Sexual Health
The next item of business is a debate on motion S2M-2958, in the name of Andy Kerr, on sexual health, and three amendments to the motion.
As MSPs are aware, the Executive decided to produce a sexual health strategy because sexual health in Scotland is undeniably poor. The number of unintended teenage pregnancies in Scotland is among the highest in western Europe, as is the incidence of sexually transmitted infections. Worryingly, the situation is worse in areas of deprivation. That is why "Respect and Responsibility: Strategy and Action Plan for Improving Sexual Health" includes a target for reducing teenage pregnancies among under 16-year-olds in the most deprived areas.
As MSPs will also be aware, the incidence of STIs is not confined to young people. Some of the highest rates of infection have been among those aged over 30. As the issue of sexual health affects us all—both the young and the not so young—the strategy is inclusive. Rather than target a particular age group, it seeks to address the issue in a comprehensive and cross-cutting manner. That is why I emphasised the sexual health strategy's central contribution to our health improvement agenda when I announced the launch of the strategy. That will be achieved through the provision of accurate information, improved and more easily accessible services and closer working across national health service boards to make better use of existing resources.
We want to foster and encourage the development of a culture of respect and responsibility. The answers to improving sexual health lie with each and every one of us. We can do something about it.
I was particularly heartened by the general welcome that the strategy received from all sectors of society at its launch. I appreciate that some aspects of the strategy will not have universal appeal, but we have always recognised that, on such a sensitive subject, views are deeply held. That is why the strategy is respectful of young people's rights and of parental and personal responsibilities, and why it recognises faith, cultural and gender diversity. However, it was reassuring that there was general agreement on the principles that underpin the strategy, which are self-respect, respect for others and strong relationships.
I am pleased to advise the Parliament that we have made good progress since the launch of the strategy. In February, the first of two workshops for key stakeholders and commissioners of sexual health services took place. That event was for clinical service providers and was attended by representatives of all NHS boards. It was quickly followed in March by a wider stakeholder event, which was attended not just by clinical service providers but by sexual health promotion specialists and representatives of local authorities, the voluntary sector, special health boards and other key stakeholders. The purpose of both events was to take forward the strategy and action plan for improving sexual health.
The consensus among those who attended the workshops indicated a strong welcome for the strategy and a great willingness and enthusiasm to make progress as soon as possible. The outcomes from the workshops included initial discussions on the benefits of clinical service provision on a regional basis; development and submission of draft integrated clinical service plans; agreement on timescales for the production of local interagency sexual health strategies; and confirmation of the need to engage fully with all stakeholders in the development of local sexual health strategies
When we launched the strategy, I was pleased to announce some £5 million of new funding for each of the next three financial years to support the strategy's implementation. That is £15 million over and above what the Executive already spends on sexual health and related issues. My aim is to ensure that that funding is targeted at making improvements in front-line clinical services. To that end, by 31 March 2005 all NHS boards had submitted initial clinical service plans that reviewed current services, with the aims of working towards integrated links between family planning services and genito-urinary medicine services; increasing services at a primary care level; and providing training opportunities to increase the capacity of hardworking professionals in the field.
The objective for all concerned is to provide a sexual health service that is fit for the 21st century. I am very pleased that the boards, in their interim clinical service plans, have already made a number of key proposals. They include proposals for additional specialist nursing and medical posts and associated training programmes; for integrated family planning and GUM services with outreach services at a more local level suitable to patients; for targeted approaches, such as increased testing for sexually transmitted infections; and for specific user services such as psychosexual services and an increased number of youth clinics.
On the basis of those clinical service plans, funding allocation letters have now been sent to boards. An important aspect of the strategy—this was recognised by the independent expert group that prepared the earlier draft strategy—is the need for leadership. At a local level, boards have now nominated an executive director lead for sexual health; all boards have either identified or are in the process of identifying the clinical lead for sexual health services; and all local authorities are identifying a strategic lead for sexual health in their area.
As regards leadership at a national level, MSPs will recall that when I launched the strategy I announced that we would set up a national sexual health advisory committee, which will be wide ranging. I will chair the committee and its membership will be drawn from a number of key stakeholders. The committee will have a pivotal role in monitoring the progress of the strategy. Most important, it will help to support the implementation of the action plan.
I see the committee's work as falling under three broad headings. Between them, the headings encompass all the actions in the remit that we set out in "Respect and Responsibility". The broad headings are the promotion of a culture of respect and responsibility; the prevention and reduction in the number of sexually transmitted infections and unintended pregnancies; and the provision of better services.
I have today announced the most up-to-date list of the membership of the committee. The first meeting will take place on Tuesday 28 June. I am indebted to the organisations and individuals who have readily agreed to be committee members. Although the membership of the committee reflects stakeholders with a major interest in sexual health, it has just not been possible to include everyone who wanted to be represented. The intention is that the work of the committee will be taken forward by sub-groups that will be able to draw on wider experience and expertise as necessary.
The committee will be an excellent forum to help to draw together other cross-cutting initiatives such as those for adult survivors of childhood sexual abuse and for street prostitution, and our work to reduce the levels of smoking among pregnant women.
In addition to the initial clinical service plans, boards have been asked to submit more detailed service plans by the end of September 2005. I have also asked boards, in collaboration with other local stakeholders such as local authorities and voluntary sector partners, to provide local interagency sexual health strategies that reflect the underpinning principles and general themes of "Respect and Responsibility". Those strategies should reflect the sexual health needs of local populations and should emerge through consultation with professionals, parents, service users and the wider community.
In that way, our approach to dealing with sexual health and well-being reflects the wider, holistic nature of the issue and the role that has to be played by local authorities, the voluntary sector, schools, parents and other key stakeholders. Ultimately, however, it is important that we all take responsibility for our own sexual health. Of course, parents have a key role in protecting the health of their children.
Although the strategy is in no way confined to young people, education has a key role to play in delivering the cultural changes that lie at the heart of "Respect and Responsibility". The strategy seeks to build on existing principles of and guidance on sex and relationships education, and to improve further the key dimensions, such as parental engagement with classroom materials and the consistent delivery of sex and relationships education to all pupils, including those who are vulnerable or disaffected.
The Executive is working with the healthy respect project and the Scottish Catholic education service to develop materials for use in denominational schools. That is an extremely positive step that reflects the absolute importance of stakeholders working together for the common good.
When I launched phase 2 of healthy respect, I had the opportunity to meet and talk to several young people who use the Midlothian young people's advice service in Dalkeith. During our discussion, which lasted for more than an hour, they shared their views on sex education, smoking, drugs and alcohol. They highlighted the value of places such as MYPAS in providing advice and services not only on sexual health, but on a range of issues that they felt were relevant to them. The attitude of the staff towards young people was highlighted as a key element of such a good service.
As I indicated, the strategy is not just about young people. I will make efforts to visit fairly soon the Sandyford initiative in Glasgow, which is an example of how sexual health services can be provided in a location that is suitable for people of all ages.
Although I am pleased with the excellent progress that has been made to date and with the support of all the key stakeholders in the field, I know that we all recognise that this is a difficult and deep-seated issue to tackle. Scotland's poor sexual health is not something that has occurred recently; indeed, it is not an easy issue for a lot of people to talk about. As I said earlier, we have made good progress, but we have still to sort out the problems of poor communication and attitudes, inaccessible and inappropriate services and a lack of knowledge and skills.
This is the start of a long journey, but I am confident that we can move forward with speed and purpose. Crucially, I am determined that we need to continue to make progress in supporting "Respect and Responsibility" throughout Scotland, which is why I am pleased to be chairing the national sexual health advisory committee in its key role of supporting the implementation of the strategy.
I move,
That the Parliament acknowledges the progress that has been made to date in implementing Respect and Responsibility, the Scottish Executive's Strategy and Action Plan for Improving Sexual Health; commends the work by stakeholders to date, and welcomes the creation of a National Sexual Health Advisory Committee which will be a key element in taking forward the action plan.
In response to the statement made by the minister on 27 January this year, the Scottish National Party gave a broad welcome to the Executive's strategy and action plan, "Respect and Responsibility". I give a similar welcome to today's debate. However, it is difficult for us to acknowledge the progress that has been made to date in implementing the action plan, as set out in the Executive's motion, when we have seen very little evidence of that progress so far.
I was concerned to note in today's press release from the Executive that it has taken six months to announce the membership of the national sexual health advisory committee. I would have thought that that could have been done much more quickly, so that we could start to see some action being delivered. However, we have an opportunity today to question the Executive about those matters and to look more closely at the targets and the timescales for the delivery of the action plan. As was acknowledged, the strategy was well overdue, given Scotland's poor sexual health record, with sexually transmitted infections such as chlamydia on the increase, not just among the young, but among the over-40s, where the incidence has doubled in the four years to 2003.
Teenage pregnancies are a worry and rates in Scotland are among the highest in Europe. As a Dundee member, I am acutely aware that we have a particular problem in the city and that it is linked to social deprivation and lack of opportunity. Tackling teenage pregnancy has as much to do with tackling poverty as it does with improving access to medical and support services.
Research tells us that confident girls and young women are less likely to become pregnant or contract a sexually transmitted infection. Conversely, those with low self-esteem are more likely to be persuaded into having early sexual experiences. We must ensure that our young people are confident enough to delay sexual activity until it is right for them and that when they become active, they are well informed about safe sex. I support the Executive's message of "Delay until you're ready, but be safe when you are active."
There is much to commend in "Respect and Responsibility", such as the important commitment to ensure that high-quality and accessible information services are provided equitably throughout Scotland. We know how difficult it can be for people of all ages, but for young people in particular, to access services in more remote and rural areas. Often, the family general practitioner is the only provider of services, and that can put many people off seeking the help that they need.
I welcome the commitment that all schools will be expected to provide high-quality sex and relationships education. However, it is important that, in delivering the strategy, we try to take parents with us. Parents must be consulted on the sex and relationships education that is offered to their child, because if they are not comfortable with what is being taught, the measures in the strategy will be very difficult to deliver. There must be a partnership. If schools fulfil those requirements and if parents play their part by showing an interest in this area of their child's education, the concerns raised in the Tory amendment will prove unfounded.
Of course, parents have the primary role in ensuring that children are brought up to have respect for themselves and others. However, schools also have that duty. The Tories seem to be saying that we should do nothing and leave everything to parents. Most parents want assistance in dealing with such difficult and sensitive issues and welcome a bit of help with their child's growing-up process. How on earth can we do nothing to address the high levels of teenage pregnancy and sexually transmitted infections in Scotland? We would be abdicating our responsibility if we did not help parents to ensure that their children grow up respecting themselves and others.
As I said, there is much to commend in the action plan, but the focus now moves to delivery. In response to the minister's statement in January, I raised concerns about the lack of specific targets and timescales. I am still concerned about that gap, and my amendment seeks to address it. At the time, in response to those concerns, the minister said that the centre for change and innovation was due to
"get all the clinicians and experts in the field together".—[Official Report, 27 January 2005; c 14028.]
That was to happen the following month, with the purpose of ensuring that the strategy could be rolled out and delivered—indeed, he referred to that in his opening speech today. He also said in January that, as soon as that event had been held, the Executive would begin to work on "reasonable" timescales. I wonder whether, in his winding-up speech, he will tell us about those "reasonable" timescales and whether they will be published, so that we can use them to measure the changes and results on the ground.
The minister mentioned that, as part of delivering the strategy, he wrote to health board chiefs and local authority leaders. What progress has been made on that front? How far advanced is the development of the local strategies and plans? Moreover, in January, he said that NHS Quality Improvement Scotland would
"set out a regime of monitoring the performance of health boards as they deliver the strategy". [Official Report, 27 January 2005; c 14033.]
Is that regime now in place?
After the minister's statement in January, I paid tribute to his decision to chair the national sexual health advisory committee. I was going to ask him about the number of times that it has met; however, given that it has not yet been established, I take it that the answer to that question is "none". In that case, will he tell us how often it will meet after its initial meeting on 28 June and how those meetings will be reported back to Parliament?
As well as the absence of timescales, we were—and are—concerned about the level of funding for the strategy. The minister announced an additional £5 million over three years on top of the existing £10 million budget for specific sexual health initiatives. That figure is somewhat less than the £300 million over three years announced by John Reid, the then Secretary of State for Health in England. Have people who work in the field, specifically those who have been appointed to the advisory committee, raised the issue of resources with the minister and will he keep the level of funding under review? I notice that, in today's press release, he announced that £4.5 million will be allocated to implement the sexual health strategy. Will he confirm whether that is simply a re-announcement of the same funding that he announced in his statement in January?
Scotland's future sexual health well-being is dependent on the strategy delivering a much-needed change in attitudes, better access to services and improved sex education. The minister has our support in trying to deliver that transformation.
I move amendment S2M-2958.2, to insert at end:
"and calls on the Executive to publish reasonable timescales for the implementation of the action plan as soon as possible."
It is now 40 years since the advent of the contraceptive pill in the 1960s put women in charge of their reproductive lives. As a result, society has changed enormously. The ability to plan pregnancies and to restrict family numbers has liberated women beyond the wildest dreams of previous generations. Their freedom to go to work and to boost the household income has made it possible for them to buy goods that were previously only a distant hope. Yesterday's luxuries are today's necessities and, even if they do not really want to, many women have to work to maintain their modern living standards. That has resulted in children spending less time with their mums than in any previous generation. Mum—and even granny—is usually in outside employment, so child minders and teachers are increasingly influential with children in their formative years, and busy parents have less time to communicate meaningfully with their offspring.
The pill has also given women sexual freedom, and many now have multiple sexual partners during their lifetimes. The easy availability of alcohol, the increase in drug taking, the decrease in the influence of religion and the open acceptance of extramarital sex put pressure on girls and women that often results in promiscuity and unprotected sex, the downsides of which are sexually transmitted infection, unwanted pregnancies and unstable relationships.
Can Nanette Milne perhaps bring herself to mention any positive benefits that have come from women taking control of their reproductive lives?
I can indeed. As I have said, women have been given untold freedom. It is not all negative, but I am highlighting the downsides simply because we know that sexual health remains poor in Scotland today. Growing numbers of people are acquiring STIs such as chlamydia, the incidence of which is widespread and increasing. That has implications for young people's futures, as they may go on to suffer from infertility or cervical cancer. We know that sexual activity is beginning earlier, with a third of 15-year-olds in a recent survey claiming to have had full sexual experience. Teenage pregnancies are common—more so, as the minister said, in deprived areas. Therapeutic abortion in women aged 15 to 44 has gone up significantly, from 11 per 1,000 in 1996 to almost 12 per 1,000 last year.
Worryingly, there are also significant numbers of people in Scotland reporting discrimination, abuse and sexual violence related to gender, sexual orientation or HIV status, so it is right that Government is seeking to improve sexual health in Scotland and to promote an understanding of sexual health and relationships that encompasses emotions, attitudes and social context.
However, any attempt to dictate to young people is doomed to failure, and sustainable change in behaviour and attitudes can only be family and community driven. There must be a clear focus on family values, and the Executive should publicly affirm the primary responsibility of parents in ensuring that children are brought up with respect for themselves and for others and that they are shown how to take responsibility for their own welfare and actions.
In preparing for today's debate, I read six briefing papers from bodies such as Barnardo's Scotland, the British Medical Association and the Royal College of Nursing. I am afraid to say that only in one briefing, from Children in Scotland, could I find any reference to parents, and that was on the third page. The briefing said that
"it must be remembered that school is just one of the many influences on young people's development—parents are also an important influence, and they must be supported in providing advice and education to their children."
I agree with Mrs Milne that parents have a key role to play in assisting in any sexual health strategy, but does she agree that her overemphasising of that role ignores the fact that some parents are either unwilling or unable to ensure that their children are properly informed, and that it ignores children who live in residential or substitute family care? Given that, what exactly are her objections to the creation of the national sexual health advisory committee, and why does her amendment seek to withdraw any reference to it?
We know that there are parents who are not best equipped to educate their children, but we must look at giving them support. It is a multi-agency problem, and we need to consider all aspects of it. However, we cannot condone the abrogation of parental responsibility, as expressed recently by the mother of the three Williams sisters from Derby, who gave birth at 12, 14 and 16. How can she blame a lack of sex education at school for their behaviour? Where was she when her youngsters were getting themselves pregnant? At such ages, she should know exactly where they are all the time.
Will Mrs Milne give way?
I have given way twice already.
Sexual health education is a complex subject. It needs to help all children with their confidence and self-esteem—not just the sexually active but those who do not want to be. There needs to be advice on sexually transmitted infections, the complex emotional aspects of teenage sex and the issues surrounding abortion. I am glad that the minister agrees that parents must be involved in selecting the literature that backs up all that information.
Parents must be given the opportunity to discuss such sensitive issues with their children in the manner that they consider appropriate. That is why we think that school boards should have a legal right to veto any sex education material and that parents should have a legal right to withdraw their children from sex education.
Will the member give way?
I will take no more interventions.
We want an assurance that the sexual health strategy will not undermine the authority of parents by providing a plethora of state-sponsored expert advice.
We welcome the Executive's efforts to promote positive sexual health in Scotland, to tackle the widespread problems of teenage pregnancy and STIs, to address the difficulties that are faced by people of all ages—including those who have disabilities and impairments—and to deal with the specific health and discrimination issues that confront the lesbian, gay, bisexual and transgender community. We also welcome the fact that education programmes will take the form of abstinence-plus education, which aims to delay the onset of sexual activity.
However, improving sexual health and changing behaviour will need the co-operation of the NHS, schools, the media, the voluntary sector and—above all—parents and individuals, who must take responsibility for managing their own sexual health and maximising their sexual well-being. The passing of much of that responsibility to schools is symptomatic of many of the social problems that face communities in Scotland today, which are the result of parents refusing to take the necessary responsibility for their children's actions.
The Executive must acknowledge that centrally directed strategies such as its sexual health and relationships strategy will have a limited reach. I reiterate that it should publicly affirm that parents have the primary responsibility for ensuring that their children are brought up with respect for themselves and others.
I move amendment S2M-2958.1, to leave out from "and welcomes" to end and insert:
"believes, however, that centrally directed sexual health strategies, such as the Executive's sexual health and relationships strategy, will have a limited reach, and considers that the Executive should publicly affirm the primary responsibility of parents in ensuring that their children are brought up with respect for themselves and others."
I will try to follow that speech with a seriousness that it does not deserve.
Yesterday, I talked at an event that the Telephone Helplines Association organised. The event gave me the opportunity to reminisce about my experience of working for the sexwise helpline, which provides sexual health information to young people between the ages of 12 and 18. I used to do two shifts a week; it was not the best job I have had in my life because pressure was high and it involved taking many phone calls and much abuse. People often wanted very simple information; for example, time after time, they wanted terms to be defined. By the time I left that job, I must have defined most sexual activities more times than I will ever participate in them—not a happy thought for a single 20-something.
That experience reinforced for me the huge number of myths that existed then. I came to that job thinking that many of those myths would have died off decades earlier, but they are still out there. We need to take serious action to tackle the great deal of ignorance and myth that continue to exist. Later in my career, I worked as a full-time youth worker, when it was again brought home to me that as far as people's sexual health needs and the issues that impact on their sexual health are concerned, individuals gain a wide range of experiences at school, at home and at work. We need to be aware of that wide range of experiences.
The Conservative party is right to tell us that parents have a responsibility for young people's sexual health and the Executive's strategy is right to say the same thing; we all acknowledge the importance of parents' role. However, we must also acknowledge that not all parents exercise that role and that the vast majority of those who do so support the provision of good-quality sex education at school on top of—not as an alternative to—their own efforts. They also support young people's access to services and information. As Scott Barrie said, not all parents will be able or willing to provide the necessary information and support.
I condemn the idea of giving school boards and parents a veto over the use of specific materials. We all saw how ugly the section 28 debate got. You can bet your bottom dollar that, if that power were available, it would be exercised and abused by some of the most unpleasant elements in society. If Nanette Milne believes what she says about wanting to support the LGBT community and its specific sexual health needs, I ask her to re-examine her policy on that right to veto.
I turn to the Scottish National Party amendment. One of the concerns in respect of sexual health as a whole has been about timescales for solid implementation plans. The Green party believes that it is worth supporting an amendment that calls for timescales to be published. Even if, at the end of the day, we expect the timescales to come from the advisory committee, we should say that we want them. We support the intention behind the SNP amendment, which asks for timescales.
The motion calls on Parliament to welcome the strategy. I welcome it, but it is most important that I do so because of the principles on which it is based. Sexual health is not just about an absence of disease; it is about a range of social and emotional—and political—factors that impact on people's sexual health and their ability and confidence to access services.
However, I have one or two caveats about the wording of the strategy document. It takes six areas as starting points, the second of which is that
"committed and stable relationships, characterised by these values, are the right setting for sexual relationships".
My point may be about just a minor aspect of language, but it is wrong to suggest that people should not have sex and that we should disapprove of people who have sex outwith committed and stable relationships. Committed and stable relationships are fantastic and we should support them and encourage people to pursue them. However, equally we should not disapprove of people just because they have sex outwith such settings.
My amendment deals with the balance between clinical and prevention services. It is perhaps understandable that the minister's speech focused largely on the clinical side. There is a great deal that we need to get right in our clinical services and in the way in which people can access a range of services. I am thinking of local services and services that need to be accessible not only geographically and physically but because they meet specific needs.
We also have to get right prevention and education. If we want to create a culture of respect and responsibility, GUM clinics are not the place to do it; the whole of society is that place. There is little point in putting all our resources into clinical services. We need to improve health and not just to treat ill-health.
We need to put equality and diversity at the heart of our understanding of the issues. We have to recognise that a one-size-fits-all approach will not work and that we need to consider issues such as age, gender, sexuality, ethnicity and language. Legal status is also important, for example in addressing the needs of asylum seekers and refugees who come from different countries and who have a different range of sexual health needs. They might have a different concept of what sexual health is and of their relationship to treatment and medical services, for example. Those matters are implicit in the strategy, but we need to ensure that they are explicit in everything that we do. I look forward to the committee coming up with the explicit aspects of the strategy.
My amendment mentions the Caledonia Youth project, whose Glasgow branch has been examining specifically the needs of excluded young people. That work has included young offenders at Her Majesty's young offenders institution Polmont and young people who are coming out of care—the sort of people who are excluded from a wide range of mainstream support services.
If we end up with the loss of existing services and if existing professionals move to other fields, lose their skills or even their motivation because of uncertainty about funding, we will go in the wrong direction. We should build services. Eventually, the new funding for the strategy will build on existing provision but, in the meantime, we absolutely must not lose our existing services.
Again, I welcome the strategy and the fact that a committee has been appointed to work on the subject. I encourage Andy Kerr in his visit to the Sandyford clinic to take the opportunity to meet the people at Caledonia Youth; that clinic is where they are based.
I want to underline that there will be a continued need for proper resourcing, and for good work with the voluntary sector as well as with the public sector, and that we will need political will. A minority of people—they present themselves as the moral majority—do not want there to be sex education or recognition of equality and diversity. It will take continued political will to ensure that that agenda does not hold sway, and that instead we end up improving the sexual health of Scotland's young and old people.
I move amendment S2M-2958.4, to insert at end:
"recognises that there is a need both for clinical services and for prevention work which enables individuals to take greater control of their own sexual health and that both elements must be delivered in ways which recognise the diversity of the population and respect their equal rights to information and services; is concerned, therefore, by the decision by NHS Greater Glasgow to cut the funding to Caledonia Youth's Glasgow branch, which will lead to the closure of a service with a record of working to address the sexual health needs of excluded young people, and calls on the Executive to work with NHS boards to ensure that existing services are maintained and improved upon wherever possible."
The strategy and action plan for improving sexual health are all about ensuring that a culture of respect and responsibility based on sound values is at the heart of our national, community and personal well-being. We aim to tackle the unacceptable levels of unplanned and unwanted teenage pregnancies and the increase in sexually transmitted infections. It is absolutely right, therefore, that the Executive takes an active role in promoting positive sexual health as a key part of improving public health in Scotland.
The Liberal Democrats argued in our 2003 manifesto for development of a national sexual health strategy. We pointed out that a healthy sex life is an important and enjoyable part of people's lives, but that significant dangers can be attached unless care is taken. We said that about 20,000 people in Scotland are treated for sexual health problems every year. To address that, we called for the development of this strategy by the Executive.
We need the strategy to enhance self-respect and to tackle the complacency that has led to increased risk taking, particularly among young people. We also want to reduce the stigma that is attached to sexual health issues. We wanted in designing sexual health services to ensure, while reflecting the different cultures, genders and orientations of individuals, that the health advantages to young people of delaying sexual experience were included in the sexual health strategy. That is what the Executive has done. All those things are included in the Scottish Executive's "Respect and Responsibility" action plan.
The motion welcomes the fact that the national sexual health advisory committee has been created. Among many of its tasks, it will have a major role in ensuring that no one is excluded from appropriate sexual health services. That is a real and important role for the committee.
The strategy and action plan make it clear that the Scottish Executive's Health Department and Education Department have specific functions in tackling the issues that are before us. Local authorities and health boards must also co-operate in fulfilling their functions. I believe that one of the most important functions that local authorities have is to ensure that all schools—all schools—are able to demonstrate that they provide pupils with equitable information about sexual health services and, importantly, about how to access them.
How would the member define "equitable"? Is there a role for parents in contributing to the decision-making process?
Of course parents have a role to play, but we are talking about taking an equitable approach so that all school kids throughout Scotland have the same information. I was pretty shocked by what Nanette Milne said and by the tone that she used. Unlike the Conservatives, we believe that everyone has a right to equitable information and equitable access to services. No one person, no body and no interest group should be able to veto that information's being given to kids anywhere in Scotland. I was somewhat shocked that the Conservatives seem to be promoting that cause.
Let us examine the Conservatives' amendment, which does them no good and reeks of complacency. We have a sexual health problem in Scotland, but the Conservative solution is to say:
"the Executive should publicly affirm the primary responsibility of parents in ensuring that their children are brought up with respect for themselves and others."
Well, that's all right then. The Conservative solution is that we should just reaffirm that it is the parents' responsibility. Oh, well done.
Let us get real. Of course the primary responsibility for a child's health and welfare is down to parents or carers, but surely we cannot say that reaffirming that will solve the problems that are faced up and down the country. I am afraid that, yet again, the Conservatives have lost the plot; they remain completely out of touch with reality.
The strategy and action plan that we are debating are ambitious and wide ranging and set out a long-term programme for tackling important issues. I am convinced that the plan that the minister has come up with is the right one; we must now ensure that it is implemented enthusiastically and comprehensively. The issue is too important to allow any section of the community to opt out of the plan. Sexual health affects us all, and everyone—no matter where they live or how they are educated—must have equitable access to information and services. The action plan is the right one. I urge Parliament to support it.
Sexual health is a controversial subject on which people have deeply held views. However, given the rising rates of diagnosed sexually transmitted infections among people of all ages, to do nothing or to do little would be irresponsible. Like Mike Rumbles, I was surprised to hear Nanette Milne's speech on behalf of the Conservative party. Like Nanette Milne, I am a member of the Equal Opportunities Committee, so I was surprised to hear the stance that she took this afternoon.
In 2003, the partnership agreement committed us to developing and implementing a national sexual health strategy; in November 2003, the then Minister for Health and Community Care launched our consultation document on the strategy and the strategy has now been launched in 2005. We did all that because we knew that to have done nothing would be unacceptable.
The important strategic aims are to promote respect and responsibility; to prevent—through education, service provision and support—sexually transmitted infections; and to provide better sexual health services that are safe and, importantly, local and appropriate. It is important to recognise that young people from deprived areas are often most vulnerable and that sexual health problems are both a symptom and a cause of social inequality. We are committed, through many different policy initiatives, to working in partnership with local organisations to tackle the causes of social inequality, which include low aspirations and lack of opportunity.
My constituency in Fife has benefited from the work of the Fife sexual health strategy group. The group, which was formed about six years ago, has created two three-year strategies, the second of which is now coming to an end. During the summer, the group will consider the next three-year strategy, which will follow the Executive's guidance. The group consists of representatives of local groups, including voluntary sector groups such as FRAE—fairness, race awareness and equality—Fife, Fife Men, Fife Health Council and key players from Fife Council and the health service in Fife. Much of the group's work has focused on schools and on researching materials that are used in schools.
People in Fife who work in sexual health have emphasised the benefits that accrue from the coterminous boundaries of different agencies that Fife enjoys. Thanks to Scottish Executive funding, plans are well advanced to integrate genito-urinary well-being, family planning and reproductive health services; the necessary research is almost complete. I would also like to mention the work of Clued Up in my constituency. The group initially dealt with young people and drugs, but has expanded to provide drop-in services that suit young people, including professional advice on sex and sexually transmitted diseases. Those services were asked for by young people.
Nationally, we must recognise the impact of parenting skills, domestic and sexual abuse and culture and religion on sexual health. We must ensure a co-ordinated approach and make full use of expertise at national and local levels. We must ensure that all levels of government work in a joined-up way so that the aims of the strategy are realised. Therefore, I am pleased that the strategy document recommends that the sexual health strategy should be linked with the Executive's wider policies on lifelong learning, equity and diversity, social inclusion and alcohol and drugs misuse.
In taking that approach, we acknowledge the strong link between social disadvantage and early initiation into sexual activity, and the challenge of tackling sexually transmitted infection among the people who are at highest risk in our communities. Through education and support, we must create a culture in which young people can take responsibility for and ownership of their sexual health. If we are to foster healthy attitudes towards relationships, parental involvement is important, as is the role of our schools; they can work hand in hand.
Importantly, the strategy endorses the World Health Organisation's definition of sexual health, which is:
"A state of physical, emotional, mental and social wellbeing related to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sex experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled."
Respect and responsibility are the key objectives of the strategy—they are what is needed. On behalf of the survivors of childhood sexual abuse cross-party group, I thank the minister for his help and support in progressing our agenda of respecting and protecting our children. It is important to put that on the record. I thank everyone who has worked with us to take that agenda forward.
As the minister indicated, the strategy is not just about young people; it is about tackling poor sexual health wherever it is found. To do that we need commitment across the board at all levels. We need continuing education and support and a change in attitudes. I agree with Patrick Harvie when he says that a one-sizes-fits-all approach is not the way forward. However, the respect and responsibility strategy sets out clearly an action plan that will allow us to tackle and prevent sexual ill-health wherever it exists. I support the motion.
My question to the minister is, "Why are we having this debate?" Is it just to announce the formation of a committee? If that is the reason, it is a bit feeble. If the purpose of the debate is to give members the opportunity to repeat what many of us have been saying since 1999, when it was first suggested that we should have a sexual health strategy, is that the best use of parliamentary time? The speech from the Conservatives was, to be quite frank, from out of the dark ages and will leave many young Scots in the dark about relationships education as much as about sexual health education.
If the debate is not about just repeating positions that people have held previously, what is its purpose? If it is about announcing progress since the statement in January, perhaps it would have been courteous and informative to Parliament to have provided members with some documentation—a photocopied report announcing progress to date would have been helpful and would have moved the debate on. Some of us are a bit tired and weary of having to return to the chamber time and again to repeat concerns about the appalling sexual health record of Scotland. However, this is a time when we should be at our least tired and weary, because the momentum to ensure that action is taken is needed more than ever.
Subjects such as relationships and self-esteem have been mentioned repeatedly in the debate. Sexual health is not the only concern we have about our young people. Perhaps the minister should discuss with his colleague Peter Peacock in the Education Department how we can ensure that self-esteem and self-respect are part and parcel of our education system, because tackling those issues will help to tackle many other issues.
On parental involvement, on page 80 of the report I see an interesting comment from somebody who attended one of the consultations. He said:
"When my son started going with a girlfriend I spoke to him and I said to him ‘watch what you're doing and go to the chemist and just be careful'. But with my daughters—my wife asked me if I was going to talk to them, but I said no. I don't feel it's the man's place to talk to the daughter—but maybe it is?"
Just over a week ago we had a conference in the chamber with parliamentarians from Africa, G8 countries and Europe. The subject of much of the conference was HIV and AIDS. In one of the workshops, a Ugandan parliamentarian said:
"One of our biggest problems in tackling HIV and AIDS is that men don't want to talk to their daughters about sex and sexual health, and politicians and public servants don't want to talk about sex and sexual health."
If we have achieved anything, perhaps we have moved on in that public servants and politicians are talking about sexual health. However, as the report says, perhaps there is a problem in how parents talk to their children and how men and women relate differently to their sons and daughters.
I would like to hear more about the McCabe report's recommendations on parental education. We have glossy documents such as "Ready Steady Baby!: A Guide to Pregnancy, Birth and Early Parenthood" to help people know what they should do with their children. I am not suggesting that the Executive should go out and produce masses of glossy documents, as it is prone to do, but perhaps a "Ready Steady Teenager!" document might be helpful. Also, although I see points about parental education in the report, I have heard nothing about what is happening.
On consistency of information, I remind members—particularly the Conservatives—that article 24 of the United Nations Convention on the Rights of the Child states that no child should be deprived of the right to access public health education and services. I welcome the Roman Catholic Church's movement on education services, but I ask the same question as I asked in January: who will monitor the quality and provision of sex education in non-denominational and Catholic schools and report to Parliament on whether they are satisfied that the points that have been made about public health and access to information are upheld? I look forward to hearing an answer to that.
I am concerned to read that some surveys suggest that the lack of information is still prevalent. A survey by Developing Patient Partnerships tells us that 45 per cent of young people in Scotland
"mistakenly thought that they had to see their GP before they could access sexual health services".
We are six years on from 1999 when we said that we needed a sexual health strategy. We need to ensure that we monitor our progress robustly to see where we are going.
I ask the minister to address online access to sexual health information, because that is what young people want. In the Developing Patient Partnerships survey, 78 per cent of young respondents cited online information as a need. However, we know that blocks on websites mean that young people who want to access such sites might not be able to do so. We need to address that technological impasse.
On funding and the provision of resources, we know that John Reid provided £300 million for the strategy in England and we have heard the minister's announcement of £5 million a year over three years, but is that enough? The briefing that we have received from the Scottish NHS Confederation suggests that
"Shortages of suitably trained staff in some areas will mean that many aspects of the strategy will take longer to implement than others".
We are talking about a national strategy, so I would like to hear from the minister what services in what parts of the country will not be able to implement parts of the strategy because of resources.
Rather than being tired and weary about progress to date, we should say to the minister that we are watching him, that we expect results and that we expect the momentum to be continued rather than slowed down. If the purpose of the debate is to ensure that he knows that, perhaps it will be useful.
Fiona Hyslop asked why we are having the debate. She also asked many questions that I want answers to. One of the reasons why we are having the debate is that organisations to which members have referred are also asking those questions. Another reason is that, since the minister made his statement on sexual health, I have been plaguing the Parliamentary Bureau for a debate, so if Fiona Hyslop thinks that the debate is not appropriate, I should be one of the people whom she blames.
Fiona Hyslop mentioned the need for dedicated resources, staff and premises if the strategy is to deliver, which is my primary concern. As she said, the Scottish NHS Confederation—a body with which I do not often agree—is expressing concerns about the need for dedicated resources, staff and premises to implement measures such as those that are contained in the sexual health strategy.
I will ask a couple of perennial questions. I have posed them in the past, so I hope that the minister will deal with them in his response. How widely available will free emergency contraception be throughout Scotland? How widely available will condoms be throughout the country? I would like them to be available to anybody who wants them, in a proliferation of places without restriction and without cost barriers.
Those were my specific questions on physical provision; the other issue to which I want the minister to return is the consistency of training and access to it by school nurses and other professionals who deliver sexual health advice or sex education in schools. How will consistency in that training be delivered to ensure that sexual advice and education are non-judgmental and non-directional, wherever they happen to take place?
I want to turn my focus to issues relating to women, which I have not done quite so much during some of the previous debates on the subject. It is notable that there was no mention of men in Nanette Milne's entire speech—apparently, all the onus is on women to be responsible. I was surprised to find out that, since the pill was introduced, we women have been liberated beyond our "wildest dreams". The pill represents only a tiny wee proportion of the liberation of women that I would like to see. We have a long, long way to go.
It is interesting that Nanette Milne did not mention the word "man" once. I refer in particular to people having sex early on. Where was mentioned the responsibility of the men who also participate in sexual relationships that involve very young women who might go on to have unwanted pregnancies?
I think that Carolyn Leckie is being a bit hard on the Conservatives. There are at least two men on our benches, but there are no Scottish Socialist Party males sitting beside her.
That is because we bumped them out of the debate.
There is a serious point to be made here. There is an element of right-wing reaction, particularly in relation to termination services. President Bush's attacks on the rights of women in the United States of America to access termination and contraception are extremely worrying. On the whole, I detect consensus in the chamber in respect of women's right to control their own fertility but, rather than simply protect that, we need to go on the offensive. In America, pharmacies are now allowed to block women from purchasing contraceptives on the basis of a conscientious objection. I would hate to think that that is happening or could ever happen here.
In some states in the USA, men have been charged and convicted for killing miscarried foetuses, but were not charged or convicted for the assault on the pregnant woman that led to that miscarriage. The result is that unborn foetuses now have more rights than women in some states, which renders the women there third-class citizens.
It is time for women and men to go on the offensive to protect, enshrine and develop a woman's right to control her own fertility without any barriers. We need to be at the forefront in resisting any further attempts to restrict access to terminations in this country. We must be extremely vigilant and we must be the stout defenders of a non-judgmental, supportive and empowering sex and relationships strategy. We need to defend equal and consistent access to information, with confidential support, advice and services being provided to people whatever their age and geographical location and irrespective of whether they are poor or wealthy, of what school they go to, of what their background is or of what their occupation is. That needs to be delivered by qualified professionals who are experts in sexual health, who have no moral or religious agenda and who will provide non-judgmental and non-directional education.
I am a wee bit concerned about why materials should be different in different schools if the underlying principles are that they should be non-judgmental, non-directional and consistent. I ask the minister to elaborate on that and—I hope—to reassure me that all schoolchildren will have access to equal and consistent information, support, advice and services.
I was previously a midwife, and I am very proud of the fact that, on any given day, I was able to deliver appropriate care, whatever the circumstances of the women I was caring for. On any one day on a labour ward, we could see a continuum of a woman's life. We might see one woman sadly having a miscarriage, another woman sadly giving birth to a much-wanted but stillborn baby, more women having happy healthy babies and, occasionally, some women having terminations because of foetal abnormality or other reasons. I am proud that professionals throughout this country are able to give consistent, appropriate and professional care to such women, whatever their circumstances, at whatever stage in their life. I am equally proud of the care that is given in every situation.
A couple of comments have been made about parents' role. Some members have said that parents should be consulted; the Conservatives raised the possibility of parents' having a veto. That would take us back to the dark ages. It is irresponsible and it is a cop out. Not only do some parents not see themselves as being in a position to offer advice—some are unable to do so and some are unwilling to do so—but quite often the last person from whom children and young people want advice, support and information is a parent. They have an absolute right to access information and the Tories are not living in the real world and do a disservice to young women, young men and adults if they think that the answer is to say that it is about parental responsibility. Heaven help the next generation and the generation after that if that is to be our approach.
I am surprised that the question has been asked why we are having this debate. It is more than five months since the Executive published a major, long-awaited policy document on one of the major public health challenges of our time. It is absolutely right and proper that we have the opportunity to debate and discuss that and to reflect on where we are and where we go from here. I will use my few minutes to do just that.
Last week, I attended one of the choices for life roadshows organised by the Scottish Drug Enforcement Agency, which was a remarkable event. More than 2,500 primary 7 children were at Ingliston that day; the day before, there had been more than 4,000. Throughout the country, in the seven or eight other roadshows that had taken place, thousands more youngsters had participated in that powerful initiative, which was as entertaining as it was educational.
Without doubt, the most powerful part of the day, which combined bands, videos, quizzes and a host of other things, was a hard-hitting dramatisation by PACE—the Paisley-based youth theatre group. It portrayed the lives of three teenagers growing up and wrestling with the dilemmas of adolescence, not least whether to take drugs. Respect, identity and peer-group pressure were just some of the themes running through that amazing drama.
Why am I talking about a drugs education event in a sexual health debate? As I sat through the event, I could not help but consider where we are now in the public policy debate on drugs as distinct from where we are with sexual health. I will make comparisons. There is the obvious one that I am not aware of our having the equivalent set of roadshows on sexual health for thousands of youngsters throughout the country, although perhaps the minister has plans for something of that nature.
I suggest that there are marked philosophical differences. On drugs, we have long since dispensed with the just say no approach, not because we do not want youngsters to say no—far from it—but because we recognise that such an approach is simply not effective. Yet in sexual health, calls for abstinence-based programmes that tell youngsters to just say no still regularly punctuate and influence debate, policy and, often, the language that is used in the area. On drugs, we are now giving youngsters more information than ever before in the hope that it will discourage them from taking drugs. Yet when we talk about enhancing sex education and giving youngsters more information on sexual health, it is frequently suggested that we are somehow encouraging them to have sex.
Central to the narrative and practice of drugs policy and education is the language of choice—hence choices for life. We recognise and respect the fact that the young and the old must make choices for themselves, and we are working to equip people with the knowledge and confidence to make informed choices. However, the debate on sexual health often still lapses into being judgmental or prescriptive. We often struggle with the language of choice and sometimes fear that such language may be construed as supporting promiscuity, or as being amoral or even immoral. I accept that drugs and sex are not directly parallel issues, but I contend that our society has not yet developed the mature and pragmatic approach to sexual health that we have developed in other areas of public policy and towards lifestyle choices—in respect of drugs, for example. I firmly believe that unless and until such an approach is developed, the step change in practice and ultimately in health that is desperately needed will not be delivered. Like other members, I welcome the publication of the strategy, the debate and the gradual progress that is being made, but it is important that we stop and reflect on how far we still have to go in order to debate the issue fully, let alone to act effectively.
Why do we continue to struggle with the issue of sexual health? Why did the production of the strategy take so long? Why did the debate outside, if not inside, the chamber sometimes prove to be so controversial? Embarrassment is an issue. We are comfortable talking about statistics for sexually transmitted infections and teenage pregnancies, but all of us—politicians and others in Scottish society—still wriggle and blush when we have to talk more about the issues, such as sex and relationships, that sit behind the numbers. There is an irony. We live in a society in which we are bombarded with graphic sexual imagery every day, but we struggle to have grown-up discussions about sex and relationships. We must overcome our embarrassment. A recent survey showed that embarrassment is one of the biggest barriers to young people seeking help with or advice about their sexual health. As politicians, we must play our part to dispense with that discomfort. If we are embarrassed by the subject, we can hardly expect others not to be embarrassed by it.
There is another reason why the debate can be jaggy—it takes us to the heart of the moral maze, which is a difficult and sometimes uncomfortable place to be. I cannot possibly do justice to the complex issues that are involved in the little time that remains, but suffice to say that it has been suggested that people who work in the field are value free. I know of no one—no individual, professional or parent—who approaches the issues of sex, sexuality or sexual health in a value-free way, but I would argue that the values of tolerance and respect are every bit as relevant in the debate as any moral absolutes.
Earlier, I spoke of pragmatism in drugs policy and education. Pragmatism has been successful in the past in fighting HIV/AIDS in Edinburgh and it will be effective in the future. People must be prepared to do things that work and to use the evidence that is available.
Since devolution, there have been several heated debates on sex and sexuality in Scotland, which have often generated more heat than light. If we are to foster a climate of informed debate and develop effective public policy, that must change. I hope that tolerance and respect will be our watchwords and that we will enable Scots throughout the land to make informed choices.
Given comments that were made earlier in the debate, I feel that I am the token male on the Conservative benches. However, I think that I have something to contribute to the debate.
In the light of the spirit in which the Parliament was created and the desire for consensual and inclusive decision making, I have been disappointed by the extremely hostile reception that has now and again been given to members who stand up in the chamber, take a particular point of view and disagree with the majority of members. When that happens, this is hardly the inclusive Parliament that we hoped for. Nanette Milne was undeservedly treated with that hostility when she made her speech earlier.
The Conservative amendment retains the motion's acknowledgement and welcome of the Scottish Executive's sexual health strategy and action plan. The one thing that we object to is the creation of the national sexual health advisory committee—a token effort, perhaps, but one that is intended to highlight the fact that the creation of a committee is no substitute for encouraging parental involvement.
Alex Johnstone has missed the point. What members objected to in Nanette Milne's speech was the fact that she was advocating that people should be able to veto access to information and sexual health services. That strikes at the core of what was said earlier about children's human rights.
I believe that Mike Rumbles has misunderstood what was said. I hope to address that in greater detail as I progress.
The Parliament has become famous for the fact that it is very politically correct. We try hard not to impose our values on other people. Yet, when we talk about sexual health, there is a danger that the desire not to impose our values on others can result in our taking a stance that is, essentially, amoral. It would be irresponsible of us to do that. There are people out there who expect their views to be expressed in the chamber and we will do that in a reasonable and measured manner. If those views differ from the views of some members of the Parliament, members should expect us to be the ones who take them up.
Some of the accusations that have been fired around today are pretty unpleasant. Patrick Harvie was perfectly happy to talk about unpleasant sectors of the community but did not go on to explain what those unpleasant sectors of the community are. If he is able to do that now, I would be delighted to hear.
Bigots.
Well, that is a fairly simple definition, and one that perhaps does not belong in the debate. That is not what we are talking about today.
The truth is that I agree with much that has been said by many members in the debate who have sought to differentiate their views from those that I am prepared to support. I agree with Patrick Harvie that the whole of society must be implicated in the sexual health strategy—that is essential. However, there is a need for us to understand that parental responsibility must never be marginalised. I acknowledge that the minister went to considerable lengths to include parental responsibility in his strategy, as he mentioned earlier, but it is our responsibility to highlight that as a significant part of what we want to see
My experience of raising two children to adulthood—I think that I can say that we have managed to get them there—differs from some of the experiences that have been described by other members. To Fiona Hyslop, I say that I was the one who spoke to my daughter. That is something that more parents should be encouraged to do. We must make a point of not losing track of what we are doing. We must ensure that a moral position can be taken by parents.
It is not only parents with whom we must concern ourselves; it is also the many cultural and religious groups that exist in this country, which can stand up and say that they have a better record than society as a whole in certain aspects of encouraging responsible sexual behaviour. If we are to be inclusive, we must accept that there are alternative views and that there will be times when individuals or groups seek to take an alternative route. Their right to do so must be defended. Although I believe that the minister understands that principle, there are members who have taken a view that goes significantly beyond that.
Abortion is an issue that I did not initially mean to address but which I feel that I should address because it has been raised by other members. I would be the first to defend a woman's right to control her fertility. I will not oppose that. However, we should be ashamed of the fact that in Scotland today abortion is in effect no more than a form of contraception. We need to ensure that that is not the case in future. We need to take a responsible attitude to abortion in our society. If that means that we have to educate, let us do that, but let us ensure that that education begins in the home.
Fiona Hyslop referred to a position that has come from the dark ages. If we all open our eyes, it is possible that we might progress out of the dark ages and, for the first time in a while, see the light.
I have some sympathy with Fiona Hyslop. How much more can we say about this subject? I came to the debate thinking, "What on earth can I talk about this time?" because we have all aired our views. I decided to listen to what was said and comment on it—I suppose we could call this a closing speech halfway through the debate, so I apologise to Stewart Maxwell.
The first thing that I noted was that the minister was at pains to emphasise his point about a culture of respect and responsibility. It is right that we have to cultivate self-respect and personal responsibility, but what seems to be missing from the debate is the point that everyone should respect what other people decide to do with their lives. A culture of respect should work both ways.
A few members have mentioned choices. If people are making informed choices, which I believe should be the central tenet of any sexual health and relationship strategy, society should respect those choices, as long as their exercise is not harming or oppressing anyone else physically or mentally. I would like there to be more emphasis on mutual respect for people and their choices.
I was interested in the progress that the minister was talking about and the stakeholder events that were held in February and March. I was also interested to hear that the health boards have now submitted their clinical service plans. However, I am concerned about the need for additional specialists in the field and the fact that that need might not be met in all areas of Scotland. Some of my constituents talked to me recently about the lack of sexual health services in Lanarkshire and about their inability to be very vocal about that because of embarrassment about speaking out about such matters.
I am glad to hear that the health boards will have executive leadership. I am also glad that the national sexual health advisory committee has now been formed. I noted that it is going to be a group of stakeholders, and I looked at the membership published in the press release. Is there any room on that committee or on any of its sub-groups for people from civic Scotland and the voluntary sector in this field? I do not necessarily mean those who run Caledonia Youth or other services; I mean people with direct experience of using such services. Recently, I was on a radio programme talking about sexual health. There were two young girls on the programme, one of whom was a teenage mum and one of whom was not because she had exercised her choice for contraception. I was so impressed at the sense that was spoken by those two young girls and I wonder whether the minister agrees that there is room for that kind of representation on the committee or on one of the sub-groups. The minister said that he talked to young people when he was formulating plans for the committee so I am pretty certain that he will have picked up on that and I hope that he will think about it.
It is excellent that the minister has decided to chair the committee himself. That is a mark of its importance. I know that we are five or six years on from when the need for a sexual health strategy was first mooted and there are concerns about that. However, we are where we are and we should move forward.
Shona Robison mentioned the social aspects of the issue. That brings us back to the need for joined-up government. As Fiona Hyslop mentioned, we need to ensure that there is cross-departmental working on the issue with the Minister for Education and Young People, Peter Peacock. The social aspects involve low self-esteem and lack of choice and aspiration, especially among young women in some areas. Those are huge issues. Again, I hope that our social policy will reflect the needs that are highlighted as the sexual health strategy advances.
On the Tory amendment, I agree with Mike Rumbles—much though it goes against the grain to say so—in that I am concerned about the suggestion that we should have no national sexual health advisory committee and that we should publicly affirm the primary responsibility of parents. As other members have said, some parents are unable to address these issues and some youngsters find it difficult to talk to their parents.
Is the fact that so many parents are unable to fulfil that responsibility not one of the primary issues that we need to address?
The need to remove the stigma about such matters is an issue, as Susan Deacon explained very well. However, we also need to address reality: some parents are not good parents. To be straightforward, some parents are pretty rubbish. We cannot simply write off all the youngsters of parents who cannot hack it. As well as parental and individual responsibility, there must be a responsibility on the state for education and health. If I thought for one minute that, just because somebody was raised with a mum and dad in a happy family, everything would be hunky-dory, I would say okay. However, that is not the case and we need to face that.
Patrick Harvie highlighted the cut in funding for Caledonia Youth. I ask the minister to explain what he intends to do about that.
Nanette Milne spoke about abstinence plus. As others have said, such models do not work. Education about choices is what will work.
As I have said before—I hope that the minister can reassure me on this point—the educational materials that go out to schools must put as much emphasis on the responsibility of boys as they do on that of girls. Too often, the responsibility seems to fall on the female in relationships. Boys need to realise that, basically, if they do not want to be a dad and take on all the responsibilities that go along with that, they need to take sexual precautions because it is 50 per cent their fault if the girl with whom they have sex ends up pregnant.
Finally, as I am aware that I am running out of time, let me say simply that the amendment in the name of Shona Robison is important because we need reasonable timescales for the implementation of the strategy and action plan, along with progress reports. I hope that the minister will accept the SNP amendment.
Unlike my SNP colleagues, I welcome the opportunity to speak in the debate. Like other, more positive members today, I praise the work that members of the expert reference group and others carried out during the consultation period.
Sexual health is sometimes brushed aside as a subject that no one wants to discuss openly, as Linda Fabiani mentioned. However, that is precisely the reason why there is a great need for us to dispel the myths. There is no getting away from the fact that Scotland has a poor record on sexual health and teenage pregnancies.
Parents are often unable or unwilling to talk to their children about sex and sexual health. I think that Nanette Milne tried to make that point, but I am a bit confused about how some of what Alex Johnstone said fitted in with the philosophy on family values that the Tories tried to promote in a previous election campaign.
Parents often leave it to the education system to deal with the subject of sexual health, but there was previously no clear strategy on how that should happen. That is why I was so pleased with the outcome of the long-awaited sexual health strategy expert group report and why I was even more pleased that the Executive accepted the bulk of the expert group's recommendations.
One of the main planks underpinning the strategy is the value of partnership working. A number of agencies have a crucial role to play in ensuring the success of the strategy, so the value of joint working should never be underestimated. The education service, the health service and the social services must work closely together, but there is also an important role for the media and the voluntary and private sectors. That was demonstrated to me last year when I had the pleasure of attending the launch of a pilot project in south Glasgow. The project is run principally by Enable, working in partnership with the Family Planning Association—or FPA as it is now known—NHS Greater Glasgow primary care division and the pharmaceutical industry. The project aims to provide an innovative approach to sex education for people with learning disabilities. Its main aim is to train people as peer trainers, and it takes the view that barriers will be broken down if sex education is delivered by people with learning disabilities and not solely by professionals. The project has resulted in an illustrated booklet designed for their peers by those who participated. The project also resulted in a drama about the issues surrounding sex and relationships and the problems faced therein by people with learning disabilities.
The success of the venture has now led to a second stage of training, which has seen the development of a workshop on barrier methods of contraception, and the making of a DVD that is one of three giving a transnational perspective on the issues surrounding relationships and sex for people with learning disabilities. It involved Enable working with its counterparts in Ireland and France.
The venture clearly demonstrates some of the outside-the-box thinking and partnership working that are already going on in our communities. Such work can be developed as part of the Executive's work on improving our sexual health statistics.
I was pleased to see in "Respect and Responsibility" that the sexual health and well-being learning network will facilitate awareness of the sexual health needs of people with learning disabilities. In his summing up, the minister might want to say a few words about that so that we can have a clearer idea of the role that the network will play.
I was going to mention—until the minister beat me to it—the Sandyford initiative in Glasgow, which is run by the NHS but supported by Glasgow City Council. The initiative is another example of partnership working. It provides a comprehensive service that covers many different aspects of sexual health.
I agreed with my colleague Carolyn Leckie when she said that all too often we talk only about women and sexual health. The Sandyford initiative is a good example of how we can also give great advice on men's health issues and on the role that men can play in reproductive health and in other general aspects of sexual health.
I look forward to the national sexual health advisory committee's work; I very much hope that it will build on community initiatives such as the Enable initiative that I mentioned and others that other members have mentioned. Those projects prove that there is a willingness to improve sexual health in Scotland. I commend the Executive for its work in this regard.
We move to the winding-up speeches.
I very much welcome the debate and the strategy. I thank the Executive for making parliamentary time available, because we need to debate not only the issues involved—which, as others have said, have been debated before—but how the strategy, which was published in January, can be taken forward.
A good thing about holding a debate such as this one is getting the chance to read all the briefings that we receive. I was particularly struck by the briefing from Children in Scotland, which said that the strategy does not mention deprivation. Several members have done so, but the strategy does not. Young, teenage girls from deprived areas are three times more likely to end up pregnant than those from affluent areas. Issues of knowledge, information and access to services arise, but a crucial issue is that of self-esteem. Various members have mentioned that and said that our vision for the sexual health of the people of Scotland should be of a healthy and confident people who are informed about and able to make choices. That is important.
We should not talk about sex being an early initiation. I do not like that term at all; it suggests that sex is some rite that is performed on people when it should be about a choice made by both people in a couple, with full knowledge and with desire to participate. It is really important that there is no coercion; that is what we should be aiming for.
I was going to mention the needs of particular groups but others—notably Janis Hughes in the speech before mine—got there before me. I was going to talk about the needs of disabled children. I very much welcome what Janis Hughes said; that is a group that particularly needs targeted information. As I was at a meeting of the cross-party group on autistic spectrum disorder this lunch time, I mention also the needs of people with such disorders, who need intensive and deliberate training in social skills of all sorts, including in sexual health. That is a challenge for schools where teachers deliver such programmes.
Other members have touched on another group—looked-after children. The topic came up in discussion of parental roles and responsibilities. I have absolutely no problem with parental responsibilities—being a parent carries with it great responsibilities as well as great joys. However, unfortunately we are only too aware that not all parents fulfil all those responsibilities. If a child's parent is a local authority and their carer is a series of foster parents or community carers, and if the child moves school several times, the chances are that they will not have had the appropriate sex and relationships education that they would otherwise have had.
For whatever reason, some parents are not able to fulfil the sex education role that we would like them to fulfil or to inform their child about relationships. Perhaps the strategy will have to work through a couple of generations before we can say that all parents do that.
I have great concerns about the Conservative amendment and Conservative members' proposal that parents should be able to opt out. Parental responsibility is fine, but I feel that the proposal would put parental rights before the rights of the child. There are choices that parents should not be able to exercise if they conflict with their child's needs. Fiona Hyslop's point about the rights of the child was very well made.
On the delivery of health and sex education in schools, I am surprised that no one else has mentioned the role of school nurses. As my colleague Patrick Harvie spoke about his past life, I will mention mine. One of my roles as a school doctor was to go with the school nurse to personal and social education classes in some of our schools—not every school wanted us—to talk about contraception. Sex education and discussion about relationships were rightly the responsibility of the teachers, but they felt that pupils might ask technical and medical questions about contraception that a health professional would need to answer.
Patrick Harvie focused on a Glasgow project that is under threat, but I will speak about issues of rurality that affect children in the Highlands and Islands. A big issue for them—Carolyn Leckie was the first to mention this—is confidentiality, which is very important to teenagers. In many rural areas, where there are perhaps two GPs, the teachers are all known to them and everybody knows everybody else, confidentiality is a huge issue for children when accessing services. When I used to talk to such kids, they said that they would far rather take a bus on a Saturday and go to the Brook advisory centre in Inverness, which might be a journey of 60 miles or more each way, than go to their local GP. We must respect that attitude. Delivering sexual health advice and ensuring that pupils, children and young people in rural areas have access to the services that they need are a big challenge.
Schools are well placed to deliver the information that young people need. From going round schools, I have seen that the information that they provide is quite variable and that teachers vary in how comfortable they are about giving explicit information. That is a training issue, and many people have highlighted training as an issue for all agencies.
Most agencies that have responded to the strategy have mentioned resources at all levels, from resources to train teachers to funding for GUM clinics, about which some members were concerned. Patrick Harvie mentioned the balance between clinical and preventive services. I argue for more resources for GUM clinics and for them not to be subject to the same target setting as other health service clinics, because it is not appropriate. I think that the British Medical Association briefing mentioned that setting a 48-hour target is no use for a service that must be available instantaneously, as and when it is needed. We must see that GUM clinics are different and must be provided for as such.
We are talking about prevention, about healthy, growing people and about empowering people to make choices. I have absolutely no quarrel with the "Respect and Responsibility" agenda. We are looking for people who both give and receive respect.
From my small-scale involvement in education, I became aware that the most challenging and difficult pupils were often the least informed and understanding and the least likely to behave appropriately. They were a very challenging group to reach, but the schools were best placed to do so. Clearly, the parents of those children were not performing that role; the children could not go to their GPs; and, by the time they had accessed health services, it was perhaps too late. As a result, we fully support teachers in delivering the message to all children, to ensure that they are informed, confident and secure enough to make the choices that they should make.
I welcome the opportunity to speak in the debate. Both Fiona Hyslop and Linda Fabiani asked why they were being asked again for their views on this matter; without being sycophantic, I say that I am very pleased that they gave us their views again, because they both made good speeches that were full of common sense. The debate is useful in allowing us to find out what progress has been made, and I will make some specific points in that regard.
Many of the issues that we have discussed have of necessity highlighted some of the negative aspects of sexual health. However, we should all try to send out the message that sex can and should be a positive part of one's life and should make it clear that issues such as access to services and information that we have highlighted this afternoon simply facilitate that.
One major problem is that the issue continues to have a stigma attached to it; people simply find it difficult to talk about and deal with. I will come out now and put on record the fact that I am a bit of a Radio 2 listener.
Oh!
Shocking, I know, but there you go.
As well as being one of Terry Wogan's old geezers—or TOGs—I listen to Jeremy Vine's lunch-time phone-in programme when I am driving about. The other day, the subject was impotence. One of the facts that was bandied about was that, because of the stigma associated with impotence, the majority of men—and, indeed, their partners—who suffer from the condition do not go to their GP or another health professional for many years even though, in the majority of cases, it can be quite easily treated. We are not just talking about young people; older people are suffering in silence because they are embarrassed about dealing with sex in a pragmatic and mature way.
Despite the amendments that have been lodged and despite the fact that we are debating a difficult and contentious subject, I think that we have managed to find many areas of agreement. We all agree on the need for action on a range of issues such as the increase in the incidence of STIs and in the number of unwanted pregnancies and abortions; the need for better screening; and the need for better resources, not only for clinical services such as the GUM clinics but for health promotion.
We agree that we need a holistic and co-ordinated approach to this issue. For example, members such as Eleanor Scott mentioned the role that poverty plays in the problem and, in her very good speech, Marilyn Livingstone highlighted the extent to which alcohol and drug misuse lead people into situations in which they might have unwanted sexual encounters and then have to deal with all that flows from that.
I am disappointed that the Conservatives have taken a different approach, especially with regard to the national sexual health advisory committee. I believe that we need to bring stakeholders together. I am sympathetic towards the SNP's amendment, and I hope that the minister will address the issue that it raises. We need timescales to ensure that we deliver a co-ordinated approach and that the strategy is monitored.
Members have accepted the key objectives of respect and responsibility. Having respect for ourselves is about trying to find ways of building our self-esteem to ensure that we can all negotiate sexual relationships at whatever time of life we come to them. Again, we are not just talking about young people.
I agree with Shona Robison that the evidence shows that many young people who go early into sexual experiences and relationships regret that later in life. It is a question of ensuring that people delay until they are ready and then protect themselves, through safe sex and greater knowledge about sexual health matters, when they do become sexually active.
We must also respect others. As Linda Fabiani said, we must consider people's right to make informed choices about their own life, and we must not judge other people's choices. With access to good information, some people should be able to make an informed choice to say, "I will abstain from sex until I am ready to do it." Other people have a right to choose to engage in same-sex activity or other sexual activity. The important thing is to take a non-judgmental approach and to tackle the issues that have been highlighted today from the angle of social need, recognising people's need for access to information.
The minister and other members, including Nanette Milne and Janis Hughes, highlighted the need for diverse groups to figure in the sexual health strategy. That is right and relates to not only the LGBT community but disabled people and people with special needs. There is a raft of people whose needs must be addressed. One of the weaknesses of the strategy is the fact that such aspects were not considered, and I hope that the continuing work will consider them.
I am deeply disappointed with the Conservative attitude. Perhaps we need to add another R: instead of "Respect and Responsibility", we should call the document "Respect, Responsibility and Reality", because I really thought that a wee bit of a reality check was needed.
All schoolchildren should be given appropriate and equal access to information and services regardless of which school they go to. As Fiona Hyslop said, children and young people have rights under article 24 of the UN Convention on the Rights of the Child to have access to information and to health care. We are talking about a health strategy, not a morality strategy. Fiona Hyslop and Carolyn Leckie mentioned a woman's right to control her own fertility. I support that. If we go down the road of having a health strategy that is actually about morality, religion and culture, we end up with the AIDS pandemic in Africa.
We should consider the issue in terms of people's right to have access to information and to make informed choices, and that includes parents. I agree that parents should have the right to examine what their kids are being taught in schools. The role of parents is implicit and explicit in the strategy. If it was not so, I would not support it. Some parents find that sort of thing easier than others. I have four teenagers, so I know that the issue is not easy to deal with. As, I think, Scott Barrie said, the majority of parents want help from schools and other organisations as well as wanting to be able to give the information themselves. Some of them are better able to do that than others are. Some of them are ignorant themselves, because we are all ignorant about some aspects of sexual health or any form of health.
We should have a place for peer group involvement, whether on the advisory group or not. A 15-year-old girl could go back into her local school and say, "Look at me. Once upon a time, I was great at geography, but now I've got a wean on my hip." She could say that although she was good at this, that and the other, she will not find it so easy to have the choices in life that she might have had. A girl and a guy who might say that they are not going to take any cognisance of the information, and who might say, "We're going to have ourselves a wean because that way we'll get our council house," could receive a powerful message if they were able to see exactly what it means to have an unwanted pregnancy and a child too early.
We need monitoring, peer involvement, delivery and investment, and we need to keep an eye on whether the investment that the minister has said is there will deliver. I remind Alex Johnstone that this is not about political correctness but about political and social reality. Let us do what works. Let us do what we need to do to address the issue with respect, responsibility and reality.
I commend Susan Deacon for her excellent speech and for the fact that, during her time as Minister for Health and Community Care, and since then, she has had a continued commitment to the topic of sexual health. She has been involved in the cross-party group on sexual health, particularly in relation to tolerance, respect and informed choices. I think that that has to be said.
I am pleased to speak again on sexual health. As Margaret Smith said, we need only look at the figures to realise that this is an enormous issue in Scotland and we must be big enough and bold enough to address it.
My party acknowledges the progress that has been made in implementing "Respect and Responsibility: Strategy and Action Plan for Improving Sexual Health". We had the ministerial statement on the strategy on 27 January, which was the same day on which I had my members' business debate on infertility. Given the subject of this afternoon's debate, it is a coincidence that tonight I will host a meeting on infertility. I acknowledge the importance of discussing both issues in the same debate.
Margaret Smith mentioned the embarrassment that is experienced in speaking about impotence, but the same applies to speaking about infertility. In my members' business debate on infertility, one of my colleagues said that they would rather discuss their bank balance than their fertility. Infertility is an issue on which MSPs must take the lead given the stigma that is attached to it.
As other members have said, the incidence of chlamydia rose by 39 per cent among under-25s and by 36 per cent among over-25s in the year ending in 2003. I was pleased that the minister mentioned the over-40s because, in the early years of awareness of chlamydia, there seemed to be an assumption that it affected only people who were under the age of 25. In the over-40s, the number of cases of chlamydia and genital herpes doubled in the four years to 2003. The equivalent increases in the Netherlands, Denmark and France were in single figures.
I refute the assertion that it is necessary to have multiple partners to contract sexually transmitted diseases. I gained that understanding through my awareness of infertility; it takes contact with only one person to become infected with chlamydia. People are embarrassed because there is an assumption that they must have been promiscuous to have picked up a sexually transmitted disease. The fact that that is not the case must be put on the record.
In relation to clinics, the BMA highlights in its briefing that
"there is continuing evidence of increasing problems with access at a time of increasing demand."
There is no doubt that the Executive needs to address that issue and to expand screening programmes. I ask the minister whether it is possible to provide chlamydia screening alongside screening for cervical cancer. There is no doubt that resources are needed to reduce waiting times for appointments. I hope that the plans that the health boards have submitted to the minister will make a difference.
Other members have mentioned the need for more trained staff and clinics and for opening hours to be convenient to patients. That needs to be addressed because we are not talking about a nine-to-five, Monday-to-Friday issue. Chlamydia is not the only cause of infertility but, given its rising incidence and the fact that people who have it experience no symptoms, there is no doubt that more needs to be done to ensure that women and men are aware of its effects on fertility.
I was pleased that Eleanor Scott mentioned school nurses. The school nurses in the Highlands got together and gave a presentation to, among others, Eleanor Scott, Fergus Ewing, Maureen Macmillan, John Farquhar Munro, Rob Gibson and me. I learned an enormous amount that day. It was interesting to hear that, in the Highlands, school nurses can be responsible for nearly 3,000 children; the figure of 2,800 was mentioned. I hope that the minister will examine the role of school nurses in supporting the sexual health strategy. One of the questions that the panel was asked was, "What does a school nurse do?" We had to refer the question to Eleanor Scott because she had working experience of the full remit of a school nurse.
When we ask school nurses to do more, we should examine the resources that they have and the shortage of staff. We need to consider whether there should be a particular school nurse-to-pupil ratio and whether pupils should be able to go to the school nurse in total confidence.
The subject of integrated community schools has not been raised. All schools are meant to have access to health and social work services. Perhaps the role of the school nurse should be considered in that context.
The member is going into her final minute.
I will not address that issue now, but I know what community schools in the Highlands do.
I am pleased that section 5, the "Practical Plan for Action", considers rural communities. I endorse the point that Eleanor Scott made. There is very little privacy in a small village compared with the privacy of the big city of Inverness with its Brook advisory centre.
It is difficult to be critical of an action plan that addresses the many serious sexual health issues. However, I ask the minister, in his summing-up, to give an assurance that the proposals will be monitored and audited in future and that health boards and local authorities will say what is meant by reasonable in relation to the timescales for progress on the local strategies.
My final point concerns the number of abortions in Scotland—there were more than 12,000 in the year ending 2003. It is worth highlighting the fact that 14 per cent of the women who had an abortion were married; 27 per cent were women over 30; 48 per cent were women in their 20s; and 25 per cent were young women under 20. We tend to think that only pregnant teenagers have abortions.
Many complex issues surround the figures and we need to understand more about them, including whether they are the result of a shortage of family planning. No woman makes the decision to have an abortion lightly.
This has been an interesting debate, to which members from all parties have made high-quality contributions. Although I do not want to pinpoint individuals, I will say that Mary Scanlon's summing-up speech for the Conservatives was much more measured and much more in tune with the rest of the chamber than some of the earlier Conservative contributions were. She hit the nail on the head.
Obviously, debates on sexual health often create more heat than light, because the issue is tied up in deeply held personal points of view. Some people come at the subject entirely from the health angle, whereas others believe that we cannot separate sexual health from morality, whether personal morality or a morality that is based on religious belief. Some people even assert that sexual morality is more important than sexual health. That is not a view to which I adhere. We often forget that sexual health is a matter not only of personal health, but of public health.
I agree entirely with Carolyn Leckie and Margaret Smith that we have to deal with the reality of the world in which we live. We must not live in the sort of dreamland to which Nanette Milne and Alex Johnstone referred—a sort of 1950s idyll in which the parents are all good and all deal with their children in the right way. That is not the reality that we face; we have to deal with the situation of today.
Is that a justification for the exclusion of parents from the process?
Clearly, Alex Johnstone has not been paying attention to the debate, by which I mean not just today's debate, but the debate over several months and years. Not one member has said that we should exclude parents. I think that every member has said that we should include them. Members have argued that there is a role for schools, teachers and health professionals, as well as for parents. The debate is not just about the role of parents, but that is the point at which Alex Johnstone and Nanette Milne are stuck.
I oppose the absolute right of veto for parents that Nanette Milne proposed. Patrick Harvie was right to condemn that. It is an astonishing point of view to say that parents should have an absolute right of veto where their children's health is involved.
A Conservative party spokesperson said today, outwith the chamber:
"A term does not pass without another board game, textbook or teaching aid causing outrage in the media."
Does Stewart Maxwell agree that such comments can of themselves provoke and help to stir up outrage and that they are in no way helpful?
I agree absolutely. Such comments serve only to fuel the fire. That remark was not helpful in the least; indeed, it was totally counterproductive.
Fiona Hyslop's speech was excellent. She rightly spoke about the rights of the child. "Ready Steady Teenager!" sounds a good idea.
I will take a couple of moments to talk about the preparation for the debate. As Susan Deacon and other members said, it is right that we should have the debate. However, it is also important, especially when we debate such a crucial issue, that members can be fully informed of the developments that are under way and the progress that has been made. As I said, such debates often produce more heat than light, so it is important that we should try to get more light than heat. That is why it is particularly disappointing that preparation for the debate has been hampered by the lack of published information on the progress that has been made.
When the debate was scheduled, I contacted the Scottish Parliament information centre to obtain any published information that I might have missed. SPICe told me that it could find no published information and suggested the Executive library as a source. I contacted the Executive library and was told, "No, we don't have anything. Why don't you contact SPICe?" That was not helpful. In the end, I was told by an individual in the Executive library that they had tried to locate a contact in the Health Department who might be able to help but had been unable to do so. That was not particularly helpful, either.
Undeterred, I pressed on in my attempt to get information and background material, because it is important that we get the facts right. We received further information this afternoon, when we learned that nothing had been published but that two meetings had been held earlier this month with stakeholders. The person who told us that stated that, unfortunately, they were not allowed to say any more, as the minister was making an announcement in this debate. Again, that did not help us to be informed so that we could fully engage in the debate with up-to-date information on what is going on.
Section 2 of "Respect and Responsibility" mentions the need to ensure that people with mental health problems are not excluded from appropriate sexual health services and it gives a commitment that the national sexual health advisory committee will carry out a diversity impact assessment to ensure that that matter is taken into account. However, nowhere in the report does that translate into a commitment to take practical action to provide services for people with mental health issues, even though those people can be extremely vulnerable. Margaret Smith mentioned people with disabilities, particularly learning disabilities, but that issue has not received the attention that it deserves. Those people are often very vulnerable. I hope that the minister will comment on people with mental health problems, particularly young people, because they are extremely vulnerable.
Section 3 of the action plan is on preventing sexually transmitted infections and unintended pregnancies. Point 9.4 of the recommended actions states:
"Where contraception is available free of charge for women, condoms should also be freely available to both men and women. The Scottish Executive should explore the feasibility of resourcing NHS Boards to achieve this."
However, the Executive's response has been to push the issue off to the national sexual health advisory committee to explore the implications. I would have thought that the implications were fairly clear—the free availability of condoms would lead to fewer unwanted pregnancies and fewer STIs. If we intend to reduce the appallingly high rates of teenage pregnancies and STIs, I can think of no more obvious action than providing free condoms, which simultaneously protect against pregnancy and disease.
One issue that has been discussed before, although not particularly today, is the morning-after pill. The strategy states:
"emergency hormonal contraception … should not be made available in schools."
I understand the sensitivity of the issue, which I know some people find awkward. It could be argued that in-school facilities in urban areas may not be as necessary, because girls could access services near at hand anyway. However, Shona Robison and Mike Rumbles touched on equality of access to services throughout the country. Will the minister say how girls in rural areas can access services? Let us take the example of a girl who lives in a farmhouse in a remote rural glen and is bussed to and from school every day. She has unprotected sex one day with a boyfriend, but how can she access services and the morning-after pill? She cannot wait for the weekend to get the bus to Inverness; she needs immediate action to deal with the mistake, if we can call it such. It is important that the Executive re-examines that issue. It may not be right to have in-school facilities in all schools, but in some cases the school might be the best place to provide the service. School nurses, who were mentioned by a number of members, could help in that area.
I ask members to support the amendment in the name of Shona Robison. It is essential that we have a timescale for the implementation of the action plan. Moreover, it would have been helpful if the Executive had produced material to show what progress has been made, so that the debate could have been as fully informed as possible.
I have a lot of material to get through. First, I thank the many members who have expressed support for the strategy. I also thank them for the degree of maturity that has been demonstrated in the debate.
I will run through some of the key issues. In my role as minister, I have always tried to keep the cross-party group on sexual health involved in the workings of the Executive, to ensure that people are aware of the progress that we are making. Nonetheless, I will address Fiona Hyslop's question of why we are having this debate.
I thank Shona Robison for her support. We made it clear in today's press release that the £4.5 million has been announced previously and that we were simply announcing its allocation—the money is to be distributed to the health boards as per the Arbuthnott formula. Of the other available resources, Caledonia Youth will receive about £400,000, £50,000 will be for research and there will be a small contingency fund of £50,000 for the work of the advisory committee. That is how the money has been allocated.
The SNP amendment is about targets. The advisory committee will be responsible for ensuring that we have reasonable and challenging targets that make a difference in our communities. That is why the amendment is misplaced. The purpose of setting up the advisory committee was to ensure that we have good targets and broad consensus on and support for them among those who are involved in that area of work. The committee should meet three or four times a year and should report regularly to the Parliament. It should have sub-groups to work on particular work streams and it should allow monitoring to take place via parliamentary processes as well as through the publication of information.
On the time-delay issue that several members have raised, we wrote to organisations in April to seek membership for the advisory committee, but I must be honest and say that I still have not received some responses, which has been an inhibiting factor. Some organisations that we want to be represented on the advisory committee have internal consultation systems to go through that have still not been finalised. Today, we announced the names that we have already, but other names will be added to the list, I hope, before the first meeting.
On the issue of resources and the comparison with England, my point is that we have set a Scottish strategy. We must ensure that we spend the additional resources wisely and that we get better value for the money that is already in the system. As members have said, we must also work with health boards and organisations throughout the public sector to ensure that expenditure is appropriate.
Ms Robison and other members talked about involving other organisations. At the launch of the strategy, we wrote to many civic organisations, including local authorities, special health boards, faith communities, youth groups and many others in the voluntary sector. We have tried to get the message across about our sexual health strategy. I had individual discussions about the strategy with as many of the editors of our national newspapers as possible—sometimes that worked, but, to be blunt, sometimes it did not.
I really worry about some of Nanette Milne's comments, on which many members have reflected. The closing speech from the Tories was much more effective and conformed more to the values that members have expressed. Parents have a key role in the strategy—we comment on their role throughout the document. I guide Nanette Milne to the final section of the strategy, where I deliberately included a role for parents along with the role for NHS boards, lead clinicians, the Scottish Executive and the Scottish Prison Service. That is a clear and full recognition of the role for parents in the strategy. The Tories are trying to create a myth about something that does not exist in the strategy. I hope that members will reject their amendment.
I hoped that Patrick Harvie would stand up when Fiona Hyslop questioned why we were having the debate, because he has pressed me for such a debate. In fact, we might be better placed to have another debate in the near future. We have set up the advisory committee and asked local health boards to produce interim strategies, which they have done, but the fuller strategies will be available in September. Therefore, arguably, we will have a much better idea of Scotland's response to the strategy then. Nonetheless, to echo Margaret Smith's comments, we have had a good debate today for all that.
Patrick Harvie made an important point about the communication strategy. One of the purposes of the advisory committee is to develop the sort of communication strategy that Patrick Harvie wants. We aim to use the specialist skills round the table and to involve the whole of society. Although one size does not fit all, we have principles and values as well as basic minimum standards of education that we must ensure are delivered throughout Scotland.
Many of the organisations to which Patrick Harvie referred are involved in the discussions with us. I fully recognise that Caledonia Youth offers user-friendly, non-judgmental advice about sexual health. It recognises the fact that not all young people can go to their local family GP or are comfortable about doing so. I respect the views that have been expressed by the Greens and others on the matter, but it is the responsibility of local health boards to deliver services appropriately in their community. I am fully aware of the discussions in Glasgow about those matters. I have sought and I have received reassurances from Greater Glasgow NHS Board about its obligations under the strategy. I will seek further detail in relation to those reassurances, but I will ensure that the sexual health strategy is delivered in Glasgow.
Mike Rumbles raised some significant points. He reminded us that sex can be healthy and enjoyable, but that nonetheless we must reduce risk taking and ensure that people act in an arena of mutual respect and responsibility. He also reminded us that Her Majesty's Inspectorate of Education is responsible for the monitoring of all aspects of sexual relationship education in our schools.
Marilyn Livingstone referred to examples of good practice in her community. I have had the chance to visit some of the organisations that she mentioned. An indication of the cross-cutting nature of our strategy is that it refers to the work that has been done on survivors of childhood sexual abuse, an issue that she has championed in the Parliament.
We will reflect on a number of issues that Carolyn Leckie raised. We want front-line support to be provided. The training strategies and training-needs analysis of our boards will be brought to us so that we can fund them and ensure that the services are delivered locally. We must develop the right ethos locally through the national guidelines. There is no moral opt-out with regard to our strategy, which must be delivered in an appropriate local setting.
With guidance from the Royal College of Obstetricians and Gynaecologists, we will continue to work on the issue of appropriate access to termination. We will perhaps deal with other matters at a later date.
Will the minister give way?
I am sorry, but I want to address many points that members have raised.
Fiona Hyslop identified an issue that the Executive has been involved in working on in a number of ways for a number of years: the link between sexual health and self-esteem. I believe that our work through our health-promoting schools and our integrated community schools is strongly delivering the agenda of self-esteem, confidence and well-being. Dedicated professionals are working for the Executive to ensure that that happens. I was recently at Moray House school of education, which has launched a document on teenage transition years. The document focuses on diet, but it also addresses wider aspects of health.
The responsibility of parents to ensure that they are aware of what their children are learning in the school environment lies at the heart of the McCabe proposals on the teaching of sex and relationship education. Parents can make decisions on such matters through school boards and through personal choice.
Mr Johnstone said that abortion was being used as a form of contraception. I will leave that pathetic point where it is.
On the cross-cutting nature of our work, I say to Linda Fabiani that the sexual health strategy covers our integrated community schools, our health-promoting schools, our integrated children's services plans, our work on street prostitution, community learning and development, the Scottish Prison Service, community planning partnerships, our work on equality and diversity, our work with academic institutions, our work on forced marriage, our work on female genital mutilation and our work on Bichard. I argue that our strategy is largely cross-cutting and that it addresses many of the concerns that members have raised in the debate.
Linda Fabiani asked whether there was room for civic Scotland on the national sexual health advisory committee. I will reflect on that point, but I should point out that the committee currently has 33 members, which is already a difficult number of members to manage. However, I respect the point that Linda Fabiani makes. We can perhaps find another way of involving the groups that she mentioned, perhaps through the sub-group structure or through formal consultation.
Janis Hughes mentioned the need to ensure that the materials that are available are fit for purpose for both genders and for people with different sexualities. That is, of course, already the case. We have also carried out specific work in relation to people with learning needs and disabilities, an issue that Stewart Maxwell raised. We have had focus groups involving children with special needs. There is also a review of literature in relation to the harder-to-reach groups in our society to ensure that we communicate in an effective manner with those individuals.
In their contributions, Eleanor Scott, Margaret Smith, Mary Scanlon and Stewart Maxwell encapsulated some aspects of the debate. In our closing speeches, we have reflected a degree of common purpose across the chamber on sexual health. We know that sexual health is an issue that we need to talk more about. I hope that, when we return to the debate in future years, the discussion will be similar to, and as committed as, the one that we have had today.
I cannot close without making my views on the amendments known. There is no need for the Conservative amendment, because parental responsibilities and rights are mentioned throughout the strategy; the strategy is clear about how we seek to ensure that parents are involved in sexual health. On the Scottish National Party's amendment, the advisory committee's purpose is to provide the tasks, targets and timescales that the SNP seeks for the implementation of the action plan. I would rather leave those matters to the advisory committee to deliver to the Parliament in an informed way. The Green amendment is also unnecessary; I have addressed the issue of Caledonia Youth. I urge the Parliament to support the Executive motion and to reject all the amendments.