Improving Sexual Health Services in Scotland
The improvements made by NHS boards to sexual health services over the last few years reflect the World Health Organization’s view of sexual health.
‘Sexual health is a state of physical, emotional, mental and social well-being in relation 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 sexual 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.’1
There are many positive aspects of sexuality but we need to acknowledge some of the undesirable consequences including sexually transmitted infections and unintended pregnancy. These can be lifelong for individuals, families and communities and we know that those most affected are often economically disadvantaged, ethnic minorities, persons with different sexual orientations, disabled people and young people.
Our challenge is to make sure that everyone of any age and background who is at risk should have access to information and services that promote and protect sexual health.
Scotland faces many challenges in relation to sexual health and the Scottish Government has provided long term and sustainable direction and funding to address these. In the recently published sexual health and blood borne virus framework, Michael Matheson, Minister for Public Health, states that ‘We want to live in a society where attitudes towards sexual health and wellbeing…are supportive and non-stigmatising. Where people of all ages and from all backgrounds feel enabled to seek the support they require without fear of discrimination or recrimination…’2
This sets the context for the role of Healthcare Improvement Scotland in improving access for all to person-centred, safe and effective sexual health services.
This is a summary of the key messages.
Highlights and progress made
Sexual health services serve a broad spectrum of people and their emphasis is on reducing inequality of access to care. NHS boards have all developed a strategic, informed and pragmatic approach with a high degree of commitment and innovation from sexual health services.
• Sexual health services are multi-agency and depend on collaboration across a range of services. We found that all but one NHS board now have integrated services that have broken down barriers between medical specialties (such as sexual and reproductive health and genitourinary medicine). NHS boards have also reached out to local authority and third sector services including schools, social work and youth outreach.
• Communities and individuals with special needs are being provided with targeted sexual health services. NHS boards are commended for the work they have undertaken to achieve the quality of services being provided.
• The sexual health and wellbeing of young people has been, and continues to be, a key priority for all NHS boards. Much consideration has been given to the location and opening times of young people’s clinics to maximise access for this group. Ways in which free condoms are made available to young people were also demonstrated.
• NHS boards also play a crucial role in supporting the delivery of sexual health and relationships education training to professional groups including teachers, youth workers and social workers.7 / Sexual Health Services / National Overview
Opportunities for further improvement
This review has identified a number of areas where improvement is required.
• Partner notification (contact tracing) arrangements are generally weak and NHS boards need to make sure these are robust in all settings delivering sexual health care, particularly in primary care. NHS boards with centralised systems for partner notification, covering both primary care and sexual health services, demonstrated more effective results than those with a variety of systems. NHS boards should have a system that records patient consent for partner notification purposes and follows this through effectively. This system needs to cover all settings where a person may present with a sexually transmitted infection.
• Data collection systems and processes need to be improved as they range in quality and scope. National data collection and information systems, such as the NHSScotland National Sexual Health System (NaSH), should also be used where possible.
• Providing a minimum of 2 full days each week of integrated, local, specialist sexual health care is challenging for some areas. Where this is not possible, NHS boards should demonstrate that they have acceptable and accessible alternatives.
• Further work is needed to make sure each NHS board has a system in place to identify and meet the specific sexual health information needs of the population it serves.
• Men who have sex with men should have a choice of where they are vaccinated for hepatitis B, and not be restricted to specialist sexual health services. This is not currently the case in all NHS boards.
There is no doubt that a strong strategic lead from Scottish Government and the supported development of a funded infrastructure is now showing clear improvement in access to high quality, person-centred sexual health care. In this field particularly we have seen so many good examples of innovative approaches to quite complex situations: these could easily be translated into other services and are not high cost. They do rely on good inter- agency working and in our experience, sexual health services are leading the way on this.
NHS board performance against the sexual health services standards is presented in a table in Chapter 3. Detailed information on the findings of our review is provided in Chapter 4.