Hansard

I welcome this debate and the opportunity that it provides for members to contribute to the development of a national sexual health and relationship strategy for Scotland. In my statement to the Parliament on 12 November, when I launched the consultation on the expert group's proposals, I stressed the Executive's desire to obtain the views of all sections of Scottish life and interests. In doing so, I recognised the important input that the Parliament could have into the final shape of the strategy. I therefore look forward to hearing members' comments.

First, let me briefly set the context. Sexual health in Scotland is poor. Sexually transmitted infections are widespread and are increasing in incidence. For example, there has been a dramatic rise in genital chlamydia diagnoses over the past decade, not all of which can be attributed to better screening. Moreover, between 2001 and 2002, there was a 60 per cent increase in the incidence of rectal gonorrhoea and a 200 per cent rise in the number of cases of syphilis among men who have sex with men. There was also, in 2002, the highest increase in the number of new HIV cases since 1987. Significantly, too, the rate of teenage conceptions in Britain is the highest in western Europe and, sadly, the problem is most acute where deprivation is keenest.

If the statistics are worrying, so are features such as regret, violence, abuse, coercion and disrespect, which 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 sex is unwanted. It is abundantly clear that sexual well-being is not just about the absence of disease or the lowering of 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 perspective informed the remit of the group that I appointed to develop a sexual health strategy for Scotland. The remit focused not just on reducing unintended pregnancies and sexually transmitted infections and enhancing the provision of sexual health services, but on promoting a broad understanding of sexual health and sexual relationships that encompasses emotions, attitudes and social context. The intention was to develop a strategy that would be more comprehensive than that in comparable documents, that would acknowledge the wider social and cultural influences on sexual health, and be rooted in the values of respect for self and others and strong, respectful relationships.

Members will by now be familiar with the expert group's proposals. Briefly, the group believes that achieving enhanced sexual health and well-being requires a number of key elements, including a society that views sexuality in an open, positive way and that values and respects diversity; acknowledgement of the importance of economic, social and cultural influences on sexual well-being, the inequalities those cause and the appropriate action to address them; lifelong formal and informal opportunities to learn about sexual health and relationships and the moral issues that they raise; and support from easily accessible, confidential and appropriate clinical services.

Five broad actions are identified as key. Those are, first, national leadership through the appointment of a national sexual health programme co-ordinator and a new, ministerially led national sexual health advisory committee to oversee implementation of the strategy; secondly, local leadership, through local sexual health strategies and sexual health networks, and local co-ordination; thirdly, setting clear national and local targets and goals; fourthly, maximising existing mechanisms such as local health plans and the performance assessment framework; and fifthly, monitoring progress to ensure delivery through the new advisory committee at national level and directors of public health at local level.

Supporting those key actions are over 100 recommendations, which set out a range of measures that are designed to give focus, structure and coherence to the approach to sexual health. The measures include steps to ensure that tackling the wider determinants that influence sexual well-being is firmly embedded in the development of policy and practice, nationally and locally; that media and mass communications work is used to exert positive influences; that vulnerable groups, especially those in deprived areas, are specifically targeted, including young people under 25 and men who have sex with men; that the important role of schools in providing sexual relationship education in a consistent way is fully developed; that the crucial influence that parents can exert on their children's sexual values and skills is recognised; and finally, in terms of the headlines, that a tiered-service approach is taken to provide a continuum in sexual and reproductive health care provision.

It would be quite wrong at this stage, in the middle of the consultation process, to give a final view on all the report's specific recommendations. However, I make it clear that I warmly endorse the general approach and way forward that the group has proposed. I am particularly attracted to the integrated, holistic approach that the group envisages. I believe that structure and co-ordination are crucial to success. Structure will ensure that the key players know precisely what is expected of them, be it schools, the media, the national health service, local authorities or voluntary organisations. Co-ordination is important because joint, integrated working within a strategic framework at national and local levels is crucial if we are to make inroads into the problem. A weakness that I have perceived in our approach has been the lack of a strategic vision and a coherent framework to carry it into practice. The group's proposals go a long way toward tackling that deficit and giving a sharper edge to our drive for better sexual health.

Especially welcome, too, is the affirmation of the key values of respect, equality and accessibility to clinical services and lifelong learning. I am clear that respect for self and others and strong, positive, trusting relationships must be at the heart of our approach to enhanced sexual health. It is no accident that relationships feature in the title of this debate and of the expert group's report. The emphasis on a cross-cutting approach and the importance of tackling the wider determinants influencing sexual health is absolutely vital and is in harmony with the thrust of current Executive policies, which place an emphasis on inclusion, equal opportunity and respect.

I am particularly pleased by the recognition of specific gender issues and the emphasis on challenging gender stereotypes.

I also welcome the support for the consensus among parents, professionals and faith groups that sexual relationships are best delayed until a person is mature enough to participate in mutually respectful relationships. That is particularly important in relation to potential abuse or coercion, and the high levels of regret recorded in the evidence, particularly by young women.

The strategy acknowledges that sex and relationship education is not just about schools, but recognises the key role that schools can play in fostering healthy and respectful attitudes to relationships. The approach that is outlined combines health promotion and service provision information with commitment to encouraging young people to delay sex until they are mature enough to cope emotionally and understand the importance of mutual respect. International evidence indicates that this is the most effective approach to sex and relationship education.

The proposals for an integrated, tiered-service approach and the creation of a managed sexual health network in each NHS board area provide a valuable formula for more consistent, integrated and flexible sexual health services. I would like to pay tribute to service providers, in the NHS and elsewhere in the statutory and voluntary services. Hitherto, this has been a relatively unglamorous element of service provision and the commitment and unremitting work of those in the field, often carried out in difficult circumstances, may have gone largely unsung. I put on record today my appreciation of their huge efforts.

I believe that the expert group's proposals offer a practical and thoughtful basis for tackling Scotland's sexual health problems in a meaningful and inclusive way; I look forward to the responses to the proposals.

When we launched the consultation process, I said that the Executive's intention was that it should be wide-ranging and inclusive. We have been true to that promise, setting in train a comprehensive and possibly unprecedented array of consultative mechanisms. We have issued about 4,500 copies of the consultation pack, consisting of a covering letter, the full strategy and the summary version. We have commissioned the Scottish Civic Forum to hold a series of meetings across Scotland. By making use of its network of local co-ordinators, it should be able to get feedback from difficult-to-reach groups that might not normally take part in a consultation such as this. We recognise the importance of input from faith groups, and in that regard officials are due to have a meeting later this month with the Scottish Churches Parliamentary Office.

It is of crucial importance to obtain the opinions and perceptions of young people themselves. Thus the Scottish Youth Parliament, YouthLink Scotland, Young Scot and the youth project of the Convention of Scottish Local Authorities, dialogue youth, have been invited to arrange feedback from children and young people of 14 years of age and upwards.

Recognising the importance of comments from teachers and parents, we have written to teachers and parents groups and placed an article about the consultation on the Executive's parentzone website. Furthermore, we have set up an internet discussion forum and have made the draft strategy available on the Scottish Executive website.

Once the consultation is completed on 27 February, the process of analysing the comments will begin. To assist in this task we have appointed researchers to assess and report independently on the results of the consultation exercise. A suite of feedback and analysis reports will be published in appropriate formats after the close of the exercise. Thereafter, the strategy will be finalised as quickly as possible.

Let me assure members that, in the interim, we are not standing still: a spectrum of measures to promote positive sexual health is in train. They include initiatives by NHS Health Scotland—for example, the think about it campaign—to encourage young people to take a responsible approach to their sexual health. There is also funding to the Caledonia youth project to set up sexual health advice centres in four key locations in Scotland. In addition, more than £8 million has been made available to NHS boards annually to help prevent the spread of HIV and other blood-borne viruses. There is also the inclusion project, which is helping to identify the support that is needed from local NHS services to better meet the needs of people from lesbian, gay, bisexual and transgender communities.

As members know, there is also the national health demonstration project, healthy respect, which is funded by the Executive and led by a partnership of the NHS, local authorities and voluntary and community groups in Lothian. Phase 1 of the healthy respect project will be completed at the end of this month. Although the independent evaluation that we have commissioned will not report until later this year, the project's emerging achievements include the development and distribution of over 5,000 chlamydia postal testing kits through leisure, retail and community settings; the setting up of eight health drop-in centres; and developing and supporting the role of the parents of hard-to-reach young people through training events and booklets on young people's sexual health. Because most of the individual projects were found to be in need of a longer period of demonstration, we have agreed to move to a second phase, where we will identify clear lessons for future policy and practice.

All that is in addition to the plethora of initiatives that are provided by NHS boards and partners locally.