Accountability Inquiry into Standards in Sexual and Reproductive Health

The All-Party Parliamentary Group on Sexual and Reproductive Health in the UK (APPG) has released a report on the findings of its inquiry into the accountability of sexual health services in England.

Download the Breaking Down the Barriers report (PDF)Breaking Down the Barriers: The Need for Accountability and Integration (PDF) says that a lack of accountability in sexual and reproductive health and HIV care in England is directly impacting patients and must be addressed urgently.

The report makes a number of recommendations.

Press release on the launch of the report >>

Breaking Down the Barriers Executive Summary (PDF)

Breaking Down the Barriers full report (PDF)

The evidence

The Inquiry received written evidence from over 30 organisations and took oral evidence from 25 individuals, including the Public Health Minister, Shadow Public Health Minister, Public Health England, Health Education England, Local Government Association, Association of Directors of Public Health, Local Healthwatch, and NHS England.

Read the minutes from the Inquiry's oral evidence sessions

The initial findings from the Inquiry were presented at a special meeting of the APPG in January 2015.

If you would like to find out more about the evidence submitted please email appg@fpa.org.uk

The background

The All-Party Parliamentary Group on Sexual and Reproductive Health in the UK (APPG) welcomed the ambitions of the Department of Health’s Sexual Health Improvement Framework and the vision it sets out for services in England.

Although good work has been carried out to deliver against the ambitions within the Framework, the APPG was also aware of ongoing areas of concern, particularly the current accountability arrangements within the new NHS and public health architecture, and the lack of proper oversight over the quality and outcomes delivered by sexual health services.

In response to these concerns, and to inform the ongoing debate about how the Framework’s ambitions can be achieved, the APPG launched its accountability inquiry in August 2014.

A central objective of the Inquiry was to make recommendations for how standards of sexual health services should be monitored and improved, and to consider what the accountability framework should look like for this vital area of public health.

The Inquiry focused in particular on:

1. Assessing the statutory and commissioning architecture for sexual and reproductive health services and what the current accountability arrangements looks like. This will include an assessment of the role played by the following bodies within the architecture and consideration of what aspect of a high quality services they should be accountable for:

  • Parliament
  • Department of Health
  • Public Health England
  • NHS England (including its local area teams)
  • Health Education England
  • Care Quality Commission
  • Monitor
  • Sexual health networks
  • Health and Wellbeing Boards
  • Local Authorities, including Directors of Public Health
  • Clinical Commissioning Groups
  • Community providers
  • General practice
  • Sexual health professionals
  • Service users

2. Inviting evidence from members of the sexual health community and others to assess what progress has been made in delivering against the core ambitions of the Department of Health’s Sexual Health Improvement Framework, and identifying the accountable body within the new structures for achieving these improvements. Core ambitions of the Framework to be considered include:

  • Rapid access to high quality services.
  • Prioritise prevention by improving awareness of the causes of poor sexual health and encouraging safer behaviour.
  • Reduce rates of STIs among people of all ages.
  • Reduce onward transmission of HIV and avoidable deaths from it.
  • Reduce unintended pregnancies among all women of fertile age.
  • Continue to reduce the rate of under 16 and under 18 conceptions.

3. Making recommendations on how the policy, commissioning and provider arrangements can be improved to reduce variations in sexual health outcomes and setting out how the ambitions within the Sexual Health Improvement Framework can be implemented further.

Written evidence was sought on the following:

  1. Under the new structural arrangements, which national organisation/s should be accountable for overseeing improvements in sexual and reproductive health services and that the ambitions in the Sexual Health Improvement Framework are delivered?  Why do you think this?
  2. At a local level which organisation/s do you believe should be responsible and accountable for overseeing improvements in sexual and reproductive health services, and why?
  3. What mechanisms within the NHS and public health architecture should be used to hold commissioners and providers to account for the quality and outcomes of sexual health services?  For instance, service specifications, performance data and commissioning plans.
  4. To what extent has progress been made against specific ambitions of the Department of Health’s Sexual Health Improvement Framework?  What steps need to be made for these ambitions to be realised?
  5. How would you assess the quality and availability of data on sexual health outcomes?  How can the use and availability of data on sexual health outcomes support greater accountability of service delivery?
  6. How would you assess the current accountability arrangements for ensuring there are sufficient numbers of trained healthcare professionals working in sexual health services? If appropriate, what improvements do you believe could be made to strengthen these arrangements?
  7. What function should the public health system play in ensuring that education plays a role in promoting good sexual and reproductive health?
  8. To what extent do women and men have choice and access to the full range of sexual and reproductive health services? How can choice in access to sexual and reproductive health services be improved?

Comments and recommendations on any other aspects of sexual and reproductive health services, including around current accountability arrangements were also welcome.

About the APPG

FPA acts as the secretariat to the All-Party Parliamentary Group on Sexual and Reproductive Health in the UK. 

The Advisory Group on Contraception (AGC) will be providing administrative services to the APPG’s inquiry into the sexual health improvement framework only. The secretariat of the AGC is provided by MHP Communications whose services are paid for by Bayer HealthCare.

Editorial control on all publications rests with the APPG alone.  All decisions about the APPG’s activity are made by its members through advice from its secretariat.