The concerning impact of government cuts to public health services is starting to show as it was reported earlier this week that 1 in 4 councils have cut or are planning to make cuts to reproductive health services. Although this is alarming, it is not necessarily surprising to those working in sexual health who have seen similarly dramatic consequences in their own field.
At a time when the NHS is being forced to reduce staff or even close clinics altogether we must look for ways to avoid turning people away. While there is undoubtedly a case for reconsideration of the scale of cuts, there's a clear need to make efficiencies and take innovative approaches to delivering contraceptive services. Online services can be effective at freeing up clinician time to deal with types of contraception that can’t be delivered remotely, such as fitting coils or implants. An appointment to pick up oral contraception at a GP surgery can cost £57 but SH:24 can deliver this at half the cost, making it a cost effective alternative for people for whom this is an appropriate solution.
As a central part of the design process to develop our remote contraception service we have been holding user forums to help us understand challenges that people face when trying to access contraception:
"When I complete my course, I often go over a week without contraception, because it takes me that long to get to see my GP"
"So, every six months I have to take half a day off work to get a repeat prescription… why?"
"I just find it really annoying… it’s a waste of my time and my GP’s time… I go in, sit down for all of 5 seconds and leave with the same prescription. I’ve got better things to do with my time, and I’m sure he has too"
It’s a story of frustration and inconvenience from both sides. Remote services provide a point of access for people who aren’t able to make it to the clinic or the GP during opening hours. They also allow people to order their contraception without booking an appointment, which can often involve a long wait.
In 2015 the government announced £200m worth of in-year cuts to public health budgets, closely followed by another announcement of £600m worth of year-on-year cuts to be spread over 5 years. This was met with concern by the sexual health community.
The consequences of limited access to contraception are huge. The Family Planning Association (FPA) 2015 report Unprotected Nation estimates that in the next five years the extra unplanned pregnancies caused by cuts to contraception services could cost the NHS up to £8.3bn.
We will launch remote contraceptive services in January 2017 as part of an evaluation of services. This academic evaluation, led by King’s College London, which will establish to what extent services like this will be able to relieve pressure on NHS clinics and GP surgeries. In order to roll this out beyond the trial period we will need to secure funding from CCGs. It is our intention that like our STI testing service, this evaluation will demonstrate the efficacy, safety and acceptability of delivering oral contraception online; coupled with the huge cost saving, this should present a strong case for CCGs to rethink how they commission contraceptive services to get the most from their budgets.
We have also begun work to be able to deliver emergency hormonal contraception online, an area which has also been subject to media scrutiny in recent days. The cost of buying the morning after pill is significantly higher in the UK than other European countries and it’s availability on the NHS is sporadic. Being able to offer the morning after pill online is another effective way of reducing unplanned pregnancy, which would entail a much higher cost to the NHS in the long term.
The projected cuts to sexual health services will inevitably bring about much greater spending in the long term. If the government is determined to make budget cuts on this scale then we must be prepared to innovate. This, combined with adding comprehensive sex education to the syllabus in all schools, is the only way to mitigate damage and to keep providing adequate sexual and reproductive services.