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Sexual health clinics at ‘breaking point’, say nurses and councils

Sexual health clinics are at “breaking point”, the Local Government Association (LGA) has said, as rates of sexually transmitted infections (STIs) continue to rise while services are stretched to their limits.

The majority of council areas in England and Wales have seen a rise in both gonorrhoea and syphilis since 2017, according to figures released by the LGA, which represents local authorities in the two countries.

“We’ll get through this breaking point and on to the next one”

Jodie Crossman

Meanwhile, a senior sexual health nurse warned that if something is not done to plug a funding gap for local clinics, the problem could snowball, as fewer people receive care or a diagnosis and go on to spread the diseases more.

The LGA reported that 97% of council areas saw an increase in gonorrhoea diagnoses, with areas in the North and South West of England being the hotspots between 2017 and 2022, the period the figures cover.

Around three-quarters (71%) observed syphilis rising, with Lambeth, London, observing the highest rate of increase.

Meanwhile, 36% of councils saw increases in the prevalence of chlamydia in their local population.

LGA reported demand for sexual health services continued to grow between 2017 and 2022.

Jodie Crossman, national nursing rep for the British Association for Sexual Health and HIV (BASHH), said the LGA’s findings match up with her experience on the ground.

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“We agree with the report,” she told Nursing Times. “It’s interesting, a year or two ago I was speaking about a breaking point, then in Covid we were talking about a breaking point. [Sexual health] is constantly in one, and the situation hasn’t gotten any better in the last few years.”

Ms Crossman, who is a clinical nurse specialist at a sexual health clinic in Brighton, said the extra strain and lack of resources was translating to patients sometimes being offered delayed appointments, or missing out altogether.

Jodie Crossman

“In my city, we’re able to offer people appointments within 48 hours, but particularly in rural areas they don’t have the access and they don’t seem to be able to do the same.

“There’s a regional disparity; we try and offer online testing, but then if someone tests positive, they have to come in for sexual healthcare.”

Sexual health, Ms Crossman said, can easily snowball as a problem; she pointed out that the longer someone waits for sexual healthcare, or is unable to get it at all, the more that STIs can spread.

The nurse said the figures, showing higher rates of diagnoses, do not tell the whole story.

She said: “We’re also seeing more complexity in the cases. Someone may attend with one problem but, actually, as we unpick it, there might be other things around sexual violence or drug use.

“Maybe they’re attending our clinic because they can’t access their GP or mental health support, they come to us because we’re an open access service.”

LGA analysis showed that the public health grant, which funds services such as sexual health clinics, has fallen in real terms by £880m between 2015 and 2024.

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The organisation called on the UK Government to publish its 2024-25 public health grant allocations and, in these allocations, to provide an increase in funding to cover the pressures on sexual health.

It also demanded the government publish a new 10-year sexual and reproductive health strategy.

Ms Crossman agreed that more funding must be allocated to sexual health, and pointed to the relationship between her field and other publicly-funded services.

“It affects other areas of care,” she said. “If someone is left with a late presentation of HIV, they might need hospital care; it might have been prevented if it’d been diagnosed.

“Someone who is pregnant and has an infection, it might impact the baby.

“Budgets have been cut year on year for the last decade, so even just correcting it to inflation would not solve the entire problem. Local authorities are really, really stretched and if they are trying to decide what to fund, sexual health might not be a priority – it might be elderly care, children’s services, etc.

“It’s not just healthcare that’s struggling, it’s everything and we see the impact of that on sexual health.”

She further said that, despite the immense pressure clinics are under, people should not be put off: “We don’t want to make people think they are a big burden or adding to a wait list.

“We’re happy to see people. It is difficult times, but we’re managing and our nurses and health advisors are so dedicated and skilled. We’ll get through this breaking point and on to the next one.”

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David Fothergill, chairman of the LGA Community Wellbeing Board, said: “These statistics show that local sexual health services are grappling with unprecedented increases in demand. The government needs to ensure sexual health funding is increased to levels which matches these stark increases.

“Councils have been working hard to encourage more people to access sexual health services and get tested more regularly to help improve detection rates and catch infections early.

“Investment in sexual health services helps to prevent longer term illness and unwanted pregnancies, reducing pressure on our NHS and improving the health of people across our communities.”

Dr Claire Dewsnap, BASHH president, said the data showed a “deeply concerning trajectory” in STI infection growth, and further called on the government to create a strategy – and to match this with adequate funding.

“As demand for care increases, without imminent action, we compromise our ability to safeguard the sexual health of our nation,” said Dr Dewsnap.

Responding, a Department of Health and Social Care spokesperson said: “This year we have allocated more than £3.5bn to local authorities in England to fund public health services, including sexual health services, and this funding will increase in each of the next three years.

“We continue to work closely with the UK Health Security Agency, local authorities and NHS England to manage pressures on sexual reproductive health services and improve access to routine services.”

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