Respect and Responsibility: Strategy and Action Plan for Improving Sexual Health
Section 5 Practical Plan for Action
The Scottish Executive
to facilitate a co-ordinated approach to the integration of sexual health in wider Executive policies and initiatives, a Ministerially-led National Sexual Health Advisory Committee - with cross-departmental and a wide-ranging membership - will be established with the aim of advising on policy, monitoring and supporting implementation of this strategy.
The National Sexual Health Advisory Committee will:
review the needs of rural communities;
review services and support for adult survivors of sexual abuse;
in conjunction with the Sexual Health and Wellbeing Learning Network address the needs of those groups facing the greatest barriers to sexual wellbeing;
recommend on further research on targeted learning interventions aimed at behaviour change in adults;
seek to ensure that no-one is excluded from appropriate sexual health services, whatever their life circumstances, by means of a comprehensive equality and diversity impact assessment process, in line with the developing SEHD/NHSScotland equality and diversity approach;
together with NHS Health Scotland and the Scottish Executive, develop a communications strategy for improving sexual health. This should include media campaigns, media advocacy and media literacy and link activities at national and local levels;
regularly review progress of the Strategy, complemented by a more comprehensive 5-yearly review;
offer advice on developing targets appropriate to this strategy;
keep the HIV health promotion strategy under review to ensure its continuing relevance;
consider the proposals developed by Health Protection Scotland for potential adoption as a national data collection framework;
offer advice on a sexual health research programme for Scotland in partnership with key policy, research and practice stakeholders in Scotland and elsewhere; and
consider how best to build on current good practice in school-based sex and relationships education in Scotland consistent with the principles of the McCabe report.
The Scottish Executive Health Department will:
in conjunction with the National Sexual Health Advisory Committee, work with professional bodies, regulatory institutions and statutory and voluntary training providers of non-healthcare professionals, to ensure under-graduate, post-graduate and ongoing CPD programmes provide staff with the range of skills and knowledge to respond to the sexual health and wellbeing agenda;
oversee the ongoing development and implementation of the Strategy with a particular focus on inequalities (including gender inequalities), people who are socially excluded, the homeless, those in prison, survivors of sexual abuse, or young people looked after or in care;
co-ordinate the development of a national sexual health training strategy to provide generic and specialist skills in sexual and reproductive health;
consider the possible extension of the chlamydia postal testing kit in the light of the evaluation of the Healthy Respect initiative;
consider the potential of development and testing of STI diagnostic kits in rural and urban settings;
explore with other stakeholders the need for clearer guidance regarding the reporting of negative HIV tests for insurance purposes;
develop an action plan to tackle stigma and discrimination to encourage a more positive view of relationships and sexual wellbeing in all Executive policies, as part of the ongoing health improvement agenda; and
monitor progress against the current target of reducing by 20% the pregnancy rate (per 1000 population) in 13-15-year-olds from 8.5 in 1995 to 6.8 by 2010 along with the further target of reducing teenage pregnancies among 13-15-year-olds in the most deprived communities by 33% from a rate of 12.6 in 2000-02 to 8.4 in 2007-09.
The Scottish Executive Education Department will:
work in partnership with Directors of Education and Social Work, NHS Health Scotland and other key stakeholders on how best high quality, consistent and appropriate sex and relationships education which is consistent with national guidance is delivered in school and other settings, to vulnerable young people such as 'looked after' young people, those who have been sexually abused, and those who are disaffected or excluded from school, as well as completing implementation of the remaining recommendations of the McCabe report;
facilitate the delivery of high quality approaches to sex and relationships education consistent with national guidance, including multi-agency training, through partnership working involving education authorities, key partner agencies and key stakeholders such as parents; and
consider with Directors of Social Work how best children and young people who are looked after should have access to sex and relationships education as and when required and that social work staff are adequately trained and supported to respond to the needs of their clients.
Local Authorities will:
designate a strategic lead for sexual health;
ensure that Joint Health Improvement Plans address both specific sexual health issues and the wider determinants identified by this strategy;
work through the Local Authority Director with responsibility for education services to ensure the delivery of consistent and appropriate sex and relationships education in all school settings and for those excluded from school;
support consistently, high quality of education about sex and relationships education throughout Scotland. Consistent with circular 2/2001 and the McCabe recommendations, sex education should be defined as sex and relationships education, based on health guidelines and built upon throughout primary school as part of 5-14 health guidelines and developed through to school-leaving age;
ensure providers of sex and relationships education training provide this on a multi-agency basis, where appropriate, and that training takes account of issues relating to different cultural and religious practices and beliefs;
ensure schools demonstrate mechanisms to involve parents and carers in sex and relationships education programmes consistent with the McCabe Report recommendations;
ensure that a member of each secondary school's management team is responsible for ensuring that school-based sex and relationships education subscribes to current guidance and delivers key learning objectives to all pupils;
ensure that on education in early school levels the emphasis will continue to be on stable family relationships, friendship and on developing an understanding of how we care for one another;
ensure that all schools are able to demonstrate that they provide pupils with equitable information about sexual health services and how to access them;
ensure that Community Planning Partnerships develop targeted educational interventions aimed at harder to reach groups (including equality groups) in a range of settings outwith mainstream services/locations with NHS Boards, and in consultation with Community Planning partners; and
work to ensure their Community Plans, local health plans and Children's Services Plans complement their local inter-agency sexual health strategies.
NHS Boards will:
The nominated Executive Director will:
ensure that an inter-agency local sexual health strategy is developed which reflects the key components of the national strategy, the local planning processes such as Integrated Children's Services and that ongoing development and implementation are led by a multi-agency, multi-disciplinary strategy group, which reflects the needs of their local population, taking into account the issues that impact on sexual health, especially in relation to inequalities and utilising the diversity impact assessment process;
appoint a Lead Clinician to integrate sexual health services across each NHS Board area, utilising community health partnership arrangements;
ensure that all elements of their local sexual health strategies are developed to be sensitive to Scotland's diverse faiths and cultures;
in conjunction with other key partners, ensure that resources for sexual health promotion are identified in local sexual health strategies so that good quality and well resourced specialist services are able to support local initiatives;
in consultation with other stakeholders, work with local agencies providing help and support for survivors of sexual abuse to consider how best to respond to local needs and include proposals in inter-agency sexual health strategies;
ensure that a full range of health promotion programmes are developed and delivered within the context of Community Planning which address the key national and local priorities relating to positive sexual health and wellbeing. These programmes should be supported by sexual health promotion specialists;
in conjunction with other statutory and voluntary sector interests, develop and provide a range of programmes for parents and carers to enhance communication skills around relationships and sexual health, which are sensitive to Scotland's diverse faiths and cultures;
in conjunction with Community Planning Partners and Community Health Partnerships, work with further and higher education, community education and youth work services and the wider voluntary sector to develop effective sexual health promotion and outreach services for adults;
explore the possibility of making a range of condoms and lubricants more extensively available free of charge to outlets and services, targeted at high risk groups and as part of outreach work;
ensure that the local inter-agency sexual health strategy demonstrates progress made in implementing the HIV health promotion strategy; and
work with Community Health Partnerships to support school nursing teams and other nurses who wish to develop their role in providing sexual health advice and health services for young people, by providing opportunities for them to update their skills and knowledge (including some training on educational skills) and access to resources.
Lead Clinicians will:
ensure that all services are reviewed in light of this strategy and ensure that proposals to address identified deficits are included in each NHS Board's inter-agency sexual health strategy;
ensure that an audit of training needs is undertaken, in conjunction with all partners providing sexual health services, to ensure that all staff have the opportunity to maintain and develop core skills in communication, attitudes and relationships, addressing the wider social and cultural determinants of sexual health. Following the audit, plans to address these should be identified in the inter-agency sexual health strategy;
ensure that local standards on agreed competencies, confidentiality, access to and provision of sexual health services are developed. This will include specialist sexual health services such as HIV testing and treatment, sexual dysfunction, and other service needs identified at local level;
ensure there is access to appropriate termination of pregnancy services, and that protocols drawing on the RCOG guidelines are in place to help provide consistency in service provision and practice. Counselling and information should be comprehensive and responsive to any individual needs, again reflecting the RCOG guidelines, and should include the biological facts about the development of the pregnancy and the possible emotional, physical and psychological sequelae of termination and alternative courses of action. While women should be given adequate time to assimilate all the implications, in accordance with the RCOG guidelines, no woman should have to wait longer than 3 weeks from her initial referral to the termination;
develop a framework to ensure that HIV testing is offered to all GUM clinic attendees not known to be HIV infected who present with a new STI. This offer should be made in the context of the HIV test being presented as a routine recommended test. Reasons for non-uptake should be recorded;
in consultation with other stakeholders, work with agencies for people living with HIV to consider how best to respond to local needs and include proposals in inter-agency sexual health strategies;
identify the impact on laboratory resources in meeting increased testing arrangements and bring forward proposals to meet unmet need to the NHS Board;
in developing services, aim to ensure that everyone is able to choose from at least two sexual health providers while recognising that this may not initially be possible in every NHS Board area;
ensure that local healthcare practitioners are able to demonstrate that they provide information and refer patients to alternative readily accessible services, where they do not provide the sexual health services required;
facilitate the development of an NHS Board-wide managed sexual health network, which includes all relevant local organisations and service providers;
all providers of sexual health advice, information, learning and services should prominently display their confidentiality approach in information booklets, on notice boards and in waiting areas in a range of accessible formats including different community languages; and
service providers should give clear information to users about their options when giving personal and identifiable information, if confidentiality and/or anonymity are of concern.
NHS Health Scotland will:
in partnership with key stakeholders, contribute to a review of the range of programmes available to support sex and relationships education across the curriculum to achieve and support consistently high-quality provision for young people;
develop information in a variety of formats targeted at parents and carers and youth and community groups;
work to define and address the sexual health needs of older people and link with older people's strategies developed by NHS Boards;
in partnership with NHS Boards emphasise the importance of using barrier contraception, in conjunction with other forms of contraception, to protect against sexually transmitted infections and unintended pregnancy in all national and local media and communications work;
ensure that local and national media campaigns and other work reflect the values and aims which underpin this strategy and do not use imagery or language that undermines the key sexual health messages that promote relationships based on self respect, respect for others and strong relationships;
disseminate evidence, commission research and develop resources to support the ongoing implementation of the Strategy;
in partnership with local sexual health promotion specialists and the Sexual Health and Wellbeing Learning Network, develop practitioner guidance so that information and health promotion materials challenge, not reinforce or replicate, stereotypes and reduce, not increase, mis-information and discrimination;
in conjunction with other stakeholders, consider actions to support positive sexual health in the workplace and affirmative action to address issues in relation to sexual orientation and HIV status; and
ensure that the Sexual Health and Wellbeing Learning Network, in conjunction with key stakeholders:
- facilitates awareness of the sexual health needs of people with learning disabilities and make recommendations for research based programmes and materials;
- develops guidance on confidentiality/disclosure of information for use by all service users and for all relevant health and social
care and education staff taking account of existing guidance; and
- develops guidance for practitioners on female genital mutilation (FGM).
NHS Education for Scotland will:
with Postgraduate Medical Deans and other relevant professional bodies, address issues affecting the career progression of doctors specialising in family planning and reproductive health;
in conjunction with practitioners, develop training and resources to enable the further extension of nurse-led sexual health services in primary and secondary care;
work with professional bodies and professional networks to develop a competency-based framework to support the implementation of the strategy; and
work with key stakeholders to develop and enhance supporting training programmes at under-graduate and post-qualification levels.
NHS 24 will:
develop algorithms which provide accurate and appropriate advice consistent with that given by sexual and reproductive health service providers; and
with service providers, ensure that they have the knowledge of up-to-date and relevant service provision.
Health Protection Scotland will:
monitor and disseminate information about new diagnoses and trends timeously so that appropriate responses can be made at local NHS Board level. This information will also need to reflect the strategy's commitment to equality and diversity;
lead action to develop standardised data collection to support the development and monitoring of sexual and reproductive health services; and
develop proposals for a national data collection framework.
Scottish Prison Service will:
Parents can help by committing to playing their part in the sex and relationships education of their children both directly and through stable family and home life and their involvement in their children's general education and school, voluntary organisations and faith-based groups that have contact with their children.
NHS Quality Improvement Scotland will:
This is an ambitious and wide-ranging Strategy and Action Plan, which set out a long-term programme for achieving our vision for improving sexual health in Scotland. The challenge now for us all is to turn words into action. Success will not be achieved overnight. But the pursuit on the part of us all - whether statutory or voluntary organisations, faith groups or individuals - of the principles of respect and responsibility, which underpin this strategy, will help us along the way to improved sexual wellbeing in Scotland.