Over-stretched and under strain: A Mystery Shopper Approach to Access to Sexual Health Services in England, Scotland and Wales.

Today marks the start of Sexual Health Week and the focus is on ‘playing it safe’. This means we’re all empowered to access contraception, testing and treatment as part of enjoying a healthy sex life. It also means understanding consent, pleasure and what a healthy relationship looks like.

These are really important messages and I’m excited to hear the conversations that it generates over the next week, as well as the activities happening across England (including from our Terrence Higgins Trust services).

But the reality this Sexual Health Week, and every other week, is that sexual and reproductive health is far from the national priority it should be and vital sexual health services are over-stretched and under strain. Which means accessing contraception, testing and treatment – a fundamental part of looking after your sexual health and preventing unplanned pregnancy and onward transmission of STIs – isn’t always easy.  

We laid bare the scale of the problem in accessing these vital services in our new Mystery Shopper report. Our persona ‘Gabriela’ tried to get a face-to-face sexual health appointment following sex with a new partner. This is a sensible approach to sexual health and one we absolutely endorse, especially as STIs can be asymptomatic. But here’s a quick summary of the difficulties she faced:

  • Face-to-face appointments were offered by just over half of clinics (51%) contacted by phone.
  • Waiting times for in person appointments available to book over the phone averaged 13 days, rising to 19 days in rural parts of England.
  • Booking an appointment online is difficult.
  • Postal STI testing, where you test at home and send samples back, isn’t nationwide in either England or Scotland
  • Availability of postal testing is least available where it’s most needed (rural England and Scotland)

These barriers to sexual health appointments come as the latest STI figures from UK Health Security Agency show a 24% increase in sexually transmitted infections in 2022. That equates to more than 1,000 STIs being diagnosed every day in England, including a 50% increase in gonorrhoea diagnoses, 24% increase in chlamydia and 15% rise in syphilis. These numbers mean services have been reduced to disease management, rather than being able to facilitate routine testing and helping people to build sexual health check-ups into their routine.

Sexual Health Week, Playing It Safe

And we’re not all impacted by STIs to the same degree with the same groups most affected year after year, including young people, gay and bisexual men, people living with HIV and those of Black Caribbean ethnicity. But little is being done to properly understand the impact of structural inequalities on poor sexual health, including racism, sexism, homophobia and transphobia. We need a long-term plan for turning this around, but currently there’s not even a short-term vision.

Our shockingly high rates of sexually transmitted infections in this country is a worrying testament to the fact that there is no vision or ambition for improving sexual health in England. We’ve seen cuts where we need to see investment. If this were any other set of health conditions with such rapid rises, there would be outcry and we’d see rapid action with funding attached.

The national governments should also set out strategic vision for sexual health and fast, including:

  • The Scottish and UK governments replicating the Welsh system of a free, all-nation, all-year-round postal STI testing service.
  • Sexual health appointments should be bookable via relevant NHS apps.
  • A 48-hour waiting time target for access to sexual health appointments should be implemented and monitored.

So, while Sexual Health Week is a brilliant and important initiative, it needs to be backed up the rest of the year with a clear vision and ambition for improving the nation’s sexual health. Because our Mystery Shopper findings reflect a sexual health system that is under immense pressure.

National governments in England, Wales and Scotland need to ensure there is increased funding specifically for sexual health services in order to meet the rising demand and deal with rising STI rates and unplanned pregnancy.