Chapter 7: Supporting Delivery: Scottish Government and National Organisations
The Sexual Health and Blood Borne Virus Framework affects a broad range of stakeholders, both professional and public. Successful delivery will be underpinned by the breadth of knowledge, skills, services and systems in place across Scotland.
The Scottish Government
The Scottish Government will support the delivery of the Sexual Health and Blood Borne Virus Framework through the following national activity:
- Governance: Performance Management and leadership nationally across the Framework, including Ministerial leadership through the National Sexual Health and BBV Advisory Committee.
- Multi-Agency approach: The National Co-ordinators will work with local, regional and national structures and groups to support multi-agency cross sector working and communication in relation to the Framework across Scotland.
- Surveys: The Scottish Government will examine options for regular surveys to determine a) public satisfaction with sexual health and blood borne virus related services in Scotland and b) awareness and competency of staff and the extent of stigma and discrimination in sexual health and blood borne virus services.
- Awareness raising: The maintenance of awareness raising around sexual health, relationships and sexual wellbeing through the national 'Sexual Health Scotland' website ( www.sexualhealthscotland.co.uk). This will continue to promote positive sexual health and wellbeing, including the delivery of sexual health and wellbeing improvement messages through the website and other national communication initiatives.
- National media: Monitoring how sexual health and blood borne virus related issues are portrayed in the media, in Scotland, to determine the extent of unduly negative, inaccurate or biased portrayal and that which is positive and supportive. Options will be explored to work with media groups such as the National Union of Journalists, national broadcasting regulators and other key stakeholders, to agree a protocol on the way in which issues around sexual health and blood borne viruses are portrayed.
- the provision of national guidance on chlamydia testing and treatment, to augment SIGN Guideline 109 ( SIGN, 2009); and
- to review and, if necessary, update, the National Guidelines for Services Providing Injecting Equipment (Scottish Government, 2010b) to support HIV, hepatitis B and C initiatives to reduce the transmission of infection occurring from the reuse of injecting equipment.
- Supporting Improvements in Effective Contraception
- increased emphasis within the new Refreshed Framework for Maternity Care in Scotland, published in January 2011 (Scottish Government, 2011a), that the contraceptive needs of women (including LARC, where appropriate) should be addressed prior to discharge. This is included as a Key Quality Indicator in the Maternity Services Framework;
- the setting of performance measures for the provision of contraceptive advice and contraception (including LARC) in termination and maternity services as part of the Health Promoting Health Service;
- the promotion of improved uptake of LARC following discussion by the National Planning Forum; and
- the examination of cost effective service models for LARC in primary care, sexual health and maternity services by the Quality and Efficiency Support Team, Directorate for Healthcare Delivery.
- National Pharmacy Contract: To consider the role of community pharmacy in the provision of sexual health and blood borne virus services including the continuation of Emergency Hormonal Contraception in the national Community Pharmacy Contract.
- Primary Care Advice: The provision of regular advice ( e.g. via CMO letters) to primary care professionals to ensure consistency in the provision of sexual health and blood borne virus services including prevention advice, support and treatment and care.
- Integrated Care Pathway: the development, with stakeholders, of an integrated care pathway and care plan for HIV with associated documentation.
National Organisations will be accountable to the Scottish Government for the deliverables specified below.
NHS Education for Scotland ( NES)
Provision of strategic support in order to progress an integrated and cohesive approach to sexual health and blood borne virus workforce education and development:
- Establish NES facilitated expert advisory group(s) in relation to both blood borne virus and sexual health workforce education and development;
- Consolidate and progress, where appropriate, existing work undertaken as part of the Hepatitis C Action Plan, HIV Action Plan and Respect and Responsibility National Sexual health Outcomes;
- Carry out further workforce education development in line with the Sexual Health and Blood Borne Virus Framework, with guidance from NES expert groups, including:
- identifying and developing educational solutions (individual/combination as appropriate);
- identify the training needs of the hepatitis B and sexual health related workforce;
- developing a Sexual and Reproductive Health Nursing Competencies Portfolio; and
- identifying leadership opportunities for Sexual Health and Blood Borne Virus Leads within the existing NHSScotland National Leadership Framework.
- Support NHS Health Scotland in their work to examine sexual health and blood borne virus contextualisation for the generic Health Behaviour Change Competency Framework in order to support NHS and non- NHS staff (health/non-health).
NHS Health Scotland
Provision of strategic support work to build knowledge and capacity and offer specific evidence informed guidance, in relation to health improvement, to NHS Boards in support of the Framework including:
- The provision of deliverables carried over from the HIV Action Plan (Actions 6, 8, 9 and 10) and the Hepatitis C Action Plan Phase II (Action 16) including support to NHS Boards and local partners. Also, a supporting role carried over in relation to HIV Action Plan Actions 2, 7 and 11.
- To review, revise and update the SHARE educational resource and support potential development of exemplar materials in line with Curriculum for Excellence .
- The evaluation and maintenance of the Teenage Pregnancy Guidance and provision of support to Local Authorities and NHS Boards in implementing this Guidance (including the provision of a briefing note and practice sharing event).
- Production of guidance for NHS Boards and Local Authorities on addressing termination of pregnancy; with a focus on repeat terminations
- The development and maintenance of the Wellbeing in Sexual Health (Wi SH) Network; to include HIV and HBV and to enable the sharing of best practice, current issues and evidence via regular eCommunications and local, regional and national events.
- Substance misuse activities and partnership working extended to incorporate HCV where appropriate.
- To examine sexual health and blood borne virus contextualisation for generic Health Behaviour Change Competency Framework to support NHS and non- NHS staff.
NHS National Services Scotland Health Protection Scotland ( HPS)
The provision of strategic leadership, advice and programme support to the Sexual Health and Blood Borne Virus Framework, including:
- The provision of expertise and guidance to agencies associated with the Sexual Health and Blood Borne Virus Framework.
- The further development and maintenance of a range of information systems, including providing data and reports on:
- blood borne virus and STI prevalence, incidence and diagnoses; and
- blood borne virus treatment and care in relation to the specified Framework Outcomes and Indicators.
- The development and maintenance of National Networks and online resources ( e.g. Framework portal) to enable the sharing of best practice, current issues and evidence.
- The production of annual reports in association with ISD and other partners.
- The provision of strategic leadership and advice to Scottish Government and national agencies in the development and effective delivery of the Framework.
NHS National Services Scotland Information Services Division ( ISD)
Provision of statistical and analytical expertise and guidance to the Sexual Health and Blood Borne Virus Framework, including:
- The implementation and maintenance of a national data collection system to monitor the provision of injecting equipment across Scotland in line with the Scottish Government National Guidelines for Services Providing Injecting Equipment (Scottish Government, 2010b).
- Production of an annual report on the provision of injecting equipment across all NHS Boards in Scotland in line with the Scottish Government National Guidelines for Services Providing Injecting Equipment.
- To maintain information systems providing annual data on teenage pregnancy, termination of pregnancy and births; to make data available by CHP and Local Authority, where appropriate.
- To maintain the development of new sexual health data through the DASH Project, including the reporting of the Key Clinical Indicators for sexual health. The DASH Project will be central in supporting sexual health indicator monitoring.
- To facilitate the extraction of data from the National Sexual Health (Na SH) system for regular national reporting; reports to be defined.
- The production of annual reports in association with HPS and other partners ( e.g.SSHI).
In order to support the education profession to deliver sexual health and blood borne virus education within Curriculum for Excellence.
- Raise awareness of, and signpost, the Sexual Health and Blood Borne Virus Framework document across the education profession.
- Provide educational advice to support national and local partners in developing materials which underpin sexual health and blood borne virus education.
- Further develop the health and wellbeing and GLOW areas of the LTS website to support the education profession and partners who are delivering Health and Wellbeing outcomes.
Healthcare Improvement Scotland (formerly NHS Quality Improvement Scotland)
- While Scottish Government develop, monitor and performance manage the delivery of national policy for sexual health and blood borne viruses in Scotland (through the outcomes and indicators in Appendix 1), Healthcare Improvement Scotland assure the quality, safety and effectiveness of the underpinning NHS services.
- As part of the Healthcare Improvement Scotland Work Programme:
- To develop, publish, implement and maintain standards/indicators for HIV and hepatitis C.
- To support implementation and maintenance of standards for sexual health.
- To maintain SIGN Guidelines 92 (Management of Hepatitis C) and 109 (Management of Genital Chlamydia Trachomatis Infection), taking further advice into account as required.
- To assess the need for clinical advice, guidance or standards/indicators in relation to hepatitis B and to develop and implement accordingly.
- Provision of information on the implementation of Healthcare Improvement Scotland standards/indicators by NHS Boards to Scottish Government to support NHS boards progression against Framework outcomes.
NHS National Services Scotland National Procurement
- To explore the potential for the joint purchasing of HIV, HCV and HBV medicines to further reduce costs to NHSScotland.
- To explore the potential to extend the procurement of HIV Home Delivery to reduce costs to NHSScotland.
- To explore the potential for procurement of hepatitis B and/or hepatitis C Home Delivery to reduce costs to NHSScotland.
- To update and maintain the national contract for injecting equipment to further reduce costs to NHSScotland.
- To explore the potential for new block purchasing arrangements and other potential savings that may benefit the Sexual Health and Blood Borne Virus Framework e.g. oral contraceptives.
Scottish Prison Service
- Effective partnership with NHS Boards, Local Authorities and Third Sector partners to take proportionate measures and host support services that deliver the aims of this Strategy.
- To seek routes to continuous improvement of through-care that supports people with blood-borne virus infections to begin, and continue to receive, appropriate treatment.
- Sustain health promotion programmes that promote sexual health and relationships and to reduce risk behaviour that is capable of transmitting blood borne viruses.