The Hospital

26 July 2010

The founding principle of the NHS - free healthcare for all - is under threat.  As the population grows older the money is drying up and young people's health is deteriorating. It has been claimed that teenagers' life expectancy has dramatically lowered, but now some experts have even warned that parents will begin to outlive their own children.

In a five-part series, The Hospital returns to further examine the impact of our young generation on the NHS. Surgeons, nurses, consultants and other hospital staff reveal how they feel about treating the endless stream of young people coming through the hospital doors - dealing with the repercussions of alcoholism, drugs and obesity, knife crime and sexually transmitted infections but at a crippling cost to the NHS. The teenagers themselves also justify the demands they are making of the health service. Is it possible to turn around the constant flow of young people who can't or won't look after themselves? And if Britain's young, unhealthy generation is an increasing strain, should the NHS be expected carry the cost for society?

The NHS are diagnosing double the number of new cases of sexually transmitted infections as ten years ago and sexual health services account for over 1 billion of the NHS budget. This first episode focuses on the Chelsea and Westminster NHS trust that runs the West London centre for sexual health. Lead consultant, Rachael Jones, and a team of doctors, nurses and health advisors are going head to head with Britain's sexual time bomb.

Of the 500 people who come for screens every week, the highest rates of infections are in 16 to 24 year olds. Chlamydia is the clinic's number one diagnosis and one in ten young people are infected. Michael, 25, is worried he's caught something from a one night stand and has previously been treated for Chlamydia: "I thought everyone gets it. If you haven't had it, you're boring. It's almost like being brought into manhood" he says.

Consultant Rachael Jones explains: "There‘s a rise in absolutely everything and it's young people in whom the major burden of sexually transmitted infections are born." According to her, many in this generation don't use condoms and take greater risks. As 19 year old, Stacey says: "if I have to put one on I'll put on one. If she's ok with it, I won't."

Undetected and untreated, STIs can lead to infertility, cancer and even death, yet staff at the clinic are not only coping with high numbers of patients. They also spend much of their time just trying to make their young patients realise the dangers of STIs and how vital it is to practice safe sex.

Former midwife, Stephanie McMillan, spearheads the clinic's integrated young persons' service, offering contraception alongside sexual health screens to every client.  They have even started stocking a wide range of condoms to suit the preferences of their patients. In order to target the most at risk the clinic also runs a confidential after school walk in service for the under 19s, but have to operate using a quick and comprehensive approach as patients often get bored and do not want to wait. "More of them are having sex younger", Stephanie says. "They'll do the sex part but they can't cope with the aftermath of it and that's why they come to us. A lot of the time they just dump the responsibility on the healthcare professional: I'm here, sort it."

Despite a miscarriage two months ago, 15 year old Shannon is still not taking her pill and constantly sneaks out to meet boys. She misses appointments to get a contraceptive implant fitted and it finally takes a sexual health support worker to step in and accompany Shannon to have it fitted. The implant is a key weapon in the government's multi-million pound campaign to cut teen pregnancy in half. Nevertheless, it won't stop the spread of STIs unless girls stick to advice on double protection. However, Dr Rachael Jones says: "You should come into our clinic and see some of the things they come home with and in comparison you might be quite pleased if she comes home pregnant."

Aged 17, Perry is on his fifth HIV screening since he was 16 and when considering the possibilities he might be positive, he says, "If I do have HIV it would be a bit upsetting but have to live with. You can't cry forever." In the last three years, Dr Rachael Jones has seen the sudden spread of HIV amongst teenagers and is even seeing a girl as young as 16 who has contracted it. The clinic staff spend 60 hours every week on outreach work; tracking down the one in three people who are unaware they have caught this potentially deadly virus and are unknowingly spreading it, but are still met with reluctance to test by the public.

While millions are spent every year and staff take on both the physical treatment and psychological battle to get through to young people about their sexual health, the statistics are still alarming. "The NHS would never turn anybody away, but we do have limited resources. Stephanie McMillan comments, "If all these preventable things were prevented, we could put the money into preparation, education and training. But we can't because we need to sort the aftermath out first."