The British Association for Sexual Health and HIV (BASHH) echo the concerns raised by the Local Government Association (LGA) that sexual health services are at a "tipping point" due to significant and sustained cuts to public health budgets.

Across the country BASHH has had reports where services have been closed or access to services or tests is restricted. This risks missed or delayed diagnosis and treatment of sexually transmitted infections (STIs) leading to increased complications such as infertility and chronic pelvic pain. Unprecedented demand for services, record levels of new STI diagnoses and the emergence of treatment-resistant infection means we are facing the prospect of a “perfect storm” in sexual health, with serious long term consequences not only for individuals but also for the whole community.

Since 2012 the number of people attending sexual health services in England has grown from 1.94 million to 2.46 million, a rise of 25 per cent. There has also been a marked increase in levels of STIs during this period, with Public Health England data showing that levels of syphilis are at their highest level since 1950, and that newly diagnosed sexual infections in men who have sex with men are 38 per cent higher than in 2012.

Despite these growing pressures, recent research led by the King’s Fund revealed that local councils are due to spend £30m less on sexual health in the coming year compared to 2016/17. This is on top of the damaging impact caused by the £200m in-year cut to public health budgets delivered in 2015, and the further 4 per cent per year cut announced to the budget in the most recent Spending Review. Combined, these constitute a real terms reduction in public health funding of at least £600m a year by 2020/21.

A recent study showed that access to care had worsened significantly between 2014 and 2015 and we believe this deterioration continues. Decades of hard work to improve access to sexual health services, provide prompt treatment and reduce teenage pregnancy is at risk. Services are indeed at crisis point with the ongoing funding cuts.

We are speaking out for the voiceless that need our services, either now or in the future, and particularly those who are the most vulnerable, including young people and those at risk of child sexual exploitation, as these ultimately stand to lose the most. We urge the Government to act immediately and safeguard funding for sexual health care. Failure to do so will be the falsest of false economies, the consequences of which will be felt for years to come.

Dr Elizabeth Carlin – president of the British Association for Sexual Health and HIV

Dr Mark Pakianathan – consultant physician in sexual health, St George's Hospital NHS Foundation Trust, London

Dr Laura Waters – consultant physician in GU & HIV Medicine, Central North West London NHS Foundation Trust, Mortimer Market Centre, London

When it comes to mental health care in the UK, we already have ‘blood on our hands’

There can be few people involved with vulnerable youngsters who will not have been touched, and outraged, by the tragic story this week of the suicidal teenage girl unable to get the support she needs.

In his summing up, High Court Judge Justice Munby is widely quoted as saying that authorities will have ‘blood on our hands’.

I would argue that we already have blood on our hands, and have done for some time. Sadly, when times are tough financially and budget cuts need to be made, it is often the most vulnerable in our society who are the most affected. Their circumstances make it difficult for them to find a voice, to make sure that they are heard, and taken seriously.

The road to suicide can be a long and painful one; often dealt with alone and in secrecy, either through the shame of their feelings and actions, or because those around them are too consumed by their own problems to find the time and space to offer support and get them the help they so badly need.

There are many reasons why people choose to end their own lives. In almost all cases it is not that they actually wish to die, but that they find their circumstances so unbearable they can see no other way out. Combine this with mental illness as a result of untreated symptoms and we end up with a toxic mixture.

In all local authorities, there is much talk of "prevention" but little evidence of this taking place as resources are stretched to the limit. This reactive approach means than any intervention that takes place, if indeed there is any, is invariably too late.

Oganisations such as Mind and Samaritans are constantly handling calls from those in complete despair. They know that their life is hell and that in order to get through the day they need professional outside support but all too often they find that they are waiting weeks and months, and even then, the support they receive does not always meet their needs.

The lack of secure residential places for those in extreme distress is just the tip of the iceberg. What I would like to see happen is more of a concerted effort towards ensuring that intervention takes place at the earliest opportunity.

We should hang our heads in shame at this systematic failure in a so-called civilised society.

Linda Piggott-Vijeh

Combe St Nicholas

The prison system is in utter crisis

The recent disruption at HMP The Mount is not unexpected, and it is likely to be reproduced elsewhere. While prison staff cope heroically under extremely difficult and often dangerous conditions, these recent events reflect the government’s apparent policy of running prisons short-staffed.

HMP The Mount was never fully staffed to cope with the opening in 2015 of its new wing for 250 extra prisoners. The latest Independent Monitoring Board Report for 2016-17 (July 2017) shows the prison to be running at 17 per cent below its full complement of staff.

A big concern is that staff shortages affect all aspects of the rehabilitation agenda. For example, in education and training where our charity has direct experience:

Wing closures for prolonged periods (mornings and afternoons) mean men are not available for classes

Lack of staff means men cannot be transferred to education classes

Education and resettlement training (which reduce recidivism) is severely disrupted

For the first time in 10 years HACRO volunteers are being told there is no point coming in to run classes where there are no men to tutor

If the consequence of short staffing is that prisoners are locked up with very little time out of their cells for teaching or even for fresh air, then it becomes inevitable that tensions build up and then trouble breaks out.

Why won’t the government give urgent attention to prisons? The Chief Inspector of Prisons has forcefully made the case; the reports of IMB’s make the case; privatising the bigger half of probation has led to a wholesale reduction in professional probation expertise; cuts in Police numbers have led to severe resourcing issues affecting crime prevention.

Cuts in prison staffing produce a tinderbox prison system, not reform. It is short-sighted, and while individual budgets have been cut to achieve targets with the right hand, the taxpayer is left to pick up the bill with the left.

Rearranging the deckchairs on the Titanic by changing the justice secretary every year (Grayling – Gove – Truss – Liddington) clearly isn’t working. It’s time surely to develop a positive long-term effective strategy.

Yasmin Batliwala – President, HACRO

The high street is here to stay

I do not believe that the high street will simply disappear as Josie Cox contends in her latest article, "Why chicken shops might soon be all that's left of the high street". The main reason for this is because people still value human interaction and courtesy when visiting the high street, which is why there isn't a mass movement to replace humans with robots. Also, a select group of people still want to buy handcrafted quality items from specialist high street shops, so the high street will be here to stay for some time even if it diminishes.

Alan Borgars

Nottingham

Are MPs held to the same standards as the rest of us?

Can someone please explain to me why I can’t get an unqualified electrician to change the plug on my kettle, but I can only get an unqualified individual to represent me in Parliament?

David Curran

​Middlesex

Trump should rethink his social media strategy

Should President Trump's official twitter account @POTUS be changed to @Pompous?