Chlamydia screening is proving ineffective and wasteful, the Public Accounts Committee of the British parliament has said.
Chlamydia is the most commonly diagnosed bacterial sexually transmitted infection and the prevalence of this infection is increasing, especially in young people under the age of 25. The infection is often symptomless but if left untreated can lead to serious health problems including infertility in women.
The Department of Health launched the National Chlamydia Screening Programme (Programme) back in 2003. Since its launch an estimated £100 million has been spent but the Department does not yet know what effect, if any, this has had on reducing the prevalence of the infection, the PAC said in its latest report.
During the financial year 2007-08, five years after the Programme was launched, only 5% of 15 to 24 year-olds were tested, against a target of 15%. When it became clear that very little was happening the Department introduced a new requirement for the primary care trusts (PCTs) of the NHS to test 17% of their 15-24 year-old population, which drove the testing rate up to around 16% in 2008-09.
The Department's lack of urgency in pressing PCTs to reach a high volume of testing means that the Programme has not yet reached the level of activity where models predict that the prevalence of chlamydia will be significantly reduced. As a result, more young people than necessary are still being infected and potential savings to the NHS in treating the consequences of chlamydia infection have been lost, the panel said in a scathing attack.
It also charges the Department of Health missed an opportunity to refine the Programme and to improve its cost-effectiveness, during the lengthy rollout. When PCTs increased their activity to meet the 17% target, a fragmented and inefficient programme became even more wasteful of taxpayers' money.
The Department needs to make this Programme a national response to a national problem. The Department should identify the most cost-effective local delivery strategies, establish regional or national commissioning arrangements, increase testing numbers and measure the Programme's impact on the prevalence of chlamydia. By improving efficiency, economies estimated at £40 million per year could be made by 2010-11.
The committee further urged the Department to -
a) establish, as soon as practical, national or regional arrangements for the procurement of testing kits, patient record forms, laboratory processing of samples and other standardised, high volume goods and services;
b) evaluate the case for a national website from which young people can request testing services, with a national brand identity;
c) review the number of separate Chlamydia Screening Offices currently in place (91 for 152 PCTs), with the aim of cutting the administrative costs of the Programme, and
d) require the Agency to complete its plans for a model contract for chlamydia screening in GP practices and pharmacies, and provide PCTs with guidance, including indicative payment rates, by April 2010.
The panel also wanted the Department to develop a business plan with a clear timeframe for measuring the Programme's impact on chlamydia and related health complications. This should specify a trajectory for the reduction in chlamydia prevalence which the Department expects the Programme to deliver.
A spokeswoman for the Department of Health said the programme had 'improved dramatically' during the past year.
She added: 'As a result, 38,185 young people were treated in 2008-09 and all local health trusts now offer screening compared to just a third in 2007.'
She said a programme on this scale 'takes time to perfect and improve'.
Dr Peter Carter, general secretary of the Royal College of Nursing (RCN), said: 'Screening is only part of the package and must be combined with effective awareness and prevention programmes in order to reduce the prevalence of sexually transmitted infections (STIs).'
Shadow health minister Anne Milton said: 'Chlamydia screening is a crucial part of improving young people's sexual health but, at times when money is tight, it is shameful of the Government to come forward with such ill-conceived, ill thought-out and ineffective ideas.