Examination of Witnesses (Questions 20-39)
MS CATHY
HAMLYN, DR
VICKI KING,
MS RUTH
STANIER,MS
KAY ORTON
AND MS
ANDREA DUNCAN
WEDNESDAY 26 JUNE 2002
20. That is a fantastic tribute, actually, to
your work. Would you put that down to changing educational opportunity?
(Ms Hamlyn) I think it will be a combination of factors,
a combination of factors of greater emphasis being put on sexual
relationships education, improving access for young people to
have for services and advice, and of giving attention to reintegration;
but it is early days, and we do have quite challenging targets
to achieve, but we need to keep on with the programme.
21. On targets, do you have targets for prevention
activities, for increasing the availability of advice in schools,
or whatever it will be, contraception; have you set a target for
that?
(Ms Hamlyn) The target that we have been exploring
with the Department for Education and Skills has been about improving
the accreditation of teachers and specifically it is about improving
teaching within schools; that is very much backed up by the recent
OFSTED report that talked about that really you would need specialist
teachers to have more effective teaching of sex and relationships
education. And our intention is to try to reach a point where
we have an accredited teacher in each primary and secondary school
who will teach sex education.
Andy Burnham: Can I just ask, on this issue
of access to sexual health information and services, do you have
a concern that faith schools perhaps might not want to implement
what you want them to implement, and that you may have a patchwork
of different levels of sexual health advice given in schools across
the country?
Chairman
22. Does not that happen now, are there not
clear distinctions between what schools do?
(Ms Hamlyn) There is a requirement for state schools
to work within the context of the Department for Education and
Skills guidance, but individual schools can take on board, obviously,
their own values and ethos, and so on, so faith schools will take
on what they think is appropriate in the context of those issues.
We are working very closely with a wide range of faith organisations,
and, in fact, do have an Inter-Faith Forum that has now been established.
Last year, we had three seminars across the country with faith
communities, and there will be a resource published later this
year, which is about working with diverse communities, with faith
communities, so that people on the ground can work effectively.
And it is about building relationships and seeing what the common
ground is, and I think our experience to date is that there is
quite a lot of support for addressing these issues, and it is
about finding where we can have the common ground.
Andy Burnham
23. I will finish with one final question. As
a result of the strategy introduced, how would you intend to evaluate
the extent to which the public have access to both information
and services, and how are you collecting the information which
shows whether that is increasing or decreasing?
(Ms Hamlyn) As a result of the Teenage Pregnancy Strategy,
or the Sexual Health Strategy?
24. Sorry, the Sexual Health Strategy, in general?
(Ms Stanier) One of our Action Plan commitments is
to develop, by next year, a detailed indicator set, which will
help to monitor improvements at a local level. We are already
exploring indicators, for example, to look at the number of sessions
offered in family planning clinics, and we also have a commitment
to develop a new indicator around waiting times for GUM services.
So I think we are going to need to put into place a whole range
of different indicators, looking at the different types of services.
25. Do you have the ability now to say, that
part of the country, at that time, is not getting enough, there
is not enough access to information and services; are you able
to do that on what you now know?
(Ms Stanier) I think that our current availability
of information is fairly patchy, so, for example, while we have
some quite good data, for example, around access to abortion services,
I am not sure that we have precisely the type of data around information
provision that you are asking about.
Chairman
26. We received some information, just going
back to Andy's point about sex education in schools, that where
there was a positive sex education programme in the school, there
was a clear correlation between a later age of first sex; is that
correct, could you sort of spell that out a bit?
(Ms Hamlyn) Yes. The evidence shows, and there is
research to back this up, that effective sex education does not
actually bring forward the age of first sex, it actually serves
to delay the age of first sex; and, far from promoting promiscuity,
it gives young people more cause to think about the issues, rather
than going headlong into sexual relationships. So, yes, the evidence
is there to back that up.
27. And you are quite convinced that that is
objective and properly researched?
(Ms Hamlyn) It is proper research evidence I was quoting
from. We can probably come back to you, to give you the quotes
on where this one is.
28. I think, because it is so significant, it
would be very helpful if you could possibly give us that information?
(Ms Stanier) It is Douglas Kirby, the US researcher,
and his best review to date, most comprehensive review to date,
of evidence on this issue, in the publication "Emerging Answers".
29. But was that research in Britain?
(Ms Stanier) It is a review of programmes that have
been undertaken in the US. It is also the case though that the
Health Education Authority has done a review of research, looking
both here and in the US.
30. Right; then that confirms the impression
that we got?
(Ms Stanier) Exactly.
Chairman: Any information on this would be very
welcome for the Committee, thank you.
Sandra Gidley
31. If I can go back a bit, "indicator
set" is a dreadful term; is that part-way towards setting
targets, towards having indicators, or am I to assume from that
that there is no point putting this in place unless you are going
to have yet more targets for people to meet?
(Ms Stanier) We are not intending to put in place
new targets, on the back of the indicators there, it is just really
so that we have got better monitoring information, and, I think,
for each indicator, we will be quite clear about which direction
we would like to see change moving in.
32. I want to go back to the education issues,
and, in particular, I think there is a problem with post-16s,
and, bearing in mind that most people do become sexually active
after that age, coupled with the fact you now have a lot of sixth-form
colleges around the country, do you feel that there is a bit of
a gap there, where issues are not readily addressed? And this
is, I think, and I would welcome your opinion on this, a particular
problem when you are talking about young gay men; because, traditionally,
schools cannot address gay sex issues, theoretically they can
but they all hide behind Section 28. So we now have a situation
where, at 16, young men, quite legitimately, can have a gay sex
relationship; but it seems to me that outside of London and the
metropolitan areas there is not really anywhere that those young
men can access for advice as to safe-sex issues and all the rest
of it. Has any thought been given to that; because I asked a question
of the Department for Education and Employment, as it then was,
and they had no plans to change current thinking, which did not
fill me with confidence?
(Ms Stanier) We have absolutely identified this gap
that you talk about, that the personal, social and health education
curriculum does not apply to FE colleges, and we actually include
within our Implementation Action Plan a commitment to work with
DfES, the Department for Education and Skills, to explore what
we can do to improve the provision of advice for the further education
setting.
33. And what were the timescales for that, because,
obviously, each year that it is not addressed we are building
up a problem, potentially?
(Ms Stanier) I think the Plan gives a deadline of
by next year.
34. Right; and, presumably, you cannot predict
what will be put in place after that?
(Ms Stanier) Not at this stage, no.
35. And how receptive are the Department for
Education and Skills to this approach from you?
(Ms Stanier) Reasonably receptive; they have agreed
to the commitment, and we are already discussing with them how
we are going to take forward the first stages of that work.
36. The other thing, with regard to information,
it seems to me that very much the strategy is slightly in two
halves, you have got the Teenage Pregnancy bit, and you have got
the STI bit, and they do not seem to mesh in the middle very easily,
in some respects. In reality, how dove-tailed will those two strategies
be?
(Ms Hamlyn) The Sexual Health Strategy does act as
an umbrella, but, yes, the development of the Teenage Pregnancy
Programme, Strategy, had already been developed, and so it is
the Sexual Health Strategy which provides an umbrella within which
the Teenage Pregnancy, as far as the prevention of teenage pregnancy
is concerned, actually fits. So, in terms of actually making the
links, I think we have made that clear, in terms of making a lot
of the links actually within the Action Plan, that certain things
need to be developed very much together for the younger age group
and the older age group. We can learn the lessons of work that
has already been done on the Teenage Pregnancy Programme now for
young adults, a lot of the work on improving services, some of
this is about mainstream services for both age groups, although
for teenage pregnancy we have been encouraging services designated
for young people. I think what I do need to point out is, the
Teenage Pregnancy Strategy, of course, goes beyond just what you
would normally describe as a Sexual Health Strategy, because it
does address the fundamental issues of social exclusion for teenage
parents, so there is a broader issue than just sexual health that
has been dealt with within that programme, so it is quite legitimate
that they will develop separately. Yes, there is a coalescence
there that needs to happen, in the context of taking forward this
strategy.
37. You have just mentioned social exclusion,
and certainly my constituency is partly rural, and it would be
difficult for people to access services outside of an education
system, it is probably more difficult, there is not somewhere
that young people can readily go to in a fairly anonymous fashion,
if that is what they want to do. So what measures do you hope
will be put in place, what is being done to ensure that everybody
has access to these services, because there are marked inequalities
at the moment, and there are populations such as perhaps ethnic
minorities who do not access the services readily?
(Ms Hamlyn) I think there are a number of things that
are within the Action Plan where we will be putting in good practice
guidance, and that includes having a Commissioning Toolkit within
which we will be putting good practice guidance around effective
contraceptive services, and, indeed, abortion services is another
example of that, and the need for those services to properly reflect
the interests and the use of a diverse community. So I think that
will be reflected in the way that we produce the Commissioning
Toolkit, and the advice that will go to PCTs. We also have within
the Action Plan a commitment to produce a Health Promotion Toolkit,
which again will be about targeting particular groups in a community,
practical tips of how you really address those diverse needs.
Specifically on the questions of service access, there is already
good practice guidance under the Teenage Pregnancy Programme that
was developed for young people, and there is specifically guidance
for black and ethnic minority communities that we have developed.
38. Has it had any effect?
(Ms Hamlyn) It is something that we are monitoring,
through the Teenage Pregnancy Programme, through the assessment
of the reports that we get back from local areas. We did actually
ask, what currently has been in operation has been an audit going
on for young people, which has been an audit that has used the
criteria in the good practice guidance; we are going to be analysing
the results of that audit. The audit is useful for local purposes,
but we are receiving at a national level, which will be analysed
so we can see what further action needs to be taken.
39. Because we have heard a lot about guidance,
and this does worry me, to some extent, because we all have guidance
on diet and know what we are supposed to eat, and people rarely
do; but, in practice, it is all very well issuing guidance after
guidance after guidance, but what measures can actually be taken,
practically, to make sure these things are enforced? It seems
to me that there is no stick, or no carrot there?
(Ms Hamlyn) Clearly, the issues are about the indicator
sets that we have to monitor progress, they are about the decisions
that are made at a local level, and, in the context of shifting
the balance of power, clearly the PCTs now have a very key role
to developing sexual health, they need to look at the needs of
their local population and what the priorities are, they need
to have a cognisance and a regard to the guidance that has been
produced; they will be performance-managed by the Strategic Health
Authorities in that regard. So where we produce guidance, and
indeed standards, the Strategic Health Authorities will be discussing
those with the Primary Care Trusts. So I think there are mechanisms
through the performance management mechanisms to make some progress
in these areas.
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