Sadiq Khan (Mayor of London):  Thank you very much for your question.  The increase in the number of syphilis cases is very worrying, and so is the fact that half of the cases in England are in London.  It is also a matter of concern that there are significant differences in race of syphilis diagnosis between boroughs.  More broadly, Public Health England’s 2016 data shows that London has the highest rate of STIs in England.  Of the top 20 local authorities in England with the highest rate of new STIs, 17 were in London.  Clearly there is more to be done to improve Londoners’ sexual health.

London’s local authorities, not City Hall, have the responsibility for commissioning the services to screen and treat STIs, including syphilis.  To be fair, boroughs have recognised the scale of the challenge and have collaborated to develop a London-wide approach, the London Sexual Health Programme that was set up in 2015, which has seen a new model for commissioning sexual health services.  From 2018, services have included a new online self-sampling kit and clinics across London provide integrated sexual health services, dealing with infection and contraception.  The free confidential online service is convenient for service users, designed around the changing ways people now access services, and delivers increased cost effectiveness for commissioners.  As the service develops it has the potential to reach groups not currently in contact with services.

Dr Onkar Sahota AM:  Thank you, Mr Mayor, for that.  You recognise the magnitude of the problem.  Of course, this is made worse by the fact there has been a huge cut in public health budgets to local authorities, something like £551 million has been clawed back from that budget.  I understand those are the pressures on local authorities. 

However, of course, this is a pan-London problem.  You allude to the fact there is a huge variation among the various boroughs in the diversity rate.  Is this something you might take up with the Health Board, to make sure we get a well-co-ordinated response across London?

Sadiq Khan (Mayor of London):  The reason why I am pausing, smirking and looking at you is that every time we have MQT you want me to take on more responsibility for health matters, which I would love to, but the problem is I do not have the powers or the resources.  I am a bit nervous about taking on your challenge in relation to a whole host of issues. 

However, you are right that I have a leadership role.  I meet regularly with the Regional Public Health Director for London, Professor Yvonne Doyle CB, and I chair the London Health Board.  Why do I not speak to her about what we can do in relation to a pan-London role?  You are right, many of these local authorities have lost money, which affects their commissioning ability and also public health awareness.  This is one where I should take it away and see what I can do as the Mayor of London, working with professionals about how we can amplify some of the work they are doing.

Dr Onkar Sahota AM:  The reason I keep pushing these issues, Mr Mayor, is because there has been, since 2012, a breakdown in the co-ordination role in London.  There is no one who takes responsibility for co-ordinating things across London, which is one of the impacts of the Health and Social Care Act 2012. 

Of course, the other thing is that this does impact on health inequality, the variation of services across London as well, and is something I need to raise with you.  You have said in your Health Inequality Strategy that we need to have a fresh focus on health education.  You talked in terms of HIV infections.  I wonder if this can be widened up to look at sexually-transmitted diseases in the wider context, rather than just focusing on HIV.

Sadiq Khan (Mayor of London):  To put the answer I gave to your first question in context, our population has never been bigger and, also, the number of young people in London has never been larger.  That provides opportunities but challenges as well. 

Yes, we are doing lots of good work around reducing HIV.  We can use the opportunity to refresh the Healthy Schools London Programme and the London Curriculum, both of which include personal, social, health and economic education (PSHE) as a way of making sure young people understand the dangers of not doing things safely in relation to sex and other issues.  Why do I not see if we can try to get into some of that work, to do with not just reducing HIV but reducing STIs generally as well?

Dr Onkar Sahota AM:  Thank you.