Chapter 1: Introduction
The Sexual Health and Blood Borne Virus Framework sets out the Scottish Government's agenda in relation to sexual health, HIV, hepatitis C and hepatitis B for the next four years.
For the first time, these four policy areas have been brought together into a single integrated strategy. Building on the solid foundations of proven and successful Scottish Government policy, notably Respect and Responsibility (Scottish Executive, 2005) and the Hepatitis C Action Plan (Scottish Executive, 2006a Scottish Government, 2008a ). The Framework reflects an ambitious vision for sexual health and blood borne viruses in Scotland. It adopts an outcomes based approach anchored by effective shared ownership and joint working with a strong focus on challenging inequalities.
The Scottish Government, NHS Boards, Local Authorities and Third Sector organisations all have essential roles to play in progressing the Framework Outcomes, both individually and in partnership, and all organisations have been fully involved in the development of this policy.
In progressing these outcomes, the Framework will also recognise the commonalities that exist across Scottish Government policy areas, including drug and alcohol policy, Early Years, child and maternal health, long-term conditions, Curriculum for Excellence and Equally Well. It will build on these going forward to support improvements in sexual health and wellbeing and to effectively tackle blood borne viruses in Scotland. These policy links are set out in Appendix 3.
Why a Sexual Health and Blood Borne Virus Framework?
Sexual health and blood borne virus policy is currently detailed in three major strategies: the Hepatitis C Action Plan (Phase II) (Scottish Government, 2008a), Respect and Responsibility (including the National Outcomes 2008/11) (Scottish Executive, 2005) and the HIV Action Plan in Scotland (Scottish Government, 2009a). Currently no overarching national policy exists for hepatitis B that encompasses diagnosis, treatment, care and prevention. The development of the Sexual Health and Blood Borne Virus Framework reflects the importance of building on our previous successes and continuing work across these policy areas.
The Sexual Health and Blood Borne Virus Framework advocates interventions and approaches to improve health and wellbeing in Scotland. It is informed by knowledge of the economic case for interventions in all of these policy areas. This includes the cost effectiveness of HIV and hepatitis C anti-viral treatment, which is well understood and notably, the annual UK cost of teenage pregnancies - £63 million to the NHS alone (Teenage Pregnancy Strategy Evaluation Team, 2003).
The costs to Scotland arising from blood borne virus infections and poor sexual health are significant. The economic impact is felt directly by the NHS, Local Authorities and the Third Sector, but also indirectly by other organisations. Costs to the public purse include, but are not limited to, the costs of clinical treatment (drug treatments, psychological support and specialist care); social services and education.
In addition to the economic case for continuing to address the effects of blood borne viruses and seeking to improve sexual health and wellbeing, there is existing and emerging evidence of the need for and value of joined-up working in these areas. Specifically:
- the impact of inequalities: those most at risk across the Framework are amongst the most vulnerable members of our society and subject to both health and social inequalities;
- the importance of the Early Years agenda across the sexual health and blood borne virus policy areas;
- increasing evidence of cross-agenda working at practice and policy level by stakeholders and within Scottish Government;
- similar prevention, testing and treatment issues;
- the importance of providing a person-centred service, addressing all of an individual's health and wellbeing needs; and
- co-infection epidemiology.
While the Framework adopts an integrated approach to these policy areas, it also acknowledges that there are still areas where policy overlaps do not occur and where priorities differ. It is for this reason that the four policy strands are separately articulated in the body of the Framework.
This joined-up approach recognises the strategic links across sexual health and blood borne viruses nationally and locally but also acknowledges that operational distinctions exist.
The Framework does not mandate that structural change is necessarily required to deliver on outcomes. The need for structural change should be determined by local circumstances against consideration of the Framework Outcomes.
An Outcomes Based Approach
The Framework has been developed to promote an outcomes based approach. The Framework will support progress towards, and achievement of, a small number of high level sexual health and blood borne virus outcomes. These are outlined in more detail in Chapter 2.
Progress against the outcomes will be monitored nationally through a small set of indicators ( Appendix 1) using, wherever possible, nationally generated data (these data will be broken down by local area when feasible and where appropriate) and by reviewing progress in the context of Local Authority Single Outcome Agreements.
The Scottish Government and other partners will work together to ensure progress is maintained and that challenges do not become barriers to delivery.
While the Framework takes an outcomes based approach, this document also provides a number of recommendations for NHS Boards, Local Authorities, Third Sector agencies and other partners which set out the key approaches or deliverables that will support achievement of the outcomes.
These recommendations are drawn from best practice and are in line with Respect and Responsibility, the Hepatitis C Action Plan and the HIV Action Plan where relevant. They outline key issues that service providers need to give consideration to, or key elements of service that providers who are delivering best practice should offer.
Throughout this document recommendations or suggested key-approaches are highlighted by indented bold text with a square bullet-point.
A Quality Approach
The development of the Framework supports the ambitions of Scottish Government's Healthcare Quality Strategy for NHSScotland (' the Quality Strategy'), which was published in May 2010 (Scottish Government, 2010a). The Quality Strategy seeks to ensure that the highest quality NHS healthcare services are delivered in Scotland. Specifically, the Framework supports the Quality Strategy by:
- engaging with those most at risk of poor sexual health outcomes and/or blood borne viruses to ensure that they are able to benefit from our NHS services;
- ensuring that effective treatments, interventions, support and services are provided to people when they need them, whilst at all times working in partnership with our stakeholders to ensure that services provided are evidence based and appropriate and that unnecessary duplication is minimised; and
- ensuring that people are able to maintain high levels of health, good relationships and positive wellbeing; to live well through self management, improved health literacy and by supporting anticipatory and preventative responses through an assets-based approach to sexual health and blood borne viruses. (The asset model accentuates positive capability within individuals and supports them to identify problems for which they can activate their own solutions.)