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Investment is needed in school nurses to help ensure young people go into adulthood well-informed and empowered to make healthy decisions around sex and relationships, experts have urged.
They described the fall in the number of nurses and health visitors working in schools across England as “concerning” and called for this trend to be “reversed”.
“School nurses play an important role in supporting relationship and sex education”
The demands were laid out in a new female health report released today by the Royal College of Obstetricians and Gynaecologists (RCOG) called Better for Women.
The report emphasised the need for national, joined-up strategies to meet the needs of girls and women across their life course – from adolescence, to the middle years and later life.
There should also be greater focus on moving the UK away from providing a disease intervention service towards a preventative health service, said the document.
A key recommendation of the report was around improving education for school children about women’s health, safe sex and healthy relationships.
“Learning about human biology, safe sex and respectful relationships at school is key to promoting healthy behaviours and tackling taboos,” said the report.
Good relationship and sex education (RSE) led to fewer unplanned pregnancies and sexually transmitted infections (STIs) and had also been shown to delay the age a person first had sex, it added.
The Department for Education has announced that relationships education for primary pupils and RSE for secondary pupils will become compulsory from September 2020.
Additionally, all schools will be required to teach health education, which will include practical advice on how to maintain a healthy weight and the importance of avoiding smoking and drug use.
The report highlighted the key role school nurses played in supporting this agenda.
“School nurses play an important role in supporting RSE and providing general health advice to many young people,” said the report.
School nurses were also “crucial” to increasing take-up of the NHS human papillomavirus (HPV) vaccine, which as of September this year is available to all boys and girls in Year 8.
“It is expensive, frustrating for me as a doctor and unfair for the woman”
The report said it was therefore “concerning” that there had been a fall in the number of nurses and health visitors working in schools across England, from around 3,000 in 2010 to 2,800 in 2018.
“Given the important contribution they undoubtedly make, this trend should be reversed,” warned the document.
The report raised concerns that women were facing barriers to receiving essential sexual and reproductive health care due to “underfunding and fragmentation” of services.
A RCOG survey of more than 3,000 women found 37% were unable to access contraception services locally and 60% of women could not access unplanned pregnancy care near home.
Over a third (34%) of women did not attend their last smear test despite the cervical screening programme being able to prevent up to 70% of deaths from cervical cancer.
Only half (50%) of women were able to access STI services and 56% of women were unable to seek help for menstrual health issues, such as for painful periods, locally.
Just over half of women (58%) could not easily access menopause services.
To help improve these statistics, the report called for a more “joined-up approach to women’s health”.
As part of this, the NHS and local authorities should work together to jointly commission sexual and reproductive health services and to create “one-stop women’s health clinics”.
These clinics should be available in the evenings and at the weekends and offer the full complement of services including contraception, STI testing, cervical screening and treatment and advice about the menopause.
“This will ensure a more joined-up approach to women’s health, diminish unnecessarily long referral times and ensure that women receive the best possible care by providing all of their healthcare needs in one location and at one time,” said the report.
Of those who responded to the RCOP survey, almost half (48%) thought a one-stop-shop women’s health clinic for all routine women’s health services could improve their access to these services.
Giving an example of how current fragmentation affected staff and women, Dr Asha Kasliwal, president of the Faculty of Sexual and Reproductive Healthcare, said: “I see a patient in my contraception clinic who requires a difficult fitting of the coil. She is also due her cervical smear test.
“This is the perfect opportunity to provide both services. However, my clinic is not commissioned to provide smears, so I am unable to do so.
“Too often also women face services that are fragmented”
“Instead of having all of her needs met in one go, this woman now has to book two appointments for two different vaginal examinations. It is expensive, frustrating for me as a doctor and unfair for the woman.”
She added: “Something has to change.”
Meanwhile, the report also called on employers to alter their workplace processes and policies to recognise the challenges of common women’s health issues such as heavy menstrual bleeding, pelvic pain due to fibroids or endometriosis and the menopause.
Professor Lesley Regan, president of the RCOG, said it was time for a “new and bold approach to transform women’s health services”.
She added that many of the barriers to access to women’s healthcare services could be improved by ensuring services were joined up and more responsive to the needs of girls and women.
“This doesn’t need to come at a great financial cost to the NHS. In fact, we believe we can do better for less,” said Professor Regan.
The report was supported by the Royal College of Midwives (RCM).
Chief executive Gill Walton said: “Too often also women face services that are fragmented, which means that some can fall through the cracks.
“We need integrated services putting women at the centre of care, based on their needs.”