Agenda item 3 is the committee’s inquiry into teenage pregnancy. Members will recall that the committee published its report on the subject in June last year and we received the Scottish Government’s response in September.
I welcome Michael Matheson, the Minister for Public Health; Felicity Sung, national co-ordinator: sexual health and HIV; Gareth Brown, head of the blood, organ donation and sexual health team—[Interruption.] I am sorry; my script says that we are joined by Gareth Brown, but he is at the back of the room. We can call on him if we need to. We are also joined by Colin Spivey, team leader in the Scottish Government’s learning directorate. Welcome to you all.
I invite the minister to make a short opening statement.
Thank you, convener.
I take the opportunity to welcome the committee’s efforts to highlight teenage pregnancy as an area of further focus. I appreciate the recommendations that the committee made in its wide-ranging report and would like our dialogue in this area to continue. It is important that the committee is engaged in the work that we are doing on teenage pregnancy across government, most notably through the teenage pregnancy and young parents strategy.
The data shows us that rates of teenage pregnancy have reduced in all age groups over the past four years. As I mentioned when I gave evidence to the committee previously, that is a significant achievement, and I would like to pay tribute to those who have worked tirelessly to support our young people and thus achieve such results.
In the light of that reduction, some people might ask why we need a teenage pregnancy and young parents strategy. The improvements that have been made in sexual health have had a major impact on unintended pregnancy among young people. That will continue to be a priority and an area of investment under our sexual health and blood-borne viruses framework but, as the committee rightly acknowledged, it is the wider determinants and interventions to which we now need to turn our attention.
A great deal of good work is already being done in that area, as is made clear in the evidence that was submitted to the committee. Some of the work that we need to do will involve bringing those elements of best practice together. That is true in relation to policy and to the work that is being done across local government, NHS boards and the third sector. We are delighted that Professor John Frank of the Scottish collaboration for public health research and policy has agreed to chair the strategy’s steering group. His vast experience will be invaluable, particularly in looking at the wider determinants associated with teenage pregnancy and health inequality.
We intend that the strategy will focus on three key aims: to continue to reduce rates of teenage pregnancy; to respond to and support young women who become pregnant; and to support positive outcomes for young parents. We do not underestimate the breadth of work that that represents, but we are confident that the partners on our steering group provide the range of expertise and enthusiasm that is needed to take forward the strategy effectively and positively.
I am more than happy to respond to any points that the committee wishes to raise.
Thank you, minister. Bob Doris has the first question.
When we carried out our teenage pregnancy inquiry, we visited Smithycroft secondary school in Glasgow. One thing that struck me was the positive contribution that the young mothers unit there makes not just to the lives of the children and the mothers in the unit, because there is a wider benefit for the whole school.
I mention that for two reasons. Depending on where someone is in the country, such provision might not be available. Does the Scottish Government have a feel for the extent to which local authorities should provide such high-quality specialist units instead of—for want of a better description—mainstreaming provision for teenage mums in secondary schools?
My experience is that young mothers who have been through the process are among the best informed about developing a sexual health and relationships strategy, so I will sneak in a second question. What role do young mothers who have been through the life experience of falling pregnant and getting on with the job of being a mum while being a teenager have to play in informing a sexual health and relationships strategy?
As a number of committee members did, I visited Smithycroft secondary school in Glasgow, which is based in the east end but supports young mums from different parts of the city. I was very impressed by the quality of the work that it does and the intensity of the programme that it undertakes with young mums.
As we discussed the last time that I gave evidence to the committee, our approach is to consider how we can not only build on the work that we have done to reduce unintended pregnancies among teenagers but support young parenting for those young women who become parents, who we know can face certain barriers in accessing services. We want to look at what we can do to ensure that our colleagues in local authorities who are working with us in this area do that much more effectively, and the approach that has been taken at Smithycroft is a very good model. One aspect of developing the new strategy lies in determining how we can build on the types of things that we can learn from Smithycroft and use them in different local authority areas.
Although the steering group will decide what will be in the strategy, we do not intend to propose one model that must be applied across all local authority areas—we want to allow for flexibility. There are key principles around the services that should be made available, and those principles should underpin how services are designed at a local level.
The new strategy is intended to work on the good progress that we have made around reducing unintended teenage pregnancies and consider what further measures should underpin the work that is carried out at a local level by local authorities, health boards and third sector colleagues to support young women who become parents.
We know about certain factors around that. A key aspect of the approach taken at Smithycroft involves maintaining young women in education. There had been a tendency for young women who became pregnant while still of school age to drop out of education, and there are consequences from that. If we can provide those young women with the right type of support at that point, so that they can make a positive choice and can go on to a positive destination, that not only helps the young mother, it improves the outcomes for the child.
It is not a question of using one particular model, but the Smithycroft model highlights the good principles that should underpin the delivery of services for young parents.
I agree with that. I had written down “flexibility and choice at a local level”. Smithycroft is clearly an excellent example of where a local authority has got the planning of support services for teenage mothers right. The school is excellent at promoting positive parenting with the children.
I asked how the experiences of mothers could be fed into any refreshed strategy. Previously, there was a lot of talk about the fact that relationship education in the very early years—at primary school—covers a variety of factors that can lead to people making either informed or uninformed choices later in life. The mothers whom we met love their children dearly and are making a wonderful success of parenthood. The point is to learn from what they think did or did not go wrong in their experience of not just education but their wider relationships, their interaction with local youth services and so on. If you are still thinking about it, that is great, but will there be a mechanism to feed in the direct experiences of teenage mums?
The steering group that Professor Frank is heading up has a range of individuals on it, including a representative from Smithycroft who is involved in delivery of the service, and they will use their experience to feed in directly to the group’s work. The steering group will determine the best way to gather the evidence that it requires and who it will engage with; we are not prescribing that. However, we have put together a wide-ranging steering group to start the process that will take place over the coming months.
I have no doubt that the steering group will wish to engage directly with young parents. How that is facilitated is obviously a matter for the group. Once the group has drafted its paper, there will be a consultation exercise before any strategy is finalised. That will provide an opportunity for individuals to be involved. I am more than happy to consider how we in the Government, when we consult on the matter, can build into the process an opportunity for young mums who have experienced some of the services that are provided to comment on what is contained in the draft strategy.
As I say, one of the individuals who was involved in developing the Smithycroft project is involved in the steering group that will develop the new strategy.
I will perhaps come back in later on but will let some of my colleagues in for some questions first.
11:45
First, I welcome John Frank’s appointment. His is an excellent appointment, and I am sure that he will do a great job for the Government and for Scotland on this issue.
Minister, as you will know, one of the things that I carp on about is benchmarking and variation. In our report, we discussed trying to explore two things, one of which was having outcome data at a local level. When I visited Oldham on behalf of the committee, I was extremely impressed by the disaggregation of the data down to individual schools, which set those schools a challenge. Some of them thought that they were doing extremely well until they saw their data, when they were horrified. The pressure, both from parent-teacher associations and the schools’ governing boards meant that the schools developed policies and were very responsive to the local support that they were getting.
My first question is about the disaggregation of data and the localisation of target setting in respect of outcome data regarding teenage pregnancies or repeat pregnancies. Oldham was an interesting case. In the initial data, the figures were well below the average for England. The Government minister went there on a visit, caught the members of the local group when they were together and said, “Look, you’ve got a big problem here. We need to see you moving towards the average.” Ways to support the area were explored, and Oldham moved up to the average. For an area with considerable deprivation, that was an exciting development.
What are you doing about disaggregating data, so that an individual school knows the challenges that it faces over time? What about the challenge faced by local authorities or the new health and social care partnerships in relation to outcome data for pregnancies and repeat pregnancies? There are other things to consider, including long-acting contraception. Oldham had to be measured against a whole series of measures.
One important aspect of the new strategy is that the work that is done under it is evidence based. The data plays a very important part. I will perhaps bring in Felicity Sung to explain a wee bit more about the work that we are doing around data. We are currently doing work to consider how we can disaggregate the data down to a much more localised level, and we are trying to manage some of the unintended consequences—issues around confidentiality—that could arise when the data is right down at the level of individual schools. That approach will allow us to focus much more on where we need to take action on particular issues.
It is important to utilise the data effectively and to learn from experience in other areas. In Lothian, for example, some work has been done to consider the history of young mums in school and how long they had not been attending school for. There was a clear pattern in when people’s level of attendance at school dropped to a certain point. There was a clear link, albeit not directly causal. Once we have established or identified such issues in the data, we must ensure that they are acted upon, not only in Lothian but also in Glasgow, Dundee, Fife and other areas. Part of the work is to ensure that we get the data down to that level, and another part is to utilise the data.
I am keen for the new strategy to have targets that are set at a national level but which can be utilised at a local level. I am also keen for it to be outcome focused. Access to data is extremely important in that respect.
Felicity Sung can give you a wee bit of further information about some of the work that we are doing around disaggregating the data.
One of the things that we are using to ensure that our strategy is based on the right outcomes and that we can measure those outcomes is a logic modelling process, whereby we consider the outcomes that we are working towards and the activities that we might undertake to achieve them. Part of the process involves considering what data we would need to measure and working out progress against achieving those outcomes. We are doing that piece of work at the moment. It is a really good piece of work, as it gets all the stakeholders involved in discussing what they want to achieve and how that could be measured, and what resources and tools are available to measure that data.
A further issue is identifying gaps and considering how we might look for the statistics or evidence that we need to measure those gaps. Therefore, it is not just a matter of measuring the things that we can measure, if you see what I mean.
Another part—once we have the statistics and we know what we want to measure—is about the level that we can take the data down to. As the minister says, we have to be careful about when data becomes disclosive and how we measure that process. However, I know that some areas, such as NHS Tayside and the local authorities that it works with, are already looking at data at school level and at community level, which is an extremely effective way of looking at local rates, outcomes and so on, so it is about using not only our modelling process but the experience of other areas that have already been effective in reducing local rates.
It might be worth while to make contact with Oldham and find out how the individual schools coped with the confidentiality issue that you have highlighted and managed not to create problems around that. The process seemed to work there—I do not know why it worked or how it worked. I acknowledge the dangers that you are talking about.
I have another question but I will come back in later with it.
We are more than happy to take away that particular point and look into it. Alison Hadley, the expert who was involved in the strategy in England, is a member of the steering group and I imagine that she would have been involved in the Oldham work—either directly or indirectly—so we can flag that up to the steering group.
On causal factors of teenage pregnancy, the minister referred—quite rightly—to the progress that has been made. The ISD figures that came out after the committee report show the significant drop in the teenage pregnancy rate in the under-16 age group between 2009 and 2010. The rate reduced from 7.1 per 1,000 to 5.7 per 1,000—from 616 pregnancies annually to 492—which surpassed the national target. Do we understand what happened in that period to lead to that dramatic reduction in the under-16 age group pregnancy rate? What lessons can be learned that can be applied in future?
As I am sure you will appreciate, there is no single factor. A whole range of factors can be highlighted over a number of years, because the teenage pregnancy figures have been on a downward trend for the past four-plus years. In part, the drop is due to some of the education work that has been taking place around positive destinations for young people. Advice on and access to contraception have also helped. The types of advice and support that are available in schools are another factor. All those factors contribute to the drop. Trying to isolate one particular factor is probably not possible; all of those are areas where there has been a much greater focus on this agenda and I have no doubt that they have played a part in the reduction in the figures.
As a committee, we recognise the direction of travel over the years but that is quite a significant drop in a year, from 616 pregnancies annually to 492—from more than 7 per 1,000 to about 5 per 1,000. Something happened in that period. Has any work been carried out to find out whether something significant was going on during that period to give us that drop or should we expect falls such as that to continue? Should we expect the number of teenage pregnancies to fall by 100-odd next year? Is that the trend?
There is a downward trend but there was a step change in the period that you referred to. I am not aware of any specific work to look at why there was a particular drop over the course of that year, other than that it was part of that downward trend. The three areas that I mentioned are probably the main contributory factors.
Another element might be that when there is a slightly higher starting point, there can be such step changes when different policies are taken forward. Once we see such a reduction, the challenge is to sustain that to get the figure as low as we would want it to be. The figure has come from a slightly higher point and is getting lower, which is the direction that we want it to go in, but I cannot pinpoint for you an exact issue—
The reduction took place between 2009 and 2010. Do we have updated figures that show that the positive trend is continuing at that level?
The next set of figures comes out on 24 June. Those figures will update us on the situation.
Okay. Thank you.
I have two questions for the minister. I know that you have been asked before about the first issue that I will raise, which is about Roman Catholic schools, and that you have been considering the matter, so perhaps you can give me an answer. The committee drew the Scottish Government’s attention to the dispute between NHS Greater Glasgow and Clyde and the Scottish Catholic Education Service. In response, the Scottish Government said that, following the enactment of the Marriage and Civil Partnerships (Scotland) Bill, it would engage with the SCES and the NHS sexual health promotion specialists network to refresh education circular 2/2001, which governs the conduct of sex education in schools. Can you update the committee on the outcome of the engagement? Has the dispute in Glasgow been resolved? What progress has been made on refreshing the circular following the enactment of the bill?
We have engaged with the Scottish Catholic Education Service and NHS Greater Glasgow and Clyde on the matter and the guidance has been revised. However, at this point differences remain between the SCES and NHS Greater Glasgow and Clyde. I will bring Colin Spivey in to expand a wee bit on the educational aspect.
It may be that some individuals in NHS Greater Glasgow and Clyde will not get to a point of agreement with the SCES on these matters. We must respect the fact that there is a difference of opinion between them on the matter. It is not for me to force the SCES to accept a particular viewpoint from NHS Greater Glasgow and Clyde. Some officials in NHS Greater Glasgow and Clyde believe that certain things should be provided in Catholic schools but the SCES does not agree with that position. However, we have engaged with both parties and have revised the guidance to try to address some of the issues. Does Colin Spivey want to go into more detail?
Yes. I will update you on the revision of the guidance. We undertook a six-week engagement with stakeholders on the draft guidance, which was available on the Scottish Government website and was sent out to key stakeholders. We received approximately 60 responses from national organisations and about 10 responses from individuals. The main issue that came out of the engagement exercise was about the parental right to withdraw children from specific sexual health lessons. Views on that issue were polarised between various organisations. On the basis of that engagement exercise and the comments on the draft guidance, we are close to having a revised document, which ministers will consider shortly. The intention is that we will issue the guidance before the end of the school year.
You referred to the specific issue involving the Scottish Catholic Education Service and Greater Glasgow and Clyde NHS Board. As the minister said, it has unfortunately not been possible for them to resolve their differences during the engagement process, although officials have met both parties as part of that process.
12:00
My other question is along the same lines; it is on sexual health and relationships education—SHRE.
The committee recommended that the Scottish Government should undertake a full review of the provision of SHRE in schools, but the Government rejected that call on the ground that reviews were carried out in 2008 and 2010. In its response to the committee’s report, the Government stated that the reviews showed that provision and training were patchy. It went on to say that it believed that that was still likely to be the case, but that it did not believe that a further review of provision would add to the evidence base. It highlighted that it was a matter for local authorities and headteachers to decide what was provided in schools and what training was given to teachers.
Are you aware of any improvements in the consistency and quality of SHRE? Given the autonomy of local authorities on this matter, will the delivery of such education always be variable? What can be done to improve the consistency of what is being delivered?
Although another review has not been carried out, some of the guidance on how to conduct such education in schools has been revised. In addition, the educational material that is available to teachers has been updated. The code on the conduct of SHRE is there to help to achieve greater consistency in how such education is delivered in schools. Colin Spivey will be able to provide a bit more detail on the practical aspects of our work.
Given that two reviews have been carried out in the fairly recent past, we felt that a full review would not be appropriate at this point. The revision of the guidance on how to conduct SHRE should help us to address some of the inconsistencies, and the new material that is being provided should allow us to ensure that staff in schools have the material that they need to deliver such education. I invite Colin Spivey to talk about the process that was gone through.
There are a number of points to make. As the minister said, the code on the conduct of SHRE is in the process of being revised and we are very near to concluding that exercise.
It has become clear through the engagement process that there are still concerns about the consistency of what is being delivered. That is in line with the messages that we got from the 2008 and 2010 reviews. We recognise that there is a need to do something about that.
We believe that the revised code will be the jumping-off point for a relaunch of that facet of the curriculum. In particular, a package of the materials that are currently available will be launched at the same time as the revised code. Education Scotland will pull those materials together in a coherent package, which will be launched jointly with the revised code. In addition, Education Scotland is considering holding an event at the start of the next school year to focus on the issue.
More broadly, there is representation from the learning directorate on the strategy group that the minister mentioned and we expect the provision of educational materials to be a key factor in the group’s considerations. It is also worth mentioning that, since the reviews in 2008 and 2010, the curriculum for excellence has been introduced and the SHRE materials have been revised and made available.
Thank you.
It sounds as if the Government is very busy. The minister is not being attacked, because he has not been in his current job since 2008. I do not view the situation that Richard Lyle described as a disappointment to the committee; I think that there is agreement with the committee. In 2013, the committee found that the educational experience of young people was patchy. The Scottish Government found that it was patchy when it carried out reviews in 2010 and 2008, so we do not need another review. We all agree that the delivery has been patchy. Why has it taken since 2008 and the committee’s inquiry into teenage pregnancy in 2013 to reach a point at which we all agree that the delivery of SHRE for young people throughout Scotland is not what we would want it to be?
There were two different reviews. The 2008 review was on secondary school provision; the 2010 review was on primary school provision. The reviews dealt with different parts of the education system—
I understand that; it may be what is in your brief, but Mr Spivey told us what both reviews found. The Scottish Government, which agreed with the committee in its response in September 2013, said that we did not need more reviews to add to what we know, which is that provision is patchy. There is no disagreement here and there can be no hiding behind one review as opposed to another. We had reviews in 2008 and 2010, and the committee reported in 2013. We all agree that provision is not good enough. Why has this taken since 2008?
I cannot comment on what happened in 2008, because I was not in my current post—
I absolve you of all responsibility for that—
I do not know whether Colin Spivey was involved in the process. He might be able to comment on what happened in 2008.
I cannot comment on what happened in 2008, but I can say that it is not as if nothing has happened between 2008 and now. A number of things have happened. I referred to the review of health resources in education; and curriculum for excellence has been introduced. Curriculum for excellence is a key element. I know that the committee was concerned about whether the focus should be on relationships rather than biology; curriculum for excellence places high importance on relationships in the area of education that we are talking about.
There has been progress over the period. That might be reflected in the reduction in teenage pregnancy figures, which has been mentioned. However, it is quite right that we continue to listen to stakeholders, as we have done through the engagement exercise around the review of the guidance. Stakeholders and the committee tell us that provision is still patchy, and I have tried to indicate what we intend to do as our next steps on that.
Yes, but when will any of that have an impact on young people in education, if the launch is in 2015?
Sorry, I am not sure—
You had the committee’s report in 2013, to which you responded. You are working through the situation, you have spent weeks and months bringing various groups together, and you expect to launch something more co-ordinated next year. Is that not what you said?
The guidance is being launched at the end of this school year. It will be launched by the end of June 2014.
This year.
Yes, this year. You were perhaps referring to the strategy, convener, which will be launched next year. It is worth saying that the strategy will consider education and how to reinforce our approach in that regard. It is the strategy that will be launched in 2015.
Right.
There has been less agreement about involving young people themselves. At the heart of Richard Lyle’s question was young people’s experiences of sex education—biology versus relationships, what is relevant and so on. The committee recommended that the Government seek young people’s views, given that young people told us that they had not had a great experience—maybe it was ever thus. I do not think that the Scottish Government was in full agreement. It seemed to qualify how we would involve young people in relation to the types of services and education that they feel are relevant.
There might be a difference of views here. At committee, I suggested the possibility of auditing young people’s views—if the committee felt that to be useful—on how sexual health and relationship services are offered in schools. The Government is considering how that can be taken forward in order to harness young people’s views. We are very much with you on the matter.
I am referring to the written response to the committee’s report, which was perhaps less than enthusiastic. However, we might have moved on with you about how we might proceed.
I suggested auditing young people’s views and the committee seemed quite supportive of that.
How would you do that?
How, mechanically, would we do that?
Yes.
I imagine that we would probably work with a third sector organisation, which would carry out that work for us, working with young people through a questionnaire and interview programme to get their opinions and views. That would be fed into how we develop policy.
When is that planned for?
We are taking forward that piece of work now; we are considering how to develop that further.
We are very much in favour of young people being able to inform and guide policy in this area, using their experience. An audit is a good way of going about that and finding out from young people exactly what their views are of what happens in school, what works, what does not work and what would help to improve matters.
When will the information be available to the committee?
I do not think that we have a timeframe for when it will be available to the committee.
Has the work been commissioned yet?
No, it has not been commissioned yet.
I will go in a slightly different direction. I am actually in favour of babies and pregnancy—that is where I am coming from. Just in case the Daily Mail says that I am in favour of young people and children engaging in sex, I had better say that that is not what I am saying—not at all, in fact. We should carefully and meaningfully educate children at all ages. That is my preference.
I was fairly taken on—the committee was fairly taken on—with Harry Burns, before we had taken any evidence. During evidence on another subject entirely Sir Harry explained how the pilot projects in family nurse partnerships were rolling out. Could you tell us how you see the family nurse partnerships engaging and what impact they are having on young people after a pregnancy, once the child is born? That is my first question.
The committee had the good fortune to meet some young women aged—I am guessing—16 to 18, who had had a baby and who had been supported. Unfortunately, there were no males there—it would have been interesting to hear what they had to say.
To reiterate my first question, what impact have the family nurse partnerships had? My second question is, how are family nurse partnerships being rolled out in this regard, throughout Scotland?
We have a commitment to rolling out family nurse partnerships to all the territorial boards. So far, the partnerships are in place in seven of those boards. Further roll-out is planned in another two. The following year, there will be roll-out in the other board areas. As far as the end point is concerned, we hope that all boards will be providing family nurse partnerships by 2015.
Like you, I have met some of the staff involved, as well as a range of parents, in different parts of the country. I was struck by how valuable they have found the input, given that the partnerships are for a specific group.
As far as some of the early family nurse partnerships are concerned, we are now at a point at which parents have graduated from the programme. Evidence has been gathered from their individual experiences, and that can help to inform how other family nurse partnerships in different health board areas can learn from that experience. Some boards have been ahead of the game in family nurse partnerships. In particular, Tayside, one of the first areas to have family nurse partnerships, has built up a considerable level of experience.
We can use that experience to inform other board areas that are developing family nurse partnerships. It is a positive way of working with young mums at an early stage in their pregnancy and through the two-year period, to support individual mothers and babies and to support families using other measures that can help them to enter education or employment or to tackle housing issues. By bringing together other services that can help, the family nurse is able to work in a collective way with people to guide and support them.
12:15A randomised controlled trial of family nurse partnerships is currently taking place in England and it is due to report at the end of this year. That will be interesting, and once we have seen the outcomes from that trial we will consider how we should use that information to evaluate the progress that we have made in Scotland and what further work can be done around family nurse partnerships.
Family nurse partnerships are not the only model, but they have a positive contribution to make. There is a clear feeling among the parents and staff I have spoken to that those who have engaged in the programme have benefitted. It is also worth keeping it in mind that the level of retention in family nurse partnerships is good, in that we do not have lots of young mums and families dropping out. Remaining engaged is a key part of the programme and how effective it can be, and some of our health board areas have had a good experience of maintaining those levels of engagement.
Views have been expressed about the negative impact on the provision of health visiting services of recruiting nurses for the family nurse partnerships, which has left a gap and has taken resources away from health visiting services. What are your views on that? Can you clarify the situation?
Health boards must try to manage the roll-out at a pace that avoids or minimises the risk of that happening. We are also considering who can be a family nurse in a family nurse partnership, to see whether there is scope to extend the role further. Health visitors have often been attracted to that role, and we are now looking to see whether we can extend the range of individuals who could become a family nurse in a partnership. We are in discussions with those who are involved in the partnerships about how that can be achieved. The pace at which we roll out the programme is important to how we manage any change in staffing levels for health visitors and other nurses when staff choose to become family nurses.
Are there any worries or concerns in the background, or are you comfortable with the shape that the programme is taking and with the movement from one service to the other? Is it leaving a draught behind, or is it under control?
Short-term challenges will always be created. For example, if an experienced health visitor chooses to become a family nurse, simply recruiting another health visitor does not necessarily fill the gap because the experience is lost as well. There is always the potential for such changes to create short-term challenges in some areas, but getting the pace right allows the change to happen in a managed way. Rather than say, “You’ve got to have your family nurse partnership by next month, irrespective of the impact that that may have on your health visiting capacity,” we must make the change in a managed way.
I am not naive about the fact that, if a health visitor of 20 years’ experience chooses to move into a family nurse partnership and their post is filled by a health visitor who is newly qualified, it will be difficult for the new person to fill the gap because 20 years’ experience has been lost. We need to manage the programme to avoid causing any local instability. It is important that health boards manage and plan it, and the programme is being rolled out over a number of years to allow that to happen.
I return to SHRE in schools. In some schools, particularly secondary schools, such education might be delivered by a pastoral support or guidance teacher. In some schools, every teacher will be a front-line guidance teacher and will take on that pastoral responsibility. Therefore, there are various skill mixes, particularly in secondary schools, in the delivery of such education irrespective of the guidelines. In primary schools, the teachers that pupils get will provide such relationship advice.
I will focus on relationships again. An educationist might be exceptionally good at teaching physics, chemistry or history, but a different skill mix might be required to teach relationship advice in school. I appreciate that provision is sometimes patchy, but we need to drive up standards and build capacity among staff, and I would monitor that by asking Education Scotland to take a view on the quality of such education in schools. I am not suggesting that every school in the country should immediately have the inspectorate in to inspect SHRE—of course not. However, to get a flavour of the quality of the support that staff have been given to enable them to give effective relationship advice, Education Scotland might touch on the matter when it carries out routine inspections of schools in areas where there is a higher prevalence of teenage pregnancy and young mothers of school age. The committee will agree that relationship advice should include the clinical and biological aspects, as required, to enable the young people to make informed decisions. Your view on that would be helpful.
I also ask for your view on something else. As a former teacher, I think that teachers sometimes get a hard time. Young people have a variety of relationships in life and, for some of them, the most positive ones are not always at school. Those who are most at risk of having unplanned pregnancies are perhaps the ones who are disengaged from school. We need good-quality youth provision. In primary schools, we need early intervention and good relationship building. However, those who are most likely to have an unplanned pregnancy in secondary school might not engage particularly extensively with the school or their wider network but might engage with good-quality youth provision.
Has the Government given any thought to how we can identify the areas where young people are most at risk of having an unplanned pregnancy, to the need to bolster good-quality youth provision in communities—which includes funding—and to how we monitor and map out some of that?
I hope that that is a helpful question.
Your job is done for you, minister.
There is quite a lot in there.
Sorry about that.
I am sure that it is not lost on the committee that the subject is now called relationships, sexual health and parenthood education and that the word “relationships” comes first in the title for specific purposes. I will bring Colin Spivey in on some of the specific issues. As we have highlighted, one of those is the materials that teachers have. The guidance and the code of conduct for teachers on the provision of that education are also extremely important.
Some teachers may be more given to that area of education than others, and it is important to have it delivered by good educators rather than by reluctant educators who are delivering it because they are forced to. How it is managed in an individual school setting and the leadership that is shown in its delivery in the school are extremely important.
Your point about the importance of youth work in the context of young people who have disengaged from education being at greater risk goes back to the point that Richard Simpson made about the use of data in this area. I have mentioned the work that we are doing to disaggregate the data. We want to continue that to a point at which we can pinpoint the existence of an issue much more effectively. Once we have identified that the rate of teenage pregnancy is higher in a particular area, we need to look at what is happening in that area and what action needs to be taken at a local level. Youth work is an aspect of that. We need to establish whether there is an issue with how education is delivered in a school or with how health, social work and other services are engaging with young people. Once we have that level of detailed data, we can consider the best approach to the issue and adopt a much more focused approach.
We might need input from education or health, or we might need to get third sector organisations involved. That would be determined on the basis of what was happening in the area in question. Youth work could be part of the solution. The availability of disaggregated data will allow us to develop a much more tailored response in places where there are particular issues and to adopt an evidence-based approach rather than just put in provision that we think might make a difference without knowing that it will. Such data will also allow us to evaluate and measure the impact of any actions that we take and to determine whether they result in a change over the following two to three years. That sustained input will be necessary. As Richard Simpson said, getting data at that level will be crucial in supporting such work locally.
That will require a multi-agency response. It will require a response from the health service, local authorities, the third sector and, in some cases, national Government. Your point is well made. The data will be key in unlocking the issue of where we need to take concerted action and what that action should be.
Colin Spivey is probably better placed to give you more detail of the materials that are available to teachers and the work that is being done with teachers to deliver such education in schools.
I will pick up on a number of issues. You mentioned the appropriateness of certain teachers delivering parts of the curriculum. I think that you mentioned physics teachers—
I was not singling out physics teachers.
I understand the point that you were making.
One of the fundamental reasons why curriculum for excellence represents such a huge step in education is that, under it, health and wellbeing are the responsibility of everyone who is involved in learning. Physics teachers, guidance teachers, school catering staff and janitorial staff all have a responsibility for health and wellbeing, and a key part of that responsibility relates to relationships. Changing people’s mindset so that they take on that responsibility is a key aspect of delivering improvements in that area.
You mentioned the role of Education Scotland. The delivery of health and wellbeing is a core aspect that Education Scotland considers during each school inspection, and it is one of the elements that it reports back on. We might be able to pick up whether an opportunity exists to establish a closer link in the discussions that take place on the strategy, as Education Scotland is on the strategy group. That is an interesting and useful suggestion to pursue.
Delivery in schools is down to local authorities and schools themselves. That is consistent with our general approach to learning. I do not think that we would want to be prescriptive and say that a particular teacher with a particular responsibility in a particular area should deliver a particular provision. It often boils down to who is most comfortable and best placed to deliver the type of education that we are talking about, and I think that that is probably quite right.
12:30
I thank Gil Paterson for raising the issue of health visitors. You will remember, minister, that, in answer to a written question that I lodged, you estimated that, once we have rolled out family nurse partnerships, half of the 350 appointments to those partnerships will be health visitors. I made a freedom of information request to the health boards on the training of health visitors, and I am concerned that we will not be replacing them even with less experienced people. I very much take your point that there will not be a like-for-like replacement.
When the workforce plans come out in June, will you be able to update us on that? I know that health visitor training is a matter for individual health boards. I am not convinced that they are considering replacement as they should be doing.
My question is a very short one on contraception. When we discussed the issue before, we raised a point about ulipristal acetate, the long-lasting emergency contraception. You indicated that you have a short-life expert working group looking into it, which is going to make a recommendation. Could you tell us where we are with that? It is now eight months since it was generally approved.
On your first point, the cabinet secretary has set up a nursing advisory group specifically to consider issues around health visiting, and the group is due to report in the near future. I hope that that will address some of the concerns that you have raised. I recognise those concerns and the importance of health visitors.
On the specific issue that you raise about the medication, NHS Health Scotland commissioned an expert group to consider the matter. The group considered a number of different issues, and it has since reported. It was in discussions with Community Pharmacy Scotland on that. If it would be helpful, I would be more than happy to get a full, detailed breakdown of the outcomes and recommendations from that expert group, which would allow the committee to consider the issue in more detail, instead of giving you a quick run-through of the key bullet points.
A draft national patient group direction—PGD—is being developed as part of the recommendations of the expert group, and I would be more than happy to give you a much fuller, more detailed breakdown if that would be useful.
We appreciate that.
I have a brief supplementary question in relation to what Bob Doris was asking about, and perhaps also in relation to an earlier question from Richard Simpson, regarding the data. Are we aware whether there is a shifting trend in young people becoming sexually active? If so, do you know what that trend is? Is there a geographical difference?
Some research indicates that young people are being exposed to information at a much earlier stage than might have been the case in the past, largely through being able to access information much more readily than was previously the case. There is research to demonstrate that children are being made aware of these things at a much earlier stage.
There are particular areas where we know, from the current national statistics that we gather, that there are issues around teenage pregnancies. Some of the work that has been done under the present strategy has been focused on those areas, and we know where they are. Getting the data down to a further level will allow us to be much clearer about the individual areas where there are issues that need to be addressed more effectively.
Are you suggesting that exposure to information is itself impacting on when young people become sexually active?
No.
The question was whether we know the age range of young people who are becoming sexually active.
I am not aware of it, but Felicity Sung might be aware of some specific research in that area.
We have some information from the health behaviour of school-age children survey, which is an international survey for which we have a Scottish arm. That gives us some information on young people’s sexual activity. I would have to get the specific figures, but the proportion of young people under 16 who are sexually active has not changed noticeably for some time. It is obviously very difficult to get specific information on young people’s sexual activity. Furthermore, it depends on what we mean when we are talking about sexual activity.
I appreciate that.
The data are quite difficult to come by. However, we can examine some proxy measures that might give us the information. As the minister says, we can consider the matter further, as there are some interesting data, particularly from the health behaviour of school-age children survey, that can give us some useful information.
There are no further questions. I thank the minister and his colleagues for their attendance.
We need your final agreement to this, minister, although we have sought to arrange this behind your back. We delayed your attendance here by about half an hour from the expected time. Committee members have time pressures, with other meetings that they have to attend at this time. Therefore, we suggest that we do not proceed with the next evidence session on today’s agenda and that we postpone it until another occasion soon. If you agree to that, we will end the meeting at this point.
Of course—I would be more than happy to do that.
Thank you for that, minister, and thank you once again for participating in this morning’s evidence session, which has been very interesting.
Meeting closed at 12:36.Previous
NHS Boards Budget Scrutiny