NSHAC (2007) 47
NATIONAL SEXUAL HEALTH ADVISORY COMMITTEE
Minutes of the eighth meeting held on Monday 29 October 2007, Committee Room 1, Victoria Quay.
Present
Members:-
Ms Shona Robison MSP, Minister for Public Health (Chair)
Dr Nil Banerjee, Consultants in Genito-urinary Medicine
Dr Jenny Bennison, Royal College of General Practitioners
Hilary Campbell, Relate Scotland - Voluntary Sector
Dr Jim Chalmers, Information Services Division
Nicky Coia, Health Promotion Managers
Shirley Fraser, NHS Health Scotland
Dr Monika Fotedar, REACH Community Health Project
Professor Anna Glasier, Lead Clinicians, Sexual Health
Hawys Kilday, Caledonia Youth
Roy Kilpatrick, HIV Scotland
Dr Alison McCallum, Directors of Public Health
Wendy Peacock, Health Promotion Managers
Rev Andrew Phillip, Church of Scotland
Dr David Sutherland, NHS Education for Scotland
Angela Timony, Society's Scottish Executive & Consultant in Pharmaceutical Public Health
Dianna Wolfson, Scottish Interfaith Council
In attendance:
Major Jenny Campbell, Public Health & Substance Misuse Division (PHSM), Scottish Government
Mary Cuthbert, PHSM, Scottish Government
Tina Melville, Specialist Registrar
Dona Milne, PHSM, Scottish Government
Cheryl Paris, PHSM, Scottish Government
David Pattison, Specialist Public Health Adviser, CMO Directorate, Scottish Government
Apologies:-
Mary Allison, NHS Health Scotland
Dr Eric Baijal, Directors of Public Health
Gordon Currie, Schools Directorate, Curriculum Health
Prof. Peter Donnelly, Deputy Chief Medical Officer, Scottish Government
Marian Flynn, Glasgow Teenage Pregnancy Steering Group
Miranda Harvey, Scottish Parent Teacher Council
Shehla Ihsan, REACH Community Health Project, Glasgow
Donald Mackay, Directors of Education
Michael McGrath, Scottish Catholic Education Service
Jamie Rennie, LGBT Youth Scotland
Agenda item 1 & 2: Welcome, introductions and apologies
1. Ms Robison welcomed everyone to the eighth meeting of the National Sexual Health Advisory Committee (NSHAC) and introduced Rak Nandwani, CMO Specialist Adviser in GUM Services, who would present to the Committee on NHS Quality Improvement Scotland Standards; Edwin Van Teilingen, University of Aberdeen, who would present on Sex and Relationships Education in schools; and Sharon Ogilvie-Whyte, Jason Annetts and Jan Law from the University of Dundee and Abertay on the stock taking review of Respect and Responsibility.
2. Ms Robison then drew attention to changes which had been made to the Sexual Health Team following a restructuring of senior management responsibilities within the Public Health and Substance Misuse Division. As a result, Mary Cuthbert had now assumed lead responsibility for all aspects of policy development and delivery in the area of sexual health. The Team had been further strengthened by the arrival of Dona Milne, former Healthy Respect Development Manager, on secondment from NHS Lothian who would have a specific role within the Team for driving forward delivery of the implementation of Respect and Responsibility. These changes were intended to increase the focus on the delivery of the sexual health strategy while at the same time creating capacity for new policy developments.
3. Apologies were noted and Members' attention was drawn to the papers for information, previously circulated, and in case of paper NSHAC (2007)46 for comment to NHS Health Scotland by 30 November.
Agenda item 3: Note of the Seventh Meeting
4. The minutes of the seventh meeting of 25 June 2007 were approved without amendment.
5. Four matters arising from the last meeting were noted and discussed:-
· It was confirmed that the Secretariat had written to NHS Health Scotland to seek a replacement for the equalities representative from the Fair For All Team.
· It was noted that SG officials would pursue the Committee's actions on equality and keep Members up to date with progress in this respect.
· Hilary Campbell indicated that she had not managed to speak with Tim Street with regards to adding a section on counselling to the Education and Training report submitted by Myra Lamont at the previous meeting. As she was resigning from the Committee, it will no longer be pursued.
· Ms Robison confirmed the recommendations contained within the Education and Training report were being considered and would be fed into the stock taking review (Action: Secretariat)
Agenda item 4: Respect and Responsibility - Stock Taking Review - Sharon Ogilvie-Whyte
6. Ms Robison invited Sharon Ogilvie-Whyte and her team from the University of Dundee and Abertay who had been commissioned by the Scottish Government to undertake a stock-taking review of Respect and Responsibility to present their initial findings to the Committee.
It was emphasised that these were very much provisional findings and the full results would be presented at the meeting of NSHAC in February.
7. The team explained the methodology adopted a combination of face to face interviews and questionnaires and the progress made to date. It was emphasised the interim findings were based solely on information gleaned from 15 out of 19 interviews and might be subject to change when the questionnaire results are taken into account. Moreover, while the presentation of the findings would concentrate on generic issues, there would be a specific focus within the final report on various strands such as the voluntary sector.
8. Members noted the key points to emerge to date including:-
· A strong feeling that it is essential for strong national and local leadership of the strategy and the funding devoted to its implementation, to be maintained at the current level. In this latter respect it was noted that the outcome of the pending review SR 2007 would be announced on the 14 November 2007 and this would hopefully allow NHS Boards to recruit longer term staff for continued developments in service provision.
· An evident lack of knowledge of how to monitor and evaluate projects or services at NHS Board level and, where the knowledge does exist, there is often perceived to be a lack of resources at administrative level to undertake monitoring and evaluation.
· Support for the National IT System which is seen as crucial to the development of Sexual Health in Scotland.
· A perceived lack of engagement from some local authorities in taking forward the sexual health strategy, particularly within education/community education settings.
· Issues surrounding access to sexual health services and confidentiality in remote and rural settings.
· The feeling that the activity around Respect and Responsibility is too clinically focused.
9. Ms Robison thanked the Review Team for their work so far and said that she and the rest of the Committee would look forward with interest to hearing the final outcome of the review in February.
Agenda item 5 - Addressing Sexual Wellbeing in the Remote and Rural Context: The Way Forward for Clinical Services
10. Ms Robison invited Wendy Peacock and Shirley Fraser to present the findings of a sub-group of the Committee which was set up to review issues involved in providing clinical sexual health services in remote and rural areas and to make recommendations on how best to address these issues in order to promote positive sexual health and wellbeing.
11. A copy of the full presentation of the sub-group's findings is provided at Annex A. Some of the "possible solutions" suggested to improve the provision of sexual health services in remote and rural areas identified by the sub-group were:-
· consideration being given to Managed Clinical Networks and enhanced primary care services;
· better use being made of community workers, nurses and pharmacists; and
· steps being taken to address the inequity in prescription costs between primary and acute care
12. Members noted the findings and voiced general support for the recommendations contained within the report and, in particular, for consideration to be given to steps to address the inequity of prescription charges between primary and acute care and the development of a national PGD for free Emergency Hormonal Contraception.
13. Ms Robison thanked the sub-committee for their work. She said she welcomed the report findings and noted the views expressed by Members. She confirmed the recommendations made would be considered along side the wider review of action under "Respect and Responsibility" and taken into account in determining future strategic direction.
Agenda item 6 - Sex and Relationships Education (SRE) - Review of Programmes and Supporting Materials - Edwin van Tiejlingen
14. In introducing this item Ms Robison explained that NHS Health Scotland had commissioned a review of Sex and Relationships Education (SRE) in Primary and Secondary Schools as a result of an action set out in Respect and Responsibility. The review which was lead by Dr Edwin van Tiejlingen, University of Aberdeen, covered 3 main strands:-
a. a rapid review of the effectiveness of SRE programmes worldwide;
b. a mapping and appraisal exercise of existing SRE programmes in Scotland; and
c. a synthesis of how the evidence identified from Strand A fits with current practice in Scotland concluding with recommendations for policy, practice and research.
15. A copy of Dr van Tiejlingen's presentation of the review findings is provided at Annex B. Key recommendations made include:-
· age-appropriate SRE being started in primary school;
· improved continuity of SRE between Primary and Secondary schools;
· all SRE to be addressed before school leaving age;
· denominational schools to consider education for every pupil no matter their sexuality; and
· regular reviews by schools of SRE material;
16. In addition, it was recommended that there should be more research on those not sexually active and on the long term impact of SRE.
17. A full and frank discussion followed the presentation during which it was noted:-
· generally speaking there were few complaints of opting out of SRE and no evidence to support the parental boundaries around SRE;
· parents appear to find it difficult to discuss sexual health issues and therefore leave it up to the schools;
· most parents want teachers to teach their children about sexual health but also want better support for their role;
· there were concerns that the current State information was not sufficient and that the voluntary sector could be used to fill gaps where appropriate; and
· how important partnership working between parents, teachers, school nurses and the voluntary sector is.
18. Ms Robison thanked Dr van Tiejlingen for his presentation. She welcomed the findings and confirmed that they would be considered along side the wider review of " Respect and Responsibility" and taken into account in determining the future direction of SRE as part of the wider national strategy.
Agenda item 7 - Draft NHS Quality Improvement Scotland Sexual Health Standards - Dr Rak Nandwani
19. Ms Robison introduced Dr Rak Nandwani, Consultant in Genitourinary Medicine (GUM), who is leading a multi-disciplinary project group which is developing national sexual health standards under NHS Quality Improvement Scotland (QIS), and would update the Committee on the progress made to date.
20. Dr Nandwani's presentation is attached at Annex C. He explained that the draft standards, which were published in July 2007, had been consulted upon for a period of 3 months with final consultation events being held across the country in September. The standards are on schedule with pilot visits to NHS Boards taking place in November and the final publication scheduled for March 2008.
21. Members noted that the standards, when published, would help to improve sexual health services throughout Scotland in a number of areas. Issues of particular note being addressed in the standards are:
· urgent conditions being seen within 2 days
· chlamydia testing for young people
· access to the most effective forms of contraception
· reducing delays for women seeking abortion and prevention of further abortions
· specialist-led services throughout Scotland
22. A full discussion followed the presentation during which the main points raised were:-
· Dr McCallum called for a specific standard on young people - this comment had previously been fed in at the consultation stage.
· Members supported having a standard developed around people living with HIV.
· Reverend Andrew Phillip reiterated his support for the time limit for abortions being reduced. He expressed concern that abortion is apparently being seen by some as a form of contraception and also that doctors seem to have little choice but to carry out abortions. While noting these concerns, Dr Nandwani pointed out that these things were far from straightforward. In spite of Mr Phillip's concerns the fact is that women and their doctors did not take such decisions lightly. It is important for sufficient time to be available so that women can take advantage of the counselling and other support which is on offer both to assist in reaching a decision and after a decision is made. It was also noted that while doctors do have the right to conscientious objection, this should not cause undue delay to a patient seeking an abortion.
23. Ms Robison thanked Dr Nandwani for updating the Committee on the progress made and said she looked forward to publication of the standards in the Spring.
Agenda item 8 - Respect and Responsibility: Annual Updates from NHS Boards - David Pattison
24 . Ms Robison invited David Pattison to give a brief update on general issues arising from the submissions received from NHS Boards and Local Authorities in relation to their local progress in implementing the national sexual health strategy.
25 . Mr Pattison thanked those members of the Committee who had contributed to their local progress reports. He explained that as in 2006, he, Shirley Fraser and Joe Logan/Dona Milne had been undertaking a round of visits to each NHS Board and the relevant local authority to discuss progress on implementing the sexual health strategy. One of the issues discussed at each meeting was how each NHS Board had spent its additional funding and around any under spend NHS Boards had identified. Obviously, Boards were keen to know the outcome of the SR2007 Budget announcement would take place on 14 November 2007. He also explained that the e-health Board had commended the approach taken in developing the national sexual health data system and thanked all who had worked together to enable this to happen.
Agenda item 9 - Any Other Business
26. Ms Robison agreed to issue an update of the Scottish Government response to the HPV announcement which had been made by the Joint Committee on Vaccination and Immunisation. (Action: Secretariat)
27. She also thanked both Wendy Peacock and Hilary Campbell for the contribution they had made to the work of the Committee and wished them well for the future.
Agenda item 10 - Date of Next Meeting
28. Ms Robison reminded Members that the next meeting would take place on 4 February 2008. Future meetings would be held on 16 June 2008 and 6 October 2008.
NSHAC Secretariat