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The state of sexual health in Scotland

The draft Sexual Health and Relationships Strategy for Scotland: Its development, key recommendations and lessons learnt Shirley Fraser Sexual Health & Wellbeing Learning Network Co-ordinator. The state of sexual health in Scotland. One in four young people sexually active before age 16

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The state of sexual health in Scotland

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  1. The draft Sexual Health and Relationships Strategy for Scotland: Its development, key recommendations and lessons learntShirley FraserSexual Health & Wellbeing Learning Network Co-ordinator

  2. The state of sexual health in Scotland • One in four young people sexually active before age 16 • Pregnancies in under 16s falling • Majority of STIs have no symptoms therefore remain undiagnosed/untreated - chlamydia on significant increase • HIV still a major concern but not a recognised risk • 1 in 10 women experience sexual assault • Social disadvantage is strongly linked to poor sexual health

  3. The state of sexual wellbeing in Scotland • Many young people regret early sexual experience • Having more than one sexual partner at the same time is becoming more common • Less than half of parents talk to their children about sex and sexual health – no consistent approach to sex and relationships education • Alcohol and drugs influence sexual behaviour in all age groups

  4. Remit To draw up a sexual health strategy for Scotland with particular reference to measures: • To reduce unintended pregnancy and STIs • To enhance the provision of sexual health services • To promote a broad understanding of sexual health and sexual relationships that encompass emotions, attitudes and social context.

  5. Developing the Sexual Health and Relationships Strategy Engagement Exercise Evidence Reviews (Cochrane, Campbell, H.D.A) Literature searches (Medline, Embase, CINAHL) Project literature (Learning network information, Healthy Respect demonstration project, commissioned research) Expert opinion and current practice (reference group and their networks, Health Scotland, professional networks) Comparison (local strategies, other countries’ strategies) Revisions Briefing papers Reference Group Project Team Draft strategy and background papers Final strategy and background papers Submission to Scottish Executive Consultation on proposals

  6. Vision A society that accepts sex as a normal and healthy aspect of life, in which people understand the value of their own sexual health, the importance of responsibility and respect for others and have the capacity and means to protect themselves from unwanted outcomes of sexual activity.

  7. Overarching Aims • To influence the cultural and social factors that impact on sexual health • To support everyone in Scotland to acquire and maintain the knowledge, skills and values necessary for sexual wellbeing • To improve the quality, range, consistency, accessibility and integration of sexual health services.

  8. Key Actions • Providing national and local leadership • Setting clear national and local targets and goals • Using existing mechanisms • Monitoring progress to ensure delivery

  9. Promoting positive sexual health Through reducing: • individual barriers to empowerment & choice • Physical barriers to service use • Social barriers to services and knowledge • Cultural barriers at a societal and service level

  10. By addressing: • Lifelong learning • Schools/community • Consistent approach to sex and relationships education/Implementation of McCabe Report • Supporting teachers • Closer links between schools and services • Parents and carers • Through information and communication skills • Adults • Through workplace and leisure • Mass communications/media

  11. By addressing: Services through • An integrated tiered approach • Supporting access & reaching those in need of services • Targets and standards

  12. Service values & principles • Be sensitive, respectful, confidential, user friendly and culturally competent • Be provided in high quality accessible premises • Adopt a non judgemental approach to sexuality and sexual orientation • Actively involve users in service planning and implementation • Offer support/information to enable informed choices and fulfilling/healthy relationships • Have appropriately trained staff supported by appropriate resources

  13. Integrated tiered approach • Tier 1: Self management • Tier 2: Individualised information with some intervention • Tier 3: Community based services • Tier 4: Enhanced services • Tier 5: Specialist services

  14. Characteristics of tiered approach • Help provide a more flexible approach to service delivery • Represent a continuum in care: individuals may move through tiers for care or stay at one tier for all care • Choice of at least two providers for each tier • Allow staff in any setting to provide services from range of tiers

  15. Supporting service access Through: • Reducing barriers • More flexible roles • Better information • Maintaining confidentiality and anonymity • Improving infection control

  16. Targets and standards In relation to: • Identifying and treating sexually transmitted infections • Access to termination services and sexual dysfunction services • Access to specialist services within 48 hours

  17. Supporting Framework • Leadership and accountability: • National • Advisory Committee/Co-ordinator • Local • Inter agency strategy group • Lead Clinician • Managed Network/Co-ordinator • LA designated lead/school lead • CHP/locality lead

  18. What does the Strategy mean for Scotland: • A supportive environment for the positive promotion of sexual wellbeing • A culture of “Healthy Respect” • Reductions in sexual ill health • A multi-layered response including lifelong learning and services to enhance sexual health improvement

  19. An integrated response to sexual health and wellbeing in Scotland Lifelong Learning Supportive Culture Accessible Services

  20. Consultation Process and beyond • Formally issued for consultation – 14/11/03 • Series of formal and informal consultation events • Online submissions • Parliamentary debate • Targeted response uptake • Close of consultation – 27/02/04 extended to 15/03/04 – 1500 submissions to date • Analysis begins………………….final strategy launched winter 2004?

  21. Lessons Learnt (1) • Need consensus from outset regarding scope, remit, timescale and ownership • Over focus on sexual ill health rather than positive sexual wellbeing • Multi agency, multi professional approach important – led by unbiased “champion” • Listening to all interests but balancing disparity of views

  22. Lessons learnt (2) • Long way to go before evidence based policy and practice natural starting point for strategy development • Little evidence on what works beyond young people and specific sub populations • Tackling the Scottish psyche and culture

  23. Shirley Fraser Sexual Health & Wellbeing Learning Network Co-ordinator Health Scotland, Clifton House, Clifton Place, Glasgow G3 7 LS • Tel: 0141 300 1047 • Email: shirley.fraser@phis.csa.scot.nhs.uk • www.phis.org.uk

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