actually, been raised with us specifically, no.[8]

  128. And, in dealing particularly with the delays, that obviously women do not want to have, obviously one big request is for abortion to be available on request, in the first trimester; what evidence do you have that would actually smooth the process, lead to a reduction in people having to have very late abortions when an earlier one obviously would be much less difficult for them, and for the NHS?
  (Ms Stanier) When you say "on request", do you actually mean a change to the current arrangements for securing two doctors' signatures?

  129. Yes.
  (Ms Stanier) Well the position is that the Government really does not have any plans to look again at those arrangements.

  130. But do you get any feedback on whether that would actually help, in terms of giving women abortions more timely, and avoiding them having to go very late and it being more difficult for them and for the NHS?
  (Ms Stanier) I am not aware that we have had any such representations, or seen any evidence on that.

  131. The Family Planning Association are also saying that the information on sexual health is very patchy at the moment, and a particular feeling that materials are not accessible in other formats, large print, particular languages, community ethnic minority languages, Braille, audio, and so on. What steps are being taken to address that?
  (Ms Hamlyn) Those issues are being looked at in the context of, as I referred to, this review of information leaflets, and what is available to the public and how they are being used.

  132. They pointed out also about, in particular, their information lines, but how they are not integrated with NHS Direct; is that something else that you are looking at as well?
  (Ms Hamlyn) We have had discussion with the FPA in thinking about what should be the model of helpline provision, particularly in the thinking about the context of having a campaign, for the people that may need to `phone up a particular service. And I think we had to distinguish between, here, an information line, where people get basic information, a line where you have a professional back-up, that the FPA currently operate, and NHS Direct, I think, is clearly where some people might argue that, if that became the main vehicle, that maybe sexual health will be normalised. But there are some issues about the approach that is taken in NHS Direct, and, in particular, that people are asked their name, and so on, but actually when people want to `phone up, they want to remain more anonymous than that. So we are not convinced that actually having NHS Direct as the main first point of reference for our campaign is the right vehicle, but we do feel that there clearly need to be very strong links with NHS Direct, because some people will go through NHS Direct. And the FPA does work already in close concert with NHS Direct, as indeed do other helplines.

  133. One very interesting question. It is rare, in officials, to have a panel of all women; any idea why? And there are quite a few women consultants in GUM; why?
  (Ms Hamlyn) I think it is probably the case that in sexual health as a whole, certainly in most of the places that I go to, there is quite a predominance of women.

  Julia Drown: Why


  134. What conclusion do you draw, why is that, because it is an issue we may want to address, quite seriously?
  (Ms Hamlyn) Yes, that issue has been raised, but, in fact, for health promotion work with men, that you need more male workers; that is an issue that is raised.

  135. Any thoughts on what we do there?
  (Ms Hamlyn) There is some very good work going on within our Teenage Pregnancy Programme, on young male workers; we were actually trying to bring them together, in terms of a network which can support and encourage them, and hopefully, therefore, we might attract more people into the field.
  (Ms Stanier) We also have one male member of our team here today. I would not like to say that our whole team is women.

  Chairman: He is sat on the floor.

Sandra Gidley

  136. Just a quickie. I have had a number of letters from people who seem to be concerned, and I do not know where they get this idea from, that, with the changes that are mooted, I think they think because sexual health is going to be the responsibility of the PCTs, there seems to be a feeling that somebody has got hold of that you have to go to your doctor to access these services. I just wondered if you would comment on that, because not everybody would feel comfortable going to their GP?
  (Ms Hamlyn) There was some confusion that came out during the consultation process about our model of service, and we did refer to wanting to see an effective Primary Care service and the role of Primary Care; but we were really talking about Primary Care in its widest sense, and not just about general practice, in that context. So, yes, there were some people who thought that we were talking about disinvesting from other services and putting everything onto the GPs, and that is not what we are talking about, we want to improve choice of access, yes, for people in a local area, but there is a range of different ways that can be provided, and, yes, general practice has a part to play, but they are not the only part to play.

  Sandra Gidley: Thanks for clarifying that.

  Chairman: Can I thank our witnesses for the helpful session. You promised us some additional pieces of information, which we look forward to. We are very grateful for your co-operation. Thank you very much.

7   Note by witness: For medical termination of pregnancy. Back

8   Note by witness: The British Pregnancy Advisory Service raised the issue at a meeting with the Department in November 2000 but were informed that under the current law only a registered medical practitioner can undertake a termination of pregnancy. Back

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