The Scottish Government

1

to facilitate a co-ordinated approach to the integration of sexual health in wider Executivepolicies 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.

National Sexual Health Advisory Committee, chaired by the Minister for Health, established.

2

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 (EDIA) process

Information on NHS Board application of diversity and consultation with key stakeholders has been provided to John Wilkes. Unfortunately John Wilkes has had to tender his resignation as a member of the Committee and chair of this sub-group. A replacement member is being sought.

This action incorporates SE Health Department Action 16.

3

Review the needs of rural communities

The 3rd project group meeting was held on 2nd August 2006.

Analysis of evidence complete. Final selection of promising practice examples being undertaken.

Draft report available for consultation from end of October

4

In conjunction with the Sexual Health and Wellbeing Learning Network address the needs of those groups facing the greatest barriers to sexual wellbeing

Identifying sexual health needs of young people from BME communities :

Badged as part of addressing equality and diversity, the findings of the research will be presented at a dissemination event in early 2007 - this will be combined with the research around the sexual health needs of young people with learning disabilities. The focus will be on identifying how the recommendations can be implemented at a strategic level.

Three subsequent regional seminars will consider how the results can support practitioners.

5

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

Clear feedback from stakeholders has identified the need to develop key messages to underpin communications work at national and local level. This is backed up by the evidence review and examples of local media work. Work is being taken forward to develop proposals for a communications framework.

6

Review services and support for adult survivors of sexual abuse

Subsumed into the National Reference Group for Adult Survivors of Childhood Sexual Abuse which is being led by 2 professionals. Good progress is being made on the strategy and work to date includes initial development of 2 pilot projects on data collection with the intent of not only assisting in determining the kinds of services available but concurrently providing training programmes, awareness raising and "training for trainers" for frontline staff asking the questions. Work is also progressing on the design and creation of a website. This is intended to underpin the strategy and will be a source of information, guidance and contacts for anyone either seeking further information on services available, or seeking help on a personal or professional level. This will help to ensure that professional networks are established to help make practical and policy links in this area.

The Group is also working on a Development Fund. The Fund will allow organisations to apply to take forward existing services to areas that they perhaps do not cover at present, or to develop more innovative approaches to causes, prevention and counselling of childhood sexual abuse. It is hoped that the website and the development fund will be available towards early 2007.

7

Recommend on further research on targeted learning interventions aimed at behaviour change in adults

In order to assess the current state of research on sexual and reproductive health, a scoping exercise has been undertaken to map the amount and types of publications produced from 2003 to present day. This review has focussed on key target groups, and identified evidence gaps with a view to identifying those areas that would benefit from further research.

8

Offer advice on a sexual health research programme for Scotland in partnership with key policy, research and practice stakeholders in Scotland and elsewhere

See above

9

Regularly review progress of the Strategy, complemented by a more comprehensive 5-yearly review

A review of progress to-date will take place in 2007.

10

Consider how best to build on current good practice in school-based sex and relationships education (SRE) in Scotland consistent with the principles of the McCabe report

(NOTE: being combined with review of SRE programmes commissioned by Health Scotland)

The work commissioned by Health Scotland on the review of SRE programmes is progressing (see 58 above).

11

Keep the HIV health promotion strategy under review to ensure its continuing relevance

Actions across sub-groups

Initial activity focussed upon gay and bisexual men, with view to use experience and work of the sub-group and apply to other sub-group processes

Sub-group I - gay and bisexual men

Sub-group 2 - African and Minority Ethnic populations

Sub-group 3 - treatment, care and support

Work is progressing through the subgroups for Men who have Sex with Men (MSM) and African communities.

• Research Assistant to be employed to draft a proforma for review and audit of HIV-related service provision across two key sub-group topic areas
• AIDS (Control) Act Reports outline of approach to review of reports
• Research Assistant to be recruited on basis of bids against tender document issued

• Three meetings held to date
• Membership agreed, with additional names and links to other bodies, such as Blood Borne Virus Forum
• Agreed Terms of reference for the sub-group
• Scope of audit agreed - generic and related topics of work at health and local authority levels, and including education and equality/diversity
• Outline of key research topics agreed
• Initial review of key documents (especially the 2000 strategy doc) as a basis for future activity

• African and Minority Ethnic HIV Network meeting held to agree broad agenda
• Core of sub-group to be from the full Network with specific skills and expertise to be agreed and added
• Link with National Resource Centre for Ethnic Minority Health established and discussions to be held with local networks and key topic areas of work, e.g. training and community development
• First meeting of sub-group expected December 06

Following discussions across various bodies to examine respective roles, the responsibilities as originally outlined for this sub-group have been adopted by other bodies from within SE, British HIV Association and Scottish HIV and Aids Group. The sub-group has been dropped in the meantime. In the light of the work for the other two sub-groups, this area might be revisited at some point in the future, but there are no immediate plans to do so.

The key tasks for this sub-group had been - access to testing, antiretroviral drugs, community support and links between clinics/health facilities and local community agencies. Application of tasks and priorities across all transmission groups, and drawing upon expertise from various backgrounds, e.g. community, primary care, 'tiers' of service delivery and care/treatment

12

Offer advice on developing targets appropriate to this strategy

NOTE: this is being taken forward jointly with the group working on standards development allocated to QIS

Statistical analysis and commentary on the 5 agreed Key Clinical Indicators will be sent to the Scottish Executive by the end of December 2006. The Sub-group strongly recommends publication prior to the end of February 2007 seeks guidance from the Scottish Executive on the preferred mechanism for this.

Key Clinical Indicator 6 on Long Acting Reversible Methods of Contraception - data sources have been identified and are currently being validated. The Sub-group is on course to produce data and commentary by April/May 2007.

Sexual Health Care in People Living with HIV (Key Clinical Indicator 7)

The group has identified the preferred method of data collection as a case note audit. NSHAC agrees this will be taken forward by the Public Health Department attached to the Scottish Executive.

Key Clinical Indicator 8 on Specialist Staffing for Sexual Health is currently on hold pending consultation with the National Workforce Planning Group.

Key Clinical Indicator 9 on Access to Services for symptomatic individuals. The preferred method of data collection is through a mystery shopper project.

The NSHAC sub-group continues to liaise with QIS and all information collected will inform and complement the Quality Framework for Sexual Health services being developed by QIS.

13

Consider the proposals developed by Health Protection Scotland for potential adoption as a national data collection framework

The Working group has met on a number of occasions. Existing data sources have been systematically reviewed and a wide variety of stakeholders consulted in an effort to determine what information is required. From this work, the data deficits have been identified and a number of possible ways of addressing these have been suggested. This work was presented to NSHAC in June 2006.

Following on from the NSHAC meeting, further work is being done to describe the various options and determine how their costs and benefits could be assessed. Wider discussions are also taking place with SEHD staff in order to propose a national structure to deal with sexual health information.

14

In conjunction with NSHAC 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

The scoping exercise for medical, nursing, pharmacy and non-health care professionals has been completed. A reporting framework has been agreed and a draft report was presented to the Committee in October. A final report should be available with recommendations for the next meeting of the Committee in February 2007.

This action incorporates SE Health Department Action 15.

15

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;

Subsumed into NSHAC Action 14

16

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

Subsumed into NSHAC Action 2

17

Co-ordinate the development of a national sexual health training strategy to provide generic and specialist skills in sexual and reproductive health

This will follow on from work that will arise from the examination of current training and identified needs, NSHAC Action 14

18

Consider the possible extension of the Chlamydia postal testing kit in the light of the evaluation of the Healthy Respect initiative

NHS Board responses on likely demand received and forwarded to NSS/Scottish Healthcare Supplies. Initial indication of possible demand may not merit a national call off contract, however a meeting will be arranged with NSS to explore our options.

19

Consider the potential of development and testing of STI diagnostic kits in rural and urban settings

Project to explore potential of extended kit to cover gonorrhoea is being taken forward by Healthy Respect and NHS Lothian. A project board has been set up and a testing kit will be created and tested.

20

Explore with other stakeholders the need for clearer guidance regarding the reporting of negative HIV tests for insurance purposes

The Association of British Insurers has removed this ambiguity from their website. Action discharged.

21

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

The Executive is in the process of introducing a Scheme to promote equality and eliminate discrimination in the creation of policy. The Executive's Scheme will cover disability, race, gender, age, sexual orientation and religion and belief.

22

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.

In 2003/04 the pregnancy rate in 13-15 year olds was 7.5. This is a downward trend from 8.5 in 1995 and we are on track to meet our target.

The pregnancy rate in the most deprived communities has fallen, to 12.5 in 2002-04. However we recognise that there is more work to do to meet our challenging target. Boards are putting more effort into Health Promotion and we are exploring what additional work may be required to achieve our target.

23

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

SEED: Qualifications Assessment and Curriculum and SEHD: Health Improvement are funding work to be undertaken in partnership by Healthy Respect and the Scottish Catholic Education Service (SCES) to develop teaching resources and training in the use of these for Catholic schools (the 'Called to Love' project). These materials are to be piloted in summer / autumn 2006 in schools, followed by further development in the 06/07 school year.

There will be future work with Health Scotland and Learning Teaching Scotland to build on and mainstream the Healthy Respect schools resources and training.

SEED published Safe and Well in 2005. This is a benchmark of good practice in child protection in school for schools and education authorities, which includes a section on teenage pregnancy and under-age sexual activity. This reinforces the role of a proactive sexual health strategy in establishments and across the authority in developing children and young people's expectations of appropriate relationships and positive choices. It guides school staff on issues of sexual exploitation, to aid case-by-case judgments in relation to child protection concerns. The national implementation project for the National Review of Guidance (Happy, Safe and Achieving their Potential - a Standard of Support in Scottish Schools, 2004) will help education authorities and schools consider best practice in personal support to pupils in school (this project runs until 2008). Effective pastoral care includes developing children and young people's help-seeking skills and their access to relevant, up-to-date information.

With regard to the provision of support for those with learning disabilities in relation to Sex and Relationships Education (SRE), accessing sexual health services etc., there will be work potentially arising from Health Scotland's Learning Disabilities Evidence Review.

Greater Glasgow Health Board has developed a Sexual Health and Relationships Policy (with guidance) for looked after and accommodated children. It is anticipated that this good practice guide will be shared via the Scottish Healthy Care Network (for which SEED: Looked After Children & Young People's Division provided some start-up funding) and through Health Scotland's Sexual Health and Wellbeing Network.

24

Facilitate the delivery of high quality approaches to SRE consistent with national guidance, including multi-agency training, through partnership working involving education authorities, partner agencies and key stakeholders such as parents

Led by SEED and involving key stakeholders, further consideration is being given to the support and training for teachers to deliver high quality SRE in schools.

SEED is currently engaged on a wide range of work to support parents, and through parental support to strengthen families and the life chances of children, particularly in the early years. This work includes the piloting through Parenting Across Scotland, a voluntary sector consortium, of work to uncover and represent the parental voice in policy-making on a range of topics including SRE and sexual health, and the development of pilot Parent Information Point sessions. These sessions engage parents in a non-stigmatising setting with a broad range of relevant information and professionals, equipping them with the skills they need to be better parents to their children. The unique 'market-place' approach of these sessions is particularly suited to disseminating information around SRE and sexual health, and work is in hand to develop this dimension.

25

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.

Changing Lives (the findings of the 21st Century Social Work Review launched in February 2006) proposes to develop national priorities for social work services. The implementation plan was launched on 28 June 2006. This will allow all service provides to focus on an agreed set of goals. The performance improvement framework and national priorities will allow everyone to focus on how best to delivery and monitor the services delivered. The National Strategy for the Development of the Social Service Workforce in Scotland: A Plan for Action 2005-2010 in November 2005 is aimed at everyone who has an interest in developing the workforce and improving the quality of services to those who need it.

26

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

The commissioned work from Aberdeen University consortium is progressing - participating secondary schools are providing information on their SRE programmes with the intention of identifying case studies to illustrate the range of current activity and extent of partnership working. It is anticipated that this work will be completed by March 2007.

27

Develop information in a variety of formats targeted at parents and carers and youth and community groups

Two booklets, aimed at supporting parents and others in talking to young people about sexual health and relationships, have been produced. Feedback from parents identified the need for this in hard copy rather than only via the web - these will be available through schools, health promotion resource libraries and parents groups. The long-term aim is to have these available via Learning and Teaching Scotland. Further work is underway to develop a parents' leaflet on school based sex and relationships education building on the work promoted by the national health demonstration project, Healthy Respect.

A review of resources on sexual health issues for young people with learning disabilities aimed at professionals as well as parents/carers is available in hard copy and downloadable on the web.

In 2007/08 a review of generic sexual health resources will be undertaken to assess what is currently available, the potential need for nationally collated resources and the format most appropriate for target audiences.

28

Work to define and address the sexual health needs of older people and link with older people's strategies developed by NHS Boards

The Health in Later Life programme is considering how best to take this forward in 2007/08.

29

30

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

These two actions are being taken forward as part of the wider actions of the NSHAC on developing a sexual health communications framework.

Joint partnership with Healthy Respect in testing out local media campaign targeted at parents and significant others and aimed at reinforcing positive sexual health messages.

31

Disseminate evidence, commission research and develop resources to support the ongoing implementation of the Strategy

Commissioning of research/evaluation -

This includes the management of Healthy Respect Phase 2 evaluation and the ongoing dissemination of learning from Healthy Respect through learning exchange events.

Research has been commissioned on young people with learning disabilities and young people from BME communities with anticipated completion by end 2006. Both include feedback from young people, systematic evidence review and identification of case studies.

Arrangements are underway for a strategic level seminar early in 2007 to consider the findings: this will be followed by local seminars for practitioners.

Evidence Dissemination

To support the ongoing dissemination of learning from Healthy Respect and to widen knowledge of the sexual health evidence base, the joint Health Scotland/Healthy Respect Learning Exchange events continued with policymakers, commissioners and practitioners in health, local authority and voluntary sectors in ten NHS Board areas.

Evidence briefing papers have been produced on: the place of abstinence within sex and relationships education; and the effectiveness of condoms in STI prevention, together with:

three seminars focusing on the role of parents, identifying the needs of young people at risk and links between education and services, with an average of 100 participants in each; quarterly WISH newsletter and monthly e-bulletins; presentations to public health events on the outcomes of evidence reviews; and contributions to national and regional meetings mainly highlighting the evidence base as well as promoting Respect and Responsibility

32

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

To be taken forward following the outcome of the review of generic sexual health resources identified in item 61 above.

33

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

The Scottish Centre for Healthy Working Lives will consider specific actions for inclusion in 07/08 work programme. This will build on the current work undertaken as part of the Scotland's Health at Work programme.

34

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

- develops guidance for practitioners on female genital mutilation (FGM).

Arrangements are underway to disseminate the findings of evidence review, analysis of "grey" literature, promising practice and views of young people - this will take place in early 2007 under the banner of equality and diversity (to be held in conjunction with the work on sexual health needs of young people from black and minority ethnic communities).

Work has been completed on drawing together the views of commissioners and practitioners across three geographical areas. These findings are being shared with key stakeholders as a contribution to the ongoing debate. Action will now be taken to develop and consult on draft guidance to support practitioners, young people and parents around confidentiality issues.

Joint seminar held with NHS Greater Glasgow following which the proceedings report posted on web and made available to wider network. Seminar feedback indicated that due to small numbers, practitioners in Scotland did not wish additional guidance over and above that already available.

35

With Postgraduate Medical Deans and other relevant professional bodies, address issues affecting the career progression of doctors specialising in family planning and reproductive health

Training programmes are available and mainly offered by the Family Planning Association. Senior House Officers have a training budget which can be used for study. Registrars will attend sessions in Family Planning and GPs who have an interest in this area and who have identified in their PDP a need for this training are able to use funds paid directly to the practice. As most training is undertaken by the FPA there can be difficulty with the numbers requiring training with in some instances courses being over prescribed

36

In conjunction with practitioners, develop training and resources to enable the further extension of nurse-led sexual health services in primary and secondary care

The use of the competency framework: A Route to Enhanced Competence in Sexual and Reproductive Health Nursing/Specialist Level (see below for more detail) is designed to help practitioners develop the required skills to extend nurse led sexual health services. The framework was developed by nurses and midwives who have specialist knowledge in this area.

37

Work with professional bodies and professional networks to develop a competency-based framework to support the implementation of the strategy

NES has worked with service and educational staff to develop competency based frameworks to support nurses/midwives in their role. The first set of competencies: 'A Route to Enhanced Competence in Sexual and Reproductive Health Nursing' was published in 2004. The competency framework enables practitioners to reflect on their practice and to plan their development. The skills outlined in the competency framework enable staff to deliver enhance sexual and reproductive health care (i.e. at a level beyond initial registration, but not at specialist level)

The second competency framework, published January 2006: 'A route to Enhanced Competence in Sexual and Reproductive Health Nursing' (specialist level) builds on the preceding framework. Both competency frameworks can be used by educationalists to prepare appropriate programmes of education. Alternatively existing educational provision can be mapped against the frameworks.

As a follow-up to the development of the two new competency frameworks, an evaluation was completed, which is acting to guide the current project phase. This includes:

• Integration of Royal College Nursing and NES competencies into a user friendly format;
• Targeted and supported dissemination to sexual health leads within CHPs.

Overall, the materials are being received very well.

38

Work with key stakeholders to develop and enhance supporting training programmes at under-graduate and post-qualification levels

NES continues to provide advice on education programmes both at undergraduate and post-qualifying levels. During 2005 nursing and midwifery programme leaders were asked to comment on how sexual health policies are addressed in their education provision. This was part of annual monitoring carried out by NES for Scottish Executive Health Department (Nursing).

For pre-registration education students had developed strong communication skills which included knowledge of how to refer clients with sexual and reproductive health need to appropriate sources of support/services.

Post-registration programmes are being supported by the development of the competency frameworks and the independent evaluation of their use.

At undergraduate level, NES is pursuing this through the Heads of Medical Schools in terms of the undergraduate curricula. At post-qualification level, the Transitional Boards will take this on as part of their workstream.

39

Develop algorithms which provide accurate and appropriate advice consistent with that given by sexual and reproductive health service providers

The decision support algorithms are reviewed in accordance with the NHS 24 clinical governance strategy, which health service providers includes alignment with publication of relevant national clinical guidelines. The decision support algorithms provide both appropriate limited advice and dispositions (which indicate the level of care required by the patient). Additionally, Health Information Advisors and Nurse Advisors have access to Quality Assured Websites, the NHS 24 intranet / knowledge web and the Health Information Support (HIS) directory that all provide updated clinical and service provider information. In addition, Frontline staff have access to library and e-library material, which includes sexual health material.

40

With service providers, ensure that they have the knowledge of up-to-date and relevant service provision.

The NHS 24 Knowledge Management team liaise with all up-to-date and relevant service provision partners to ensure that local service provision details are kept up to date. This is achieved through the 'Update and

Maintenance Process' and managed by the Knowledge Management Team in conjunction with the local geographical Board leads for the maintenance of this local service information. NHS 24 Knowledge Management to establish link with SEHD Sexual Health Strategy team.

41

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

Incorporated into NSHAC Action 13.

42

43

Lead action to develop standardised data collection to support the development and monitoring of sexual and reproductive health services

Develop proposals for a national data collection framework.

Incorporated into NSHAC Action 13

44

Take forward the development of appropriate clinical standards for dealing with sexually transmitted infections in its 2005/06 work programme, in consultation with the Scottish Infection Standards and Strategy Group

Dr Rak Nandwani was appointed as clinical adviser to NHS QIS for sexual health in July 2006. A project team from the Standards Development Unit has been identified to work with Dr Nandwani to take forward, in the first instance, the development of standards for sexual health services. Work currently in progress is the gathering and updating of the evidence base, working closely with NSHAC.

45

Sustain its commitment to health improvement and harm reduction enabling the availability of condoms for males and dental dams for females throughout the course of their detention in young offender institutions and adult prisons

All SPS establishments have now established links with NHS Boards and are working in partnership to progress sexual health initiatives for the prison population.

A Pilot is currently underway at Cortonvale Prison as part of a Choose life initiative, and a Counselling service supporting women with a history of Sexual abuse has recently been evaluated

We are also presently undertaking a rapid appraisal of current sexual health need across the estate.

Two research proposals have recently been submitted to assess sexual health needs for prisoners and are currently under consideration