Sexual Well-being
The next item of business is a statement by Malcolm Chisholm on "Enhancing Sexual Wellbeing in Scotland: a Sexual Health and Relationships Strategy".
On a point of order Presiding Officer—
I will come to you, Mr Crawford, after I have finished my statement.
The minister will take questions at the end of his statement. There should therefore be no interventions during the statement.
I seek the Presiding Officer's guidance. In December 1999, the then Minister for Health and Community Care, Susan Deacon, announced that she was developing a new group to drive forward a sexual health strategy. In August 2002, Malcolm Chisholm announced that he was setting up an expert group to draw up a sexual health strategy. The issue was given a fair airing in the press on Sunday.
I am sure that the documents that the Scottish Executive has published today represent a good body of work. Unfortunately, we have not yet had the chance to examine them properly. Why is that? The documents did not appear in the Scottish Parliament information centre until 1.15 pm today and were not on the Executive's website even at 2.10 pm this afternoon. However, the media have just confirmed for me that they had access to the documents at 1 o'clock.
This process began four years ago and, frankly, it is not acceptable for the Opposition to have a chance to examine the documents only a quarter of an hour beforehand, and after the press has seen them. Presiding Officer, I ask you to use your offices to ensure that the Scottish Executive is not allowed to use such a practice in future. It does not help to foster a climate in which we can go forward together on this very important issue.
I am sure that the Minister for Parliamentary Business has taken note of what you have said, Mr Crawford. Of course, we are not going into a debate, which would require vast amounts of information. Instead, the Executive will make a statement and the chamber will have an immediate opportunity to question it. I think that we should get on with it.
On a point of order, Presiding Officer. Following on from Bruce Crawford's point of order, I should say—if my understanding is correct—that it was conveyed to us at yesterday's Parliamentary Bureau meeting that the documents would be available in SPICe this morning.
I am advised that the Minister for Parliamentary Business made it clear that they would be made available at half-past 1 or thereabouts.
The Minister for Parliamentary Business (Patricia Ferguson) indicated agreement.
On a point of order, Presiding Officer. I seek assurances about the process involved. Is it really acceptable in the Parliament for the press to receive documents for scrutiny purposes before MSPs?
I cannot rule on that point of order because you have just told me that that has happened. I will look into the matter and will perhaps come back to you a bit later.
I think that we should get on. I call Malcolm Chisholm.
Today, I announce to Parliament the launch of a wide-ranging consultation on proposals for a national sexual health strategy that have been prepared by an expert reference group. I do not want to take time out of my statement to deal with the points of order that have been raised; however, I want to make it clear that this is not our report—it is the expert group's report. That is the full answer to Bruce Crawford's point of order.
The consultation is a crucial step in the Executive's commitment, as set out in the partnership agreement, to develop and implement a national sexual health strategy.
First, let me set the context. However we look at it, sexual behaviour and attitudes are changing. Behind the trends and opinions, the statistics tell us that sexual health and well-being in Scotland are poor. For example, diagnoses of chlamydia rose by 41 per cent between 2000 and 2001, followed in 2002 by a 12 per cent increase, from more than 10,000 to more than 11,000 cases.
Moreover, the rate of teenage conception in Britain is the highest in western Europe, and in Scotland slightly more than half of the pregnancies in under-16-year-olds and two fifths of those in the 16 to 19-year-old age group are terminated. Sadly, rates of teenage pregnancy are higher in areas of deprivation than elsewhere. During the 1990s, the differences in rates of teenage pregnancy between more affluent and more deprived areas widened.
If statistics are worrying, so are features such as regret, violence, abuse, coercion and disrespect that all too frequently go hand in hand with irresponsible sexual behaviour. For example, studies indicate that a significant proportion of first sex is unwanted, particularly for young women, and that the younger a person is, the more likely it is that the sex is unwanted. One thing is abundantly clear: sexual well-being is not just about the absence of disease or lowering the incidence of this or that sexually transmitted infection. On the contrary, sexual well-being embraces a raft of social, cultural and ethical issues that must be addressed if we are to attain the level of sexual health, responsibility and well-being in Scotland to which we all aspire.
That is no easy task. It is crucial that, in developing a strategy, we have regard to and respect for the many genuinely held views on this sensitive and emotive topic. That is why, in August last year, I set up the expert reference group, which had a broad membership from the field of sexual health services and education as well as representatives from voluntary organisations and religious groups.
The group had a wide remit, which included the promotion of a broad understanding of sexual health and sexual relationships that encompasses emotions, attitudes and social context, while retaining a particular focus on measures to reduce unintended pregnancies and sexually transmitted infections, and the enhancement of sexual health services. Such an approach not only reflects the wide social and cultural influences on sexual health, but highlights the Executive's aim for a strategy that is rooted in strong relationships based on self-respect and on respect for others.
The outcome of the group's work is the proposals that are contained in "Enhancing Sexual Wellbeing in Scotland: A Sexual Health and Relationships Strategy", which was made public earlier today. I take this opportunity to express my gratitude to all the members of the expert group, under the chairmanship of Professor Phil Hanlon, and to NHS Health Scotland, which provided support for the group's work.
The reference group's proposals are being published precisely in the terms in which they were submitted to the Executive. The proposals have been built on a survey of existing sexual health services in Scotland and on an analysis of the attitudes and lifestyles found in a sample survey of Scots. The survey draws on existing research findings, both at home and abroad, and the experience of people who work in the field of sexual health. Although we are publishing the reference group's proposals in full, it does not mean that they will all form part of the final strategy agreed by the Executive. I launch the consultation today in order to inform the Executive's final decisions.
The draft strategy provides a succinct and telling commentary on the state of sexual health in Scotland, to which I have already referred. It highlights that health inequalities, which the Executive is resolved to tackle, carry over to many aspects of sexual health, and it identifies a strong link between social disadvantage and early initiation into sexual activity.
It is apparent that improvements in sexual health and well-being are inextricably connected to broader efforts to tackle health inequalities. Of paramount importance, too, is the nurturing of self-esteem, respect for others, individual responsibility and responsibility to the wider community.
The reference group recognised that there are no simple solutions or quick fixes. No one intervention will provide a panacea. What is required is a multicomponent and multilevel programme that adopts an integrated, long-term and socially orientated approach. That is founded on evidence that shows how a range of interventions, in various settings, to address multiple influences on sexual health, can lead to significant improvements in sexual well-being.
Five key actions are highlighted by the reference group. The first is the need for national leadership to be addressed by the appointment of a national sexual health programme co-ordinator and the creation of a new national sexual health advisory committee. The second is local leadership, with all NHS boards having a sexual health strategy informed by a multi-agency strategy group. The third is the setting of clear national and local targets and goals. The fourth is to use existing mechanisms, such as local health plans, community plans and the performance assessment framework to ensure the on-going integrated delivery of the strategy's goals and vision. The fifth is to monitor progress to ensure delivery, with the proposed new advisory committee monitoring national progress towards targets.
Those key actions underpin over 100 recommendations made by the reference group. It is not the time today to focus on specific recommendations since the consultation process will give full opportunity for that.
Suffice it to say that the recommendations address the needs of those facing the greatest barriers to sexual health; outline a broad approach to sexual health promotion; respond to the importance of acquiring knowledge and skills about sexual health and well-being; set out, respectively, the roles of schools, higher and further education institutions, and parents and carers; identify the contribution of the media and mass communications; and highlight specific actions to reduce sexually transmitted infections, including ready access to services.
The group has produced a comprehensive, well-researched and positive report, which needs to be considered in the round. I believe that its strengths lie in the integrated approach that it proposes. Particularly welcome is its affirmation of the key values of respect, equality and accessibility to clinical services and lifelong learning. I am clear that the group's proposals provide the basis for a workable and constructive framework within which progress to enhance sexual well-being can be made.
However, I am keenly aware of the many views that exist in Scotland, and indeed in the Parliament, on this complex issue. That is why we are embarking on a wide-ranging consultation before we consider which of the recommendations to accept, or whether to accept them in their entirety. Copies of the draft strategy have been placed in the Scottish Parliament information centre, and it can also be accessed electronically on the Scottish Executive website. The group has prepared a summary version that can be made available in other formats, including Braille and audio tape and in different languages to facilitate access for ethnic minority groups. For those who are interested, background supporting papers used by the group can be accessed on the Scottish Executive website.
All this reflects our determination to ensure that the consultation process is as broad ranging and comprehensive as can be arranged. In addition to the traditional means of seeking comments from groups and organisations, we will invite the Scottish Civic Forum to facilitate aspects of the consultative process and will make special efforts to engage minority groups. I hope that people, young and old, throughout Scotland will feel able to engage in the consultation process. I look forward to receiving the comments of parents, young people and other individuals, as well as organisations and professional bodies, to help to ensure that the final strategy that emerges from the consultation is a fair reflection of the views of people in Scotland.
The time is right for a mature and considered debate on this sensitive, but vital issue and I am sure that the reference group's proposals provide a helpful focus for that. I hope that the debate will not be hijacked or sidetracked by focusing on high-profile or single, contentious issues. The topic is too serious for that. Moreover, as the reference group's report stresses, success does not rest on one single intervention, but on a range of initiatives and services across the whole policy spectrum. In short, a holistic approach is needed.
I recognise, of course, that some of the issues that are raised in the draft strategy will be controversial and that complete consensus may be elusive. However, that is not a reason to do nothing, or to concentrate disproportionately on the points of difference. There is a great deal on which we can unite and build, and the consultation will allow us to identify the common ground and the difficult decisions that may have to be made.
Members, and indeed the Parliament, will no doubt want to contribute to the consultation, and the Executive will propose to the Parliamentary Bureau that a debate be held in the Parliament on the subject before the end of the consultation period.
There is a real opportunity to make a difference. Sexual health is a dimension of health that we cannot afford to neglect if the quality of life and overall health in Scotland are to be enhanced. The reference group has shown the way in producing proposals that have regard to the diversity of views that surround the issue. The challenge for all of us now, including the Parliament, is to contribute our views in a measured and constructive way that will pave the way for improved sexual well-being for this and future generations. The pillars of that improvement must be self-respect, respect for others and strong, respectful relationships. I am confident that we can build on them together.
I thank the minister for an advance copy of his statement and welcome the long-awaited report from the expert reference group. I am keen that urgent action be taken to reverse Scotland's sexual ill health, but I find it frustrating that a whole generation of teenagers has grown up in the time that it has taken the Executive to get to this stage. Why did it take from December 1999—when Susan Deacon first established a new group to develop a national demonstration project on teenage sexual health—to 2002 for the current Minister for Health and Community Care to commission a national sexual health strategy, and more time still to establish an expert reference group to develop the strategy and for the strategy to go out to consultation? Will the minister confirm that the consultation will not be completed before the end of February 2004? Will he tell us at what point after that we are likely to have sight of the Executive's strategy and when we can expect some action to be taken to begin to tackle the problem? On what basis will the Executive decide which elements it will pick and choose to form part of the final strategy that it will agree? Does the minister have any views of his own as to what should be in that final strategy and, if so, will he enlighten us as to what they are?
Shona Robison made a great many points. The leading one was about the time that it has taken to reach this stage, but, in a sense, she answered her own question. She said that, at the end of 1999, the Executive established a new group to establish a demonstration project—I do not have the exact name—which is a separate issue. That project was, of course, the healthy respect demonstration project, which is on-going and from which we have set up a learning network for sexual health. Many lessons are being learnt from that project, but Shona Robison must know that that group was not the expert group. I set up the expert group in my first year as Minister for Health and Community Care. I appointed the members and gave the group its broad remit, which was important.
The expert group asked me for an extension of time to allow it, as part of its work, to carry out a more comprehensive consultation and involve more of those who have expertise in the area. There are valid reasons for the time that the work has taken.
I hope that Shona Robison will also agree that there are valid reasons for our carrying out a proper consultation on the issue, which is why it would be wrong for me to give the Executive's view of each recommendation in the report. I have made the Executive's general position absolutely clear, but it is right that the people of Scotland should be involved in deciding the final strategy on this important issue.
I will mention a matter on which I did not want to spend too much time in my statement. Given that the report comes from the expert group, it was up to that group to launch the report, which it was due to do at 1.30 today. If the report got to the media at 1 o'clock rather than 1.30, I had no control over that. The point is that the report would go to the Parliament when the expert group released it. It is not my report; it is the group's report.
I thank the minister for providing an advance copy of his statement. I, too, welcome the report and the work of the reference group. I agree with the minister that no quick fixes are available, but I have deep concern that the targets are not sufficient to deal with the growing problems of sexually transmitted infection and youth pregnancy.
Does the minister agree that the first step must be through education in a moral climate and that parents must approve what their children are taught in school about relationships and sexual health? Does he agree that parents must be supported in changing the current prevalent culture to one in which young people delay starting sexual relationships until they are mature enough and have a full understanding of the implications and risks involved? Why does the minister think that appointing a tsar will influence young people, when parents have the best opportunity to educate their children?
I remind David Davidson that the proposal for a tsar comes from the expert group which, he will accept, is a broadly constructed group that represents many key players.
To return to the beginning of the question, I observe the slight irony that the man who lambasts me every other day of the year for having too many targets is now criticising the group for not having enough targets. Passing over that, I agree that the parents' role is central and I am glad that the expert group takes the same view. Our present guidance on sex education in schools—which flows from the McCabe report, which the present report endorses—lays out that the involvement of parents is crucial. I agree entirely with David Davidson on that point.
One of the points that the group makes—partly because it was given such a broad remit—is that, apart from the headline issues of sexually transmitted infection and teenage pregnancy, there are other big issues about the social and wider ethical and cultural influences on sexual behaviour. One of the points that the group flags up, which I mentioned in my statement, is that many people regret that they began sexual activity so young. The group has taken that point on board and we also want to do that. Because the group had a broad remit, that point came through. We intended that to happen because we do not want the issue to be considered narrowly; we must consider the wider issues of attitudes, emotions and values.
I warmly welcome the publication of the strategy and the substance and tone of the minister's statement.
Does the minister agree that, by its nature, sexual health is a deeply personal and private matter? Consequently, does he agree that the many thousands of Scots who seek treatment for sexually transmitted infections, termination of pregnancy or advice and support on a host of sexual matters, often will not speak out about their experience in the way in which patients' lobby groups and individuals in other situations will? Will the minister ensure that, in the consultation process, he employs imaginative methods of reaching out to individuals' experience in a sensitive and confidential way? Will he ensure that, in developing policy on the issue, he does not respond simply to those who have the loudest voices or who are the best organised? Despite the fact that he may not get the same number of representations on this issue that he gets on others—for the reasons that I have given—will he ensure that the necessary action is taken and that sufficient resources are provided to address the needs in Scotland on this vital health issue?
I certainly agree with Susan Deacon's main point about ensuring that the consultation goes beyond the traditional methods of involving people in this matter. As I said in my statement, we are going to set in train a series of measures to ensure that the broadest possible range of people is consulted. I pay tribute to the work that Susan Deacon did in this area when she was a minister, and to the work that she has done subsequently.
I also agree that we must ensure that we listen to those who are silent, as well as those who are vocal on the issue. We must make an effort to get a cross-section of public opinion. I am not hiding from that. We are trying to build the broadest possible consensus around the issue, which is an admirable thing to do. There is a broad consensus around the values that I and the expert group have described, concerning mutual respect and responsibility, irrespective of people's religious beliefs. Those with religious beliefs and those with no religious beliefs share in that consensus, to a large extent, and we want to build this strategy around that consensus.
The Liberal Democrats warmly welcome the strategy on sexual health and relationships—because it is about relationships. On that note of consensus, can the minister confirm that, among the 25 members of the expert group that produced the report, there were representatives of the Church of Scotland, the Catholic church, the Jewish community and organisations such as Children 1st? Can he confirm that all those representatives supported all the 118 recommendations in the report?
I welcome the fact that Mike Rumbles has pointed out the key word on the front page of the document—relationships. In many ways, this is a strategy about relationships. We should welcome the fact that, unlike comparable documents in some other places, it takes a broad view and locates sexual health within relationships and within the values of respect and responsibility, which I have highlighted.
I also thank Mike Rumbles for pointing out the broad basis of the group. He referred to the religious people, and I welcomed their presence. Many sexual health professionals were also involved, and I was keen for there to be a representative of Zero Tolerance on the group as well. We wanted to build all those views and perspectives into the group. It is not up to me to speak about the precise views of all the individuals on all the recommendations; it is up to them to speak for themselves. However, the fact of the matter is that they all signed up to the report.
I add my warm welcome on the publication of this draft strategy. From my background in the voluntary sector sexual health field, I know that it has been keenly awaited and that much in the strategy will be welcomed.
Would the minister endorse the view, which is made clear in the report, that all young people—whatever kind of school they attend—should have a right to sexual health education and services, delivered in a way that is consistent with the holistic and inclusive understanding of sexual health that the minister mentioned?
As I have said, in relation to education the expert group is backing the McCabe report and calling for it to be fully implemented. It has been implemented, to a large extent, but if there is still more to be done, that will be taken on board.
Equally, the group is saying that people have a right to sexual health services. There have been debates about the location of those services, and that matter is left open by the report. However, it is clear that people have a right to sex education. The guidance that we have issued on that indicates our broad approach, and much of the thrust of the document is about improving the availability of sexual health services within the broad context of the values that I have described.
I welcome the publication of the report, especially the contributions of professionals and agencies in providing us with a comprehensive strategy. I will focus on what I have been able to ascertain from the report in the short time that I have had it.
Paragraph 4.64, which is on contraception and termination, states that
"access should not be restricted on grounds of cost."
The following page states that
"the availability of emergency contraception from pharmacies has helped to improve choice and access."
Does the minister agree that, following reviews of gynaecological services, for example, there is a problem relating to access at certain outlets, and that access should not be restricted on the ground of cost? Does that apply to emergency contraception, including contraception that is available from pharmacies? Does availability of emergency contraception apply to schoolchildren? Will the minister clarify what the strategy document means and does he support free availability of emergency contraception?
Carolyn Leckie has fastened on to one important sentence in the document. We will certainly consult on the matter and give a view in due course. The strategy is clear and some issues relating to the availability of contraception that she mentions have already been taken on board.
I think that all of us support the principle of access to sexual health services in general and that there is no disagreement in principle. Obviously, there is a debate about the location of such services. It is well known that the Executive has ruled out the morning-after pill in school settings, but of course the Executive is not saying that the morning-after pill should not be available. Indeed, it is available in sexual health clinics, pharmacies and through general practitioners' prescriptions. We certainly support such routes.
About seven minutes are left for questions. If questions and answers are kept reasonably tight, we might just about get in all members who wish to speak.
I, too, welcome the minister's statement and the publication of the expert group's sexual health proposals. However, in the consultation that the minister will undertake, will he assure members that the views of young people and of professionals will be given equal weight? Will he also undertake, in the forthcoming strategy, to examine the point that patient lifestyles and their compliance with contraception must be fully considered when determining the form of contraception to be prescribed?
On the member's first question, I strongly agree that young people will have to be involved as fully as the other groups whose views will be sought. We will certainly ensure that we approach the matter in the most imaginative and innovative way that we can.
On the second question, prescribing contraception is fundamentally an issue for those who are involved in prescribing; I hesitate to intrude on their territory. However, I am sure that all of us accept the general principle that Margaret Jamieson has enunciated.
Does the minister appreciate the frustration that many members feel? We are at an important staging post in the debate, but we have not had time to read the document. Even if we had had enough time to read it, the minister says that he cannot answer many questions that he is being asked about its content and he is neatly—actually, quite clumsily—sidestepping them.
When will the minister publish a strategy? He has confirmed that this is not a strategy but is, rather, proposals that he has not endorsed. What will happen in the meantime? I managed to read page 9 of the summary document in which the reference group talks about the healthy respect project that is being piloted in all schools in Lothian. If the minister wanted to choose to pilot the project in all schools in all regions, could that be done now, or will we have to wait until some time in the future? When will we know what the minister wants to do, rather than just what the summary content of the document is?
I do not know where to start after all that. I would have thought that, as a result of the consultative steering group principles—which I thought we all supported—we would welcome the fullest possible consultation. Indeed, if I gave the final say on 100 recommendations today, I am sure that Fiona Hyslop would attack me for making consultation less meaningful, if not meaningless.
The reality is that we will have a debate in the Parliament, subject to the view of Fiona Hyslop and the other members of the bureau. That is what the Executive proposes. We will have a wide-ranging consultation that we hope will be—I am sure that it will be—more inclusive than a traditional consultation. We will end that at the end of February.
Obviously, we will produce the final strategy soon after that. That does not mean that there is no other activity going on simultaneously in this area. For example, the healthy respect programme is about to go into its next phase and the Caledonia youth project, which has set up excellent services in Glasgow, Dundee, Falkirk and Edinburgh, is being funded by the Executive. Furthermore, we give £8 million to health boards each year to tackle blood-borne viruses such as HIV and hepatitis C. Such work does not stop because we are consulting on a more general strategy, although I stress that it is important that we get that long-term strategy right.
I welcome a lot of what the minister has said, in particular what he said about respect and self-esteem. The work that can be done in our schools to build up young people's self-esteem will be as important as many of the other services that are provided.
I would like to focus on genito-urinary medicine clinics. People are being encouraged to take greater responsibility for their sexual health and to go for regular testing and screening, but there is evidence to suggest that GUM clinics do not have in place the resources to do the job that they might be needed to do, given that we can at present see only the tip of the iceberg in relation to chlamydia figures and so on. Will the minister consider properly resourcing those clinics?
The section on sexual health services—roughly from page 41 to 62—is the most substantial section of the report. Obviously, the issues that Margaret Smith has raised have been examined comprehensively by the group. We should acknowledge the model of service that has been produced. There is a tiered service that has five levels and it is proposed that various services should be networked consistently with the general model of managed clinical networks that we have for other services.
We are committed to providing funding for the services that Margaret Smith mentions but, once again, I have to say that I will be able to give details of the precise amounts at the end of the process rather than today. I assure Margaret Smith that we acknowledge that funding is required for the strategy and that we will take that fact on board.
The document says that it is not known how many young girls in Scotland have undergone female genital mutilation. Does the minister agree that female genital mutilation is clearly an issue of violence against women and children? Can the minister indicate at this stage whether he is committed to the recommendation that there be further research, training and education in this regard?
I agree with Elaine Smith's point about violence against women. I would also like to flag up the fact that the dimension of violence against women has been built into the draft strategy. Gender is an important aspect of the issues that we are discussing today.
I thank and congratulate the group for taking such a broad view and for encompassing gender and health inequalities as well considering as the media and the other broader issues to do with social, cultural and ethical influences on sexual behaviour.
I entirely agree with what Elaine Smith says. Although I cannot respond to every recommendation today, I welcome in general terms the recommendation that Elaine Smith refers to.
I, too, welcome the minister's statement that self esteem and respect for others will be pillars of the strategy. It is of great concern that we have the worst record in Europe for teenage pregnancies; I believe that there is a strong link between misuse of alcohol by teenagers and early sexual activity and the resulting unplanned pregnancies. I welcome the Executive's commitment to dealing with alcohol abuse and the proposal to enhance sexual well-being, but I ask the minister to assure me that he will not ignore the link between alcohol abuse and teenage sexual activity and pregnancy.
I cannot disagree with Maureen Macmillan. The aspect that she raises is another dimension of the problem that will be examined. Indeed, my colleague Tom McCabe is examining the issue in relation to the broader alcohol strategy. The sexual health agenda overlaps many other agendas, which is another way of saying that we have to approach the subject holistically.
As that was the last question, I take this opportunity to thank the expert reference group for its comprehensive, well researched and positive report. The report needs to be considered in the round—I hope that it will be considered by the people of Scotland in that way. We shall certainly do everything that we can to ensure that that happens.