When Alison was 16, she developed some uncomfortable symptoms after having unprotected sex. Anxious that she might have caught something, she made her way to the nearest sexual health clinic to get tested.
She didn’t have to travel far, or book an appointment. Within walking distance of her home in Ipswich, Suffolk, was a centre specially set up for young people. As it turned out, she did have a sexually transmitted disease, and treatment was swift.
But most important to Alison, now 19, was that she didn’t have to worry about bumping into any adults she knew. As a service embedded in the Young People’s Health Project, or 4YP as it was known, she could just turn up without anyone knowing what she was there for. “No one knew I was there for that reason,” she said. “It’s so hidden.”
But two years ago funding for the clinic was withdrawn by the council. It was instead reallocated to the local Terrence Higgins Trust, which offers just four hours of drop-in services a week for young people.
In doing this, services were centralised – a move common across the UK as councils consolidate budgets. Once Y4P closed its sexual health service, Ipswich’s Orwell Clinic brought together two existing health centres in the area, offering contraception, HIV care and testing for STIs all under one roof.
But the new clinic is far away, and for many of the teenagers who used Y4P, it means getting two buses – a deterrent, Alison said. “I would have had a real problem if I’d had to walk into the Orwell Clinic. At 4YP, we didn’t have to book appointments, we could just come in and speak to someone.
“For example, with chlamydia which is what I thought I had, it’s something you can live with for a couple of months. Especially if there are no symptoms, you just think ‘oh I could just go in a couple of weeks’. And meanwhile, it’s doing serious damage to you. I think [cutting the clinic] is a massive loss,” she said.
Like so many decisions driven by austerity over the past few years, the changes in Ipswich made sense on paper. Services were not withdrawn completely, and the young people who used 4YP still had access to another site. But as with so many similar cuts across the UK, there was a quiet but profound impact on the people who relied on it.
It’s one of just many cuts that we have been examining in our new series, What It’s Like To Lose. After nearly eight years of shrinking local budgets, HuffPost UK has been focusing on the disappearing bus routes, leisure centres, clinics and job centres that together paint a picture of what life is like for millions of people who rely on public services.
For Alison, it’s not that young people are too unreliable to attend the new clinic, it’s that unless it’s a serious emergency they aren’t likely to prioritise their health. “With young people nowadays, if you’ve got to make an appointment and they say they can only see you next week, they’re probably not going to turn up,” she said.
Over the past four years, planned spending on sexual health services has fallen by £64m
Responsibility for sexual health was taken away from NHS England and handed to councils in 2013. Since then STI testing and most contraceptive services have been overseen by local authorities.
According to the British Association for Sexual Health and HIV (BASHH) councils last year spent £30m less on sexual health compared to year before, representing a 5% reduction in the total amount of money available. Over the past four years, planned spending on sexual health services has fallen by £64m, equivalent to 10%.
In December the government announced it would cut the public health budget by £85m. BASHH pointed out this came at a time where gonorrhoea rates had increased by 22% in 2017, compared to the previous year and syphilis rates are at levels not seen since world war two – up 148% since 2008.
Last year Suffolk council also announced the closure of sexual health clinics in Sudbury, Stowmarket and Felixstowe in response to reductions to the public health grant, and reduced opening hours at the existing clinics in Ipswich and Bury St Edmunds.
Tibbs Pinter, chief executive of 4YP, said the move could have grave repercussions for the spread of infections in the region. “This is a really important matter, particularly in terms of the future and prevention. What I think we’ll find out in five years time is that we have a really expensive problem and it’s absolutely down to austerity,” he told HuffPost UK.
While 4YP still provides young people with condoms and other contraceptives, anyone in need of an STI test is referred elsewhere, and for Tibbs, the big thing for young people is the fear of being found out.
“What’s key here is that it was a service for young people in an area where they could be anonymous. One of things we pick up more than anything is that those who go to the main sexual health service often end up sitting next to their neighbour, or find that their mum’s aunt is a receptionist at the clinic,” he explained.
Without the clinic they are not getting the emotional support from the nurses, that’s all being missedScarlett McMurty
“At the Orwell Clinic everybody knows you are there for a very specific reason, it’s not like you’ve gone to your GP because you’ve got the flu.”
Pinter says young people still come to the 4YP centre looking for STI tests – with around 30 such visits in the last year. “That’s the hangover. I’ll open the door and it will be a very bright, smart young lady, asking ‘Hi, is the sexual health clinic open?’ and I’ll reply ‘No, I’m sorry, but come in.’ Then she’ll turn around to her friend who is standing across the road, head down, with her shoulders hunched, looking really scared and worried. That’s the sort of person I do not want to leave out in the cold.”
Pinter isn’t the only one to link the problems to government-led austerity. Scarlett McMurty, a young people’s coordinator at the centre, said the cuts create a “knock-on effect”, putting pressure on other organisations.
She said she was accompanied a young woman who was being sexually exploited to get help at Y4P, and has supported lots of young women who have think they may be pregnant. “Without the clinic they are not getting the emotional support from the nurses, that’s all being missed. It does impact their wellbeing and their mental health as well as their sexual health.
“As for the Orwell, it’s on the other side of town. Some people have to get two buses to get there. It’s also about gang postcodes, some young people simply won’t go there. Others might have a disability and it’s just too far a journey for them.”
Dr Mark Lawton, from BASHH, told HuffPost UK that there are many issues in sexual health that “need to be handled directly, especially with regard to identifying and supporting vulnerable individuals and particular children at risk of sexual exploitation,” he said. “The added value of a holistic approach to public health and provision of health promotion is better facilitated face-to-face.”
Public Health England figures show Ipswich has a HIV late diagnosis rate of 54.8% over the period 2015-17, worse than the country-wide average of 41.1%. Meanwhile the chlamydia detection and screening rates for Suffolk are significantly worse than the rates for England in 2017.
Explaining the cut, councillor James Reeder, the cabinet member for health, told HuffPost UK that Y4P had received low attendance numbers, and said online STI-testing kits can now be ordered to people’s homes.
“We recognise that the way in which people want to access sexual health services has changed, so we’ve introduced alternatives to clinics such as an online HIV home self-sampling service, where anyone living in Suffolk who is at risk of contracting the HIV infection can order a free HIV test online,” he said.
In addition, he said, the council had supported the training of staff in primary and secondary care, while also commissioning services in GP surgeries, pharmacies, including chlamydia screening and treatment, emergency hormone contraception and free condoms.
But Alison is sceptical about the changes, and said it was the chance to speak to someone, without fear of feeling exposed in a small community, that made Y4P so important. “That sounds quite simple but it’s all about talking to someone you don’t know. A lot of people came to 4YP because they know it’s a safe space,” she said.
“To have to go to a desk in a pharmacy and ask for the morning-after pill... ouch.”
In a new series, HuffPost UK is examining how shrinking local budgets are affecting people’s daily lives. These are stories of what it’s like to lose, in a society that is quietly changing. If you have a story you’d like to tell, email firstname.lastname@example.org.