Sexual health and blood borne virus action plan: 2023 to 2026

Governance, accountability, data, and collaboration

Governance and Accountability

To support and develop the actions within this plan it is vital that Scottish Government, NHS Boards, local authorities, third sector, academia and other key stakeholders are part of a network that provides both support and challenge. There are currently a number of groups under the umbrella of the Scottish Health Protection Network (SHPN), overseen by the Sexual Health and BBV Strategic Leads, within which key sexual health and BBV priorities are coordinated and monitored. Whilst these multi-disciplinary groups have been instrumental in facilitating progress to date, through the sharing of best practise and reporting on key topics, there needs to be a review of these structures to ensure Ministerial accountability in terms of policy implementation, and clear roles and responsibilities for all stakeholders to make progress against deliverables.

We know that due to disparities in size, population and rurality, Scotland's fourteen territorial NHS Boards face different challenges. As a result, a 'one size fits all' approach to all sexual health and BBV care is not appropriate, however where there is best practice and learning that can be shared between NHS Boards, a 'once for Scotland' approach should be encouraged. A revised governance structure will allow NHS Boards to work towards national deliverables while considering their specific circumstances and priorities, and to support national and regional collaboration where appropriate.

A revised national governance structure will support this Action Plan. The SHPN is overseen by an SHPN Oversight Group, but for delivery of the relevant national policies and action plans the sexual health and BBV groups will also report into a National Sexual Health and BBV Oversight Group, chaired by the Minister for Public Health and Women's Health. This will allow direct Ministerial oversight of progress towards delivery of this Sexual Health and BBV Action Plan.

Action 1: Scottish Government to review governance structures and form a Ministerial-led Sexual Health and BBV Oversight group.

Data and Technology

The availability of robust, routine data and reporting is essential when tracking progress against goals or identifying areas which may require additional intervention. Public Health Scotland (PHS) produces a range of sexual health and BBV surveillance reports which provide valuable insight into infection and treatment rates as well as longer acting reversible contraception (LARC) provision, teenage pregnancy rates and abortion rates. This high quality, national data has been utilised to underpin world-leading research papers on a number of subjects, including the impact of HIV PrEP and HCV treatments. However, some sexual health and BBV data reporting was downscaled during the COVID-19 pandemic as resources were reallocated to focus on the essential pandemic response and this has not been fully restored. In addition to this, some areas of data have never been fully utilised or integrated, for example primary care contraception data remains limited.

The focus now must be on ensuring that sexual health and BBV data gathering, and reporting is fit for purpose, providing timely, accurate data to Scottish Government, NHS Boards, and the public, to allow the monitoring of progress towards agreed priorities and targets as well as a greater understanding of the epidemiology and needs of the population.

The WHP also includes actions to improve the collection and use of data on women's health, so collaboration here is vital.

Action 2: PHS with support from Sexual Health and BBV National Monitoring Assurance and Research Group (NMARG) to develop a data monitoring plan to accompany this Action Plan by end of March 2024

NHS Scotland's National Sexual Health (NaSH) electronic patient record and online booking system underpins all of NHS Scotland's specialist Sexual & Reproductive Health Services and has been live since 2008. NaSH handles scheduling, test requests and automated results processing, clinical documentation, prescribing, and data reporting across Scotland. Work is however needed to upgrade NaSH to improve the functionality for clinicians and patients to ensure services can meet and manage increased demands and requirements.

Action 3: Scottish Government to commission upgrades to NaSH system to improve patient pathways for sexual health and HIV services with longer term investment into NaSH considered by Scottish Government and NHS Boards.

NHS Board Collaboration

Due to ongoing resourcing pressures, we know that a number of specialist sexual health and BBV services are currently lacking resilience due to capacity issues. There are potential benefits to be found in regional collaboration, with NHS Boards reaching agreements to work together on delivery of specialist services, where appropriate, to ensure national coverage and population equity of access.

Through the national governance structures, work will be undertaken to explore opportunities for national and regional collaboration across sexual health and BBV services, and in particular where this can benefit smaller, rural boards

Action 4: NHS Boards should take steps to collaborate on sexual health and BBV service delivery where possible and appropriate.

As part of the original Sexual Health and BBV Framework regular NHS Board Visits were conducted as part of support and monitoring by Scottish Government. Through consultation and development of this Action Plan, we have noted that these visits were widely welcomed by NHS Boards, as a supportive way in which to explore how work to support the delivery of outcomes was progressing and how the Framework recommendations were being delivered as well as to address challenges and overcome barriers. As a result, Scottish Government will work with NHS Boards to conduct further support visits to NHS Boards over the lifetime of the action plan to help NHS Boards identify areas of improvement and overcome barriers in the delivery of the actions within the plan. We will consider the role of the Centre for Sustainable Delivery in exploring innovative models of collaboration.

Action 5: Scottish Government to arrange support visits to NHS Boards in line with local need.