ENHANCING SEXUAL WELLBEING IN SCOTLAND - A SEXUAL HEALTH AND RELATIONSHIPS STRATEGY: Analysis of Written Responses to the Public Consultation
CHAPTER 5: WIDER INFLUENCES
The Scottish Executive should ensure cross-departmental representation on the National Advisory Committee (NAC) on Sexual Health.
The National Sexual Health Programme Co-ordinator should work with the Social Inclusion Division to ensure that opportunities to improve sexual health through national policy are taken. Social justice policies and other policies or initiatives which address social exclusion and lack of opportunity in disadvantaged areas should encompass actions to address sexual health.
Local Sexual Health Co-ordinators should ensure that, within NHS Board areas, Community Plans and Local Health Plans address the issues that impact on sexual health, especially in relation to inequalities.
5.1 These recommendations were referred to mainly by Health Professionals and representatives of Equalities Groups. Less than a tenth of responses referred to the Co-ordinator and National Advisory Committee (NAC), with the considerable majority being generally positive or positive with qualifications.
5.2 There was, however, a call for further clarity on the specific roles of the Programme Co-ordinator and NAC. In particular, respondents were keen to know how these would link with Community Health Partnerships and other existing structures and strategies. Further issues and qualifications for those in agreement or partial agreement were as follows:
There were strong feelings that efforts must be made to make the NAC as inclusive and diverse as possible.
It was suggested that it must contain representatives from the following groups: Practice Nurses, Midwifery, Community Pharmacies, Voluntary Sector service providers, LGBT groups, gender equality groups, deaf people, people with learning disabilities, different Faith Groups and ethnic minorities.
As well as being inclusive in terms of the professions and organisations represented, it was also considered important for local issues to be recognised.
"The National Advisory Committee (NAC) must reflect the diversity of Scotland and recognise local issues." (Social Health)
"The committee should include a broad range of expertise and have complete geographical representation - including Highlands and Islands." (Medical Health)
"This is all-important to ensure that this agenda for positive change can be delivered effectively. If this group were to have a ministerial lead, with cross-departmental representation, it should ensure that it has the breadth of knowledge, credibility and authority necessary to affect change." (Equalities)
There were some suggestions about changing the name of the National Co-ordinator to reflect the importance of relationships as well as sexual health (e.g. "Sexual Health and Relationship Programme Co-ordinator" (Social Health)).
A minority of respondents were not in support of a NAC as they felt this would undermine local democracy - in particular, it would undermine the role of elected local councillors in making decisions about sex and relationships education within their local authority area.
"It must come under the control of locally elected representatives" (Individual)
"Local authorities in a much better position to oversee sex education" (Individual)
"Local authorities and schools should maintain their autonomy" (Individual)
The National Sexual Health Programme Co-ordinator should seek to influence Scottish Executive policies that cover the determinants of sexual health, including those addressing gender inequalities
5.3 For those who commented, this was seen as a particularly important recommendation. It was also noted that it would be especially important to adequately take into account the needs of other specific groups. For example,
"For people with a learning disability their influences may be slightly different i.e. that they are not given adequate information or support, that they are often seen by others as asexual, that they can be vulnerable and open to abuse." (Equalities)
5.4 In relation to accessing services and many other aspects of the Draft Strategy, Equalities Groups (among others) highlighted the need for the particular requirements of different groups to be taken into account (e.g. in relation to representation on strategy and advisory groups; the materials used in mass media campaigns; the education materials used for both young people and adults; the need to support parents, teachers, service providers etc. in understanding the needs of particular groups; deciding which are the 'hard to reach' groups and which are those facing the greatest barriers). Rather than continuing to list the groups that were mentioned in relation to each recommendation (e.g. 'the needs of deaf people should be considered here'), in general, we have quoted respondents only where specific points have been made (e.g. 'most materials are only suitable for hearing people'). However, it is important to note that some respondents indicated that the needs of various groups need to be considered throughout the Draft Strategy itself. The specific groups mentioned included: people with learning disabilities including those with profound and multiple learning disabilities, deaf people, victims of gender-based violence, male and female sex workers, LGBT people, HIV positive people and survivors of child sexual abuse.
The National Sexual Health Programme Co-ordinator should work with Scottish Executive colleagues to ensure that policies which impact most on people who are socially excluded include actions to address sexual health, for example, policies aimed at homeless people, those in prison, or young people looked after or leaving care
5.5 There was broad support for this recommendation across the range of different respondent groups.
"We are pleased to see that having acknowledged the link between deprivation and sexual ill health the strategy specifically recommends addressing sexual health issues in initiatives to tackle social exclusion". (Education and Young People)
"[this recommendation] can make a significant contribution to promoting sexual health, given that socially excluded groups generally face the greatest barriers to sexual health and wellbeing." (Education and Young People)
"We welcome the appointment of a National Sexual Health Programme Co-ordinator and agree that this Co-ordinator should have a strong focus on individuals and groups who are socially excluded, and thus develop an effective action plan to tackle stigma and discrimination around HIV and sexuality. Included in this should be a move from reference to 'high risk groups' to reference to 'more vulnerable groups'; this would begin to acknowledge the link between risk and social disadvantage." (Faith Group)
5.6 It was, however, suggested by some respondents that the Draft Strategy as a whole did not do enough to tackle some of the underlying causes of teenage pregnancies and what was described by many respondents as 'promiscuity'. Some thought the Draft Strategy failed address the underlying causes of 'promiscuity' and teenage pregnancies - such as deprivation, for example. Additionally, several respondents thought the issue of peer pressure should be given more prominence.
"Targets relating to teenage pregnancies need to be linked to other strategies as teenage pregnancies are a result and a cause of inequalities." (Social Health)
The Scottish Executive should develop an action plan to tackle stigma and discrimination around HIV and sexuality and to encourage a more positive view of sex and sexual health in all Executive policies, as part of the ongoing health improvement agenda
5.7 There was general support for this recommendation by the few who commented. An indicative response is as follows:
"… the recommendation is welcome. There is a real need for high-profile work to be undertaken to raise awareness of, and challenge stigma around, issues for LGBT people. We also believe that if this work was championed by the Scottish Executive, it will carry more credibility across the nation as has been seen with the 'One Scotland. Many cultures' campaign. (Equalities)
5.8 An additional specific point made was:
[We] have concerns, however, that stigma and discrimination around HIV and LGBT issues are place alongside each other so readily […] they are completely separate issues and, indeed, the popular connection between HIV and gay and bisexual men is one of society's stigmas that needs to be tackled." (Equalities)