Lessons for a sexually healthy population in the era of mandatory RSE

Lisa Hallgarten is Head of Policy and Public Affairs at Brook, the UK’s leading sexual health and wellbeing charity for young people. In this month’s eFeature, Lisa discusses a new Brook/Open University report looking at how local authorities (LAs) are supporting good Relationships and Sex Education (RSE) in schools and making links with sexual health services.

 As we scour the grey clouds of the Covid-19 pandemic for silver linings, the increased profile of local authority (LA) public health teams may prove to be one for the future. Before the pandemic many people would have had little idea about a local council’s crucial health protection remit or that it is also responsible for supporting a range of public health outcomes, including those relating to sexual and reproductive health (SRH). SRH outcomes specific to young people, include the reduction of under 18 and under 16 conception rates and chlamydia rates in 15-24 year olds. Lessons learned from the 10-year teenage pregnancy strategy and evidence from around the world suggest that these outcomes are achieved most effectively by providing accessible, young people friendly sexual health services; and high quality Relationships and Sex Education (RSE) – which addresses pregnancy and STI prevention, and links young people to local services. 

Are LAs making links between schools and sexual health services?

Following a change to the law which made RSE mandatory in all English secondary schools, research by Brook and the Open University used Freedom of Information (FOI) requests to find out more about activities that LAs were providing or planned to provide to support high quality RSE in their local schools. We also asked about their investment in young people’s sexual and reproductive health services; and how they use their commissioning power to ensure that services communicate with young people in general and young people in schools specifically.

Many LAs offer good support but uptake by schools is mixed

The national picture is patchy. But scratch the surface and there are examples of significant LA support for RSE in their local schools. This is work that some understand is critical to achieving their public health outcomes and that is funded, in spite of the academisation programme that means 77% of secondary schools in England are no longer funded via, or the responsibility of, LAs. Some fund a whole staff role or more than one within the LA to provide support for schools with curriculum design, training, local professional networks, healthy school schemes that include RSE, and more.

According to LA staff, we interviewed in eight areas that provide RSE support, the take up of those services is inconsistent. Schools are hampered by a lack of money to fund teaching cover and training and many can’t prioritise RSE in their overloaded timetable. This means that good LA support does not always translate into good sexual and reproductive health knowledge in the school population.

A picture of inconsistency within schools emerged in what was taught and learned, with students reporting entirely different lessons depending on which teacher they had. Many students in year 10 focus groups we carried out were unable to name or explain different contraceptive methods and had little knowledge of STIs. Most students didn’t understand their right to confidential sexual health advice and treatment, or where to go for help.

Poor quality RSE and constant service change may impact young people’s access to essential SRH services

With RSE a key vehicle for improving SRH knowledge and skills, we should all be concerned that poor quality RSE may hamper or delay young people’s access to essential services. This may be exacerbated where services are in flux, with previously highly visible stand-alone young people’s services absorbed, and eventually disappearing, into all-age provision. Even where specialist young people’s clinics remain, their opening hours, the age group they service and what they can offer have shrunk, mirroring commissioners’ shrinking budgets in the context of year on year cuts to the public health grant.

There has been no research about how cost effective these changes are: how they affect the accessibility of services for young people, or sexual health outcomes, especially for those at risk groups still experiencing higher levels of teenage pregnancy and STIs. Our FOI request asked LAs about spend on young people’s provision, and how many contacts young people had and where, within SRH services and general practice, over multiple years. Most were unable to provide meaningful statistics.

Need for properly resourced RSE and data-informed commissioning of services

There are messages here that can inform the Department of Health and Social Care’s forthcoming sexual health strategy. We are told that LAs will maintain responsibility for SRH, so they must be properly resourced.

• RSE should be seen as part of sexual health promotion, and adequate funding invested into schools for training and teaching
• LAs must receive long term spending settlements that will allow them to maintain specialist services and avoid the constant changes in provision that can make services less visible and less accessible to young people; that impede consistent data collection, and can hamper evidence-based commissioning

LA respondents told us that they haven’t forgotten the lessons of the successful teenage pregnancy strategy. Those lessons should inform a well-funded, ambitious, joined up, data-informed national SRH strategy with support for local areas and a focus on those at highest risk; helping the health and education sectors to work together to nurture and support a sexually healthy population.

Lessons for the new era of mandatory RSE: How Local Authorities are making the links between schools and sexual health services, Brook & Open University, 2020

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