Sexual Health Data: 13th December 2012

The Parliamentary Under-Secretary of State for Health (Anna Soubry)
I congratulate the hon. Member for Stockport (Ann Coffey) on securing this important debate. I pay tribute to the work she does. Her energy and commitment to the most vulnerable people in our society are admirable and rightly well known. She has raised some important and disturbing issues. There is nothing wrong with anecdotes, because after all, that is what evidence is—it is, of course, anecdotal. As we have heard today, and as we know from the work undertaken by the Office of the Children’s Commissioner, a large number of our young people are victims of sexual exploitation and abuse. Tragically, many of them do not even see themselves as victims. This is a very difficult subject; it is all about striking the right balance.

The deputy Children’s Commissioner recently noted that in preparing her report, she asked for certain data on young people attending sexual health clinics, as the hon. Lady explained. The deputy commissioner wanted the data to enable matching with other data to give an estimate of the numbers of young people suffering from sexual exploitation. The Department of Health took legal advice on whether it would be possible to share the sexual health data requested by the deputy commissioner. Our legal advice said that, given the limits on disclosure in the legislation and the fact that the data requested might identify individual patients, they should not be shared. I understand that around 60% of primary care trusts provided some data as requested. That is clearly a good example of confusion, with one piece of legal advice seemingly at odds with another. The hon. Lady is therefore right to make the point that she did about her great concern, which I share.

I understand that the point about the advice was that it was the deputy commissioner who had made that request, which is different from the point that the deputy commissioner—as well as the hon. Lady—is most concerned about, which is: what happens with data sharing out in the real world when children come along to sex clinics? Unfortunately, we hear many stories of things going wrong—we are all aware of those—but I would say, I hope with confidence, that in the overwhelming majority of cases things go well.

I pay tribute to all those in the health and other services who do a magnificent job in protecting our children. Sometimes we forget that. My experience at the criminal Bar, for what it is worth, taught me that those professionals involved in the protection of children—the hon. Lady read out a long list of the organisations involved—use their own common sense and compassion as well as all the guidance that is available. Anyone involved in such work should always be motivated by an overriding desire and determination to protect the child. That should be at the forefront of their considerations.​

We know from the deputy Children’s Commissioner that repeat attendances at a sexual health clinic are one of the key indicators of potential child sexual exploitation, which is a form of child abuse. Sexual health clinics are open access. That means that anyone can go into a sexual health clinic and receive free and confidential advice and treatment. Patients do not need to go to a clinic in the area where they live, or in the area where they are registered with a GP. They do not even have to give their correct name, age, address or other details in order to receive treatment. The purpose of that is to ensure that anyone, regardless of their age or circumstances, can get the advice and treatment that they need to protect their own sexual health and that of their sexual partners.

We know from a number of studies that confidentiality is highly valued by young people, as I know the hon. Lady will understand. They perceive that the services offered by clinics are likely to be more confidential than going to a GP. We need to reach a point at which any child sexual exploitation can be identified by the health or other professionals who come into contact with the child. Those professionals then need to build up a relationship of trust so that the child feels able to work with them and others to tackle the issues that they face and to make the necessary disclosures to enable action to be taken to protect the child and, if necessary, to bring the perpetrator to justice. Of course, that does not always happen. We know from the deputy Children’s Commissioner’s work that, all too often, the children do not see themselves as exploited or abused. That can result, in the initial stages, in the abuse not being identified by the professionals.

The starting point for everyone who receives health care is that, generally speaking, information about them is not shared without their consent. That is rightly at the heart of the working practices of all health professionals. Additional legislation limits the disclosure by the NHS of information that identifies a person who has been examined or treated for a sexually transmitted illness. That is to ensure that people do not feel reluctant to come forward for testing and treatment. There is agreement on that, too. The legislation allows the information to be disclosed in order to treat, or prevent the spread of, sexually transmitted illnesses. For example, the information might need to be disclosed to the patient’s sexual partners to prevent the spread of the illness.

For under-16s, specific concerns and issues must be addressed. The Sexual Offences Act 2003 provides that the age of consent is 16 and that sexual activity involving children under 16 is unlawful. The age of consent is there to protect children aged under 16 from exploitation and abuse. It is accepted that children under 16 are vulnerable to exploitation and abuse, and that they do not have the necessary maturity to make the decisions that young adults can make. That is why we have an age of consent. It is to protect children from exploitation and abuse.

All health professionals should be aware of the age of consent, and of child protection and safeguarding issues, and I believe that most of them are; they take the matter very seriously. When dealing with a child under 16, they ​should be alert to the possibility that that young person is being exploited or abused. It goes without saying that a 15-year-old cannot make a life choice to become a prostitute. Advice and guidance on child protection are available in “Working Together to Safeguard Children” and “What to do if you are worried a child is being abused”. The advice and guidance are available in sex clinics and they are also issued to workers in this field.

All sexual health clinics should have the guidelines and the referral pathways, as they are called, in place for risk assessment and management for child sexual abuse. They should use a standardised pro-forma for risk assessment for all those under 16 and also for those between 17 and 18 where there is a cause for concern or learning difficulties. They should be aware of local child protection procedures and work collaboratively under local safeguarding children arrangements to ensure victims are identified and protected. In my view, perhaps most of all, they should use their own common sense. If a child under 16 presents who has clearly been involved in sexual activity and where it is clear to the worker that there is an element of abuse or any damage caused by sexual activity, alarm bells should be ringing immediately that this is a child who needs protection, help and assistance if only to disclose what has been going on that has led them to be in that position. It is very difficult work, and it often takes a great deal of effort and intervention even to get a child to disclose what has been going on. It then requires even more work to take them through the long, difficult journey to full disclosure and, as I say, to protect them fully and, if necessary, to bring the perpetrators of the abuse to justice.

However, given the issues raised by the report from the Office of the Children’s Commissioner, we think it would be valuable to work with the NHS, Royal Colleges and other key stakeholders to develop guidance on effective information sharing within the law in order to identify and protect the victims of child sexual exploitation. As we work through those issues, we will need to strike a careful balance between sharing data in a way that achieves our goal of helping victims of sexual exploitation, without discouraging them, or other young people, from visiting a sexual health clinic.

As I said—I hope I did say this at the beginning—we have set up a health working group on child sexual exploitation, and it is working with the experts, the professional bodies and the voluntary sector on these issues. It will produce a report and recommendations in the spring next year. That report will determine the future direction of our work. We want to work closely with bodies representing health care professionals because they hold the key to making progress. We want to make sure that they can identify and support these young people to help them get the help they need at the earliest stage possible.

Finally, I thank the hon. Lady again for bringing this matter to the Floor of the House and for raising all the issues she has about identifying the need for real work to be done in the future to make sure, frankly, that we get it right.