This report was written to identify the various consequences of reducing access to contraceptive and sexual health services in the UK, a resulting consequence of changes to commissioning in the UK. The implications are not just for short-term health care costs, but for medium and long-term financial aspects of all public sector departments, including education, and social care and welfare. The report does not look at the impact on policing, crime, justice, and antisocial behaviour, but this is something to be aware of, as it might also change as a result of cuts to contraceptive and sexual health services.
This paper is useful to people working in public health, and family planning services, commissioners, and sexual health practitioners, so that they can be aware of the facts and issues surrounding the continued availability of contraceptive and sexual health services.
Cost to the NHS
Currently, the estimated cost to the NHS alone of unplanned pregnancies over the next three years, will be almost £2 billion, 10% of the savings that need to be made by the NHS by 2015. On top of this there are the increased health costs of the children themselves, their education, the loss of earnings of the mother, resulting in lower tax and national insurance revenues, and the general cost of living associated with bigger populations. Between 2002 and 2011, the diagnoses of sexually transmitted infections, such as chlamydia, gonorrhoea, syphilis, herpes, and pelvic inflammatory disease increased by 49%. These figures do not include cases of HIV. While some of this is due to improved diagnosis and data collection techniques, incidence of STIs is on the increase. Worryingly, if it continues at this level, then reducing access to supporting services could result in public health spending increasing from £314 million to £6.35 billion. A further consideration is the cost of treatment of additional long-term conditions, resulting from STIs, such as mental health issues, cancer, infertility, and heart disease. A breakdown of costs to the NHS, of chlamydia, gonorrhoea, syphilis, and comparisons with other European countries, shows that the incidence of these diseases is on the rise throughout Europe, and not just the UK.
Looking at these figures and the evidence, it shows that improving access to sexual health and contraceptive services could actually bring in about £1.13 billion savings for the NHS by 2020. Financial savings for the NHS are not the only benefit to the public sector of improving access to these services.
Impact of reducing access to contraceptive and sexual health advisory services
The report looks at several themes, including the impact of unplanned pregnancy and/or sexually transmitted diseases on the future healthcare of the population, the increased demands on education, health, and social services. Reducing access to these services will not just affect the NHS, but will also increase the burden on the state. There are:
- short-term implications, such as greater use of health services;
- medium-term implications, such as increased educational needs;
- long-term implications, such as children in deprived areas leaving school without formal qualifications or skills to contribute to society, and women losing out on participating in the work environment and improving their promotional and earnings potential.
Evidence shows that there is a link between areas of social deprivation and an increase in unwanted pregnancies, abortions, and STIs, but it is not clear whether this is because contraception and sexual health services in those areas have been cut.
To summarise, reducing access to these services may have a long-term negative impact on the well-being of the population and the country as a whole.
Contraceptive and sexual health services do reduce levels of unplanned pregnancy, abortion, and sexually transmitted diseases; whether this is by providing advice or preventive products, such as birth control pills, condoms, etc is not clear. While the NHS is being forced to make cuts, in order to make the required £20 billion savings, it is also trying to facilitate more efficient ways of working, thus making those savings and improving quality of care. Contraceptive and sexual health services offer advice and products. Perhaps, some research is required to assess whether providing preventive products is more effective than education/advice or vice versa, and make commissioning decisions based on this. Rather than cutting the whole service in an area, perhaps the service could be reviewed, with efficient practices being introduced, so that fewer cuts need to be made, while the service can continue to improve, which is clearly what needs to happen.
Do you have any ideas of what is best with regards to contraceptive and sexual health services? Is this an area of work you are involved with? What do you think the changes will be with the new commissioning structure?
Unprotected nation: the financial and economic impacts of restricted contraceptive and sexual health services (PDF, 1MB)
A report by Development Economics