Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 20-39)



  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?


  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.


  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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