April Fools’ Day 2013 saw a transformation of the sexual health landscape in England. Local authorities, controlled by elected local councillors, now purchase most sexual health services including genitourinary medicine services and contraceptive (CASH) clinics.1 Important exceptions are General Practice services, and abortion which is currently considered a step too far for local authorities. At present sexual health budgets are ring-fenced. However we are all familiar with the history of ring-fencing, and cash-strapped local authorities will circle hungrily over services for young people, as they struggle to provide basic care for the elderly and frail. HIV care will be centrally commissioned, potentially divorced from preventive services.

In accordance with the Act,2 Public Health departments have already moved lock, stock and barrel into the politically charged environment of local authorities. Separation of public health from the NHS is a strategic political shift with far-reaching consequences, and sexual …