Ingrid Sutherland outlines controversial new guidance on the provision of sexual health services in schools

Government plans to bring sexual health services into schools have proved divisive, with ‘pro-life’ groups leading the charge: Rob McDonough, head of West Bridgford school, Nottingham, was accused by anti-abortion activists of conspiring to murder unborn babies — because his school gave the morning-after pill.

But what is all the fuss about? Here, we take a detailed look at new guidance on school sexual health services, placing it in the context of other pupil health initiatives.

Every Child Matters
The 2003 Every Child Matters agenda underpins all the work that schools do in relation to children and young people. One way of achieving some of the Every Child Matters outcomes  (staying safe, being healthy, enjoying and achieving, economic well-being, making a positive contribution) is to provide sexual health advice services in schools.

Sex education forum This is the national authority on sex and relationships education, set up in 1987 as an assembly of 47 organisations. The forum manages a ‘schools and services network’, providing advice and support for schools that are setting up, or considering, a school-based health advice service.

Sex and relationship education

Every local authority, head teacher and governing body has a statutory duty to take account of the Sex and Relationships Education Framework issued by the Sex Education Forum. The framework requires that sex and relationship education be provided:

  • The biological content of sex and relationship education must be taught as part of the national science curriculum.
  • A written sex and relationship education policy must be in place.
  • The DfEE 2000 guidance on sex and relationship education recommends that sex and relationship education be planned and delivered as part of personal, social, health education.
  • There are three main aspects to sex and relationship education: acquiring information, developing skills and exploring attitudes and values.

Extended schools
Under section 27 of the Education Act 2002, schools’ governing bodies are responsible for extended services. An extended school is supposed to be a key way of delivering the Every Child Matters outcomes — working with local agencies (and in many cases, other schools) to provide a variety of extended services:

  • wraparound childcare 8am-6pm, all year round
  • parenting and family support
  • varied activities, including study support, sport and music clubs
  • swift and easy referral to specialist services such as speech therapy
  • community use of facilities including adult and family learning and ICT

These will often be provided beyond the school day but not necessarily by teachers or on the school site. Ofsted will report during school inspections on how extended services are contributing to improved outcomes for children and young people. Working towards offering extended services is supposed to support a school in gaining healthy school status.

Pregnancy strategy and STIs
This government strategy has helped reduce the number of teenage pregnancies, although the UK rates are still much higher than those of other Western European countries. And whilst the incidence of some sexually transmitted infections is falling, the rates are still highest among young people.

Improving access to advice and support on relationships, contraception and sexual health is crucial in helping young people make healthy and positive choices.

Every local authority has a teenage pregnancy coordinator responsible for coordinating the local teenage pregnancy strategy. Coordinators can advise on local teenage pregnancy rates, and can identify schools that serve wards where the rates are highest. They can also comment on schools’ emerging plans, drawing on their knowledge of young people’s views about accessing services.

The new guidance on sexual health services is called Extended Schools: Improving Access to Sexual Health Advice Services. It is relatively short, and gives information on setting up school-based health advice services.

The guidance builds on recent guidance to local authorities and primary care trusts on effective delivery of local teenage pregnancy strategies, which included a range of measures to improve young people’s access to contraceptive and sexual health advice.

Helping young people access confidential health advice services allows schools to help all pupils achieve the ‘being healthy’ and ‘staying safe’ Every Child Matters outcomes. It also allows them to meet the swift and easy referral requirements of the extended schools core offer.

Provision of information about local contraceptive and sexual health services is also one of the criteria needed to meet the PSHE standard in the healthy schools programme.

Guiding principles
The guidance lists these as:

  • accessibility (location, hours — for example, offering services outside the school day)
  • publicity (ensure this makes clear that the service is open to boys and young men)
  • confidentiality
  • welcoming, discrete environment
  • trained staff (with non-judgmental attitudes and values)
  • co-ordination with other advice services for young people
  • broad-based (covering a wide range of health issues, such as smoking, healthy eating, alcohol and drug misuse, as well as sexual and reproductive health)
  • monitoring and evaluation (reasons for using the service need to be understood, while retaining individuals’ anonymity)
  • Reference is made to quality criteria issued to primary care trusts (You’re Welcome Quality Criteria: Making Health Services Young People Friendly, 2005, DH).

Case studies
The new guidance includes case studies. There is no set model for a school-based service — it is for the school’s governing body to decide, in consultation (see right) with parents, teachers and pupils.

Some GPs run on-site drop-in services, others offer a sexual health nurse, counsellor, practice nurse and mental health service worker. Alternatively, where an on-site service is not possible, some schools have developed effective referral systems to services in community settings. In most schemes, a school nurse co-ordinates health advice services and referral arrangements.

The three case studies give contact details so that you can discuss the effective programmes with the schools that run them:

  • One offers advice rather than medical treatment.
  • A second offers a lunchtime clinic, including contraception and sexual health, off-site at a nearby health centre (with exclusive use once a week), providing access to services during the school day.
  • The third offers a drop-in health session, with single-sex sessions (which allow use of male and female workers, and target-work around health promotion issues).

There does not appear to be any specific ring-fenced funding for these services. The guidance recommends that local authorities consult and work with their primary care trust to ensure services reflect local priorities and complement other services provided by the primary care trust.

Children’s trust arrangements should be in place in all local authority areas by 2008. This will bring together services for children and young people, and help schools develop links with other services such as health and social care.

These trusts will be able to pool budgets between partners, making more efficient use of resources.

The consultation process should be led by the school’s governing body, which decides whether or not to set up the service and its scope. Consultation should be with parents, teachers and pupils, as well as through liaison with the local primary care trust — to negotiate the health professionals’ input and practical requirements such as space and equipment.

Avoid stigma
Young people may shy away from sexual health services because of the stigma attached to using them. To avoid this, it is recommended that broad-based health advice services be developed, with contraceptive and sexual health advice being just one component, together with, for example, diet and exercise, emotional heath and well-being, drug education and sexuality.

Teachers’ role
It is important to note that teachers are not required to provide sexual health advice. This should be provided by health professionals, such as a school nurse, GP, or sexual health outreach worker. Teachers must, however, be able to show young people where they can get confidential advice on sexual health issues.

Confidentiality and consent
Health professionals work to their own codes of practice and to Department of Health guidance (Seeking Consent: Working with Children, 2004, DH; and Best Practice Guidance for Doctors and other Health Professionals on the Provision of Advice and Treatment to Young People Under 16 on Contraception, Sexual and Reproductive Health, 2004, DH).

These stipulate that young people (including those under 16) have the same rights to confidentiality as do adults, provided that there are no child protection issues (if there are, health professionals must follow the Working Together guidance).

Young people can consent to advice and treatment without parents’ agreement, so long as they are judged competent to understand the choices presented to them. Health professionals must always try to discuss with young people the benefits of involving parents.

Where a young person is adamant that s/he does not want his or her parents to be informed, every effort should be made to involve another trusted adult, such as an aunt, older sibling or family friend.

Ease of access
Under-16s are the group least likely to access sexual health advice, both before their first sexual experience and when they become sexually active. There are various reasons for this:

  • fear of broken confidentiality
  • not knowing they can use services without their parents being informed
  • restricted opening times
  • lack of confidence

Providing services in schools and other non-clinical settings, such as FE colleges and Connexions one-stop-shops, is part of the Government’s drive to improve young people’s access to health advice. Ease of access can make the difference between whether or not the young person seeks advice.

Parents’ views It is important that parents (and governors) be aware of the nature of the services provided, and that their children will be able to access confidential advice.

While some parents may object, especially in faith schools, evidence suggests that the majority support sex and relationship education — and agree that young people should have access to advice on contraception and sexual health. Where health advice services are being offered on-site, schools say that parents are generally supportive.

Meeting a need
Concerns have been raised that these services will encourage early sexual experimentation and that parents will be kept in the dark. But young people need appropriate advice — those not yet sexually active need to know the choices available and those who are need contraceptive advice. Schools can give practical help in this important area.

Find out more

Extended schools: Improving access to sexual health advice services

(DfES, January 2007)
Sex and Relationship Education Guidance (DfEE/0116/2000):
Sex Education Forum
Sex and Relationships Education Framework (SEF Fact sheet 30)

Ingrid Sutherland is a solicitor, giving advice and training for the Advisory Centre for Education