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Women’s Health Strategy for England

Volume 823: debated on Thursday 21 July 2022


The following Statement was made in the House of Commons on Wednesday 20 July.

“With permission, Mr Speaker, I will make a Statement on the women’s health strategy for England.

I know that many honourable and right honourable Members will agree that, for too long, women’s health has been hampered by fragmented services and women being ignored when they raise concerns about their pain. On too many occasions, we have heard of failures in patient safety because women who raised concerns were not heard, as with the Ockenden review into the tragic failings in maternity care and the independent inquiry into the convicted surgeon Ian Paterson. I also remember the outstanding work of my constituent Kath Sansom and her Sling the Mesh campaign where, once again, the response was too slow when women raised issues with their care.

We are embarking on an important mission to improve how the health and care system listens to women’s voices and to boost health outcomes for women and girls, from adolescence all the way through to later life. This is not only important for women and girls; it is important for everyone. This work is already well under way.

Last month we announced the appointment of Professor Dame Lesley Regan, one of the country’s foremost experts in women’s health, as the first ever women’s health ambassador for England. On top of this, we are investing an extra £127 million in the NHS maternity workforce and neonatal care over the next year, and we are creating a network of family hubs in local authorities in England.

Today we are announcing the next step. We are publishing the first ever women’s health strategy for England, which sets out a wide range of commitments to improve the health of women and girls everywhere. I take this opportunity to pay tribute to the almost 100,000 women who took the time to share their stories with us, as painful as it may have been. Your voices have been heard and were vital in shaping this strategy.

I will now set out the key components of the strategy. First, we are putting in place a range of measures to ensure that women are better listened to in the NHS. Indeed, 84% of respondents to our call for evidence recounted instances where they were not listened to by healthcare professionals. We need to do more to tackle the disappointment and disillusionment that many women feel. We are working with NHS England to embed shared decision-making where patients are given greater involvement in decisions relating to their care, including when it comes to women’s health.

Secondly, we want to see better access to services for all women and girls. Women and girls have told us that the fragmented commissioning and delivery of health services can impact their ability to access them. That means they have to make multiple appointments to get the care they need, adding to the NHS backlog. There are better ways to deliver women’s health through centres of excellence in the form of women’s health hubs, designed specifically to holistically assess women’s health issues and where specialist practitioners can be more attuned to concerns being raised. We are encouraging the expansion of those hubs, and indeed I visited Homerton University Hospital this morning to see the benefits these local one-stop clinics bring, enabling women to have all their health needs met in one place.

Thirdly, it is essential that we address the lack of research into women’s health conditions and improve the representation of women’s data in all types of research. Currently, not enough is known about conditions that only affect women, as well as about how conditions that affect both men and women impact them in different ways. The strategy sets out how we will tackle the women’s health data gap to make sure that health data is broken down by sex by default.

Fourthly, we will provide better information and education on issues relating to women’s health. Our call for evidence showed that fewer than one in 10 respondents feels they have enough information about conditions in areas such as the menopause and that many people wanted trusted and accessible information about women’s health. The NHS website is currently a trusted source of health information for many people, and we will transform the women’s health content to improve its existing pages and add new pages on conditions that are not currently there. But we know that the NHS will not be everyone’s first port of call for health information, so we will expand our partnerships, such as the one between YouTube and NHS Digital, who are working together to make sure that credible, clinically safe information appears prominently for UK audiences. It is also important that medical professionals have the best possible understanding of women’s health, and I am pleased that the General Medical Council will be introducing specific assessments on women’s health for medical students, including on the menopause and on gynaecology.

Fifthly, our strategy sets out how we will support women at work. In the call for evidence, only one in three respondents felt comfortable talking about health issues with their workplace, and we also know that one in four women has considered leaving their job as a result of the menopause. So we will be focusing our health and wellbeing fund over the next three years on projects to support women’s wellbeing in the workplace, and we will be encouraging businesses across the country to take up best practice such as the menopause workforce pledge, which was recently signed by the NHS and the civil service.

Sixthly, we will place an intense focus on the disparities in women’s health. We know that although women in the UK on average live longer than men, they spend a significantly greater proportion of their lives in ill health and disability than men. Even among women there are marked disparities and our strategy shows our plans to give targeted support to the groups who face barriers accessing the care they need, for example, disabled women and women experiencing homelessness. It also shows how we are putting an extra £10 million of funding towards 25 new mobile breast screening units that will target areas and communities with the greatest challenges on uptake and coverage.

Finally, as well as these cross-cutting priorities, the responses to our call for evidence also highlighted a number of specific areas where targeted action is needed. Those include fertility care, where we will be removing barriers that restrict access that are not health-based but based, for example, on whether someone has had a child from a previous relationship, and making access to fertility services much more transparent. Another of our priority areas is improving care for women and their partners who experience the tragedy of pregnancy loss. At the moment, although parents whose babies are stillborn must legally register the stillbirth, if a pregnancy ends before 24 weeks’ gestation there is no formal process for parents to legally register their baby, which I know can be distressing for many bereaved parents. So we will be accepting the interim update of the independent pregnancy loss review and introducing a voluntary scheme to allow parents who have experienced a loss before 24 weeks of pregnancy to record and receive a certificate to provide recognition of their tragic loss.

This is a significant programme of work, but we cannot achieve the scale of change we need through central government alone. We must work across all areas of health and care. We will need the NHS and local authority commissioners to expand the use of women’s health hubs; the medical schools, regulators and royal colleges to help us improve education and training for healthcare professionals; the National Institute for Health and Care Research to help make breakthroughs that will drive our future work; and many others to play their part. I would like to finish by thanking everyone involved in the development of this important strategy, including the Minister of State, Department for Health and Social Care, my honourable friend the Member for Lewes, Maria Caulfield, who is on the Front Bench with me today, for the determination she has shown in taking this strategy forward. I would also like to pay tribute to my predecessors, my right honourable friends the Members for West Suffolk, Matt Hancock, and for Bromsgrove, Sajid Javid, the latter of whom is in his place, for their commitment to this important issue, even during the pressures of the pandemic. This is a landmark strategy, which lays the foundations for change and helps us to tackle the injustices that have persisted for too long. I commend this statement to the House.”

My Lords, I thank the Minister for taking this Statement today, and I hope her noble friend is fully recovered from the bug that he acquired—goodness knows where. I declare an interest as a maternity safeguarding champion at a London trust hospital.

We must welcome this rather late and delayed strategy. For too long, women’s health has been an afterthought and the voices of women have been at best ignored and at worst silenced. I welcome the appointment of Professor Dame Lesley Regan as the first ever women’s health ambassador for England.

If this strategy is properly funded and actually delivered, it may not solve the crisis in women’s healthcare after 12 years of Conservative mismanagement but it would certainly help shift the policy and delivery of services. Four out of five women who responded to the Government’s survey could remember a time when they did not feel listened to by a healthcare professional.

The context for this strategy is that, in recent years, we have seen a string of healthcare scandals primarily affecting women: maternity services at Shrewsbury and Telford; more than 1,000 women operated on by rogue surgeon Ian Paterson; thousands given faulty PIP breast implants; many left with traumatic complications after vaginal mesh surgery; and the use of medication such as Valprol during pregnancy, as highlighted by the noble Baroness, Lady Cumberlege, in her report, First Do No Harm, which has helped to transform issues in this space

There is one issue I wish to raise with the Minister immediately, and of which I have given prior notice, which calls into question the Government’s commitment to sexual health rights for women. In the past few days, it has emerged that a statement on freedom of religion or belief and gender equality was issued by the UK as part of the intergovernmental conference it hosted in London on 5 and 6 July. Commitments to abortion and sexual health rights have been quietly removed. Is that true, and, if so, why has that happened?

I return to the Statement. The context of the strategy is that every woman who needs to use the NHS today faces record waiting times. The NHS is losing midwives faster than it can recruit them. Gynaecology waiting lists have grown faster than any other medical speciality. The number of women having cervical screening is falling, and black women are 40% more likely to experience a miscarriage than white women. We need to look at what is being proposed in this strategy.

The strategy promises new research, which is absolutely vital and very welcome. I draw the Minister’s attention to the report from the University of Birmingham commission into safe and effective, accessible medicines for use in pregnancy, Healthy Mum, Healthy Baby, Healthy Future. Chaired by the noble Baroness, Lady Manningham-Buller, it addresses the terrible lack of research into conception and pregnancy. The starting point is that virtually no drugs have been developed or trialled for pregnant women in the many decades since Thalidomide. This leaves women at the mercy of general diseases, the diseases of pregnancy and drugs that are usually unlicensed.

Pregnant women and babies throughout the world continue to get sick and die from largely preventable and treatable causes. Even in the UK, the way in which medicines are developed currently risks preventing pregnant women accessing the benefits of safe and effective medicines. Most recently, the exclusion of pregnant women from Covid vaccine trials has probably led to needless deaths among pregnant women and babies, which highlights this issue. The commission provides a blueprint for action. Will the Government make use of it?

Studies suggest that the gender bias in clinical trials is contributing to worse health outcomes for women. There is evidence that the impacts of female-specific health conditions, such as heavy menstrual bleeding, endometriosis, pregnancy-related issues and the menopause, are overlooked. Can the Minister set out how exactly the Government intend to make use of the new research to improve outcomes for women? How will they address widespread bad practice across clinical trials where women are not selected because their hormones might distort the results—which really means that they might reveal the side effects that treatments will have on them?

Moving on, we welcome improving the education and training of health professionals as absolutely vital. Almost one in 10 women have to see their GP 10 times before they get proper help and advice about the menopause. Why is it that almost half of medical schools do not teach doctors about the menopause, given that it affects every single woman? Those are two small consequences of not addressing gender in the training of our medical professionals.

I want to ask a question about what my honourable friend Carolyn Harris said in the Commons yesterday:

“I am delighted that my private Member’s Bill that I negotiated with the Government last October now appears as part of the strategy, but I am bitterly disappointed that the timeframe for that once annual charge is delayed until April 2023—18 months after it was promised”.—[Official Report, Commons, 20/7/22; col. 980-81.]

My honourable friend needs an answer on that. Why have the HRT costs been delayed until April 2023?

We can only welcome the extra £10 million for the breast screening programme. This screening can prevent avoidable deaths by identifying breast cancer early, but we must note that fewer women in the most deprived areas receive regular breast screening. Even before the pandemic, too many women with suspected breast cancer were waiting more than the recommended two weeks. Can the Minister tell the House how the programme announced today will make a difference to outcomes for patients if, once diagnosed, they end up on a waiting list that is far too long?

There are plans in the strategy to remove barriers to IVF for lesbian couples, which we welcome. For too long, they have faced unnecessary obstacles to accessing IVF for no other reason than the fact that they love another woman. It is encouraging to see the Government take action to set this right.

As well as the appalling figures on black maternity deaths, a quarter of black women surveyed by Five X More felt that they received a poor or very poor standard of care during pregnancy, labour and post-natally. Women who live in deprived areas are more likely to suffer a still-birth than their richer counterparts. Labour has pledged a new race equality Act to tackle the structural inequalities in our society, including in healthcare. Does the Minister acknowledge that those inequalities exist?

There is one final issue that I would particularly like to draw to the attention of the House. Support counselling for women victims of rape is absolutely vital but End Violence Against Women estimates that the Government need to provide a minimum of £195 million each year to rape crisis services to properly respond to that need, with a significant proportion ring-fenced for specialist BAME services. The problem, as a recent survey revealed, is that 60% of people believe that access to free counselling is readily available for rape survivors. That is not the case. The waiting lists are growing. Do the Government accept that this is not an acceptable situation?

My Lords, I agree with much of what the noble Baroness, Lady Thornton, has said. It is always interesting to see what is included and what is excluded in documents such as this. Like the noble Baroness, Lady Thornton, I would like straightaway to query the omission of rights to abortion and sexual healthcare. Is that now the policy of the Government and the Department of Health? If it is, that is a very significant change that will have a huge, detrimental effect on the health of women.

It is notable that this document lists its ambitions at the beginning, talking about the availability of RSHE in schools so that young people know and understand what good health is and what their rights to it are. Unfortunately, there is still a dearth of appropriate material getting to schools and there is equally no commitment to training staff in schools to deliver appropriate training. I therefore ask the Minister when that situation is going to be rectified.

Organisations such as the Faculty of Sexual and Reproductive Healthcare and RCOG have been telling the Government for years that there is an absolute crisis in reproductive health services. We have a completely fragmented system for access to basic contraception, which is having a huge impact. We now know that approximately 50% of pregnancies in this country are unplanned. That statistic in itself tells us how far reproductive health has slid backwards.

I am glad to see the appointment of Professor Dame Lesley Regan. Some of the work that she has done in this report says that investment in contraceptive and fully inclusive reproductive and sexual health services is a public health investment which has a massive return on investment. Every £1 spent on contraception is a saving of £9 in public health services. If you invest that £1 in maternity services, the return on investment increases to £33. It is a no-brainer, yet at the moment we fracture access to services so that women who want access to proper reproductive health services end up going multiple times to multiple places. Why? It is because funding streams are fractured. Can the Minister say when that is going to be rectified? The sooner it is, the swifter we get a proper impact on women’s health.

One of the things that I have noticed, having read the review, is that for the first time it tries to be inclusive in its definitions. I also welcome the statements made about access for lesbians to assisted reproduction. The review includes Roma women. It notes the disparities in the appalling health inequalities for black women and women of colour. It also completely ignores trans people. I have a simple question for the noble Baroness. Is that the policy of the Government and the Department of Health? Are these people going to be excluded from our health policy in future?

The final thing I wish to say is that one of the big things that has been noted all the way through our reviews of continuity of care and the great work by the noble Baroness, Lady Cumberlege, is that continuity of care is key to outcomes, in particular, continuity of care in primary care, which is where most women want to get their health services. Will the Minister say what will be done to do that?

One other thing we certainly know is that we have an impending crisis in the workforce. The skilled women and men—largely women—who have been delivering women’s health services for the past 30 to 40 years are, by and large, about to retire now. Young male and female doctors and nurses, particularly in primary care, have not been given access to training. What will be done to make sure that the looming skills deficit is dealt with? Unless we address that, this is just a load of pipe dreams that will never come to pass.

My Lords, I thank both noble Baronesses for their questions. The noble Baroness, Lady Thornton, said that for too long the voices of women have been ignored in the healthcare system. She is absolutely right, which is why I am proud that this Government have produced the first women’s health strategy in England. It has been widely welcomed, if not overdue. We should recognise that.

The noble Baroness also said that women have not been listened to in the past. That is the feedback across the range of different experiences. That is why I am so pleased that at the heart of the development of this strategy was the call for evidence we held, which saw nearly 100,000 responses. Listening to those responses has really shaped the strategy. We are also cognisant that there may have been people who did not proactively respond to that call for evidence, so we made particular efforts to reach underserved groups who might not otherwise be heard. That is important, and it has been translated into the approach we took in the strategy.

On the question from the noble Baroness, Lady Thornton, we wanted to address a perceived ambiguity in the wording used in the statement on freedom of religion or belief and gender equality at last week’s international interministerial conference and ensure that its scope remains focused on freedom of religion and belief. A revised version of the statement was produced in light of that. I reassure the House that we remain committed to defending and promoting universal and comprehensive sexual and reproductive health and rights, including safe abortion. This is fundamental to unlock the potential agency and freedom of women and girls in this country and across the world.

The noble Baroness, Lady Barker, asked why sexual and reproductive health, and abortion in particular, were not covered in depth in this strategy. The Department of Health and Social Care is developing an action plan to improve sexual and reproductive health, including ensuring that women can continue to access robust and high-quality abortion services. We aim to publish this later this year. I hope that addresses many of the points she raised.

The noble Baroness, Lady Thornton, highlighted the importance of research. She drew my attention to a particular piece of work by the University of Birmingham, which I will happily take back to the department. As someone who was pregnant during the pandemic, I have personal experience of trying to navigate the guidance on whether to get a vaccine combined with the advice that I was at higher risk. That stems from the difficult problem of how to represent women and pregnant women more in medical research. That is not straightforward to solve, but we are making efforts towards it. There will be a new policy research unit in the National Institute for Health and Care Research dedicated to reproductive health. The department’s chief scientific officer, Professor Lucy Chappell, will lead a round table of researchers this autumn to explore the best ways to tackle the underrepresentation of women in research. This will include women from ethnic minority groups, older women, lesbian and bisexual women, pregnant women and disabled women. The NIHR is leading work to improve the diversity of research participants, and we wo;; continue to press ahead with that.

The noble Baroness asked about our action on menopause and our commitment to reducing the cost of accessing HRT treatment. I do not have the latest timelines on that, so I will write to her. We have established the UK Menopause Taskforce to join up and accelerate work across the UK to tackle menopause-related issues. We have also set up work to tackle access to supplies for certain HRT treatments.

On breast cancer screening, the additional money announced in the strategy is aimed at doing exactly what the noble Baroness said about addressing disparities. All the work going into addressing the NHS backlog in elective treatment is looking to close that gap between diagnosis and treatment.

I will address a few other points. On training for teachers, we have invested more than £3 million to date in supporting teachers to teach PSHE in schools. We continue to focus on that.

I will address the question from the noble Baroness, Lady Barker, on trans people and their inclusion or otherwise in this strategy. The strategy’s aim is to improve the health of all women and girls, and we will work with NHS bodies to ensure that women are properly represented in communications and guidance and that there is appropriate use of sex-specific language to communicate matters that relate to women’s and men’s individual health issues and different biological needs. We recognise that some transgender people may experience some of the same issues—for example, transgender men perhaps needing cervical screening or menopause care—and we will ensure that our work acknowledges that. Transgender healthcare is a very important but separate issue. For example, the noble Baroness will know that the NHS is working on guidance to enable GPs to have a better understanding of the health concerns of transgender patients, which will improve their experience of primary and community care.

I will pick up one final point from the noble Baroness, Lady Thornton, about disparities in maternity care for black mothers or mothers from ethnic minorities. I believe a task force has been set up, the Maternity Disparities Taskforce, to look specifically at this. That is an important piece of work that I know is ongoing. I will write to both noble Baronesses in response to the other questions I have not addressed.

My Lords, I thank the Government for this important announcement. I particularly welcome the aim to introduce a voluntary certificate of loss scheme to parents who have suffered a miscarriage or stillbirth before 24 weeks of pregnancy. I have a Private Member’s Bill in the House asking for this provision, so I declare an interest. This will provide comfort to millions who have experienced this type of loss, and I congratulate the charity Saying Goodbye on its work on this over the last eight years. When will the scheme be implemented? Who will administer it?

I pay tribute to the noble Baroness’s work in this area and campaigning on this issue, and to the chairs of the pregnancy loss review, Samantha Collinge and Zoe Clark-Coates. That review’s work is still ongoing, but we were able to pick up an interim recommendation from it to allow us to start work on the introduction of the certificate. I believe the NHS will implement this and is undertaking the appropriate scoping work to make sure we get the implementation right. That will be taken forward as soon as it can.

My Lords, the Minister referred to the Government’s work developing a reproductive health plan, particularly in the context of what she said was the commitment to safe abortion. I hope that she is aware of the letter that was sent to the DPP by 66 organisations, including the Royal College of Obstetricians and Gynaecologists, and Southall Black Sisters, which was calling for an end to prosecutions for accessing abortion in the UK. Recent research has demonstrated that over the past eight years, at least 17 women have been investigated by the police for allegedly ending their own pregnancies under illegal circumstances, although the actual figure is likely to be higher.

I am sorry that this is very disturbing. In one case, a 15 year-old suffered what was seen as an unexplained stillbirth at 28 weeks’ gestation. She had her phone and laptop confiscated in the middle of her GCSE exams. She was driven to self-harm. A coroner concluded that this stillbirth had occurred through natural causes. Are the Government seriously looking at what can be done about not inflicting similar ordeals on girls and women, and are they considering the obvious step of decriminalising abortion?

My Lords, prosecution decisions lie with the Director of Public Prosecutions and his staff. The Government have no plans to decriminalise abortion, but we are absolutely committed to ensuring that women can continue to access robust and high-quality abortion services and that young women can access sexual health services and other health services, to ensure that they get the proper support that they need, whatever circumstances they are in, and that they get support and care from the services that they seek to access.

My Lords, coming to another issue, I welcome the strong coverage of endometriosis in this strategy. However, there is great concern from those who have been campaigning to get better recognition for chronic urinary tract infections. These get two mentions in the glossary only, and nothing in the main text. The background to this is that chronic—rather than recurring—urinary tract infections affect women in particular for many months or years. The NHS has only just realised that this condition exists. The term has still not been clinically defined by NICE. I am aware that this is a very detailed area. Can the Minister perhaps write to me about what progress is being made on ensuring that the full assessment is available to women? Currently it is available only in a limited number of oversubscribed specialist clinics.

I would be really happy to write to the noble Baroness in detail on the point that she raises. It is one that I am aware of, but I cannot give her a more detailed answer at this time.