The Scottish Government

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….

Each local sexual health strategy has been reviewed in terms of EQIA processes and updates have been received as part of the annual reporting process. Discussions with the Scottish Government Equalities Team have indicated the need to identify further actions which have taken place locally as part of the EQIA process. This will be actioned as part of the 07/08 reporting process.

A vacancy currently exists on NSHAC for an equalities representative - a replacement is being sought from the Equalities and Planning Directorate of NHS Health Scotland.

3

review the needs of rural communities.

A working group comprising representatives from remote and rural areas in Scotland was convened to address access issues around sexual health services. Over the course of 18 months they consulted widely on draft proposals to ensure that findings were grounded in practice as well as being evidence-informed. Actions covering both sexual health specific issues and general service issues pertaining to access in remote and rural areas were identified and presented to the October 2007 meeting of NSHAC. The results will be fed into the stock taking review of the strategy and other relevant policy areas.

4

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

This is being taken forward in a number of strands:

a)Learning disabilities:

Health Scotland commissioned a review of current evidence and practice around services, sex and relationships education and methods of involving young people and professionals in programme design and delivery. The review results have been pulled together in a summary briefing paper and accompanying action plan: these reflect the views of commissioners and practitioners who attended three consultation events. This has now been submitted for consideration as part of the stocktake review of Respect and Responsibility as well as being forwarded to the national implementation group reviewing the impact of the "Same as You" policy.

b)Ethnic minorities

In parallel to the work on learning disabilities, Health Scotland commissioned a review of the sexual health needs of young people from black and minority ethnic communities. The findings have been brought together in a summary briefing which commissioners and practitioners considered in late November: further consultation took place with the range of national and local stakeholders responsible for equality and diversity issues and for sexual health services. This work is now complete with the findings being fed into the discussions on the Respect and Responsibility stocktake review.

c) The Scottish Prison Service, with support from Health Scotland, have commissioned the fpa (formerly family planning association) to develop an appropriate sex and relationships education programme that takes account of the varied circumstances of different prisons, their workforce and prisoners. This work will be completed in March 2008 with the intention of rolling out across the prison estate thereafter.

d) Men who have sex with men

A review of the sexual health needs of men who have sex with men has been undertaken by an NSHAC subgroup: this includes an evidence review and update of current service provision. This work will contribute to the ongoing discussions on work to raise the profile of HIV and sexual health.

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.

This has been placed on hold pending the outcome of the Scottish Government Review of Health Improvement communications activities with a view to developing a social marketing approach. The intention would be to take this action forward in 2008/09.

7

8.

· recommend on further research on targeted learning interventions aimed at behaviour change in adults.

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

Health Scotland, in partnership with the Medical Research Council, commissioned a scoping review to identify potential research gaps and the knowledge of effective interventions to promote sexual health and wellbeing. This review identified that gaps existed in terms of knowledge at a Scottish population level, at UK population level and at international level for a number of groups who are at risk of poor sexual health outcomes. This work is being updated with a review of the research literature (published, pending and grey literature) relating to these population groups almost completed. A position paper with recommendations for further research and suggestions of areas that require a fuller review of the literature will be fed into the discussions on the Respect and Responsibility stocktake review.

Workstream B: Preventing Sexually Transmitted Infections and Unintended Pregnancies

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)

Health Scotland commissioned a review of sex and relationships education in Scottish secondary schools: detailed feedback from over 70% of schools has identified the range of programmes used, the training to support delivery and the involvement of parents and young people in development and delivery of such programmes. In addition, a series of six case studies demonstrate examples of how SRE is being implemented. The results of this review were presented to the NSHAC meeting in October 2007 and to a practitioner's seminar on 4 December. The full report and summary briefing will be made available by the end of March 2008.

To complete the picture, Health Scotland will shortly commission a parallel review of primary schools activities and it is hoped that the results of this review will complement the work in testing out the Respect programme in primary schools undertaken by the national health demonstration project, Healthy Respect.

Learning and Teaching Scotland and Health Scotland continue to collaborate in their support of local authorities to further promote sex and relationships education. LTS are building up examples of promising practice on their website.

11

· keep the HIV health promotion strategy under review to ensure its continuing relevance.

Initial activity has focussed upon gay and bisexual men and African and minority ethnic populations given the rising rates of HIV among these groups.

This has included a review of current service provision, associated funding and current epidemiology which has informed the development of key priorities for action that will focus on the prevention of HIV among men who have sex with men (MSM) as well as promoting positive sexual wellbeing among HIV positive MSM. The subgroup's report has been widely circulated among those stakeholders with an interest in HIV issues and gay and bisexual men - the findings have been fed into the discussions on the Respect and Responsibility stocktake review.

The African and Minority Ethnic sub-group membership is being brought together by the African and Minority Ethnic HIV Project Network supported by HIV Scotland. This subgroup will mirror the approach taken in the MSM subgroup. Given that the research undertaken by the MSM group also includes service provision for African and minority ethnic communities, it is anticipated that swift progress will be made in identifying priorities and in reporting to NSHAC in summer 2008.

Workstream C: Providing Better Services

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

A report on each Health Board's 2005 performance on the five Key Clinical Indicators (KCIs) developed to provide baseline information on a range of sexual health issues was made available on www.scotland.gov.uk/Topics/Health/health/sexualhealth/publications. It is anticipated that this reporting will happen on an annual basis with the 2006 performance being published in February 2008. In reporting on their 2006/07 activities, each Health Board has provided a commentary on their performance against these KCIs in their Annual Reports.

A Key Clinical Indicator on Long Acting Reversible Methods of Contraception was published at the end of November 2007. This has demonstrated a significant increase in prescribing of these methods during the period of Respect & Responsibility which is in line with national policy and our strategy. Simultaneously information on accessing GUM services through a Mystery Shopper project was released on www.isdscotland.org/sexual_health

Further consideration is being given to how to take forward an additional Key Clinical Indicator on sexual health services offered to individuals with HIV. One option is for individual HIV services to collect this data as part of the routine audit process with the data collated and published by the Information Services Division in line with the other KCI documentation.

The work undertaken to develop these Key Clinical Indicators has directly informed the draft Sexual Health Service Standards from Quality Improvement Scotland.

13

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

To support the collection of sexual health data, particularly for GUM and Family Planning services, work has been actively pursued in developing a National Sexual Health (NaSH) system. The national procurement exercise has been completed with relevant contracts authorised. NHS Lanarkshire will act as the pilot site with a subsequent roll out programme to other NHS Boards being completed by end 2009. National funding has been secured for the first two years for central hosting costs with the subsequent three years' costs being picked up by NHS Boards. The methods used in achieving this end outcome have been praised by the E-Health Board as an exemplar model of partnership working.

As well as supporting the data analysis for the Key Clinical Indicators, ISD and Health Protection Scotland have jointly brought together key interests to consider future data requirements with a view to securing internal resources to further develop national sexual health data collection within their respective organisations.

Consideration has been given to how sexual health information is collected through surveys. It is proposed that the way forward is to add questions to existing surveys rather than develop new ones: accordingly additional questions have been suggested for the next round of the Scottish Health Survey. Proposals to boost the Scottish arm of the "National Survey of Sexual Attitudes and Lifestyles" (NATSAL) due for 2010 will be submitted in early 2008 for consideration by Scottish Government.

At the end of November 2007, HPS and ISD published their annual report concerning Sexually Transmitted Infections (STIs) and other relevant information, including pregnancies. This report was preceded by the latest information on teenage pregnancies which was reported in such a way to make this data more easily comparable with data from England and Wales.

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 report outlining the current provision of training and suggestions for improving such education across clinical and non clinical professions was presented to the June NSHAC meeting. This drew on direct experiences of commissioners and practitioners and was widely circulated for comment prior to formal submission. The findings are being fed into the discussions on the Respect and Responsibility stocktake review and individual agencies will take forward relevant actions.

Further scoping work is underway with NHS Health Scotland and NHS Education Scotland (NES) to assess the reports and relevant documentation for common threads and overlaps. A submission to Skills for Health to develop appropriate competency frameworks for non clinical staff will be made for consideration in early 2008.

Actions for Health and Wellbeing Directorate

Progress Update - JANUARY 2008

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.

This action has been subsumed into the 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 be considered as part of the outcome to the recommendations proposed by the Education and Training Report submitted under 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.

Consultation with NHS Boards identified the level of interest in using postal testing kits to increase the uptake of testing of chlamydia among local populations. As this was not deemed sufficiently high enough to develop a national procurement contract arrangement, Healthy Respect agreed to act as the conduit to provide Postal Testing Kits to those Boards who requested them, namely Borders, Dumfries and Galloway, Lothian, Lanarkshire, Orkney and Tayside.

19

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

Further discussions have taken place with Healthy Respect and Gordon Scott, GUM Consultant NHS Lothian: this action is no longer relevant.

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 now removed this ambiguity from their website.

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.

This work has been progressed through the introduction of the Scottish Government's policy to Equality Impact Assess all future policies. The forthcoming Stocktaking review will generate actions for the future implementation of the strategy, these recommendations will be equality impact assessed prior to acceptance. In addition, sexual health will be added as an issue for consideration under the guidance for Better Policy Making within the Scottish Government.

Actions for Education and Life Long Learning Directorate

Progress Update - JANUARY 2008

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

Schools Directorate: Curriculum Division and Health and Wellbeing Directorate funded work being taken forward through the partnership of 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 have been piloted, further developed and were published by SCES in November 2007 with a view to these being used in schools from the 2008/09 school year.

Schools Directorate commissioned Learning and Teaching Scotland (LTS) in partnership with NHS Health Scotland to support the provision of sex and relationships education in schools. Funding has been provided to support a programme of professional development for teachers, build sustainability and disseminate leaflets to parents. 29 local authorities have submitted proposals and the remaining authorities are being followed up by LTS.

Schools Directorate 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 ability to seek support and their access to relevant, up-to-date information.

Glasgow Young People Sexual Health Steering Group is developing a Sexual Health and Relationships Policy (with guidance) for looked after and accommodated children. Once produced it is hoped 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.

A conference, led by Health Scotland and supported by Schools Directorate, LTS and CoSLA, was held in November 2006 for local authorities (education and social work) and health boards, to explain and clarify the role of local authorities in improving sexual health and relationships.

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

Schools Directorate is currently engaged on a wide range of work to support parents, and through parental support to strengthen families and the life changes of children, particularly in the early years. This work includes the pilot work conducted by Parenting Across Scotland (PAS), a voluntary sector consortium, of 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 information 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. PAS are also carrying out work to uncover and represent the parental voice in policy-making on a range of topics including SRE and sexual health.

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.

' We Can and Must Do Better' includes commitments to delivering high quality sex and relationships education and drugs education for looked after and accommodated children. Specific additional national training programmes for social workers have not been developed alongside this although ' We Can and Must Do Better' is a key strategic reference point for the Scottish institute for Residential Child Care, the major centre for delivery of education and training in the sector.

NHS Health Scotland

Progress Update - JANUARY 2008

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

(see also NSHAC Action 10)

The research on sex and relationships education in secondary schools is now complete: questionnaires were completed by schools from all 32 local authorities with 70% secondary schools coverage. A practitioner focused seminar was held on 4 December which heard about these findings and those from research on Tayside primary schools, together with contributions from Healthy Respect, Caledonia Youth and fpa will highlight the wide spectrum of SRE inputs.

A new resource, entitled Learning about sexual health at school and at home, and developed in partnership with parents has been disseminated to local authorities and schools. Targeted at those with children in upper primary and early secondary school years, this resource highlights the role of parents and schools as complementary SRE educators - copies of the resource, Talking with your Teenager about relationships and sexual health has also been circulated for distribution to parents.

To support the delivery of effective sex and relationships education programmes, two further SHARE Trainer for Trainers events were offered to education, health and other professionals - there were offered in different parts of Scotland to encourage more concentrated uptake in those areas who had not yet managed to partake in SHARE training.

33

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

(see also NSHAC Action 4)

Following a review of current research and promising practice case studies, two events were held for commissioners and practitioners highlighting issues for young people with learning disabilities accessing sexual health services and receiving sex and relationships education (based on their own perceptions). The recommendations for further action around research, policy and practice were considered at these events as well as more widely circulated for comment: the final briefing and recommendations will be submitted for consideration as part of the Respect and Responsibility stocktake review process as well as being posted in early 2008 on www.healthscotland.com/shw

A further print run of the review of sexual health and relationships resources for people with learning disabilities has been made due to the successful uptake of this publication highlighting the interest in this area.

34

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

A review of current practice and responses to confidentiality issues, particularly in relation to young people aged 13, 14 and 15 years has informed the ongoing discussions on how best to respond to the outcomes of the Bichard enquiry from a Scottish perspective. The tracking results of the latest campaign undertaken by Healthy Respect will further inform the next steps in the development of practical guidance anticipated by early summer 2008.

NHS Education for Scotland

Progress Update - JANUARY 2008

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 Faculty of Sexual and Reproductive Health. SHOs 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 Faculty of Sexual and Reproductive Health 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 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

Building on the previous work to develop competency based frameworks to support nurses and midwives, NES completed an evaluation to guide the current project phase. This includes: integration of RCN and NES competencies into a user friendly format; Targeted support; and dissemination to sexual health leads within CHPs. A small group of key stakeholders developed draft documentation which was 'piloted' with a group of staff to ensure that it is easily understood and is in a user friendly format. This has now been circulated to those within the NHS in Scotland with responsibility for the employment of, and for the education and training of, nurses and midwives.

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 and contributed to the NSHAC working group examining education and training issues.

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.

NHS 24

Progress Update - JANUARY 2008

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 Health Protection Scotland

Progress Update - JANUARY 2008

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

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

Incorporated into NSHAC Action 13.

43

develop proposals for a national data collection framework.

Scottish Prison Service

Progress Update - JANUARY 2008

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

Following the successful pilot to improve the availability of condoms and dental dams with one prison, this practice is being adopted throughout the prison estate.

The Family Planning Association have been awarded the contract for provision of a needs assessment and development of a sex and relationships education programme. The aim of the initiative is to provide staff and prisoners with the skills and knowledge to make positive choices about their sexual health, improving equitable access to comprehensive sexual health services and influencing the wider environment to help reduce unintended sexual ill health outcomes and promote better relationships.

The scope of the project, comprises of 3 inter-related stages: a needs assessment to identify the needs of prisoners and the knowledge and values of staff; an assessment of available resources that could meet the identified educational needs and develop an appropriate training programme and associated materials to meet this need; a pilot and evaluation of this programme in the prison setting.

NHS Quality Improvement Scotland

Progress Update - JANUARY 2008

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

The sexual health service draft standards were published in July with the consultation period closing in November 2007. As part of this process, two open meetings were held in Inverness and Glasgow. The feedback was positive with constructive comments to support refining the standards.

Two pilot visits, to Forth Valley and Ayrshire and Arran NHS Boards, took place in November 2007 with the main focus to test the measurability of the standards.

All comments received during the consultation period, and feedback from the pilot sites, will be collated and presented to the project group for consideration when finalising the standards. The response to all comments will be logged and available at the end of the process.

NHS QIS will also work with the project group to develop a self assessment tool and guidance notes for its completion. It has also been recommended that this work should include identifying the information/data sources required to evidence the standards and support their implementation by ensuring that such information/data collection is embedded within routine practice.

The final standards are scheduled to be published in Spring/Summer 2008.