"There is a continuing crisis in sexual health and in some respects the situation is worse than it was in 2001."

        Professor George Kinghorn, Consultant in Sexual Health

"There are very good grounds to believe that the charges for overseas visitors are causing, and will continue to cause, harm to public health in the UK. In other words, not only is there no positive gain from introducing charges for HIV treatment and care. Serious harm is going to result."

National AIDS Trust

1. In June 2003 we published a report into Sexual Health, concluding that as rates of sexually transmitted infection and teenage pregnancy soared, services in this unglamorous and underfunded area of the NHS were reaching crisis point.[1] Our initial inquiry into sexual health left a deep impression on the Committee, particularly given the high incidence of sexually transmitted infections (STIs) amongst young people. We were therefore pleased to see a great many of our recommendations adopted by the Government. It also seems that since our inquiry, sexual health has become less of a taboo subject.

2. The Government's White Paper on Public Health gives prominence to tackling sexual health problems.[2] However, according to clinicians working in the area of sexual health, the crisis we identified in 2003 is in fact showing no signs of abatement—rates of sexually transmitted infection have continued to climb. Because of this, and perhaps fuelled by increasing public awareness of the risks of STIs, waiting times for GUM services have increased in every part of country; this, in turn, may contribute to further rises in infection levels as people cannot get treated promptly and so continue to infect more partners. In the light of this, we decided to revisit our report's recommendations and investigate progress to date on implementing them.

3. Since our first report on sexual health was published in 2003, the Government has also consulted on and introduced changes to regulations governing access to free NHS treatment for overseas visitors.[3] One of the impacts of these changes has been to deny, for the first time, access to free treatment for people living in this country without proper authority. It was brought to our attention that these changes were likely to have a significant impact on people with HIV, and thus on the nation's health. We therefore decided to devote a significant proportion of this short inquiry to addressing the specific issue of charges for overseas visitors for HIV/AIDS treatment.

4. Our advisers on this inquiry were Professor Michael Adler, Royal Free and University College Medical School and Dr Anton Pozniak, Chelsea and Westminster Hospital. We are extremely grateful to Professor Adler and Dr Pozniak for their excellent support during this inquiry which has enabled us to address a great many complex issues in a condensed timeframe.

5. We held two evidence sessions, taking oral evidence from Melanie Johnson MP, Parliamentary Under-Secretary of State for Public Health and officials from the Departments of Health and for Education and Skills; Professor George Kinghorn, Dr William Ford-Young and Dr David Asboe, clinicians with specialist knowledge in this area within primary and secondary care; Anne Weyman of the Family Planning Association; the Health Protection Agency; the National AIDS Trust, the Terrence Higgins Trust, and the African HIV Policy Network; Pam Ward, Co-Chair of the Overseas Visitors Action Support Group, and Peter Nieuwets, HIV Commissioning Manager for West Sussex. We are very grateful to all our witnesses for their evidence.

6. We received over 30 written submissions and these were invaluable to us in our work. Those submitting included GUM consultants, academic institutions, charities, lobbying groups, and Royal Colleges. These memoranda were a very valuable resource for us and we would like to thank those who submitted them.

7. This report begins by examining Government progress to date in implementing the recommendations of our 2003 report into Sexual Health, and then considers in detail the separate but linked area of charges for overseas visitors for NHS services with particular regard to HIV/AIDS.

2   Department of Health, Choosing Health, November 2004, Cm 6374 Back

3   Department of Health, Proposed Amendments to the NHS (Charges to Overseas Visitors) Regulations 1989 - A Consultation, July 2003; NHS (Charges to Overseas Visitors) Charging (Amendment) Regulations 2004 Back