13th July, 2015

A lack of accountability in sexual and reproductive health and HIV care in England is directly impacting patients and must be addressed urgently.

That is the finding of an inquiry by an All Party Parliamentary Group into the standards of sexual health services since responsibility for commissioning was transferred to local government in 2013 through the Health and Social Care Act.

Download the Breaking Down the Barriers report (PDF)The APPG on Sexual and Reproductive Health, of which FPA is secretariat, received evidence from a wide range of experts, including the Government, Public Health England, Department of Health, Local Government Association, and representatives of royal colleges, charities and NHS trusts across the country.

Baroness Gould of Potternewton, chair of the APPG and FPA's president, said: “Everyone is affected by sexual and reproductive health, and many people by HIV, and yet these are areas of public health where people tend to be more reluctant to speak out when there are problems.

“A common theme throughout the inquiry was the lack of clarity identifying who is ultimately responsible at a national level for these services, and what powers they have to drive up standards and outcomes across the country."


One of the key recommendations of the inquiry calls for Health Secretary Jeremy Hunt to clarify and publish a clear accountability structure for sexual and reproductive health and HIV services ‘as a matter of urgency’.

Other recommendations include:

  • Local authorities need a clear mandate on what services they should commission to ensure open access for contraception and STI testing as there is growing evidence of restrictions based on age and location.
  • The public health ring-fence should be retained beyond 2016 to provide protection for sexual and reproductive health and HIV services, and local authorities must be held to account over their spending.
  • The Department for Education should implement the recommendation of the Education Select Committee that sex and relationships education and PSHE education (personal, social, health and economic) be made statutory in all primary and secondary schools.

Evidence collected during the inquiry also highlighted a lack of national direction on training and development for the sexual and reproductive health and HIV workforce, which has a direct impact on patients.

Written evidence from the Women of Walthamstow group, who have campaigned publicly for access to local contraceptive services, said: “We are one of the most active local patient voices in the area on sexual health, yet we have often found it difficult to get our voice heard, chiefly as a result of the transfer of public health from the NHS to local government.”

“Our experience is that some council members are more used to discussing pot holes in the road than sexual health services.”


Baroness Gould added: “In transferring commissioning to a local level, it was anticipated that there would be integration and opportunities for joint working – all focused on the specific needs of local communities.

“In some places these aspirations are being realised and we heard evidence of good practice and successes but, in many areas, these structural changes have created a complex and fragmented system that is not in the best interests of the people who rely on these services.”


Editor’s notes

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The full report into the inquiry (PDF).

The inquiry was chaired by Baroness Gould - Chair, APPG on Sexual and Reproductive Health and supported by a panel of experts:

  • Dr Jan Clarke – President, British Association for Sexual Health and HIV
  • Dr Kathy French – Independent Nurse Adviser
  • Alison Hadley OBE – Director, Teenage Pregnancy Knowledge Exchange, University of Bedfordshire
  • Jane Hatfield – Chief Executive, Faculty of Sexual and Reproductive Healthcare Ruth Lowbury – Chief Executive, MEDFASH (Medical Foundation for HIV & Sexual Health)
  • Sir Nick Partridge – Vice Chair, Sexual Health Forum
  • Lord Rea – Member, APPG on Sexual and Reproductive Health in the UK
  • Baroness Tonge – Vice Chair, APPG on Sexual and Reproductive Health in the UK
  • Chris Wilkinson – President, Faculty of Sexual and Reproductive Healthcare

Further background on the inquiry.

About the APPG

The All-Party Parliamentary Group on Sexual and Reproductive Health in the UK aims to raise awareness in Parliament of the needs of women seeking abortion and the importance of improving all aspects of the sexual health of women and men in the UK.

The APPG is chaired by Baroness Gould of Potternewton and supported by FPA, the Faculty of Sexual and Reproductive Healthcare and the British Association for Sexual Health and HIV.

Sexual health