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Section four: Providing better services

Key points:

• Patients across Scotland are already benefiting from improved services as a direct result of implementation of the strategy.
• Services across Scotland are at different stages of development, partly depending on where they started from.
• Key challenges around staffing, premises and resources remain.
• NHS boards and others are working together to find innovative solutions to overcome challenges.
• Rural areas face particular issues in ensuring access and choice of services.

Service redesign

When the strategy was published in 2005, sexual health services varied across Scotland and some areas had services which were much more developed than others. Obviously the areas which were less developed had further to go to meet the strategy objectives.

Progress is definitely being made, however. Last year we reported that a number of boards were drawing up plans to develop integrated GUM and family planning and reproductive health services. This year we can say that a number of these services are now up and running and treating patients, although some areas, notably Lothian, are still in the planning stages for one reason or another.

Again this year we can report that NHS Boards are making good use of sexual health strategy funding to employ more people and to provide targeted training for existing staff. Service redesign, making more use of healthcare professionals such as nurses and pharmacists in extended roles, has also transformed capacity in most areas of Scotland.

Rural areas too, which face particular challenges in meeting the strategy aims of access and choice of services, have been thinking innovatively about how they can do this, within the constraints of geography and funding.

Case studies

Patient choice in rural areas

A key recommendation in the sexual health strategy is to ensure that patients, where possible, have a choice of places where they can access services. While this is easier in cities where there are a number of service providers, it is more challenging in rural areas where there might be only one GP for several miles.

Nowhere is this more the case than for Scotland's remote and island communities, which have had to be imaginative to introduce patient choice within the restrictions of geography and tight resources.

Both NHS Orkney and Shetland have risen to the challenge by developing sexual health and wellbeing services which provide both GUM and family planning services. This serves both patients who do not wish to see their GP, perhaps because of fears around anonymity in a small community, as well as those who are referred by their GPs for more specialist help.

In Orkney, the new service involves an open access drop-in clinic at the Health Promotion Department every Monday from 4pm to 6.30pm and two clinics on a Wednesday afternoon at Kirkwall Health Centre. The latter is by appointment or referral only and is used mainly for procedures such as insertion of long-lasting, reversible contraception and endometrial biopsy.

'We chose the health promotion department because it is community-based and doesn't really feel like a clinical setting,' says lead clinician Dr Anne Nicolson.

'It was already known to the public as a place where health information on all topics was available, so we hoped this would help to "disguise" those seeking sexual health advice.'

Opening times were decided following consultation with young people and taking transport to and from country areas and the outer Isles into account.

So far, the clinics are proving popular with attendances rising each month. In May 2007 there were 31 patient contacts at the drop-in clinic.

NHS Shetland opened a new Sexual Health and Wellbeing Clinic in November 2006. Running on Monday evenings in the out-patients department of the Gilbert Bain Hospital in Lerwick, it provides both family planning and GUM services, with an emphasis on health promotion.

During the first six months, 53 women and 22 men attended the clinic with the numbers of weekly contacts more than doubling between the first and second three month periods.

'Although 22 men might seem a small number it is more than the team expected and demonstrates the success of the clinic in reaching men,' says Dr Susan Laidlaw, consultant in public health.

'The staff were also pleased to see a number of couples attending the clinic.'

'The general feedback has been positive and we are pleased that the number of people attending through word-of-mouth has been increasing.'

Unfortunately staffing issues meant that the service had to be halted temporarily and there will also be challenges in keeping the service going once sexual health strategy funding runs out in April 2008.

Dr Laidlaw is convinced of the benefits, however. 'Before the clinic started, people in Shetland had the option of seeing their own GP or going to Aberdeen or elsewhere in Scotland for sexual health services,' she says. 'For many people, especially young people, it might be difficult to explain to family why they needed to go to Aberdeen or even find the fare.

'The provision of a local sexual health and family planning service has meant that people can access services far more easily, costing less and involving less time and fewer explanations to others.

'We believe this has resulted in patients accessing the service who may not have gone to their GP or to Aberdeen.'

Case study

Making use of technology, old and new, to improve access in rural areas

Telephone and email consultations are being offered in Orkney to try to overcome some of the barriers to people living in remote locations.

Clinic staff at NHS Orkney's new integrated sexual health and wellbeing service are available to give advice to other health professionals, both by phone and by email.

'We find that this service is being used quite frequently and is appreciated, especially by some of the single-handed GPs from the outer isles,' says lead clinician Dr Anne Nicolson.

'We also offer this service to patients in the hope of overcoming some of the barriers to access caused by fears around anonymity and our remote geography.'

So far, few patients have taken up the opportunity of remote consultations but the service planned to advertise it more widely from the latter part of 2007.

Case study

Improving choice in rural areas

GP practices in Highland are helping to provide a wider range of specialist sexual health services closer to where people live.

Seven practices, most outside Inverness, have received funding to implement a locally enhanced service ( LES) under the new GP contract and two on Skye are hoping to do so soon. This amounts to around one in six GP practices in the former NHS Highland region or nine per cent including practices in Argyll and Bute.

Gill MacVicar from NHS Highland says introduction of the enhanced service is at an early stage because most practices found the level of service required challenging. 'Through our clinical lead in sexual health services, we negotiated a developmental approach and local specification with several practices across Highland and are working to encourage a better coverage to improve access,' she says.

'This is in addition to the core services for sexual health and family planning that are delivered by all practices and the service delivered by Highland Sexual Health.'

Highland Sexual Health and Obstetric and Gynaecology clinics are now also offered in Invergordon.

Examples of service redesign

Case study

A mini-Sandyford planned for every CHP in Greater Glasgow and Clyde

Mini sexual health clinics based in communities continue to open across Greater Glasgow and Clyde, bringing services closer to where people live.

While the focus of the sexual health services is Sandyford Central, the integrated service in the city centre, community 'hubs' are being set up across the region.

Between September 2006 and May 2007, hubs opened in Parkhead, Inverclyde, Springburn and Barrhead.

'Hubs include most of the services available at Sandyford Central, including a range of clinical tests, back-up counselling and information services,' explains lead clinician Dr Alison Bigrigg.

'The programme, which is due to be completed in summer 2008, will eventually result in a "mini-Sandyford" in each CHP and CHCP (Community Health (and Care) Partnership) area.'

The aim of the hubs is to improve access to services via expanded opening hours and a broadened range of services available locally.

Each hub is designed to meet the needs of its particular community. For example, Sandyford South-East, which opened in Govan in 2005, offers priority sessions for Urdu and Punjabi speaking women.

The hubs have found in general that they are attracting more patients than services which were there previously and were having some success in reaching target groups. For example, Sandyford Inverclyde, the first hub in Clyde, experienced an increase in male patients, including a number of gay and bisexual men.

Improved access in Tayside

NHS Tayside is working to improve access to sexual health services by opening more clinics outwith traditional consulting times.

The clinic system in family planning was revamped in 2006 to offer additional drop-in clinics and more nurse-led and procedure-specific clinics (such as for long acting reversible contraception).

Lunchtime and early morning clinics in family planning have been opened to provide choices which may suit women who are at work or in education.

There are also additional clinics in GUM with nurse practitioners treating more patients in shorter appointment slots. More new appointments have also been opened up because the number of follow-up visits has decreased thanks to introduction of a new self-care programme for genital warts.

Patients in GUM are now seen within one week for a routine appointment and within 48 hours for an urgent appointment.

In family planning, there is no waiting time for a routine appointment and patients who wish insertion or removal of long-acting reversible contraception can usually have it within a week.

Integrated service in Fife

Patients in Fife are now benefiting from a new, integrated sexual health service at the Beeches Centre in Forth Park Hospital, Kirkcaldy.

Both GUMSH and family planning (now called Contraception and Sexual Health - CASH) have moved in to the new unit which was officially opened by the then health minister in January 2007.

'Early reports from patients and staff suggest that the move has been successful,' says Dr Lorna Watson, clinical lead for sexual health in Fife.

'Facilities are brighter and more spacious with less crowded waiting rooms. Staff have access to more examination rooms causing fewer delays for patients and co-location makes referral between the services easier - and means both services can see a patient in the same clinic visit.'

Money allocated under the sexual health strategy helped fund the move, with £41,600 spent on equipment.

Now work is underway on an action plan to integrate the two services fully under one management structure and to develop joint clinics in Dunfermline and St Andrews.

The move has helped to improve access to services and has cut waiting times. For example, out-patient clinics for termination of pregnancy services are now held at the Beeches Centre and the number of clinics has doubled.

There is a daily nurse practitioner genito-urinary medicine and sexual health ( GUMSH) clinic for patients without symptoms of an STI and GUMSH has an open access policy with five or six slots per day for walk-in patients, who see either a doctor or nurse practitioner.

'The integrated sexual health service has proved popular with users, including LGBT users,' adds Dr Watson.

'For example, while in the past the GUM clinics shared a waiting area with other clinics, the GUMSH clinic now has a dedicated waiting room.'

The centre also provides improved physical access, with a ramp for wheelchair users and a reception designed specifically with their needs in mind.

Overhaul of services in Borders

Sexual health services in clinics in the Scottish Borders have been redesigned to improve the range, accessibility and visibility of services.

In February 2007, the Scottish Borders Sexual Health Service, integrating GUM and Family Planning, moved to new premises at the Currie Road Health Centre in Galashiels. The new centre provides a mix of specialist and combined drop-in clinics four days per week. All clinics offer core contraceptive and STI testing services, some with additional specialist services.

New drop-in services are being phased in across the Scottish Borders area, providing family planning and STI diagnosis and treatment in local health centres and non-medical settings. By mid-2007, new drop-in services had been opened in Hawick, Eyemouth, Galashiels and Duns.

Dr Dan Clutterbuck, lead clinician, says: 'With the full support of NHS Borders at every level, we've gained maximum value from additional strategy funding through joint working with NHS colleagues in gynaecology, health promotion and public health, with the local authority and the voluntary sector.

'With over 50 sites providing postal testing kits for chlamydia and 22 community pharmacies providing free emergency contraception, we are increasing the range of services available in medical and non-medical settings and we delivered sexual health education directly to around 10 per cent of people aged under 25 last year.'

Extended roles for pharmacists in Ayrshire & Arran

Pharmacists in Ayrshire & Arran are playing an important role in implementing the sexual health strategy.

Last year's annual report highlighted a pilot project which was underway into the feasibility of a community pharmacy-based chlamydia testing and treatment service. This is now being extended.

The pilot was carried out in 15 pharmacies in the North Ayrshire Community Health Partnership area and, in the first instance, targeted women who requested emergency contraception.

After interim evaluation in September 2006, the service was extended to include males and females who considered themselves to be at risk from chlamydia infection.

In the first phase, 76 testing kits were given out, 30 per cent were returned to microbiology for testing and there were four positive results. Between September and March 2007, a further 51 kits were given out, 55 per cent were sent back for testing and there were two positive results.

Pharmacists can treat those who test positive, who are then recommended to attend a GUM clinic for full screening and contact tracing.

In 2007-2008, it is anticipated that the pilot will be extended to allow interested pharmacists across Ayrshire & Arran to take part.

This will allow more effective marketing and awareness raising of the issue throughout the NHS Board area.

Nurse-led services

NHS Borders is making more use of the nursing workforce to expand services and improve access.

Two community nursing specialists in sexual health have now been employed (one in 2005, one in 2006), each covering particular GP practices in the Borders region.

The nurses are providing support, advice and training to help GPs and practice nurses who are offering sexual health services, as well as running drop-in clinics and supporting health promotion activity in schools and colleges.

A nurse-led clinic is also helping to improve access to long-acting reversible contraception, allowing up to five extra Implanon insertions per week.

Lead clinician Dr Dan Clutterbuck says: 'By capitalising on our specialist nursing workforce our small services provides at least 10 clinics every week at seven sites with the equivalent of less than one full-time doctor.'

Case study

working with GP practices in Greater Glasgow and Clyde

The Sandyford Initiative is developing more ways of engaging with general practices across Greater Glasgow and Clyde.

These include a specialist website for GPs, which provides information on other services, guidance on how to treat sexual health and reproductive health problems and patient information leaflets, which can be downloaded.

The Sandyford also runs a nurse helpline, from 9am to 5pm Monday to Friday. This receives around 600 calls per month.

Health advisors based at the Sandyford Initiative also offer advice and assistance to primary care clinicians taking tests for STIs. When a test is positive, the health advisor offers help as required in treatment and partner notification.

Involving service users in planning and improving services

Patient and public involvement is increasingly a priority and is a particular focus of the Scottish Government's consultation document, Better Health, Better Care, which was published this year. There are good examples of public involvement in drawing up strategies, meeting information gaps and improving services throughout the report. But here is just a flavour of some specific initiatives.

Case study

Consulting service users in Greater Glasgow and Clyde

Throughout the year, sexual health services in Glasgow conducted a number of surveys and other work to make sure service users' needs are being met.

This has involved ongoing consultations with existing and potential service users and finding ways of involving them in development and delivery or appropriate services.

A number of 'How was it for you?' surveys were held in different sites, including the Centre for Women's Health - where 30 women (88 per cent) said the service was 'very good' and Sandyford South East, where 29 out of the 30 people who responded were satisfied or very satisfied with the service they had received.

Different groups have also been specifically targeted in user involvement projects. These include the African Sexual Health Planning Group, which conducted focus groups in May and June 2006, attended by almost 60 people from different African communities in Glasgow. A work plan has been drawn up from the findings and this will be implemented over the next three years.

Case study

NHS Lothian doctors 'appraised' by patients

Patients at NHS Lothian's Family Planning Service in Dean Terrace, Edinburgh, have been invited to judge their doctors as part of attempts to ensure that visiting clinics is a positive experience.

Four consultant gynaecologists and two staff grades took part in the project, which involved asking randomly selected patients to fill in a short questionnaire after seeing the doctor. The patients were asked to comment on the particular doctor they saw, who then received the specific feedback.

'We conducted the survey over a four-month period because we felt that would give a true picture of performance,' explains lead clinician Professor Anna Glasier. 'Anyone can up their game if they are being monitored for one clinic - you can't keep that up for four months.

'The doctors felt a little nervous about it at first but we were delighted with the feedback, which showed a high level of satisfaction with the service. It's something we'd like to repeat on an annual basis and we hope to roll it out to other sites across Lothian.'

Around 120 questionnaires were completed and indicated a patient satisfaction rate of around 98 per cent. The only negative comment related to the Dean Terrace premises.

Patient comments included: 'I am impressed by friendly approach, easily understood and felt I was being listened to for a change - excellent service.' 'I was more than happy with the whole consultation from reception to minimum waiting to cheerfulness of staff and assistant and doctor. Lovely people, very reassuring and professional.'

The doctors themselves can use the results as part of the on-going professional appraisal system, which requires them to show that patients are happy with consultations.

Key challenges

Staffing remains a key challenge across Scotland, with some NHS Boards reporting difficulty in recruiting to posts, despite the availability of funding.

There are also some concerns around whether resources will be available to 'mainstream' services set up using sexual health strategy money at the end of the three-year initial implementation period.

Premises have also been an issue in some areas, particularly in Lothian and in Dumfries & Galloway where plans to develop an integrated service on one site have been delayed, but are now finally underway.

National committee tackling key challenges

The National Sexual Health Advisory Committee ( NSHAC), now chaired by the Public Health Minister, continued its work during 2006-07 and made progress against all its objectives.

Details on the work of the committee can be found on the Scottish Government website.

Clinical standards and targets

The strategy recognises that it is important to be able to monitor services, both nationally and locally, to ensure that they are improving.

NSHAC was charged with offering advice on developing targets appropriate to Respect and Responsibility. The group responsible for this has also been supporting NHSQIS in developing standards (see page 37).

In February 2007, the first five KCIs were published, covering chlamydia testing, access to male and female sterilisation, termination of pregnancy, HIV therapy and hepatitis vaccination for men who have sex with men.

KCI 6 on long acting reversible contraception was published in November 2007.

The performance of each NHS board against the first five KCIs can be found on the NSHAC website ( http://www.scottishexecutive.gov.uk/Topics/Health/health/sexualhealth/advisory-committee)

Dr Alison Bigrigg, who is leading on this piece of work for the committee, says the first report, which provided a baseline on individual health board performance compared to other areas of Scotland, has been actively used by Health Boards to plan priorities and service improvements as part of Respect & Responsibility. 'The second round of data, due to be published in February 2008, will help Health Boards to evaluate the extent their policies and new services have improved sexual health for local people,' she added.

Working together to improve sexual health

Implementing the strategy involves a wide range of groups and agencies, including schools, health services, the voluntary sector and parents. Across Scotland progress is being made in encouraging different agencies to work together more closely to improve sexual health.

Case study

Partnership working in Dumfries & Galloway

Dumfries & Galloway's sexual health strategy stresses the importance of partnership working. It is led by a steering group which involves representatives from a number of different agencies, including health services, local authority, voluntary agencies and service users. There is also a Young People's Sexual Health Steering Group which has recently taken on new members to give wider representation.

Financial support is provided by the local authority to a number of groups who contribute to sexual health, including South West Rape Crisis and Sexual Abuse Centre, Wigtownshire Women's Aid, Age Concern, Couples Counselling and D&G Coalition of Disabled People.

There is also strong partnership working with the area's GPs. Locally enhanced services ( LESs) have been agreed under the new GP contract so that GPs are paid a fee for inserting intra-uterine devices ( IUDs) with 19 out of the area's 34 GP practices taking part. A LES for Implanon insertion has also been agreed and 14 GPs in 11 practices in nine towns have been trained.

The use of link workers, most of whom are nurses, is also being pioneered. These workers actively promote the area's sexual health services by going out to different groups, including LGBT, looked-after children, homeless people, prisoners, substance misusers and people with mental health problems. 'We want our services to be accessible and welcoming to everyone,' says lead clinician Dr Maggie Gurney. 'But if people aren't accessing our services we want to make sure we are meeting their needs by going to them.'

Case study

joint working to address sexual health of young people in Glasgow

A Young People's Sexual Health Steering Group has been set up by Glasgow City Council and NHS Greater Glasgow and Clyde.

This is intended to improve the response of both organisations to the sexual health needs of young people, including how services respond to young women who become pregnant.

A Strategic Manager - Young People's Sexual Health is jointly funded by the council and NHS Board.

Over the last year, the partnership undertook a variety of activities, including reporting on the findings of a consultation with almost 3,000 young people and establishing the Talk 2 project to help parents talk to children and young people about sexual health and relationships issues.

It also developed a new core curriculum for sexual health and relationships education in schools (P1-P6), which will form the basis of a pilot Sexual Health and Relationships Health Promoting Schools Programme due to be piloted in 2007-2008.

Case study

Working together to meet needs of victims of sexual abuse and assault in Forth Valley

Fast track appointments for victims of sexual assault have been set up as part of the Forth Valley sexual health service.

Extra resources also mean that this client group can also have rapid access to post traumatic stress disorder therapy.

The move followed a seminar, held in June 2006, for those working in the field of sexual abuse, sexual assault and psychosexual dysfunction.

The seminar, which included a forensic physician and voluntary agencies, fostered links between different services and led to the setting up of a special interest sub-group of the Forth Valley Sexual Health Network.

The network identified care of men and women after rape and sexual assault as an area of particular need. 'Various options were considered and it was decided to promote services available to women and men, not only based in GUM settings but in family planning and voluntary agencies as well,' says lead clinician Dr Chris Kelt.

As a result, a leaflet is being designed to promote the support available in Forth Valley. People can refer themselves to the service even if they have not reported the incident to the police - potentially a much bigger user group.

In addition, a training event was held in June of this year (2007) for sexual health and other staff who might be first point of contact for those who had been assaulted, for example, people working in A&E. Local voluntary agencies also attended.

Case study

Joint working in Grampian

An integrated sexual health services plan is being developed in Grampian. The aim is to create closer working to bring benefits to patients and the organisations involved.

In 2006, both genito-urinary medicine and sexual and reproductive health transferred to the management of the Aberdeen City Community Health Partnership.

A service redesign group has been established to facilitate closer working between GUM and family planning, with the eventual aim of co-location in the Aberdeen City CHP Health Village, which is in the early planning stages.

'Although full convergence, working within one building, remains some way off, interim co-location arrangements are currently being explored,' says Chris Stewart, deputy general manger of the City CHP.

'We believe that closer working will benefit patients as well as helping us organisationally.'

Contribution of special health boards and Scottish Prison Service

The strategy makes a number of recommendations for other agencies, including special health boards and the Scottish Prison Service. All have reported progress and more detail can be found on each organisation's own website.

NHS 24

NHS 24 has responsibility under the strategy to make sure its systems are up-to-date in terms of both the way it deals with calls on sexual health issues and that they work with service providers to make sure that they have the best information on services available. The Board reported this year that its algorithms (the computer system used to support decisions of how to move people through the system) were up-to-date and that staff had access to library and e-library material on sexual health.

The organisation also said that the NHS 24 Knowledge Management team liaises with those providing services to ensure they have the most up-to-date information in each NHS board area.

NHS Education for Scotland

A great deal of work is being done to identify Scotland's sexual health workforce and ensure that staff are properly trained and meeting the right standards. NHS Education for Scotland ( NES) has been at the forefront of much of this work. Under the strategy, NES has responsibility for looking at career progression of doctors specialising in reproductive health, developing training so that nurse-led sexual health services can be extended, developing a competency-based framework to support implementation of the strategy and improving training at undergraduate and postgraduate levels. All of the above are in conjunction with other relevant groups, such as professional bodies and networks.

Progress is being made in all these areas.

Case study

In January 2006, NES published a second competency-based framework, A Route to Enhanced Competence in Sexual and Reproductive Health (specialist level). This builds on the non-specialist competency framework published in 2004. Both were drawn up by nurses and midwives with specialist knowledge in this area and both can be used either to prepare education programmes or to map existing education programmes.

The frameworks were evaluated and found to be well-received and the evaluation is being used to guide the next stage of the project. This includes integrating NES and RCN competencies into a user-friendly format, which will be piloted with a group of staff to ensure that it is easily understood before being rolled out across NHSScotland.

NES has also developed a competency record book for staff working at pre-specialist level. This booklet allows individuals to identify those competencies that are relevant to their own role and, with a mentor, to work towards gathering evidence to support achievement of competence.

NHS Health Protection Scotland and ISD

Health Protection Scotland and the Information and Statistics Division of the NHS in Scotland are making progress in meeting the recommendations in the report.

• Monitoring and disseminating information about new diagnoses and trends timeously so that the 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.

Moving Forward - Sexually Transmitted Infections, including HIV, in Scotland 2005 was published in November 2006.

This was the second annual report produced by the Sexually Transmitted Infection Epidemiology Advisory Group ( STIEAG), bringing together data from a variety of sources including laboratories, GUM clinics and primary care.

For the first time, it contains sections on ethnicity and work to allow data to be collected on disability is progressing.

The main findings include:

• In GUM clinics, a 10 per cent increase in workload in 2005 compared to 2004, partly explained by a large increase in uptake of HIV testing.
• Diagnoses of genital chlamydia increased by 8 per cent with around two thirds of women diagnosed in a non- GUM setting, eg at their GP while two thirds of men were diagnosed in a GUM clinic.
• In 2005 there were 405 cases of HIV identified in Scotland, most were new cases. This was the highest number of new cases on record and was up 11 per cent on the previous year.

For more information see the table on page 3 or access the full report via www.isdscotland.org.uk

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

Work has been ongoing to identify gaps in the data available and to consider options for addressing where the information is inadequate.

• Develop proposals for a national data collection framework.

The project leader post for the Data Augmentation for Sexual Health ( DASH) has been funded for another year. Proposals have been made to NHS National Services Scotland to develop a sexual health information programme for April 2008, although discussion is ongoing. There is recognition that a stronger infrastructure is needed to deal with the information needs of sexual health. An integrated IT system will be piloted in Lanarkshire during 2007-08 and will be used to inform further roll-out across Scotland.

NHS Health Scotland

NHS Health Scotland, Scotland's health improvement agency, is one of the key bodies involved in implementing the sexual health strategy. In 2005-2006 progress was made against all the actions identified in Respect and Responsibility. These include developing guidance, commissioning and disseminating research, developing information and raising awareness as well as playing an important role in sex and relationships education.

As NHS Health Scotland is central to the strategy, many examples of its work are given elsewhere in the report and more details can be found on its website, www.healthscotland.com

Case study

Shared learning on teenage pregnancy

In November 2006, representatives of 12 NHS Boards and 26 local authorities came together to discuss the issues facing them in implementing Respect & Responsibility. As well as hearing about national work, participants shared learning from both their own and other areas.

The event was organised by the voluntary agency Brook and supported by NHS Health Scotland, the Scottish Executive and the pharmaceutical company Schering, and particularly looked at initiatives to reduce teenage pregnancy rates.

There was also an overview of success factors identified by the Teenage Pregnancy Unit in England. Speakers included health professionals, managers and even a teenage mother who works with Brook in Oldham.

The conference was well-received with 91 per cent of delegates saying it was useful or 'very useful'.

Delegate comments included: 'All the English evidence was very informative and will inform my practice. It also reinforced the fact that my service is striving to do the right thing.' 'All very interesting and useful.' 'What was the most interesting part of the day? All of it!'

NHS Quality Improvement Scotland

NHSQIS was tasked with developing standards for sexual health services in Scotland. Draft standards have been drawn up and were published for consultation in July 2007. These are based around six key themes: access, capacity, co-ordination of approach, equity of service provision, patient choice and quality of care.

The standards focus on outcomes, not process as they are not intended to be prescriptive. Instead they are intended to inform NHS Boards' decision making, recognising that different solutions will be needed to respond to local circumstances.

There are 12 draft standards looking at particular issues. These are:

• Access to specialist sexual health services
• Information provision
• Termination of pregnancy
• Partner notification
• Sexual health care of people living with HIV
• Male and female sterilisation
• Chlamydia testing
• Hepatitis B vaccination for men who have sex with men
• Long-acting, reversible contraception
• Appropriately trained staff providing sexual health services
• Comprehensive provision of specialist sexual health services
• Local sexual health service delivery is consistent with national guidelines.

QIS anticipates that the final standards will be published in March 2008. The draft standards can be found via www.nhshealthquality.org

Scottish Prison Service

The Scottish Prison service has continued to work to meet its strategy objective of sustaining its commitment to health improvement and harm reduction, enabling availability of condoms and dental dams in young offenders institutions and adult prisons.

At a national level, condom distribution within prisons and young offender institutions is being implemented and staff, in conjunction with their local NHS boards, are being trained in the C-Card scheme to facilitate this. Currently this is at different stages in different parts of the country, but in Barlinnie, for example, 20 members of staff have been trained on providing C-Card and condoms for those in prison and when they are released.

Initiatives are taking place in prisons and young offender institutions across the country in partnership with NHS Boards, statutory organisations and the voluntary sector. For example, in Fife, a health worker visits prisoners from the area before their release, to provide advice and information on health issues, including sexual health.

Case study

The SPS has commissioned development of a Sexual Health and Relationships Education Programme aimed at staff and prisoners. The programme will provide the skills and knowledge to make positive choices about sexual health, improve equitable access to comprehensive sexual health services and influence the wider environment to promote better relationships and improve sexual health.

The programme will be developed in three stages with potential for a fourth. These are:

• Stage 1 - undertake a gap analysis to identify the needs of prisoners and the knowledge and values of staff via focus groups in each establishment
• Stage 2 - assess the available resources that could meet the identified educational needs and develop an appropriate training programme and associated materials to meet this need
• Stage 3 - pilot the programme in a cross-section of establishment, evaluating and updating as necessary and providing measurable outcomes
• Stage 4 - (optional) to support or lead on-going training.

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