Section one: Setting the scene
Introduction
Sexual health and wellbeing matters to us all, no matter where we live or what our backgrounds are.
Good sexual health depends not just on effective sex and relationships education and the right health services in the right places, but on a host of other factors involving a number of different agencies across Scotland.
It also depends on people, both as individuals, in communities, as partners and as parents and carers.
Respect and Responsibility: A Strategy and Action Plan for Improving Sexual Health was published in January 2005 after extensive consultation and against a background of poor teenage pregnancy rates and rising incidence of sexually transmitted infections ( STIs).
Some £15 million of additional funding was allocated over the three financial years from 2005 to 2008 to help implement the strategy, which was based on the principles of respect for self and for others, on strong relationships and on recognising the diversity of needs and lifestyles of people in Scotland.
In last year's progress report on the strategy, we saw that the building blocks for implementation were being put in place. This years report shows how much further we have come - and sets out the challenges for the future.
The first two years
By the end of the financial year 2006-2007, some £10 million of additional resources had been distributed to help implement the sexual health strategy across Scotland. NHS Boards and others have made what in some cases are relatively small sums of money go an extremely long way. For example NHS Orkney, as one of the smaller Boards, has received under £20,000 per year under the strategy, yet services have transformed (see case study).
Just as the first year of the strategy saw important preparatory work, such as developing local strategies to suit local circumstances, employing and training members of staff and planning new services, the second year has seen these plans come to fruition. For example, many health boards have made considerable progress towards developing integrated sexual health services, incorporating genito-urinary medicine ( GUM) and family planning. Some, such as NHS Borders, have moved into new premises to amalgamate services on a single site. Likewise sexual health and relationships education across Scotland has been boosted, with many more professionals being trained and supported to deliver it appropriately.
There are also good examples of joint working between different parts of the health service, local authorities and with other agencies, including the voluntary sector. In some cases these are building on relationships developed in the first year of the strategy.
Throughout the report there are examples of how the strategy is being implemented and the improvements which are already benefiting patients and the public.
Sexual Health Strategy
Second Annual Report
Case study
Making good use of resources in Orkney
As a small health board, NHS Orkney's allocation from the money attached to Respect and Responsibility comes in at under £20,000 per year. Yet with such a modest sum the board has made considerable progress which is already benefiting patients. 'We've gone from a position where there were virtually no clinical services outwith primary care, with no local clinical leadership or overview in this area to us having an integrated sexual health and wellbeing service providing a broad range of services at a semi-specialised level, appropriate to the needs of our small population,' says lead clinician Dr Anne Nicolson.
'During the last two years the profile of sexual health has been raised considerably locally among both the public and healthcare professionals. Expectations of clinical service availability have also been raised and it is difficult now to imagine a return to solely GP provided services.'
Where we are now
Two years is much too short a time to judge the effectiveness of the strategy by looking at statistics. Significant change is a long term process and we are at the very early stages. Statistics do, however, provide a useful benchmark and give an idea of the scale of the challenge. Both Health Protection Scotland and the Information and Statistics Division of the NHS in Scotland have an important role in implementing the strategy (see page 35 for more details of their contribution) and help to give us an up-to-date picture of sexual health in Scotland.
The latest figures, published in November 2007 show a similar picture to the same time last year.
- In 2006, 17,926 laboratory diagnoses of chlamydia were made. This is an increase of 4% from that for 2005 (17,289), and a 45% increase from that for 2002 (12,391). Over 70% of diagnoses were in those aged less than 25.
- In 2006, 900 laboratory diagnoses of gonorrhoea were made. This figure is similar to that for 2005 (904), the highest number of diagnoses recorded during the past 10 years. More than three quarters (80%) of diagnoses were among men, more than half of these were men who have sex with men.
- In 2006, 246 diagnoses of infectious syphilis were recorded at GUM clinics; this is the highest annual total recorded since 1952 and represents a 31% increase on that reported for 2005 (188). Almost nine in ten of these were men who have sex with men.
- In 2006, 345 new cases of HIV were identified in Scotland; this includes 209 who had previously been diagnosed or presumed to have been infected elsewhere in the UK or abroad.
Source: ISD, Sexually Transmitted Infections and Other Sexual Health Information for Scotland, published November 2007.
Teenage pregnancy - main points
- The teenage pregnancy rate is counted as the number of deliveries combined with the number of abortions. It does not include miscarriages.
- The teenage pregnancy rate has been fairly steady for the past decade. In 2005 there were 56.7 pregnancies per 1,000 females aged below 20 (denominator is females aged 15-19) and 7.1 pregnancies per 1,000 females aged below 16 (denominator is females aged 13-15).
- There have been some changes in the balance between teenage pregnancies which are aborted and pregnancies which are delivered.
Source: ISD, Sexually Transmitted Infections and Other Sexual Health Information for Scotland, published November 2007.