Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 160-179)



  160. Yes.
  (Ms Weyman) The issue of Chlamydia screening is really the time that it is going to take to roll it out. There is obviously the resource question about having sufficient trained people to do it, having the laboratory facilities to process samples and things like that. Partly that is the question, also, of how rapidly you put the resources in. Certainly it has taken a very long time for this country to get to the stage of having Chlamydia screening. They have been doing it in Scandinavian countries for 20 years or more and it would seem that it has had an impact in those countries, yet we are only just now starting to do it properly. I think our concern has been that here is a situation where there is a preventable harm, women are contracting Chlamydia, they go on to get Pelvic Inflammatory Disease, they develop infertility as a result and this can be prevented. It seems really horrific it is not happening quickly to prevent as many cases as we possibly can. I think it is really making a bigger commitment, more upfront is what we would like to see.

  161. Could it be done as part of the so-called screening programme or would that not be a good way of doing it?
  (Dr Randall) I was one of the two pilot sites which did the original Chlamydia pilot and we are now doing the follow on for that. Portsmouth and the Wirral were the two sites. We are now doing the follow on to look at how often these people need to be screened because it is all right doing one test but do you test everyone every six months, one year, five years or whatever, so that needs to be answered. Yes it could be tied in with cervical cytology and there are various new tests being looked at, at the moment, something called thin prep where you take cervical cytology cells but you can use that same preparation also to perhaps look for Chlamydia as well. The technology is out there only, unfortunately, of course, the first cervical smear is not until you are 20 to 25 so that might be a bit late when we have been picking up people who are 15-16. It goes back to the whole business about the concept of sex and using condoms or not having sex at all and talking about it really.
  (Dr Guthrie) If you look at the young people who we are talking about, young people buy into screening like that. We got some free urine tests for Chlamydia back in the days when we were doing cervical swabs. We only had 200 free tests in a pilot study, then it stopped, and yet they still came and queued at the door, aged 15-16, saying "I want that test you have got". Young people are right into screening for Chlamydia really quickly. There is not a problem of selling it to the community we are talking about, the problem is not with those who need the help, the problem is with us as service providers.
  (Dr Randall) And with funding.
  (Dr Guthrie) Obviously with funding.

Mr Burns

  162. Can I just ask one question, just going back to your comments on education, Ms Weyman. You said, and you admitted it was controversial, about education and the primary school sector which, as you will be aware probably more than many, causes a great deal of concern to a significant number of parents in this country. What surprised me slightly in the answers was you seemed to concentrate on education in schools but there was not a lot said about what many families might think was their responsibility at that age, to set the pace, move the pace with their children as to what they should or should not know or be taught about sexual matters and sexual education at that age. Why did your answers seem to concentrate more simply on the school system rather than the parents because many parents in this country would possibly take the view that at that age their children should get what sex education they feel is appropriate from the home rather than the teacher?
  (Ms Weyman) We do not see it as an either/or because parents are very, very important. What we find so often is when you ask older children what they would like to happen is they will say "We would like our parents to talk to us about sex" and parents say "We would like to talk to our children about sex" but actually it does not happen and it is a difficult area. We do need to support parents to do that and from an early age for them to do that. The evidence is that in those families where sex is openly discussed children start to have sex later and they are more likely to use contraception when they do have sex. The family is very important. They are two roles, they are complementary roles. The concerns of parents I think can be much addressed if schools work with parents and consult with parents and show parents the materials they are going to use and discuss these issues with the parents. Not all children have that sort of relationship with their parents and they need to get information also

  163. I accept not all parents do but would it not be better possibly the other way round where instead of the parents talking to schools about how the schools are going to do it for primary school children, the schools talk to the parents about how the parents are going to do it?
  (Ms Weyman) Interestingly we have been doing quite a lot of work with parents and one of the projects we are going to be doing is working with schools to work with parents, particularly primary school children. I still do not think it is a one or the other, I still think it is both. I think there is a lot going on in schools which parents never get to know about, what their children are talking about, what they are talking about with other children who are getting other messages from all sorts of places. Parents, however much they are doing outside the school, they are not participating in that part of the education or the misinformation that children are getting. So the school does have a very important role to play and it enables children to get to think about these issues and to talk about them in a way.

  164. What sort of age do you think it is appropriate for children to start talking about these issues?
  (Ms Weyman) For me, I think children who are very young.

  165. Like?
  (Ms Weyman) Four or five.

  166. Talking about sexual activity/sexual matters? You think that is appropriate? Most children probably have not given it a moment's thought at that age.
  (Ms Weyman) Children ask all sorts of questions at a very early age and they are interested in aspects of their lives and other people's lives. I know many people—you may not—who do talk to their children and explain to them about what would be called the "facts of life" when they are very young.

  Mr Burns: I understand that and I do not want to prolong this but I am thinking back from personal experience. Neither of my children aged four or five were discussing or enquiring in any shape or form things that probably come within the definition of sex education.

  Jim Dowd: They were not telling you.

Mr Burns

  167. I do not think they were telling each other either.
  (Ms Weyman) I would like to say something about that because we give children signals about what it is they may or may not talk to us about at a very early age. One of the most powerful signals about sex being a subject you do not talk about is the fact you do not talk about it and parents often wait for their children to raise it as an issue, and if they do not raise it as an issue the assumption is that they are not interested. When we think things are important we talk to children about them. Whatever you are doing in your family or in the school around the issues that you are talking about, you are giving very strong messages, particularly when there is so much discussion about these issues in the broader world which children are picking up all the time from when they first can understand what is going on on the television. They understand much more than most adults would give them credit for.

Dr Naysmith

  168. I want to go back something that sounds a bit tame after that. It was something Anne said and it was picked up by Ms Thomas and Dr Guthrie about the question of contraception and where it should be delivered, whether it is delivered at the GP surgery or in the specialised clinics. A few years ago there was a big fuss about this. I am not sure whether it came from the Department of Health or where it came from, but there was a big push to move it towards surgeries generally and towards GPs and primary care and clinics were closing all over the place. Firstly, was that a bad thing? I would suspect myself it was a really bad thing. Secondly, is it still going or has it been resolved in a more sensible way with the necessity of having choice?
  (Ms Weyman) From what we understand, the pressure is still there and there are still clinics—

  169. You mentioned resources earlier on and I thought at the time it was more than resources and somebody was pushing it in the background.
  (Dr Guthrie) It was political, due to the shift to fundholding.
  (Ms Weyman) There has always been the view that there should be choice and there should be open access services that will commute, but what that means in practice varies very much from area to area and the fact women can go to their GPs was seen as providing the service. In the Strategy it defines three levels of service and the fact that these should be available to be used. However, only some of them will be provided in general practice, so the idea would be that if general practice cannot provide the full range of methods, it would be an entry point so that women could get a full range of methods, but that does require there to be those services that can provide that full range of methods to be available and, as I say, we are seeing in some areas clinics are under pressure and they are under pressure for two reasons. One is because of not wanting to put the money in at the local level and the other reason is the inability to attract staff—and that is because it is not necessarily an area where the career structure for doctors is very good. We as an organisation are not there to represent professional interests but we recognise that if doctors are not able to pursue their careers in a particular area of work then they may not be attracted to go into it and the day has passed when you had quite a lot of women doing sessional work in family planning. That is changing. If you do not have clinics, it reduces the opportunity to train new people because that is one of the main training grounds for people to come into the service. It is a problem and it is something that I do not think the Strategy was necessarily aware was as big a problem as it is.

  170. Presumably there must be a problem with younger people preferring to go to clinics than going to their own GP or the family GP? Is that right?
  (Dr Randall) There has been a problem here because in a lot of areas clinics were closed and we were told they will not see anyone over the age of 25. That left services for young people and to get back to the business of training, if you are expecting all the normal people to go to GPs and yet you have got nowhere to train those GP and if they come to clinics they are only seeing youngsters, then this is a disaster area. Although some GPs are very interested in the subject, they are generalists and a lot of GPs do not want to do it. It has been a disaster in a lot of areas that clinics have closed. Those that have been left open have increased demands. Certainly around my area you have some clinics which are totally swamped. They have got perhaps four clinics trying to deal with what was originally a week's worth of clinics foreshortened and whereas perhaps GUM services have appointments and can show an increase in their waiting lists, a lot of family planning lists are non-appointment so all it means is that you sit there until you have seen all the clients. You might get 30, you might get 70, and you are there until they have gone.

  171. It is still a problem?
  (Dr Randall) It is still a problem.
  (Dr Guthrie) I think you are right. Historically as we become competitive for service provision between community services and general practice/primary care, it is all primary care. The funding streams were different; the funding streams changed and it then became fundholders and whatnot so it becomes even more competitive for funding streams, and that is where we lost clinics. Hopefully, that has become historical but the spectre is still there when there is no new money coming with this Strategy. The answer to your second question of who should be providing the answers is we have got an opportunity to be really adventurous and innovative when it comes to service provision because services should be provided by the right person in the right place for the community for which you are providing. It is very different in a community that is very socially deprived if you have got a lot of refugees and asylum seekers and young people. The focus is very much on outreach services and services in schools, next door to schools, church halls. I do not care where services are delivered as long as the delivery is appropriate. In some place else you might have got very few young people, an area to which people will retire or the commuter belt, and you are looking for a completely different sort of service. So there is no blanket answer to that. If there is a blanket answer the answer is know your community and then do what is appropriate.
  (Dr Randall) Also have the appropriately trained people wherever they are. I think that is the answer.

Andy Burnham

  172. Following on from Doug's question there, am I right to infer that you think the services are not adequately sign-posted or advertised at the moment, that people would rather it be word of mouth and that is how people hear about the service at the moment?
  (Dr Guthrie) Personally I think nationally it is extremely inadequate. It is progressively becoming the "poor cousin" in terms of health care provision.

  173. Is that because young people, thinking about them particularly, would much rather arrange these things for themselves and get hold of the contraception in a way that they feel comfortable with rather than going to the Health Service, which would not be their first port of call. Or have social habits changed?
  (Dr Guthrie) Young people have to know where to go. It is one of the best kept secrets from young people. You really have to work quite hard if you are young to get information/access services. I have got young teenage children. They say, "Our friends come to ask us, and if we were not your children we would not know where to go either." This is because the whole health care circuit has been designed by people like us who are far too old, and until young people tell us what they want, which the Teenage Pregnancy Unit has done very well on because they have got young people asking young people what they want unless we ask.

  174. So you would favour greater advertising amongst young people, possibly in schools?
  (Dr Guthrie) We have to ask the users what they want and then deliver it. We do not know what they want and where they want it.

Jim Dowd

  175. How do you attract people that are not users?
  (Dr Guthrie) There are the obvious users, kids who do come along and they speak up. What was very difficult to get at was the potential users who do not come along so how do you get information to them? That is why you have to get into a participatory appraisal which is a way of going out into the community and asking the community what they need by more indirect methods. Otherwise, it is us setting up services which we can only hope are hitting the right targets.
  (Dr Randall) Could I add, also, there was a problem with the schools because we could not advertise specific services in schools, that was considered not correct, whether that will change—I mean if schools can be more open about advertising local facilities or they have access to be able to go to find out from schools, because after all that is where they are, then that would help.

  176. Sure.
  (Mr Jones) I would like to add, I agree with everything my colleagues have said in relation to advertising for contraceptive services and the like and the emphasis on teenagers but I think there is a problem overall about the openness of the subject which is what Dr Taylor was on right at the beginning and that is where I think, also, this is a huge opportunity for us to normalise these services as a routine part of health care. Can I just make the point about teenagers where, rightfully, we are concentrating on them both within education and in signposting and service provision. Please bear in mind in relation to access to abortion care 79 per cent of all women who had an abortion last year, or in the year 2000, were not teenagers so it is a problem with adults not just with teenagers.

  177. Can I say as a Catholic married to a Dutch person I am slightly torn in two directions on these issues. Actually while I can see the logic of a lot of what you say, if you do not mind me saying I think you would favour more moves towards the Dutch model, so to speak. They seem to have it right. I believe, also, you cannot push the British character in a way that people would not feel comfortable with. I think, personally, some of the successes that they have had in that country would go further than the British public, I would say, would be able to go. Would you say I am totally wrong and an old fogey for saying that?
  (Ms Thomas) The Dutch have got it right because they are comfortable about talking about sex. I happened to grow up in Scandinavia, the Scandinavians are very comfortable talking about sex. They have adverts in cinemas and things about condoms, you have to normalise it. People have to talk about it, they cannot meet contraception or try to use it for the first time when they are having sex because it is not going to happen. You have got to make services—whether it is about infection or about contraception—easier to access and people have to know about them and know where to go and be able to get there before they have sex and that way you prevent some of the problems. People are not having more sex in this country they are just doing it badly.

  178. They are not having more. When we came back from Brussels, the trend here is that young people are having more partners and they are sexually active at an earlier age and while that is a similar trend abroad, I think we picked up the case that it is more the case here linked to an alcohol culture, is that not the case?
  (Dr Guthrie) It is partly alcohol but it is partly because they are ill-educated. We keep coming back to if you are talking about young people, they are ill-educated, their parents are-ill-educated. They are in an educational environment which is in itself ill-educated, that is what the research evidence has shown. That is why Holland and other parts of Europe are different. Sexual education is not just about having sex.

  179. Let me put back to you the absolute opposite view. Spain, the Catholic countries, have a better record than we do, why is that?
  (Dr Guthrie) Because they have a different cultural environment.

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2002
Prepared 19 August 2002