As you will know from previous posts, we met with Anna Soubry in January. Here are the notes of the meeting.
Notes from meeting with Anna Soubry and Judith Hind (Contraception Manager, Sexual Health Team, Department of Health)
Anna began her meeting by telling us that she was aware of our issues but it was clear as we presented the extent of problems within Walthamstow that she had not understood the seriousness, particularly in relation to the blanket approach at Addison Road Medical Practice. Although she had heard anecdotes about single practice doctors denying sexual health provision based on religious or ethical grounds, she had never heard of an entire practice doing so. She said this was appalling and could not believe that this situation could have remained unaddressed for so long.
Judith Hind concurred that in four years on the Sexual Health Team she never came across such a case. Although contraception is an additional service, those refusing to provide it on moral or religious grounds are obliged to refer patients to another practitioner within the area. When asked whether there should be a legal requirement for every practice to have at least one doctor able and willing to provide such services Anna replied that this would not be possible as GP practices are private organisations and their autonomy is a “freedom they enjoy”.
Stella informed her that since the closure in 2006 of a specialist clinic on Hurst Road there has been a massive gap in sexual health and contraceptive provision in this area of Walthamstow. The service to which patients were referred to (Oliver Road Clinic) was not a practical option for many being a drop-in service and in a location difficult to get to from Walthamstow. This was emphasised by Jenny, whose own experience of trying to access contraception from both Addison Road and Oliver Road led her to challenge levels of provision through the creation of WoWstow.
Anna wanted to understand why the problem hadn’t been tackled seriously until now –was it the fault of the PCT and why didn’t Stella’s predecessor address it? Why had the NELFT not stepped in and commissioned an appropriate service to fill the gap? Stella replied that it has been difficult for her and members of the public to get a full understanding of who is responsible and ultimately accountable for the provision and performance of sexual health and contraceptive services.
The provision of a drop-in clinic at Comely Bank was entirely the result of pressure from the WoWstow campaign but it was noted that the local councillors, especially Councillor Khan (remit for Public Health), understood the concerns and were keen to help address them. The problem for them was funding, which had become obvious at a meeting some members of WoWstow had had with Councillor Khan the previous day.
Jenny made clear Councillor Khan’s concerns about the budget allocation. He had indicated that the extra 10% from central government for public health would be swallowed up by an inherited deficit for genitourinary medicine services and other aspects of public health, which had not been accounted for in the government’s allocation.
Anna responded that the money for public health is ring fenced and there is a statutory duty for sexual health services to be provided. With the 10% uplift awarded to Waltham Forest there should be no excuses for not providing proper public health services. She was very proud of the 10% the government had been able to give but acknowledged that it “can’t change the budget” and it “can’t change the law”(over the collective opt out of GPs who don’t want to provide contraceptive services on religious or moral grounds). Adequate sexual health provision needs to come from the public health budget. She advised that we have two powerful tools for ensuring this happens: the Local Authority and the Director of Public Health.
Caroline pointed out that while the 10% increase in funding was welcome, it still fell short of what the government itself said should be spent per head on public health in the borough. The outgoing primary care trust had not prioritised public health, as a result of which the local authority was starting off from a low baseline figure and would have a lot of catching up to do.
Anna argued that the upcoming shift in responsibility to local authorities should be a positive step for this campaign. However, Anna recognised the seriousness of the situation in Walthamstow and said she would write both to the local authority and to Duncan Selbie, Public Health England. PHE can intervene if a local authority is not meeting its statutory duties.
Lynn raised our concerns about the continued existence of the Comely Bank clinic, which WoWstow had successfully fought for. Councillor Khan had told WoWstow that the government had advised local authorities to stick with their current contracts for the next year, irrespective of how good they thought these were.
Anna responded that the PCT award 12 month contracts and that the local authority can change these if they are not meeting their objectives. Stella suggested that the clinic at Comely Bank was most likely an outpost of the Oliver Road service and probably would not have its own separate contract. WoWstow would need to ask Councillor Khan and the PCT to confirm this.
Anna and Judith acknowledged that contraception has traditionally been seen as a poor relation to other sexual health areas e.g. STIs. This would be addressed in the new Sexual Health strategy document to be published in the next few weeks. Since her appointment last September, she said she had rewritten large parts of the report e.g. abortion, child protection, age of consent. Contraception is to the fore – a whole section is devoted to it. Fewer unwanted pregnancies is a particular target. This document will provide guidance to CCGs across England and will be going out to all local authorities in the next few weeks. There will be outcome indicators for sexual health.
Public Health England is committed to making the transfer of public health to local authorities work and wants to make more CCG level information available to the public online, Anna said.
Lynn also asked about safeguarding provision for patients in London seeking advice on sexual health/contraception outside their own borough. For example, a number of WoWstow campaigners have used the Margaret Pyke Centre in Camden as it’s easier to get services there than in Walthamstow. Anna assured us that the secondary legislation would protect such services and open access would remain across London. There is an issue with funding with the outer boroughs and that would need to be sorted out between them.
WoWstow also drew attention to the wider issues of sexual health beyond contraception, including the prevalence of unplanned teenage pregnancies, repeat abortions and STIs – see briefing for statistics.
Conclusion and next steps
In order to protect what we have already achieved and to further our campaign Anna’s advice was that we “need to hit councillors hard’ and “demand full disclosure”. If necessary we should go to straight to the Chief Executive of the council as this is such a serious issue. Anna wants to make sure local authorities have “nowhere to hide” and provide the services the public needs. She is keen to support us and said she would write to both Councillor Khan and Duncan Selbie in the next few days. Stella will be copied in on this letter.