Chamber
Plenary, 12 Nov 2003
12 Nov 2003 · S2 · Plenary
Item of business
Sexual Well-being
Today, I announce to Parliament the launch of a wide-ranging consultation on proposals for a national sexual health strategy that have been prepared by an expert reference group. I do not want to take time out of my statement to deal with the points of order that have been raised; however, I want to make it clear that this is not our report—it is the expert group's report. That is the full answer to Bruce Crawford's point of order.
The consultation is a crucial step in the Executive's commitment, as set out in the partnership agreement, to develop and implement a national sexual health strategy.
First, let me set the context. However we look at it, sexual behaviour and attitudes are changing. Behind the trends and opinions, the statistics tell us that sexual health and well-being in Scotland are poor. For example, diagnoses of chlamydia rose by 41 per cent between 2000 and 2001, followed in 2002 by a 12 per cent increase, from more than 10,000 to more than 11,000 cases.
Moreover, the rate of teenage conception in Britain is the highest in western Europe, and in Scotland slightly more than half of the pregnancies in under-16-year-olds and two fifths of those in the 16 to 19-year-old age group are terminated. Sadly, rates of teenage pregnancy are higher in areas of deprivation than elsewhere. During the 1990s, the differences in rates of teenage pregnancy between more affluent and more deprived areas widened.
If statistics are worrying, so are features such as regret, violence, abuse, coercion and disrespect that all too frequently go hand in hand with irresponsible sexual behaviour. For example, studies indicate that a significant proportion of first sex is unwanted, particularly for young women, and that the younger a person is, the more likely it is that the sex is unwanted. One thing is abundantly clear: sexual well-being is not just about the absence of disease or lowering the incidence of this or that sexually transmitted infection. On the contrary, sexual well-being embraces a raft of social, cultural and ethical issues that must be addressed if we are to attain the level of sexual health, responsibility and well-being in Scotland to which we all aspire.
That is no easy task. It is crucial that, in developing a strategy, we have regard to and respect for the many genuinely held views on this sensitive and emotive topic. That is why, in August last year, I set up the expert reference group, which had a broad membership from the field of sexual health services and education as well as representatives from voluntary organisations and religious groups.
The group had a wide remit, which included the promotion of a broad understanding of sexual health and sexual relationships that encompasses emotions, attitudes and social context, while retaining a particular focus on measures to reduce unintended pregnancies and sexually transmitted infections, and the enhancement of sexual health services. Such an approach not only reflects the wide social and cultural influences on sexual health, but highlights the Executive's aim for a strategy that is rooted in strong relationships based on self-respect and on respect for others.
The outcome of the group's work is the proposals that are contained in "Enhancing Sexual Wellbeing in Scotland: A Sexual Health and Relationships Strategy", which was made public earlier today. I take this opportunity to express my gratitude to all the members of the expert group, under the chairmanship of Professor Phil Hanlon, and to NHS Health Scotland, which provided support for the group's work.
The reference group's proposals are being published precisely in the terms in which they were submitted to the Executive. The proposals have been built on a survey of existing sexual health services in Scotland and on an analysis of the attitudes and lifestyles found in a sample survey of Scots. The survey draws on existing research findings, both at home and abroad, and the experience of people who work in the field of sexual health. Although we are publishing the reference group's proposals in full, it does not mean that they will all form part of the final strategy agreed by the Executive. I launch the consultation today in order to inform the Executive's final decisions.
The draft strategy provides a succinct and telling commentary on the state of sexual health in Scotland, to which I have already referred. It highlights that health inequalities, which the Executive is resolved to tackle, carry over to many aspects of sexual health, and it identifies a strong link between social disadvantage and early initiation into sexual activity.
It is apparent that improvements in sexual health and well-being are inextricably connected to broader efforts to tackle health inequalities. Of paramount importance, too, is the nurturing of self-esteem, respect for others, individual responsibility and responsibility to the wider community.
The reference group recognised that there are no simple solutions or quick fixes. No one intervention will provide a panacea. What is required is a multicomponent and multilevel programme that adopts an integrated, long-term and socially orientated approach. That is founded on evidence that shows how a range of interventions, in various settings, to address multiple influences on sexual health, can lead to significant improvements in sexual well-being.
Five key actions are highlighted by the reference group. The first is the need for national leadership to be addressed by the appointment of a national sexual health programme co-ordinator and the creation of a new national sexual health advisory committee. The second is local leadership, with all NHS boards having a sexual health strategy informed by a multi-agency strategy group. The third is the setting of clear national and local targets and goals. The fourth is to use existing mechanisms, such as local health plans, community plans and the performance assessment framework to ensure the on-going integrated delivery of the strategy's goals and vision. The fifth is to monitor progress to ensure delivery, with the proposed new advisory committee monitoring national progress towards targets.
Those key actions underpin over 100 recommendations made by the reference group. It is not the time today to focus on specific recommendations since the consultation process will give full opportunity for that.
Suffice it to say that the recommendations address the needs of those facing the greatest barriers to sexual health; outline a broad approach to sexual health promotion; respond to the importance of acquiring knowledge and skills about sexual health and well-being; set out, respectively, the roles of schools, higher and further education institutions, and parents and carers; identify the contribution of the media and mass communications; and highlight specific actions to reduce sexually transmitted infections, including ready access to services.
The group has produced a comprehensive, well-researched and positive report, which needs to be considered in the round. I believe that its strengths lie in the integrated approach that it proposes. Particularly welcome is its affirmation of the key values of respect, equality and accessibility to clinical services and lifelong learning. I am clear that the group's proposals provide the basis for a workable and constructive framework within which progress to enhance sexual well-being can be made.
However, I am keenly aware of the many views that exist in Scotland, and indeed in the Parliament, on this complex issue. That is why we are embarking on a wide-ranging consultation before we consider which of the recommendations to accept, or whether to accept them in their entirety. Copies of the draft strategy have been placed in the Scottish Parliament information centre, and it can also be accessed electronically on the Scottish Executive website. The group has prepared a summary version that can be made available in other formats, including Braille and audio tape and in different languages to facilitate access for ethnic minority groups. For those who are interested, background supporting papers used by the group can be accessed on the Scottish Executive website.
All this reflects our determination to ensure that the consultation process is as broad ranging and comprehensive as can be arranged. In addition to the traditional means of seeking comments from groups and organisations, we will invite the Scottish Civic Forum to facilitate aspects of the consultative process and will make special efforts to engage minority groups. I hope that people, young and old, throughout Scotland will feel able to engage in the consultation process. I look forward to receiving the comments of parents, young people and other individuals, as well as organisations and professional bodies, to help to ensure that the final strategy that emerges from the consultation is a fair reflection of the views of people in Scotland.
The time is right for a mature and considered debate on this sensitive, but vital issue and I am sure that the reference group's proposals provide a helpful focus for that. I hope that the debate will not be hijacked or sidetracked by focusing on high-profile or single, contentious issues. The topic is too serious for that. Moreover, as the reference group's report stresses, success does not rest on one single intervention, but on a range of initiatives and services across the whole policy spectrum. In short, a holistic approach is needed.
I recognise, of course, that some of the issues that are raised in the draft strategy will be controversial and that complete consensus may be elusive. However, that is not a reason to do nothing, or to concentrate disproportionately on the points of difference. There is a great deal on which we can unite and build, and the consultation will allow us to identify the common ground and the difficult decisions that may have to be made.
Members, and indeed the Parliament, will no doubt want to contribute to the consultation, and the Executive will propose to the Parliamentary Bureau that a debate be held in the Parliament on the subject before the end of the consultation period.
There is a real opportunity to make a difference. Sexual health is a dimension of health that we cannot afford to neglect if the quality of life and overall health in Scotland are to be enhanced. The reference group has shown the way in producing proposals that have regard to the diversity of views that surround the issue. The challenge for all of us now, including the Parliament, is to contribute our views in a measured and constructive way that will pave the way for improved sexual well-being for this and future generations. The pillars of that improvement must be self-respect, respect for others and strong, respectful relationships. I am confident that we can build on them together.
The consultation is a crucial step in the Executive's commitment, as set out in the partnership agreement, to develop and implement a national sexual health strategy.
First, let me set the context. However we look at it, sexual behaviour and attitudes are changing. Behind the trends and opinions, the statistics tell us that sexual health and well-being in Scotland are poor. For example, diagnoses of chlamydia rose by 41 per cent between 2000 and 2001, followed in 2002 by a 12 per cent increase, from more than 10,000 to more than 11,000 cases.
Moreover, the rate of teenage conception in Britain is the highest in western Europe, and in Scotland slightly more than half of the pregnancies in under-16-year-olds and two fifths of those in the 16 to 19-year-old age group are terminated. Sadly, rates of teenage pregnancy are higher in areas of deprivation than elsewhere. During the 1990s, the differences in rates of teenage pregnancy between more affluent and more deprived areas widened.
If statistics are worrying, so are features such as regret, violence, abuse, coercion and disrespect that all too frequently go hand in hand with irresponsible sexual behaviour. For example, studies indicate that a significant proportion of first sex is unwanted, particularly for young women, and that the younger a person is, the more likely it is that the sex is unwanted. One thing is abundantly clear: sexual well-being is not just about the absence of disease or lowering the incidence of this or that sexually transmitted infection. On the contrary, sexual well-being embraces a raft of social, cultural and ethical issues that must be addressed if we are to attain the level of sexual health, responsibility and well-being in Scotland to which we all aspire.
That is no easy task. It is crucial that, in developing a strategy, we have regard to and respect for the many genuinely held views on this sensitive and emotive topic. That is why, in August last year, I set up the expert reference group, which had a broad membership from the field of sexual health services and education as well as representatives from voluntary organisations and religious groups.
The group had a wide remit, which included the promotion of a broad understanding of sexual health and sexual relationships that encompasses emotions, attitudes and social context, while retaining a particular focus on measures to reduce unintended pregnancies and sexually transmitted infections, and the enhancement of sexual health services. Such an approach not only reflects the wide social and cultural influences on sexual health, but highlights the Executive's aim for a strategy that is rooted in strong relationships based on self-respect and on respect for others.
The outcome of the group's work is the proposals that are contained in "Enhancing Sexual Wellbeing in Scotland: A Sexual Health and Relationships Strategy", which was made public earlier today. I take this opportunity to express my gratitude to all the members of the expert group, under the chairmanship of Professor Phil Hanlon, and to NHS Health Scotland, which provided support for the group's work.
The reference group's proposals are being published precisely in the terms in which they were submitted to the Executive. The proposals have been built on a survey of existing sexual health services in Scotland and on an analysis of the attitudes and lifestyles found in a sample survey of Scots. The survey draws on existing research findings, both at home and abroad, and the experience of people who work in the field of sexual health. Although we are publishing the reference group's proposals in full, it does not mean that they will all form part of the final strategy agreed by the Executive. I launch the consultation today in order to inform the Executive's final decisions.
The draft strategy provides a succinct and telling commentary on the state of sexual health in Scotland, to which I have already referred. It highlights that health inequalities, which the Executive is resolved to tackle, carry over to many aspects of sexual health, and it identifies a strong link between social disadvantage and early initiation into sexual activity.
It is apparent that improvements in sexual health and well-being are inextricably connected to broader efforts to tackle health inequalities. Of paramount importance, too, is the nurturing of self-esteem, respect for others, individual responsibility and responsibility to the wider community.
The reference group recognised that there are no simple solutions or quick fixes. No one intervention will provide a panacea. What is required is a multicomponent and multilevel programme that adopts an integrated, long-term and socially orientated approach. That is founded on evidence that shows how a range of interventions, in various settings, to address multiple influences on sexual health, can lead to significant improvements in sexual well-being.
Five key actions are highlighted by the reference group. The first is the need for national leadership to be addressed by the appointment of a national sexual health programme co-ordinator and the creation of a new national sexual health advisory committee. The second is local leadership, with all NHS boards having a sexual health strategy informed by a multi-agency strategy group. The third is the setting of clear national and local targets and goals. The fourth is to use existing mechanisms, such as local health plans, community plans and the performance assessment framework to ensure the on-going integrated delivery of the strategy's goals and vision. The fifth is to monitor progress to ensure delivery, with the proposed new advisory committee monitoring national progress towards targets.
Those key actions underpin over 100 recommendations made by the reference group. It is not the time today to focus on specific recommendations since the consultation process will give full opportunity for that.
Suffice it to say that the recommendations address the needs of those facing the greatest barriers to sexual health; outline a broad approach to sexual health promotion; respond to the importance of acquiring knowledge and skills about sexual health and well-being; set out, respectively, the roles of schools, higher and further education institutions, and parents and carers; identify the contribution of the media and mass communications; and highlight specific actions to reduce sexually transmitted infections, including ready access to services.
The group has produced a comprehensive, well-researched and positive report, which needs to be considered in the round. I believe that its strengths lie in the integrated approach that it proposes. Particularly welcome is its affirmation of the key values of respect, equality and accessibility to clinical services and lifelong learning. I am clear that the group's proposals provide the basis for a workable and constructive framework within which progress to enhance sexual well-being can be made.
However, I am keenly aware of the many views that exist in Scotland, and indeed in the Parliament, on this complex issue. That is why we are embarking on a wide-ranging consultation before we consider which of the recommendations to accept, or whether to accept them in their entirety. Copies of the draft strategy have been placed in the Scottish Parliament information centre, and it can also be accessed electronically on the Scottish Executive website. The group has prepared a summary version that can be made available in other formats, including Braille and audio tape and in different languages to facilitate access for ethnic minority groups. For those who are interested, background supporting papers used by the group can be accessed on the Scottish Executive website.
All this reflects our determination to ensure that the consultation process is as broad ranging and comprehensive as can be arranged. In addition to the traditional means of seeking comments from groups and organisations, we will invite the Scottish Civic Forum to facilitate aspects of the consultative process and will make special efforts to engage minority groups. I hope that people, young and old, throughout Scotland will feel able to engage in the consultation process. I look forward to receiving the comments of parents, young people and other individuals, as well as organisations and professional bodies, to help to ensure that the final strategy that emerges from the consultation is a fair reflection of the views of people in Scotland.
The time is right for a mature and considered debate on this sensitive, but vital issue and I am sure that the reference group's proposals provide a helpful focus for that. I hope that the debate will not be hijacked or sidetracked by focusing on high-profile or single, contentious issues. The topic is too serious for that. Moreover, as the reference group's report stresses, success does not rest on one single intervention, but on a range of initiatives and services across the whole policy spectrum. In short, a holistic approach is needed.
I recognise, of course, that some of the issues that are raised in the draft strategy will be controversial and that complete consensus may be elusive. However, that is not a reason to do nothing, or to concentrate disproportionately on the points of difference. There is a great deal on which we can unite and build, and the consultation will allow us to identify the common ground and the difficult decisions that may have to be made.
Members, and indeed the Parliament, will no doubt want to contribute to the consultation, and the Executive will propose to the Parliamentary Bureau that a debate be held in the Parliament on the subject before the end of the consultation period.
There is a real opportunity to make a difference. Sexual health is a dimension of health that we cannot afford to neglect if the quality of life and overall health in Scotland are to be enhanced. The reference group has shown the way in producing proposals that have regard to the diversity of views that surround the issue. The challenge for all of us now, including the Parliament, is to contribute our views in a measured and constructive way that will pave the way for improved sexual well-being for this and future generations. The pillars of that improvement must be self-respect, respect for others and strong, respectful relationships. I am confident that we can build on them together.
In the same item of business
The Presiding Officer (Mr George Reid):
NPA
The next item of business is a statement by Malcolm Chisholm on "Enhancing Sexual Wellbeing in Scotland: a Sexual Health and Relationships Strategy".
Bruce Crawford (Mid Scotland and Fife) (SNP):
SNP
On a point of order Presiding Officer—
The Presiding Officer:
NPA
I will come to you, Mr Crawford, after I have finished my statement.The minister will take questions at the end of his statement. There should therefore be n...
Bruce Crawford:
SNP
I seek the Presiding Officer's guidance. In December 1999, the then Minister for Health and Community Care, Susan Deacon, announced that she was developing a...
The Presiding Officer:
NPA
I am sure that the Minister for Parliamentary Business has taken note of what you have said, Mr Crawford. Of course, we are not going into a debate, which wo...
Carolyn Leckie (Central Scotland) (SSP):
SSP
On a point of order, Presiding Officer. Following on from Bruce Crawford's point of order, I should say—if my understanding is correct—that it was conveyed t...
The Presiding Officer:
NPA
I am advised that the Minister for Parliamentary Business made it clear that they would be made available at half-past 1 or thereabouts.The Minister for Parl...
Bruce Crawford:
SNP
On a point of order, Presiding Officer. I seek assurances about the process involved. Is it really acceptable in the Parliament for the press to receive docu...
The Presiding Officer:
NPA
I cannot rule on that point of order because you have just told me that that has happened. I will look into the matter and will perhaps come back to you a bi...
The Minister for Health and Community Care (Malcolm Chisholm):
Lab
Today, I announce to Parliament the launch of a wide-ranging consultation on proposals for a national sexual health strategy that have been prepared by an ex...
Shona Robison (Dundee East) (SNP):
SNP
I thank the minister for an advance copy of his statement and welcome the long-awaited report from the expert reference group. I am keen that urgent action b...
Malcolm Chisholm:
Lab
Shona Robison made a great many points. The leading one was about the time that it has taken to reach this stage, but, in a sense, she answered her own quest...
Mr David Davidson (North East Scotland) (Con):
Con
I thank the minister for providing an advance copy of his statement. I, too, welcome the report and the work of the reference group. I agree with the ministe...
Malcolm Chisholm:
Lab
I remind David Davidson that the proposal for a tsar comes from the expert group which, he will accept, is a broadly constructed group that represents many k...
Susan Deacon (Edinburgh East and Musselburgh) (Lab):
Lab
I warmly welcome the publication of the strategy and the substance and tone of the minister's statement.Does the minister agree that, by its nature, sexual h...
Malcolm Chisholm:
Lab
I certainly agree with Susan Deacon's main point about ensuring that the consultation goes beyond the traditional methods of involving people in this matter....
Mike Rumbles (West Aberdeenshire and Kincardine) (LD):
LD
The Liberal Democrats warmly welcome the strategy on sexual health and relationships—because it is about relationships. On that note of consensus, can the mi...
Malcolm Chisholm:
Lab
I welcome the fact that Mike Rumbles has pointed out the key word on the front page of the document—relationships. In many ways, this is a strategy about rel...
Patrick Harvie (Glasgow) (Green):
Green
I add my warm welcome on the publication of this draft strategy. From my background in the voluntary sector sexual health field, I know that it has been keen...
Malcolm Chisholm:
Lab
As I have said, in relation to education the expert group is backing the McCabe report and calling for it to be fully implemented. It has been implemented, t...
Carolyn Leckie (Central Scotland) (SSP):
SSP
I welcome the publication of the report, especially the contributions of professionals and agencies in providing us with a comprehensive strategy. I will foc...
Malcolm Chisholm:
Lab
Carolyn Leckie has fastened on to one important sentence in the document. We will certainly consult on the matter and give a view in due course. The strategy...
The Presiding Officer:
NPA
About seven minutes are left for questions. If questions and answers are kept reasonably tight, we might just about get in all members who wish to speak.
Margaret Jamieson (Kilmarnock and Loudoun) (Lab):
Lab
I, too, welcome the minister's statement and the publication of the expert group's sexual health proposals. However, in the consultation that the minister wi...
Malcolm Chisholm:
Lab
On the member's first question, I strongly agree that young people will have to be involved as fully as the other groups whose views will be sought. We will ...
Fiona Hyslop (Lothians) (SNP):
SNP
Does the minister appreciate the frustration that many members feel? We are at an important staging post in the debate, but we have not had time to read the ...
Malcolm Chisholm:
Lab
I do not know where to start after all that. I would have thought that, as a result of the consultative steering group principles—which I thought we all supp...
Margaret Smith (Edinburgh West) (LD):
LD
I welcome a lot of what the minister has said, in particular what he said about respect and self-esteem. The work that can be done in our schools to build up...
Malcolm Chisholm:
Lab
The section on sexual health services—roughly from page 41 to 62—is the most substantial section of the report. Obviously, the issues that Margaret Smith has...
Elaine Smith (Coatbridge and Chryston) (Lab):
Lab
The document says that it is not known how many young girls in Scotland have undergone female genital mutilation. Does the minister agree that female genital...