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The Sexual Health and Blood Borne Virus Framework 2011-2015

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Appendix 3: Policy Links

As detailed elsewhere in the Framework, the links between the issues addressed in this document and other government, national and local policies are many, varied and complex. This appendix is intended to provide an overview of the key policy areas where there is an overlap with the content of this Framework and to provide signposting to where further information can be found.

Multi-agency partners involved in planning or delivering services under the Framework should ensure they are familiar with these links and that appropriate connections are made locally. The Scottish Government will endeavour to promote this approach, where possible, at the national level.

This section is not intended to be exhaustive and there will be many other policy links between the work of this Framework that are not explicitly noted here.

An Assets-Based Approach to Health Improvement

In his 2009 report, the Chief Medical Officer for Scotland described the benefits of taking an assets-based approach to health and health improvement. The asset model accentuates positive capability within individuals and supports them to identify problems for which they can activate their own solutions. This enables individuals to take control of their own health and wellbeing, promoting self esteem and increasing the coping abilities of individuals and communities through, for example, self-management approaches to long-term conditions such as HIV or viral hepatitis.

Initiatives to support good sexual health and relationships, to reduce the incidence of blood borne viruses and to empower people living with blood borne viruses to strive for better health and wellbeing can create positive attitudes, enabling individuals to develop the resources that they require in order to be resilient in the face of challenging circumstances.

The assets-based approach is relevant to sexual health and blood borne virus improvement through combining key prevention initiatives with social and cultural approaches which will support Scotland to positively influence sexual health, prevent new blood borne virus infection, reduce undiagnosed infection and support those with blood borne viruses to live longer, healthier lives. (Scottish Government, 2010e).

Early Years

Improving the early years experience in Scotland is key to enabling us to address some of our most entrenched problems in terms of poverty, poor health, poor attainment, risk taking and anti social behaviour. This is backed up by a large body of research evidence from a variety of academic fields, including sexual health. That is why the Scottish Government and COSLA published the Early Years Framework in December 2008 (Scottish Government and COSLA, 2008a,b). The Early Years Framework sets the strategic policy direction for all early years' services.

Investing in children and supporting their parents to be the best parents they can be for their children helps to develop resilience and life skills that have implications far beyond the early years of life. It is in our very earliest years that we develop skills such as empathy, communication with others and co-operation with others.

The Early Years Framework makes clear that improving the early years experience is not only about what have been traditionally viewed as early years services, such as preschool education and childcare. Improving the early years experience begins preconception, but ensuring that young people are prepared for parenthood and our work with the Health and Wellbeing strand of Curriculum for Excellence plays a key role in this. The work being done by the More Choices More Chances teams around Scotland, helping young people into positive post school destinations, also contributes to this.

There are a number of specific initiatives that seek to support first time teenage parents in developing their parenting skills. These include the Family Nurse Partnership projects in Edinburgh and Dundee and the, the Barnardo's You First projects in West, East and Midlothian. All of these seek to build parenting capacity in order to break the cycles of inequalities that can be passed down from generation to generation (for further information see the following: http://www.scotland.gov.uk/Topics/People/Young-People/Early-Years-and-Family).

Getting It Right for Every Child ( GIRFEC)

The aim of Getting it right for every child (Scottish Government, 2006) is to ensure that we get it right for Scotland's children and young people by providing a framework for all services and agencies working with children and families to deliver a co-ordinated approach which is appropriate, proportionate and timely.

Getting it right for every child provides the how for positive change within children's services and adult services that have an impact on children and young people: how we can adapt and streamline systems to deliver the Early Years Framework (Scottish Government and COSLA, 2008a,b), Child Protection, Equally Well, Achieving our Potential (Scottish Government, 2008e) , More Choices More Chances (Scottish Executive, 2006b) and many more. It is crucial to supporting the delivery of improved outcomes for children and young people, from the highest strategic decision-making to the smallest practical actions.

Getting it right for every child provides mechanisms for identifying and planning how we help children and young people, set out in the 10 Core Components. It seeks to improve services and measure the impact they have on a child's wellbeing as expressed through the eight Wellbeing Indicators (Safe, Healthy, Active, Nurtured, Achieving, Respected, Responsible and Included). This includes wellbeing with regard to sexual health.

Inequalities

The Scottish Government firmly believes that there is no place in Scotland for prejudice or discrimination and that everyone deserves to be treated fairly, regardless of age, disability, gender, gender identity/reassignment, race, religion or sexual orientation. In one of a number of initiatives in this field, the Scottish Government has committed significant funding to support projects Scotland-wide that increase the visibility of LGBT communities, to build the capacity of these communities and work with public services to develop high quality practice for LGBT inclusion into society.

The introduction of the Equality Act 2010 has been a positive step to reduce prejudice and discrimination in our society. In addition, the NHSScotland's "Fair for All" programme aims to ensue that whatever the individual circumstances of people's lives, including gender and sexual orientation, they have access to the right health services for their needs.

Equally Well

Intervention in children's early years, in addition to continued support for early intervention at different stages over the lifecourse, are at the heart of the Government's continued work to address inequalities - as set out in the Equally Well Review 2010 (Scottish Government, 2010c). The latest review of Equally Well recommends a collaborative approach across different public services, with a key focus on early intervention.

Equally Well recommends that local agencies should provide high quality, consistent information to young people in a wide range of settings, including easily accessible drop-in services, staffed by health professionals and youth workers.

Reducing Antenatal Health Inequalities

Outcome-focussed evidence into action, Guidance for NHS Boards (Scottish Government, 2011b) has been developed to support NHS Boards increase their capacity to reach women in high risk groups as per recommendation 4 of Equally Well.

A recommended action for NHS Boards is to promote LARC to teenagers, women with substance misuse problems and women involved in prostitution prior to discharge from postnatal care. This guidance is a sub-set of the Refreshed Framework for Maternity Care (Scottish Government, 2011a). A national implementation support group is being developed to commission support tools for NHS Boards to enable them to carry out the specific actions in the guidance and to implement the refreshed framework.

Curriculum for Excellence

Education is a key tool in promoting positive sexual health and relationships and an understanding and awareness of blood borne viruses. Through the Health and Wellbeing outcomes of Curriculum for Excellence, sexual health and blood borne virus education will become part of the wider educational experience whilst also ensuring that young people, importantly including those who are more challenging to engage with, receive high quality education that equips them with the skills they require to maintain positive sexual health and wellbeing and prevent blood borne virus infection.

Drugs Policy

The Road to Recovery (Scottish Government, 2008f) strategy sets out the Government's approach to tackling Scotland's long-standing and serious drug problem based on the concept of recovery. Recovery is a process through which an individual is enabled to move on from their problem drug use towards a drug-free life and become an active and contributing member of society. Core to this is the reform of the way that drug services are planned, commissioned and delivered to place a stronger emphasis on outcomes and on recovery.

Alcohol Misuse

The Scottish Government Alcohol Framework: Changing Scotland's Relationship with Alcohol (Scottish Government, 2008c) sets out the Scottish Government's approach to tackling alcohol misuse. Taking a whole population approach, this includes supporting and encouraging people to make more positive choices about alcohol which will help them to maximise their potential both individually and collectively. The Framework links to work in other related fields, including on early years, poverty and health inequalities.

Refreshed Framework for Maternity Care in Scotland

There is increased emphasis within the new Refreshed Framework for Maternity Care in Scotland (Scottish Government, 2011a) on ensuring that the contraceptive needs of women, including Longer Acting Reversible Contraception ( LARC), where appropriate, should be addressed prior to discharge. This is included as a Key Quality Indicator in the Maternity Services Framework.

Health Promoting Health Service and Quality Strategy

Performance measures on the promotion and, where relevant, the provision of LARC in maternity and termination services have been developed as part of plans for an extended suite of Health Promoting Health Service performance measures. The intention is to embed the revised Health Promoting Health Service measures within one of the strands of the Quality Strategy.

Long-term conditions

HIV, hepatitis C and hepatitis B are considered to be 'long-term conditions'. A great deal of work is being progressed across the long-term conditions agenda within the Scottish Government which will provide support for people living with blood borne viruses.

Gender Based Violence

Addressing gender-based violence falls within our legislative obligations to promote gender equality as detailed in the Equality Act (2006) and within our responsibility to implement both the cross governmental Safer Lives: Changed lives: A Shared Approach to Tackling Violence Against Women in Scotland (Scottish Government, 2009c) and the Strategic Approach for Survivors of Childhood Sexual Abuse (Survivor Scotland, 2005). The National Domestic Abuse Delivery Plan for Children and Young People (Scottish Government, 2008d) developed under the auspices of Getting It Right for Every Child (Scottish Government, 2006) also includes a range of actions that have implications for the NHS, in particular the inclusion of a programme of routine enquiry of domestic abuse.

The Sexual Offences (Scotland) Act 2009 .

The Sexual Offences (Scotland) Act 2009 came into force on 1 December 2010 and reforms the law concerning sexual offences, replacing a complex patchwork of common law and statutory provision with a single statutory framework which reflects the values of modern society.

The Scottish Government has developed National guidance on under-age sexual activity: Under-age sexual Activity: Meeting the need of Children and Young People and Identifying Child Protection (Scottish Government, 2010d) as a consequence of the new legislation. It seeks to supplement Scotland's National Child Protection guidance and the Getting it right for every child approach. The guidance advises on how protocols can be developed locally to ensure the early identification and support for such children and young people and also, importantly to help ensure that in cases where there is no child protection issue, their needs are still met appropriately.

Mental Health

Through Towards a Mentally Flourishing Scotland (Scottish Government, 2009b), Scotland's national policy and action plan, the Scottish Government is committed to:

  • promoting and protecting good mental wellbeing, both how we feel (emotions and life satisfaction), and how we function (self-acceptance, personal control over our environments, purpose in life and positive relations with others);
  • preventing common mental health problems, suicide and self-harm; and
  • improving the quality of life of those experiencing mental health problems, e.g. by improving physical health and social inclusion.

The approach taken is based upon a social model of health which recognises that our mental state is shaped by our social, economic, physical, and cultural environment. Many of our more vulnerable members of society, such as those with addiction problems, with a blood borne virus infection, or with other poor sexual health outcomes may have associated mental health problems which need to be recognised and addressed. This requires a combined effort on the part of Local Authorities, the NHS, Third Sector organisations, the individuals themselves and their communities.

The health of gay and bisexual men, in general, is poorer than average. Levels of depression, self-harm and suicide are also higher in this community, with many facing discrimination because of their sexual orientation. In order to begin to address this, the Scottish Government is funding LGBT Scotland to deliver an effective specialist LGBT Mental Health Service in Lothian as part of the Demonstration Project, which is also assisting with building an evidence base around mental health intervention with LGBT people.