ENHANCING SEXUAL WELLBEING IN SCOTLAND- A SEXUAL HEALTH AND RELATIONSHIPS STRATEGY: ANALYSIS OF NON-WRITTEN CONSULTATION EVIDENCE ON THE DRAFT SEXUAL HEALTH AND RELATIONSHIPS STRATEGY
CHAPTER ONE INTRODUCTION AND BACKGROUND
THE DRAFT SEXUAL HEALTH AND RELATIONSHIPS STRATEGY
1.1 The UK fares badly compared with other developed countries in terms of the sexual health of its population. It has the worst rates of teenage pregnancy in Europe and within the developed world is second only to the USA. Teenage conceptions are both a symptom and a cause of social inequalities. Sexual ill health in Scotland remains poor. Growing numbers of people are being diagnosed with sexually transmitted infections (STIs), which have significant implications for those diagnosed and for onward transmission. Considerable numbers of people in Scotland report discrimination, abuse and sexual violence related to gender, sexual orientation or HIV status.
1.2 In response to growing concerns about Scotland's sexual ill health, in August 2002, the Minister for Health and Community Care appointed an independent expert Reference Group to draw up a strategy for improving sexual health in Scotland, with particular reference to measures:
to reduce unintended pregnancies and sexually transmitted infections;
to enhance the provision of sexual health services; and
to promote a broad understanding of sexual health and sexual relationships that encompasses emotions, attitudes and social context.
1.3 Membership of the Reference Group draws on those with interests in medicine, public health, education and sexual health and included representatives from voluntary organisations and religious groups. The draft strategy has also been informed by international and national evidence, including research specifically commissioned for this purpose by the Health Education Board for Scotland (HEBS) (now NHS Health Scotland) and the Scottish Executive and input from key stakeholders across Scotland through an engagement exercise. Eight supporting papers that informed the evidence base for the strategy are also available 3.
THE CONSULTATION PROCESS
1.4 The consultation process on the draft Sexual Health and Relationships Strategy (SHRS) was launched on 12 November 2003. The strategy was published in the form submitted by the expert Reference Group and submitted to the Scottish Executive (Scottish Executive 2003). It contained over 100 recommendations. The Minister for Health invited comment on any aspect of the strategy in total or in part. In particular, the Minister asked for comment on whether the strategy provides an acceptable framework for improving sexual health in Scotland or whether there are any points or issues that should be given greater or less emphasis.
1.5 The strategy was distributed to a wide range of consultees and was also made available in electronic format on the Scottish Executive website. The initial invitation to respond was sent to over 2000 organisations including those that have an interest in issues for children, disability, education, equalities, minority ethnic communities, justice, NHS Scotland and other medical interests, older people, religious and faith organisations and women's issues. Subsequently, in January 2004 a further call for responses was issued to ensure that the views of all sections of Scottish life and interests were included. This was addressed to key agencies with interests in social inclusion including minority ethnic and faith communities. In total, over 5000 copies of the SHRS were distributed. The main Web page received over 10,000 requests from the launch until 23 April 2004. The consultation process was conducted in accordance with the Scottish Executive's Consultation: Good Practice Guidance (Scottish Executive, 2003a).
1.6 The consultation exercise involved a number of components. There have been almost 1,400 written responses including submissions by e-mail and contributions to the electronic discussion forum. These are the subject of a separate report (Scottish Executive, 2004). In addition, a number of consultation and research exercises were conducted to open up the consultation to a wider audience. This report brings together the responses from those activities and reports on those elements of the consultation process that have taken a non-written form.
1.7 The Scottish Civic Forum (SCF) was commissioned by the Scottish Executive to host a series of consultation events across Scotland. These events were aimed at gathering views of different civic groups and individuals, in reaction to the draft Sexual Health and Relationship Strategy. The Scottish Executive also commissioned the Poverty Alliance to gather views on aspects of the proposals from members of the Poverty Alliance and Communities Against Poverty Network. In addition, Children in Scotland were commissioned to gather the opinions of young people (aged 14 years and over) on the draft Strategy and to identify significant areas of concern regarding its implementation. Finally, Research for Real was commissioned to monitor and advise on the consultation process, to manage the evidence arising from the associated research and to ensure that the consultation process drew on as wide a range of views as possible. This has involved a number of additional research exercises to gather the views of those for whom the SHRS is very relevant but whom otherwise may not have responded to the consultation exercise.
AIMS AND OBJECTIVES OF THIS RESEARCH
1.8 The specific aims of the research were to monitor and advise on the consultation process, ensure that the non-written consultation events contributed effectively to the debate and anticipate and identify 'gaps' in the consultation and address these by undertaking research with key groups.
1.9 This research is not intended to provide a definitive view of the draft strategy, but is an important part of the process of consultation to ensure that a wide range and depth of views are recorded. The views expressed illustrate the challenges that the draft strategy faces in implementation and in many respects, have raised as many questions as answers.
Research Methods
1.10 Consultation responses were tracked from the outset in order to anticipate and identify key gaps in the responses. It was anticipated that key population groups or their representatives for whom the SHRS is very relevant would not necessarily respond to the consultation exercise. A number of such gaps were identified and focus groups or interviews organised to gather their views on the SHRS, by engaging directly or indirectly with some of those who are identified as having the greatest barriers to good sexual health. These were people of African descent living with HIV; working men who are not otherwise categorised as 'young'; men who have sex with men but who don't necessarily identify themselves as gay or bisexual; commercial sex workers or prostitutes; and older people.
1.11 Four focus groups were organised through contact with voluntary agencies and other organisations working with the key target group. These were with:
African men living with HIV (African men group)
African women living with HIV (African women group)
Working men aged 20s-60s employed in different industries (Working men group)
Outreach staff working on LGBT issues (LGBT outreach group)
1.12 In addition, individual or small group interviews were conducted with nine individuals as follows:
Female commercial sex workers/prostitutes (Sex worker interviews)
A Consultant Clinical Psychologist working with older people (Consultant clinician interview)
A national voluntary sector agency working with older people (Older agency interview)
1.13 A number of events and meetings organised during the consultation process were also attended to provide insight into the anticipated responses and emerging gaps. These included those organised by the Scottish Churches Parliamentary Office and the Scottish Youth Parliament. Both these organisations subsequently submitted written responses to the consultation.
1.14 In addition, the approach included a quality assurance role in relation to the written responses and the consultation events. This was in part to inform the design and conduct of the fieldwork and to ensure that the analysis of the written responses and consultative events themselves contributed effectively to the debate by producing useful evidence of views. Fuller details of the methodology are included in Appendix 2.
1.15 The Scottish Civic Forum (SCF) organised eight events, one in each of the Scottish Parliament Regions of Scotland in February 2004. Over 100 people attended including those with a professional interest in the issues and lay people. The results of their analysis of the meetings have been integrated into this report. The Poverty Alliance (PA) conducted two focus groups in February 2004 with women in Greenock and Maryhill, Glasgow and their findings are also reported here. Children in Scotland (CIS) conducted five focus groups with young people (aged 14 and over) between January and April 2004. These include:
Young women who are mothers (Young mothers group)
Young men currently accommodated in a young offenders' institute (Young men group)
Young gay men (including care leavers), (Young gay men/care leavers group)
Young men who are fathers (Young fathers group)
Young women who are in third year at secondary school (Young women group)
1.16 Findings from these focus groups have been reported separately to the Scottish Executive and are also integrated into this report.
1.17 In addition, Research for Real was formally responsible for the moderation of the on-line discussion forum. In practice, this had very few contributions and to preserve anonymity these have been treated as written responses and incorporated into the analysis of all the written responses.
Structure of this report
1.18 The findings from all the non-written responses to the consultation process are reported here. The report is largely structured around the chapter headings and sub-headings used in the draft strategy itself. The data from all strands of fieldwork and consultative events is analysed thematically and reported together. The data available does not address all the recommendations made in the draft strategy. There is less data on those recommendations that focus on the administrative aspects of health services and medical issues. This is because participants were encouraged to respond to the aspects of the strategy that most interested them or which they felt most affected them.
1.19 For an overview of responses to the consultation process this report should be read in conjunction with the companion report on the written responses (Scottish Executive 2004). For ease of reference both reports are summarised in a single Research Findings (Scottish Executive 2004a).