Women’s Health Outcomes
(3 years, 5 months ago)
Lords ChamberRead Hansard Text Read Debate Ministerial Extracts
Baroness Jenkin of Kennington
That this House takes note of the steps taken to improve women’s health outcomes.
Baroness Jenkin of Kennington (Con)
My Lords, it is an honour to be introducing this debate on a topic so close to the hearts and other more intimate body parts of 51% of the population—and some men too, of course.
In my International Women’s Day speech this year, I departed from my usual topics of either women in Parliament or the reality of women’s and girls’ lives in the developing world to talk about women’s health. This change was a result of the Government’s very welcome launch of the first ever consultation and call for evidence to improve the health and well-being of women in England, designed to use women’s voices and experiences to write a new women’s health strategy. For the first time in years, I pondered a woman’s life cycle in terms of health, and I am grateful for the chance to expand on those thoughts today. What I found then, and again now, brought home to me all too graphically the experience of millions of women at different stages of their lives.
Let us start with puberty. It is a confusing time for any child but it is especially so for girls, who are entering puberty about a year earlier than they did back in the 1970s according to global data of 30 studies on breast development. Studies also show that early menstrual bleeding, the last clinical sign of puberty for girls, is associated with a higher risk of obesity, type 2 diabetes, heart disease and allergies. During this period—excuse the pun—I thank journalist Emma Barnett for her book, Period: It’s About Bloody Time, which asks why we are so uncomfortable talking about, and clam up about, menstruation—girls have their first introduction to expensive sanitary products, starting for many period poverty, which affects their school attendance. Estimates vary, but around one in five women of childbearing age suffers from painful, irregular or heavy periods, many to a truly debilitating extent.
Endometriosis manifests itself around this time as well. It is a long-term condition where tissue similar to the lining of the womb grows in other places, such as the ovaries and fallopian tubes. The main symptoms are back and stomach pain, increased period pain, pain during or after sex, pain when peeing or during a bowel movement, feeling sick, constipation, diarrhoea, blood in pee and difficulty getting pregnant. There is a seven-year wait to get diagnosed, with 40% of women needing 10 or more GP appointments before being referred to a specialist.
At this age, social media pressure and social contagion start to have an impact on teenagers’ body image, including anorexia and self-harming. Since 2016, there has been a 45% increase in labiaplasty operations, a female genital cosmetic procedure flippantly referred to as “designer vaginas”. This coincides with a time when vulnerable girls are groomed on the internet and the effects of porn not only are felt on their mental health but lead to this irreversible surgical procedure.
I turn to STIs and birth control. Syphilis and gonorrhoea have almost doubled in the past five years in school-age girls. While chlamydia is decreasing thanks to the screening programme, it remains a problem because of the irreparable damage to girls’ fertility and chronic pelvic inflammatory disease. Avoiding pregnancy is still largely seen as a girl’s responsibility. Boys should be taught that using a sheath not only prevents unwanted pregnancies but also reduces STDs for girls.
I now move to the stage of planned pregnancies and hoped-for motherhood. One in four pregnancies ends in miscarriage, and these women feel let down. There is insensitivity and a lack of empathy in healthcare and arrogance among healthcare professionals, mainly male doctors, who will not and do not listen to patients. My friend had six miscarriages and finally visited a male Harley Street IVF doctor, who put her on a standard protocol for getting pregnant despite her arguing vociferously that getting pregnant clearly was not her problem. She got pregnant again and endured another avoidable miscarriage because she was not listened to. She then went to a female consultant and had a live birth on the first round of tailored treatment.
Antenatal care is inconsistent. Every woman should have the option of the same midwife throughout, up to their delivery. I wish my noble friend on the Front Bench today—she is probably very uncomfortable in her last two weeks—luck and an easy, quick birth, although I am afraid that there is no such thing as a pain-free birth. I also wish her access to the pain control that she wants and, ideally, no episiotomy. I am afraid that nothing can prepare her or other new mothers for the post-birth challenges of getting her body back to a reasonable condition, breastfeeding, disrupted sleep and so called “baby blues”, possibly followed by postnatal depression, which affects between 10% and 20% of women.
I come to motherhood next. In the vast majority of cases, women are the lead parent, combining most child- care with work, usually at a greater career cost than the father. This in turn leads to tension at home and often a relationship breakdown, leaving the mother as the major childcare provider, which in turn leads to increased mental health issues—I think other colleagues will talk about this—or the use of drugs or alcohol as crutches, which I think the noble Lord, Lord Brooke, may raise.
I turn to the eventual emptying of the nest, which is another time of stress in a relationship and often comes at the same time as caring for elderly parents. This is close to my heart because last year we lost my mother, whom we lived with, aged 96.
I now move on to the menopause, which is a “big one”. Some 34 years ago, I ran the Amarant Trust, a menopause charity funding ground-breaking research into HRT with the team at King’s College Hospital, which also ran our self-referring clinic. Women attended in droves, largely because of hostile, and in some cases misogynistic, GPs. I was pregnant at that time so my own hormones were in turmoil, although not lacking in oestrogen and the myriad of miserable symptoms that so many women experience at that time. I can still remember the distress that so many patients suffered in silence and how debilitated they were by the onslaught of flushes, sweats, sleeplessness, vaginal dryness, discomfort during sex and problems with memory and concentration.
A couple of years ago, I attended a round table with the then Women’s Health Minister and campaigners. I was astonished to find that the situation for menopausal women is no better than it was all those years ago when I was actively involved. Indeed, 23% of women who visit their GPs with symptoms are prescribed antidepressants instead of HRT. I was one of the lucky ones—I sailed through—but those suffering symptoms should of course be given the informed option of taking HRT, a transformational drug that makes life worth living again for so many women. I give a big shout-out to James Timpson, who wrote in last weekend’s Times of the need to
“stop the menopause hijacking careers”.
One newish MP told me that, before she was prescribed HRT, she thought that she would have to give up her job as an MP because it was impossible for her to do it properly. I am delighted to be a founder member of the new APPG for the menopause and look forward to its forthcoming inquiry.
In between all this, we have a miserable list of prolapses, cystitis and thrush. Although I have been comparatively lucky in my own health journey, the latter two caused hours of itching and discomfort, including of course painful sex. This is not always easy to discuss with a partner.
Then we have the female cancers. Cancer Research’s most recent figures, from 2015 to 2017, report about 75,000 new cases of breast, cervical, uterine and ovarian cancers. The Government’s sustained good work with the introduction of HPV vaccination is very welcome. Since then, infections of HPV in 16 to 18 year-old women have reduced by 86% in England. Considering that around 80% of all cervical cancers are caused by HPV, we hope for big reductions in that cancer in the years to come, but let us keep the pressure on for improving the treatment and life expectancy of women suffering these diseases.
I turn to the final countdown, once we have passed the period of caring for aging parents and the move towards osteoporosis, leading to life-changing fractures caused by brittle bones, and then finally dementia.
Even with the generous 12 minutes that I have today, I can only touch the surface of women’s health issues. I pay credit to Health Ministers for taking our problems seriously and, in particular, to Nadine Dorries for driving this agenda, and whose own personal challenge with having an IUD fitted 36 years ago—which in the end she failed because of the intensity of the pain—was laid bare in the Daily Mail earlier this week. Many women are unable even to have a cervical smear because of the agony, but they now feel emboldened to speak out because of other women talking publicly, including the campaigner Caroline Criado Perez.
I am not alone among women in wondering whether, if these debilitating conditions afflicted men, better treatments would have been found by now. Less than 2.5% of publicly funded research is dedicated solely to reproductive health, despite the fact that one in three women in the UK will suffer from a reproductive or gynaecological health problem. There is five times more research into erectile dysfunction, affecting 19% of men, than into premenstrual syndrome, which apparently affects 90% of women.
Women are underrepresented in clinical trials even though biological differences between males and females can affect how medication works. The general assumption is that women do not differ from men except where their reproductive organs are concerned, and data obtained from clinical research involving men is simply extrapolated to women. This has important implications for health and healthcare. I understand that over 100,000 women have responded to the Government’s consultation and that they are currently unpacking the data. On behalf of women everywhere, I thank the Government for the initiative and for the forthcoming sexual and reproductive health strategy.
Noble Lords may not be aware that instances of domestic abuse increase by 26% when England play football and by 38% if they lose. So those who may not be looking forward to Sunday’s game will be especially welcoming the actions that the Government are taking on violence against women and girls.
I look forward to hearing from my noble friend the Minister about how these initiatives will improve life for millions of women who are suffering in at least some of the ways that I have described today.
Baroness Massey of Darwen (Lab) [V]
My Lords, I thank the noble Baroness, Lady Jenkin, for introducing this important debate. I know that many important issues relating to inequalities in health will be addressed. I am delighted that the noble Baroness spoke eloquently about young women’s health; I shall raise concerns about young women’s mental health in particular.
The Association for Young People’s Health, of which I am a patron, has welcomed the proposal to develop a women’s health strategy for England, stating that this must take account of the diversity of young women’s health issues, and that young women and girls must participate in the development and implementation of the strategy. Young women’s experiences of healthcare are affected by general factors, such as deprivation, ethnicity and geography, and by specific issues, such as sexual and certain kinds of reproductive health issues, mental health, and gender-based violence. In general, young women’s health outcomes are less favourable than those of young men.
As the Mental Health Foundation states,
“There is no health without mental health”.
Mental health affects physical health and the data on mental health and well-being, self-harm, suicide and eating disorders show that the link between body image and life satisfaction is twice as strong for girls as for boys. Young women’s mental health gives specific rise to concerns: 43% of young women aged between 16 and 29 experience some depressive symptoms, compared with only 26% of men of the same age. Girls between the ages of 11 and 17 have had more emotional difficulties than boys during periods of school closures. As we know, Covid has had an unequal impact on different groups and individuals. Young people generally have been less likely to become infected with the virus, but have faced enormous upheavals in education, employment and social interaction during what is often a difficult period in their lives.
Given the different mental health needs of boys and girls, the Royal College of Psychiatrists has suggested that, to deal with these needs, different interventions and methods for supporting different young people are required. It recommends that an extra £500 million of investment is needed to address the mental health needs of children and young people. These needs, including treatment, have intensified to an alarming degree during Covid-19.
Can the Minister say whether the strategy for women’s health will take account of the importance of maintaining and improving research and data collection on young women’s health? Will the views of women and girls be taken into account as the strategy develops? Both these issues are important in ensuring access to services and appropriate, high-quality preventive measures and treatment. I look forward to the Minister’s reply.
Baroness Walmsley (LD) [V]
My Lords, I am delighted to take part in this debate on women’s health issues, so ably introduced by the noble Baroness, Lady Jenkin.
A common issue coming out of all the briefings, and particularly from the report by the noble Baroness, Lady Cumberlege, First Do No Harm, published last year, is the need to listen to women when they talk about their health. We all heard the noble Baroness talking movingly in this House, when we first debated her report, about how upsetting it was when she really listened to the women who had been damaged, or whose babies had been damaged, by valproate, Primodos or vaginal mesh and how relieved the women were to be listened to at last. Can the Minister say when the Government will implement all her recommendations?
Information is vital because, without it, women cannot exercise proper choice. In the case of the anti-epilepsy drug valproate, we heard from women with epilepsy when we debated the report last year that women were still not being fully informed of the risks in case they become pregnant. Let us remember: about half the pregnancies occurring in the UK are unplanned.
So information is key, but so is listening. I am horrified when I hear that women who eventually get a diagnosis of endometriosis have usually been to their GP 10 times before they finally get a proper investigation, diagnosis and treatment—just one example of where women’s pain is not taken seriously. I recognise that the non-specific symptoms are of course difficult to diagnose, but I would like to know what training trainee doctors get in actively listening to women.
As we just heard, women are also underrepresented in clinical trials, even for drugs specifically aimed at women. This is completely unscientific when you understand the differences between women’s and men’s biology. Can the Minister say why the regulator allows this?
I am, like the noble Baroness, Lady Massey, very concerned about women’s mental health services, particularly since the pandemic has isolated so many women in their homes with sole responsibility for caring for their children and sometimes elderly relatives. A listening ear has been more important than ever during the pandemic and many kind members of the community have stepped up, but they are no substitute for clinical services. Asking questions and listening to the answers is particularly important in antenatal clinics, where mental health issues and domestic violence can often be detected early. I ask the Minister: will women’s mental health be specifically included in the new Secretary of State’s plan for mental health?
Another factor of women’s health which has worsened over the past year is nutrition and obesity. We have seen an increase in poverty, which is linked to obesity, and an increase in eating disorders. When will we get Henry Dimbleby’s long-awaited national food strategy? This is really important for women themselves and for those they feed and care for.
Lord Rooker (Lab) [V]
My Lords, as the first male Member of your Lordships’ House to speak in the debate, I welcome very much what the noble Baroness, Lady Jenkin, had to say. Her opening speech was, frankly, awesome—that is how I would describe it.
I do not apologise for returning to the Marmot review, which the Minister has heard me speak about before. Inequalities in life expectancy have increased since 2010, especially for women. Female life expectancy declined in the most deprived 10% of neighbourhoods between 2010-12 and 2016-18. Female life expectancy decreased in every region save for London, the West Midlands and the north-west. Life expectancy in England has stalled since 2010, which has not happened since 1900. When health has stopped improving, it is a sign that society has stopped improving. That is all from the Marmot Review 10 Years On, published in February 2020.
Of course, health is linked to all the other conditions in which people are born, grow, live and work, together with inequalities in power, money and resources. Frankly, the Government have not prioritised health inequalities, despite the concerning trends, and there has been no national health inequality strategy since 2010. This is a national UK issue and cannot be shoved off as a devolved matter.
I have not mentioned Northern Ireland. It has suffered the same as the other three nations but one figure, set out on page 12 of Build Back Fairer: The COVID-19 Marmot Review, is unique in respect of female health. The table is titled: “Relative cumulative age-standardised all cause mortality rates by sex, selected European countries, week ending 3 January to week ending 12 June 2020”. Of the eight countries where the situation got worse—as opposed to the 11 where it got better—the UK’s four nations were in the eight, and in only one of all the countries where it got worse, it got worse for females compared to males. That was Northern Ireland. There is quite clearly something badly wrong in health inequalities between men and women in Northern Ireland for it to stick out like that among all those countries. The recommendations for change are all well known. They are listed in both the Marmot reports I have used.
I note the BMA has highlighted more targeted issues, such as those relating to domestic abuse, pregnancy and maternity services, which male Secretaries of State keep ignoring. However, the first move has to be an acceptance that things have gone really badly since 2010, when the coalition Government imposed swingeing cuts to public expenditure without any analysis of the consequences. One consequence is the stalling of life expectancy, where women have been affected worse than men.
Baroness Greengross (CB) [V]
My Lords, I welcome today’s debate on women’s health outcomes and thank the noble Baroness, Lady Jenkin of Kennington, for bringing this Motion to the House today in an extraordinarily moving way.
We know that there are many conditions where women are overrepresented—for example in mental health, where 26% of young women have experienced anxiety, depression or eating disorders. We know that with gynaecological conditions it often takes seven to eight years to receive a diagnosis of endometriosis, with 40% of women needing 10 or more GP appointments before being referred to a specialist.
In one area of women’s health, I became aware late last year that there was a national shortage of widely used contraceptive preparations and hormone replacement therapy products. In response to my Written Question, the Minister, the noble Lord, Lord Bethell, responded that this shortage was due to
“Issues such as regulatory or manufacturing problems, problems accessing supplies of pharmaceutical raw ingredients and commercial decisions to divest certain products”,
which
“can affect the supply of medicines.”
Throughout 2020, thousands of women were not able to access their normal oral contraceptive or hormone replacement therapy products. This is one recent example of women not having access to the pharmaceutical products they regularly used, though this also happens, as we know, with various medicines that both men and women take.
I declare my interest in the register as co-chair of the All-Party Parliamentary Group on Bladder and Bowel Continence Care. Women are five times more likely to develop urinary incontinence than men. This is something many women feel uncomfortable talking about or raising with their GP. For many women, bladder continence issues can result in a loss of independence, as they feel unable to leave their homes unless they know there are accessible public toilets near to where they are going. Much like gynaecological conditions, issues with continence care can take time to diagnose and cannot always be treated. Much greater awareness is needed of these conditions and, in particular, how they impact on women’s lives.
My final point is to draw attention to some depressing findings from the 2020 Marmot report, about which the noble Lord, Lord Rooker, spoke so movingly just now. According to Sir Michael’s 2020 report on health disparities, women living in the most deprived 10%—
Baroness Penn (Con)
My Lords, I am afraid I am going to have to remind the noble Baroness of the time limit for Back-Bench contributions, given the number of speakers we have in this very important debate.
Baroness Penn (Con)
My Lords, I suggest to the noble Baroness that perhaps she is already over the time limit and that we move on to the next speaker.
Baroness Chakrabarti (Lab) [V]
My Lords, I thank the noble Baroness, Lady Jenkin, for leading this debate, an initiative wholly consistent, if I may say so, with her long record of campaigning on behalf of women.
Even in these days of deliberately stoked and exaggerated culture wars, there can be few who do not agree that millennia of structural inequalities have undermined women’s health worldwide. Further, it is obvious that the current devastating pandemic has magnified every such inequality on the planet. This includes the shocking, yet predictable, rise in domestic violence during necessary lockdowns, reduced access to sexual and reproductive healthcare and other vital women’s health and social services internationally.
Women are more likely to be involved in childcare, social care and cleansing, whether in the home or outside it, placing millions of them on the front line of infection. While older men seem more likely to die of Covid-19, it seems that women who survive it may be more likely to suffer from the chronic symptoms associated with long Covid. That means that every current decision in the debate about how best to either combat or live with the virus is likely to have a gendered impact.
The extent to which casting off the mask has become associated with one’s love of freedom is unfortunate indeed. I worry about the way in which some in government have become so wedded to irreversible “business as usual” from a particular date that they are risking more than necessary and perhaps forgetting that, for many, business as usual, even before the pandemic, was far from free, fair, safe or healthy.
If the Government want to honour their promise to vaccinate the planet and an earlier pledge for a new era of global Britain, they must stop siding with Germany in blocking the TRIPS waiver at the WTO and join the United States, India, South Africa and most of the Commonwealth—celebrated here earlier this afternoon—in demanding that industry shares know- how around vaccines, tests and treatment manufacture so these can be decentralised and scaled up to meet global demand.
19 July is not “freedom day”, but it could yet be solidarity day in a global race against vaccine-resistant variants and even more deaths.
Baroness Bull (CB)
My Lords, I congratulate the noble Baroness, Lady Jenkin of Kennington, on securing this debate, which feels particularly timely as we mark the 73rd birthday of the NHS this week. Women were undoubtedly among its most immediate beneficiaries, as the expansion of maternity care put an end to many of the horror stories of obstetric disasters, post-delivery haemorrhage and infections needlessly killing mothers after childbirth, for want of sterile surroundings. We have come a long way since then, but there is still some way to go.
The Library’s helpful briefing makes clear a range of healthcare areas in which women experience worse outcomes than men, including mental health. The Mental Health Foundation reports a strong relationship between women’s physical and mental health, with 85% of its surveyed members reporting that menstruation, menopause, pregnancy, fertility pressures and contraception impacted negatively on their mental health.
I will focus on eating disorders—serious mental health disorders that can affect anyone, but which are much more prevalent in women than men. A recent Finnish study found that one in six female adolescents and young adults met the criteria for an eating disorder, compared with one in 40 males. The pandemic has seen eating disorders spike, with demand for services up 200% in some areas and waiting lists at record highs. Those with high-BMI eating disorders cannot access treatment, since clinical pathways for binge eating are currently closed, as the NHS struggles to cope with the increase in low-weight disorders.
This is nothing short of a public health crisis, yet it receives neither the attention nor the funding it warrants. The best-known eating disorder, anorexia nervosa, has the highest mortality rate of any psychiatric disorder in the UK, yet the last available dataset comparing all mental health related research grants from major UK funders revealed that eating disorders received just 1% of the near £500 million available over the four-year period surveyed.
It is hard not to conclude that eating disorders suffer a triple whammy of perception and misperception: first, they are seen as a niche problem largely affecting a middle-class elite, which is not true; secondly, they are mental health conditions and, despite claims to the contrary, we have yet to live up to our promise to give mental and physical health parity of esteem; and finally, above all, they are seen as women’s issues.
Earlier this year, in the other place, the Minister Nadine Dorries said,
“for generations women have lived with a healthcare system that is designed by men, for men.”—[Official Report, Commons, 8/3/21; col. 535.]
Women continue to suffer as a result. I look forward to the forthcoming women’s health strategy and hope that it has some effect in redressing this age-old imbalance.
Lord Hunt of Kings Heath (Lab) [V]
My Lords, I very much welcome this debate and commend the noble Baroness, Lady Jenkin, on her opening speech. One of my main concerns is that, historically, women have been underrepresented in clinical research, as both researchers and the subject of research. The noble Baroness, Lady Jenkin, also referred to that. As a result, many diagnostic tests and treatments have been based on data gathered from men. Women are still not taking part in clinical trials to the same level as men. We need to understand the barriers that prevent women taking part in these trials, and encourage and enable them to take part.
This impacts across medical provision, but I will focus on heart attacks. Research into different treatments for men and women has shown that women are more likely to be treated less aggressively in their initial encounters with the healthcare system, until they have to prove that they are as sick as male patients. Once they are perceived to be as ill as similarly situated males, they are likely—but not always—to be treated similarly. This can be seen with heart attacks, where women having a heart attack delay seeking medical help longer than men because they do not recognise the symptoms and believe it is men who get heart attacks, not women. Some 50% are more likely than a man to receive the wrong initial diagnosis for a heart attack. Many are less likely than men to receive a number of potentially life-saving treatments in a timely way and, following a heart attack, are less likely to be prescribed medications to help prevent a second heart attack.
If there was any complacency about women’s health issues, the recent report from the Health Select Committee on the shocking state of many maternity services should be a great warning to us. This has been known for some time now. There has been an endless number of inquiries, yet we have been waiting for action for far too long.
It is not just about research and treatment of disease, as experienced by women. Ensuring women’s safety, privacy and dignity while they are in hospital is vital. Women often favour single-sex wards for very good reason: rates of sexual assault are far higher in mixed-sex wards. The Health Service Journal reported last year that at least 1,000 sexual assaults were reported by female and male patients on mixed-sex mental health wards between April 2017 and October 2019, yet there are indications that the NHS is moving away from giving enough provision to single-sex wards. Could the Minister look into this and see what can be done to ensure the NHS does what Ministers asked of it over the last years?
Baroness Bottomley of Nettlestone (Con) [V]
My Lords, this is an important and timely debate and I give full congratulations to my noble friend Lady Jenkin on introducing it. I start by echoing the noble Baroness, Lady Walmsley, on the requirement for urgent action following my noble friend Lady Cumberlege’s report. It is harder being a Health Minister in the Lords because there are so many experts. I chose my noble friend Lady Cumberlege and we worked together harmoniously. It is time we had a patient safety commissioner. That is part of the recommendations, only one of which has been properly implemented. We need a register of doctors’ interests.
My real purpose in speaking is to relate my experience at the University of Hull. Only one in four medical deans is female. At Hull, Professor Una Macleod is a general practitioner who still works in east Hull. She shapes and fashions the medical school so that it is relevant to the disadvantaged and underprivileged. Many in the House will know that my first job was working for the noble Lord, Lord Field. He went to the University of Hull and, for 16 years, I have been proud to be its chancellor. It is trying to reach out to the disadvantaged and neglected, who I call the inarticulate needy, not the articulate greedy, to whom I was so used in my former constituency.
I applaud much of the research, often by nurses and the professor of nursing, because nurses listen and are where the patients are. We have talked about underrepresentation in surveys, and Professor Lesley Smith has done some magnificent work on why younger women in lower socioeconomic groups are less likely to take part in population surveys. She has fashioned a tool to reach out to underprivileged, disadvantaged, less-connected and younger women so that we can understand what they need and want.
Dr Roger Sturmey talks of one in four women suffering from a miscarriage, but of only 2% of research going into miscarriage. A nursing professor of perinatal mental health said that women’s health outcomes and that of their babies are not good enough. He has designed a new measure, a revised birth satisfaction scale.
Over the years, there has been a dramatic improvement in women’s health. When William Wilberforce lived in Hull, women lived to 44. Now, the overall life expectancy is 82.7 years for women and 78.7 years for men but, as noble Lords have said, this conceals areas of neglect and suffering. It is not the extra years only, but the quality of them. I believe that, by looking more deeply and working with professions other than the traditional medical professions and by focusing our research, we can do more to meet the unmet need that so many in this House are so knowledgeable about and have contributed so strongly on.
Baroness Bennett of Manor Castle (GP) [V]
I thank the noble Baroness, Lady Jenkin of Kennington, for securing this debate—a timely update a year on from the brilliant report of the noble Baroness, Lady Cumberlege, as the noble Baroness, Lady Bottomley of Nettlestone, just said.
Today’s debate led me to look back over our debates on the Medicines and Medical Devices Bill, during which the Government conceded, after Scotland led the way, on a patient safety commissioner for England. We were promised then that serious consideration was being given to the report’s other recommendations to support victims of disastrous medical procedures and to prevent future avoidable damage. I follow the noble Baroness, Lady Walmsley, in pointing out that the victims of sodium valproate, pelvic mesh implants and Primodos are still waiting. The First Do No Harm report concluded that thousands of lives were ruined because officials failed to listen to female patients. I hope we might hear some good news on that issue from the Minister.
In three minutes, there are many issues I could cover, but I want to extend the conclusions of the noble Baroness, Lady Cumberlege, to broader issues. I note that women wait longer to be diagnosed for many conditions, including cancer, and that heart disease in women is more likely to be misdiagnosed. Mental health is likely to be the diagnosis for a wide range of conditions that have a clear physical cause, often discovered only after many years of suffering.
I note too that intersectionality is at sometimes deadly and always damaging play here, and that women from BAME backgrounds and the LGBTIQA+ community are more likely to report poor treatment from their GP and receive inadequate support from services.
In the brief time left to me, I thought I would focus on an area still getting far too little attention and, like so many others, that is being exacerbated by the Covid-19 pandemic. That is musculoskeletal disorders. I point the House to the excellent briefing for this debate from the Chartered Society of Physiotherapy, which covers that as well as many other important issues. I should perhaps declare a personal interest here, having relied over many decades on physiotherapists to keep me going and repair damage wrought on the sporting field and in the workplace.
As I read that briefing’s recommendations on preventing musculoskeletal problems through access to occupational health physiotherapy, I thought of some women I met in Sheffield working at picking up baskets for a major supermarket’s home delivery service from midnight to dawn. I heard from them how physically challenging it was and how tough it was in the chiller and freezer sections.
We have to think about the many women who are doing what is often a double shift in the home with child and elder care. They also suffer musculoskeletal damage from that, and would greatly benefit from musculoskeletal first contact physiotherapists in primary care being available to all.
Lord Boateng (Lab) [V]
My Lords, thanks are due to the noble Baroness, Lady Jenkin, for all she has done for women’s health. She mentioned pregnancy. Black women in the UK have higher rates of morbidity and mortality related to pregnancy and childbirth than any other section of the community. They have worse outcomes too for breast and cervical cancer. Black women of Afro-Caribbean origin are less likely to consult health professionals regarding symptoms of perinatal depression. The British Journal of General Practice gives as the perceived reasons for this a lack of compassion in healthcare workers and a lack of culturally sensitive staff. I hope the Minister will address how training is going to address these issues.
Reference has been made to Covid. In a study of maternal death in the course of the Covid pandemic, it was revealed that 88% of the deaths investigated in the report Saving Lives, Improving Mothers’ Care were from black and ethnically diverse groups. I hope the Government will ensure that, in learning the lessons of Covid, the impact of ethnicity and racism is taken into account. The Royal College of Obstetricians and Gynaecologists has called on the Government to take action on racial disparities and on the Government’s own racial disparity audit and the extent of the real problem it reveals. What action is in fact being taken in that area?
Black and south Asian ethnic-minority women suffer a double whammy of gender and ethnicity. They suffer a real disadvantage in their access to healthcare and of positive outcomes. There is an issue—we cannot ignore it—of unconscious bias. This leads to adverse behaviours. It leads also, I am afraid, to adverse outcomes. We need to address this in training and continuous professional development.
The absence of black and ethnic-minority women in all too many clinical trials reveals an equally important issue, as well as a stereotyping of south Asian women as somehow more likely to suffer pain and of black women as non-compliant. If you are a black or Asian woman, you are more likely to find yourself locked up in a secure ward. You are less likely to have treatment by way of talking therapies. We know that we need partnerships with women’s organisations; we need to listen better to women, especially black women, and we need resources. All these things are necessary if we are to translate good intentions into action that makes a real difference for women in general and black and ethnic-minority women in particular.
Baroness Nicholson of Winterbourne (Con)
I welcome this important debate on women’s health. I congratulate the noble Baroness, Lady Jenkin of Kennington, and thank her profoundly for her deep and permanent commitment to the health and welfare of girls and women.
Like her, I have worked overseas and on the ground as a volunteer on violence against girls and women and, specifically for this debate, on raped and tortured female victims. Indeed the noble Baroness, Lady Bull, and I were working on that together only 10 days ago for Yazidi victims. I seek our Government’s ongoing commitment to the plight of these most special girls and women, both here and in the war-torn nations where I work, above all others. These heavily damaged survivors of continuous rape by different but always violent males deserve the very best of surgical and general healthcare.
My praise for our NHS staff and volunteer rape crisis centre teams in Britain, all of whom treat raped girls and women with outstanding care and sensitivity, is unbounded. However, the natural growth of social concern for difference and our proper national commitment to greater inclusion has led to the appointment of natal males to tend to acutely female needs, such as intimate care for mentally challenged in-patient girls, and to lead staff posts in rape victim settings. I believe the noble Baroness will join me in examining these breaches of customary dignities afforded to women whose capacity is either limited since birth, accident or illness or has been compromised by rape or other indignities. Should they not be care for, nurtured and helped to live by fellow females? Common sense and parental requests suggest they surely should, yet that is not the case today. I urge the Minister, for whom I have the highest respect, to pay heed to research and take steps to correct this situation.
Lord Brooke of Alverthorpe (Lab)
My Lords, I join others in expressing my gratitude to the noble Baroness. She is a great campaigner and is prepared to reach out across all Benches. That is much required with the problems we face.
I think I am probably the first to mention football, but I mention Denmark and congratulate it on the work it does with women. Denmark ranks the highest in the whole world in presenting a community in which women have equality; it respects and does not abuse women. Women are treated as well as men at work and in health terms. It is a great country and should be proud of what it has done.
We could learn a lot from Scandinavia about how we treat each other, and in particular how we treat women. Look at what Denmark does with justice—restorative rather than punitive justice, which we engage in so much in this country. Do noble Lords know that Denmark does not fill its prisons? In fact, it invites neighbouring countries with a surplus of prisoners to send them to Denmark. That is because of the way it approaches its problems.
Similarly, we find that Denmark deals with issues we have here, where women are abused because of alcohol—that and a whole range of other topics were mentioned earlier—in a quite different way. We really ought to learn that we should visit others and invite them here to try to help us with some of our problems. Basically, I think it does so well because, as in other Scandinavian countries, the inequality in wealth is so minimal by comparison with what we experience. We cannot run away from that.
My noble friend Lord Rooker and the noble Baroness, Lady Greengross, raised Sir Michael Marmot’s continuing work on inequality and the need to get incomes and salaries closer together, in the way that we had 30 or 40 years ago. This is fundamental to health and so many aspects of what happens in society. I look to the Minister to see whether the Government are doing work on it.
This morning I listened to Nadine Dorries talk on a Zoom exercise about the coming review. There have been 112,000 responses to the strategy. Like others, I look forward to seeing whether something positive comes out of it and that we have attached to it a firm action programme.
Like others, I spoke on the great report from the noble Baroness, Lady Cumberlege, but when is the action coming? What are the Government going to do with that? When will we see the action programme presented to the House?
Lord McColl of Dulwich (Con) [V]
My Lords, I join others in thanking the noble Baroness, Lady Jenkin, for initiating this debate. In my practice of medicine and research, mental health has always been one of my concerns, and it is obviously a very important feature in the health of women. One survey, which I think has already been mentioned, showed that 90% of people believe that mental health affects physical health and 90% believe that physical health affects mental health.
In trying to achieve better outcomes, I think it is sensible to look for cost-effective ways. For instance, the mental harm done by loneliness can be mitigated by frequent visits from friends and relatives, and this may also delay the onset of Alzheimer’s disease and help them when the condition progresses. Importantly, there are many ways to reduce stress—for instance, bringing in a four-day week. When a three-day week was introduced in 1974, there was no drop in productivity, which was interesting and surprising.
Better outcomes could be achieved by reducing violence, rape and abuse of all kinds, and alerting the public to the increased domestic violence following football matches, as the noble Baroness, Lady Jenkin, mentioned. Violence against women is also bound up with pornography and prostitution. A Swedish law making it illegal to pay for a prostitute reduces the opportunities for violence against women and could be passed here in this country. Those opposing such a law might be asked whether they have an interest to declare.
It is estimated that there are several million disabled people being cared for by women at home. For them, respite care is absolutely essential.
Lastly, a great deal of mental and physical ill health is due to the obesity epidemic, which has caused an enormous amount of ill health and is also responsible, in this country and many others, for the high mortality from Covid. There is only one way of dealing with obesity: put fewer calories into the mouth. The noble Baroness, Lady Jenkin, has done a great deal, in practical ways, to achieve this by advocating ways of finding and cooking healthy and affordable food and inviting people to these healthy and cheap lunches.
We must make a real effort to achieve better health outcomes for women in this country.
Baroness Bryan of Partick (Lab) [V]
My Lords, I too thank the noble Baroness, Lady Jenkin, for enabling this important debate. Unlike other health comparisons, the gap between men’s and women’s health is wider in some developed countries than in some less-developed ones. The UK ranks 87th in the world for men’s health, while it ranks 125th for women’s health—38 places lower. This gap puts it 12th in the international list of women’s health inequality. How can this be?
One of the reasons appears to be the misdiagnosis of women’s symptoms, which I will come to later. A second reason is that women are more likely to live in poverty than men. Whether as single parents, unemployed, on low pay, disabled or as pensioners, women are likely to be poorer than their male counterparts.
Not all inequalities in health relate to gender. Better-off women can expect 20 additional years of healthy life than those who are worse off. Even before the pandemic, progress on healthy life expectancy had stalled and begun to go backwards. The latest figures show that less than a third of women are still in work by the time they reach retirement age. For many, this is not through choice but because they cannot find work or are actually too ill to work. We are condemning many of these women to spend the remainder of their lives in poverty.
As we have heard from several speakers, women have to shout louder to get their concerns listened to. Some of the women who have had to shout the loudest are those affected by mesh implants. The independent review chaired by the noble Baroness, Lady Cumberlege, produced its report First Do No Harm one year ago today. It found that women describing their excruciating chronic pain were dismissed as imagining it or told it was their “time of life”. The report argued that anything and everything that women suffer is perceived as a natural precursor to, part of or a post-symptomatic phase of the menopause. What do the Government intend to do to prevent so many women spending their later years in ill health and poverty? When can we expect the establishment of a redress agency, as proposed in First Do No Harm?
Baroness Uddin (Non-Afl) [V]
My Lords, it is nearly 40 years since a group of us women set up our country’s first women’s health advocacy group, with the aim of improving both equality of access for women’s health and prenatal mortality rates for women and babies, in addition to unlocking women’s voices and choices of maternity care. According to the same project, to this day women’s experiences remain poor and unequal.
While we continue to frame minority women, particularly Muslim women, within the parameters of numerous health and social problems, including domestic violence and cultural disadvantages, Muslim women’s presence in the public square remains negligible and they are mostly absent from NHS management and decision-making boards. Some minority women, when they are in such positions, feel so constrained in their advocacy on racism, prejudice and Islamophobia that in order to avoid political rejection they feel unable to effect any meaningful changes for women, who continue to have no voice and to experience generations of poor health and inequalities, as my noble friend Lord Boateng so ably pointed out.
The experience of Islamophobia is deep-rooted, affecting every sinew of politics, policies and, therefore, services. In maternity and care services, Islamophobia has continued to impact the quality of care, attitudes and behaviours for the last five decades. It is so regrettable that women continue to experience these painful inequalities. I do hope the new strategies that the noble Baroness, Lady Jenkin, so powerfully highlighted will speak to all women in all communities.
Baroness Eaton (Con) [V]
My Lords, I add my congratulations to my noble friend Lady Jenkin on her excellent introduction to this very important debate.
As we have heard, one of the biggest health issues for women is mental health, which has been exacerbated by the Covid pandemic. Evidence suggests, and the front-line experience of GPs I have spoken to shows, that women are more prone than men to experiencing anxiety, depression and somatic complaints. Depression is the most common mental health problem for women and suicide is a leading cause of death in women under 60. Linked to this, there has been an increase in physical and psychological problems and sexual abuse, with increasing domestic violence towards women.
During the pandemic, the resulting reduction in sexual health and pregnancy services has caused serious problems. Women’s health is incredibly important because women are frequently the cornerstone of a family’s overall health and well-being. They are carers of children, providers of home schooling and often carers of elderly, sick and/or disabled family members. There is clearly a major impact on the family when there is a deterioration in women’s health.
It is estimated that 28% of women over 65 have diagnosable depression but only 15% will receive treatment from the NHS. Ensuring that women have access to quality and appropriate care directly leads to improved health for children and families. Future service provision should mean co-producing collaborative care models that encourage service users and clinicians to engage in a shared understanding of care needs, treatment and support preferences. This agenda should prompt greater public mental health and preventive self-management. I am impressed by the work being done by Dynamic Health Systems, a company about to launch an evidence-based, artificial intelligence-enabled platform for the self-management of mental health conditions by individuals and populations. An appropriate and effective mental health service needs a gender-informed approach, with services diagnosed to take account of the differential needs of women and men. There must be recognition of the need to collect gender-informed health and social care data. If women’s mental health services are to improve, successful implementation requires a workforce trained in gender differences in mental health.
Can my noble friend the Minister clarify in his response the approach that the Government will take to wider mental health support, particularly in suicide prevention work? What support are the Government giving to the self-management of mental health through digital services such as those to which I have referred?
Lord Sikka (Lab) [V]
My Lords, I thank the noble Baroness, Lady Jenkin, for this debate.
The key to reversing poor health for women is ensuring that the Government provide a range of public services related to women’s health, child and family care, domestic violence and reproductive and sexual health, as well as a just redistribution of wealth and income. Fiscal and welfare policies have major consequences for women but government announcements are rarely accompanied by any gender impact assessment.
Wage freezes for public sector workers have hit women the hardest, as many occupy low-paid jobs, but there has been no gender impact assessment even though poverty levels are higher for female-headed households. By freezing personal allowances, the 2021 Budget will force poorly paid women to pay more in tax. The 107 pages of the Budget document uses to the word “women” just three times. Childcare was not even mentioned. Some 46% of mothers being made redundant say that lack of childcare is a major factor in their redundancy.
The Government are cutting universal credit by £1,040 a year. That is not accompanied by any assessment of the impact on women. Janet Mackay from Oxfordshire wrote to me. She stated:
“My disabled daughter can’t just get a job and this cut will lower her quality of life. It’s monstrous to do this to the disabled.”
Despite gender inequalities, the Government raised the state pension age to 66 and deprived millions of 1950s-born women of their state pension for six years. The impact assessment said little about the quality of life for women. It does not get any easier after retirement either. As a fraction of average earnings, the UK state pension is one of the lowest in the industrialised world. The charity Independent Age has reported that 2.1 million pensioners are living in poverty and 1.1 million in severe hardship. People aged over 85 are most affected, and women are worse affected than men.
I therefore ask the Minister to give a public undertaking that all fiscal and welfare policies will be accompanied by an impact assessment from women’s perspective.
Baroness Fraser of Craigmaddie (Con)
My Lords, I, too, thank my noble friend Lady Jenkin of Kennington for this important debate and for her awesome—as the noble Lord, Lord Rooker, described it—opening speech. Given the time constraints, I simply want to make two points.
First, women’s health is not only important for all the reasons noble Lords have already outlined. Women’s health issues have far-reaching implications beyond just the health of women. When looking at positive outcomes for families and children, particularly disabled children, the burden of care still, in 2021, falls disproportionately on mothers. Therefore, ensuring continued good health for women has consequential effects on the well-being and good health of the rest of the population, as well as on women themselves.
Secondly, I want to address the importance of data, including what data we are collecting, how we are collecting it and what we might do with it to improve women’s health outcomes. Good data can ensure that women’s issues are addressed in research and lead to practical improvements in service delivery. NHS Greater Glasgow is currently undertaking a project funded by the Scottish Government to develop an epilepsy register for Scotland so that appropriate continuous care can be successfully delivered. I declare an interest as, in my capacity as chair of the National Advisory Committee for Neurological Conditions in Scotland, I have been able to monitor the progress of this work. The project team has started by focusing on women with epilepsy because, as was previously noted by the noble Baroness, Lady Walmsley, there are risks associated with pregnancy. In particular, taking epilepsy medicines containing sodium valproate can cause serious harm to an unborn baby. The project has identified who holds what data: GP, consultant, midwife or pharmacist. These data sources may not even talk to each other but, once the data has been gathered, consultants can cross-reference to see who is taking what medication, whether medication is being missed and whether appointments are being missed so that the highest-risk women can be identified and their care actively managed. Early results are showing that the development of a register is leading to significant improvements in outcomes for women with epilepsy and their babies.
This is just one project in one area covering one condition. I hope that this work will find a way to be scaled up to cover more conditions in more areas. Think what could be achieved if we were able to ensure that the information gathered and stored regarding women’s health could be co-ordinated in such a positive way, for it remains the case that if you are not counted, you do not count. I believe that the Covid pandemic has illustrated the importance of robust health data and has given us the impetus to ensure that such data is co-ordinated across services. I ask that the Government’s first women’s health strategy for England ensures that women’s health data is identified, collected and used to inform service improvements so that we can see actions and results to improve women’s health outcomes.
Lord Young of Norwood Green (Lab) [V]
My Lords, I, too, thank the noble Baroness, Lady Jenkin, for this debate and for her thoughtful and informative intro. She pulled no punches—rightly so—in her description of the often painful lifelong journey of women and girls. I welcome the statement by Nadine Dorries, the Minister for Patient Safety, on the government-led women’s health strategy—the first one.
In May 2020, in response to a Written Question on whether hospitals were required to provide single-sex services, including spaces for patients, the noble Lord, Lord Bethell, said that the revised guidance on delivering same-sex accommodation published by NHS England and NHS Improvement stated that
“providers of National Health Service-funded care are expected to have a zero-tolerance approach to mixed-sex accommodation, except where it is in the overall best interest of all patients”.
Many NHS trusts interpret that in a number of ways that are not always conducive to the health and treatment of women and girls as patients. As many noble Lords have said, we should be listening to patients and seeking examples of best practice. Women often favour single-sex wards for good reason. Rates of sexual assault are far higher in mixed-sex wards. In 2009, Channel 4 discovered that almost two-thirds of sexual assaults by patients occurred in mixed-sex wards.
The Minister stated that there were
“no plans to withdraw the guidance.”
Can I suggest to the Minister that he reconsider this whole issue? He also stated:
“NHS trusts have not been asked to provide the information required to make an assessment of the impact of allowing patients to self-identify their gender and there are no plans to ask them to do so.”
There are many examples of assaults on women in mental hospitals and other areas. Surely we recognise that, when women enter hospital, they do so to experience a calm, safe and non-threatening environment. I ask the Minister to meet Peers concerned about this issue.
Baroness Ritchie of Downpatrick (Non-Afl) [V]
My Lords, I commend the noble Baroness, Lady Jenkin, for securing this important debate and for depicting the lifecycle of women, with its many challenges. There are life challenges, societal challenges and, above all, gynae- cological challenges, which we have all faced in our lives.
It is quite clear that research has found a gender health gap in the UK, where many women receive poorer healthcare than men. This poses the question: why has this been the case and what measures will be taken to rectify the situation at governmental level, working with communities and the voluntary sector?
Many of the challenges facing women’s healthcare have already been raised in the Paterson Inquiry, and the First Do No Harm report, which found that the healthcare system was
“disjointed, siloed, unresponsive and defensive.”
The Saving Lives, Improving Mothers’ Care report said that, between 2016 and 2018, 217 women, or 9.7 women per 100,000, died during pregnancy or up to six weeks after childbirth
“from causes associated with their pregnancy”.
In academic research, Caroline Criado Perez, to whom the noble Baroness, Lady Jenkin, has already referred, has argued that women have been considered less important in healthcare as far back as ancient Greece. Arguing that the problem still exists due to a patriarchal worldview being prevalent in our healthcare system, she said that women are routinely under- represented in clinical trials and that medical research proposed by women is not allotted the same funding as medical research proposed by men for men. I am not sure about that, as somebody who is on a clinical trial—a double-blind trial for breast cancer.
Research and observations would show that, in many societies, women have provided the caring at the expense of being cared for, thus placing their health needs as secondary to those of men. I look at research from Northern Ireland and a matter that has already been referred to by the noble Lord, Lord Rooker. It shows that women have a 70% chance of providing care, compared with 60% of men. By the time they are 46, half of all women have been a carer—11 years before men. I look forward to the Minister’s response.
Baroness Altmann (Con) [V]
My Lords, recent ONS figures show that there is a gap of more than 20 years in the healthy life expectancy of women between the least and most wealthy parts of the country. For men, the gap is around 15 years. In the most deprived parts of the country, women will only stay healthy to just over age 50, while for the best-off areas it is around age 70 or a little above. Women are also more prone to poverty, financial insecurity, interrupted and low-paid employment, and mental health problems, all of which obviously impact their health outcomes.
Covid-19 risks accelerating women’s health inequalities, for example due to delays in regular screening that are likely to increase the number of women with pelvic and breast cancers detected and diagnosed too late. Also, as the pandemic has placed so much more strain on women in their family roles as carers, whether combining home schooling with home working or caring for elderly loved ones, the added responsibility and loss of wider support that they had previously relied on will all take a toll on women’s health, in both the short and longer term.
I therefore congratulate my noble friend Lady Jenkin on her excellent timing on this debate, and her most brilliant introduction—what a tour de force. In fact, I have been concerned for a time about older women’s health deteriorating since 2010. Cuts to council budgets have led to reductions and delays in social care provision, as well as the removal of preventive measures in many areas such as meals on wheels, day centres and early-stage care support. This obviously poses a risk to the health of older women both directly, because there are more elderly women than men and they are not receiving the care they need, and indirectly because of the added burdens on family carers, who tend to be predominantly daughters and mothers. Social care reform is important for women’s health outcomes and I hope there is an increased recognition of this.
Finally, problems faced by older women in the workplace are troubling. In certain sectors they face more age discrimination at work than men, particularly women who have challenging health issues when they go through menopause. Even though menopause systems tend to affect women’s health only temporarily, the lack of understanding of the impacts too often lead women to either leave work or lose their jobs. There is insufficient appreciation that a change to performance and efficiency, whether due to a lack of sleep after night sweats or hot flushes and hormonal changes that undermine concentration, will not be permanent. Therefore, I hope my noble friend the Minister will address some of these issues of menopause at work that could allow women to return or stay in their jobs. Currently, they are too often leaving work.
Baroness Brinton (LD) [V]
My Lords, I echo the thanks of the Chamber to the noble Baroness, Lady Jenkin, for securing this important debate. Along with the noble Baronesses, Lady Jenkin, Lady Massey of Darwen and Lady Walmsley, I was trustee of UNICEF. Its work to help educate and protect girls and young women in dangerous countries across the world—of which the noble Baroness, Lady Nicholson, spoke so movingly, when talking of the horror of rape for girls and women in war-torn communities—demonstrates that we absolutely need to support United Nations projects to protect girls and women throughout the world. The noble Baroness, Lady Nicholson, is right: we need worldwide action to eliminate this scourge.
The noble Baroness, Lady Jenkin, was so right to set this debate in the lifecycle of a woman. She gave us a female equivalent of Shakespeare’s seven ages of man and, while it may not have been in iambic pentameters, it was striking in its arguments.
The noble Baroness, Lady Penn, faces the glorious arrival of a baby. I want to offer, as other noble Lords have done, best wishes for a safe arrival and a hope that, if the baby is a girl, her daughter’s experience of health will be very different from her mother’s and her grandmother’s. Predominantly male medics told us what they thought we had and wanted but, too often, I am afraid, had not listened to us before they spoke. Much has improved over the years, but there is still room for improvement, as this debate has shown.
The noble Baroness, Lady Bull, talked about the incidence of eating disorders, and how important it is that young women are listened to and supported—and, of equal importance, have access to specialist medical help early on.
The noble Baroness, Lady Massey of Darwen, focused on the problems that many women face with mental health today. The Royal College of Psychologists is right to set out the need for an extra £500 million of funding to ensure that they get the tailored support they need, when they need it. There are too many long delays in CAMHS.
My noble friend Lady Walmsley and the noble Baronesses, Lady Bottomley and Lady Bennett, were spot on to remember the failures that fell to the women with valproate and vaginal mesh problems, investigated by the noble Baroness, Lady Cumberlege, in her excellent report. When will the Government implement the key recommendations from that report, particularly the patient safety commissioner?
My noble friend Lady Walmsley also referred to domestic violence. There is no doubt that the healthcare providers can help to spot signs of concern early on. But the BMA has reminded us that healthcare professionals need training early on and support from other agencies to make that happen. That most women wait until in excess of 30 incidents before they go to the police is shocking, but GPs, nurses and midwives are often able to assist women in recognising that they are facing problems early on, and help them to deal with that.
It is extraordinary that women have a much higher level of autoimmune diseases than men. With some diseases, it is 80% higher. Researchers are still trying to understand why, but serious autoimmune diseases can still significantly reduce lifespan, or the patient has to face many years on immune suppressants to prevent the disease progressing. In this year of Covid, that has of course given them further problems. Endometriosis, which happens to be my second autoimmune disease, introduced me as a young woman to the indignity of the mostly male doctors managing my condition and its consequences for fertility, high miscarriage risk and a life of severe pain, which hardly any medics understand. That GPs think it is just like a bad period pain completely misses the point.
The noble Baroness, Lady Greengross, referred to contraceptive services and their supply during the pandemic. She was right to say that women need to be able to access those services all year round, and throughout the United Kingdom, because failures can have serious consequences for young women.
The noble Lord, Lord McColl, ably set out a range of women’s services where other countries are setting us good examples of how we can improve the lives of women, including respite care for the many unpaid carers, mainly women. His point was echoed by the noble Baronesses, Lady Eaton, Lady Fraser and Lady Ritchie. The noble Baroness, Lady Fraser, also gave us an excellent example of combining data to cross-reference women with epilepsy and their medicines. She said, “If you’re not counted, you don’t count”. I am reminded here that the suffragists scrawled “Votes for women” across the 1911 census and are visible to history, whereas the suffragettes chose just to boycott the census, so their contribution is invisible to history.
The noble Baroness, Lady Bennett, and the noble Lord, Lord Hunt, talked about women’s cancer diagnoses coming significantly later than men’s. I know that other Members of your Lordships’ House have faced this, but we have a close family member whose 34 year- old daughter missed her cervical smear test last year because of the pandemic and now is facing terminal cancer. That is really shocking. The noble Lord, Lord Hunt, rightly reminded us of shocking failures at some maternity hospitals. While it is good that reports are now highlighting these failures, is there also a systematic review of the funding and staffing of maternity services across the country, as most of the reports refer to staff shortages as well as problems with the culture?
The noble Lord, Lord Rooker, vitally reminded us of the Marmot report and how it set out the problems that women face in society today, especially in Northern Ireland. One of the topics in the Government’s consultation paper was on using data to improve women’s experiences. How is this sort of data shared and used to understand the disparity between the four nations?
The noble Lord, Lord Brooke, and the noble Baroness, Lady Bryan, talked about the male-female inequality league and how the UK should do better. How do the Government plan to address some of the clear health disparities?
The noble Baroness, Lady Greengross, also talked about continence services. Twenty years ago, discussion of periods in public was pretty taboo. Endometriosis and the menopause have recently become more acceptable issues to discuss but, frankly, continence services remain taboo for many. Women who often face long-term problems after difficult childbirth are unable to seek the help they need when their bladders start to fail in the later years. I hope that this debate will help to start that discussion and encourage women to seek help from their GPs at an early stage.
Recently, I had some discussion with young doctors working with the elderly—mainly women—who fell and broke limbs, imperilling their independence and ability to stay at home. These doctors are looking at best practice on early intervention with these patients, after minor falls, that supports and trains the patient. This has already significantly reduced the serious falls that too many women have later on. It is also saving the NHS a vast amount of money and keeping these women independent for much longer.
The noble Baroness, Lady Uddin, and the noble Lord, Lord Boateng, raised the problems of unconscious bias and the stereotyping of black and Asian women. I am sorry to say that this is also true of LGBT women. My noble friend Lady Barker has often spoken of the need for specialist geriatric services for them. Those who claim to object to the woke agenda need to understand that these biases—conscious or not—are the root of women’s health inequality. The contribution of the noble Lord, Lord Sikka, pointed at how the voices of, and services for, women were invisible in the Budget. Today’s debate has shown that this House is keen to see the eradication of all health inequalities affecting women, and I look forward to hearing the Minister’s response.
Baroness Thornton (Lab)
My Lords, I declare my interest as the maternity champion for Whittington Health, of which I am a non-executive director. I congratulate the noble Baroness, Lady Jenkin, on bringing forward this debate, which has been of very high quality. Her introduction was both comprehensive and—although I am not sure that I would say Shakespearean —encompassed the whole of life.
I am particularly proud of my nine or 10 noble friends who took part in this debate. My noble friend Lady Massey talked about young women; my noble friend Lord Rooker talked about health inequalities and Marmot; my noble friend Lady Chakrabarti talked about our international responsibilities; my noble friend Lord Hunt talked about heart attacks and discrimination —I will come back to that later—my noble friend Lord Boateng talked about the higher rates of mortality for black people and racial disparities within healthcare; my noble friend Lord Brooke talked about learning the lessons of domestic violence; my noble friends Lord Sikka and Lady Bryan talked about the misdiagnosis of symptoms and inequalities in health; and my noble friend Lord Young talked about single-sex wards. But contributions have come from all sides of the House. I welcome the women’s health strategy consultation: I very much look forward to seeing what comes out of that.
As did the noble Baroness, Lady Jenkin, I want to address the systematic discrimination against women and the gender data gap. She and several other noble Baronesses mentioned Caroline Criado Perez and her work in this area. She said that medical research has traditionally been based around the male body. Indeed, my noble friend Lord Hunt pointed out that women were 50% more likely to be misdiagnosed following a heart attack, but they make up only 25% of the participants across the landmark trials for congestive heart failure. Given that we have a Minister in this House who is very enthusiastic and keen about data and its use and all those things, this issue is very important.
Most medical trials are done on male cells; even female cells react differently. For millennia, medicine has functioned on the assumption that male bodies represent humanity as a whole. As a result, we have a huge historical data gap when it comes to female bodies. That means that women will be dying when they do not need to. The medical world is complicit in this and that needs to change. I am pleased that this was referred to in the women’s health strategy. I hope that it is going to be followed up when the strategy comes to fruition after the consultation process.
It is interesting; I learned, for example, that the first production of the Fitbits that we are all so keen on did not include menstrual cycles in their data, so over 50% of the world was not properly recognised. I am assured that that is absolutely no longer the case. The tech world, of course, is designing the future, so we have to acknowledge the need for diversity in that. If tech is designed by white, middle-class men from America, the future might look very nice to them but not for everybody else. Diversity in the teams and ideas is vital. Artificial intelligence that helps doctors with diagnoses and scans, and with conducting job interviews and so on, is vital, but it all depends on the datasets. If those datasets are designed by those white males in America, then we are all—or at least half of us are—in serious trouble. If you tell an algorithm what a heart attack is based on male symptoms, how are we going to make sure that it recognises female symptoms? These are the issues on which I am particularly interested to know the Minister’s thinking.
I turn briefly to women and Covid. We know that Covid-19 did not strike the sexes equally. Globally, for every 10 Covid-19 intensive care unit admissions for women, there were 18 for men. While men over 50 tended to suffer the most acute symptoms of Covid, there is evidence that women seem to be disproportionately affected by long Covid; one study suggested that women outnumber men by as much as four to one. A study led by the University of Glasgow concluded that
“women under 50 are seven times more likely to be breathless and twice as likely to report fatigue than men, seven months after seeking medical assistance for Covid-19.”
Some academics have linked this to the fact that women have a higher lifetime risk of inflammatory immune conditions such as chronic pain, chronic fatigue and autoimmune diseases. Can the Minister assure us that these issues are a standard part of the ongoing research on the effects of Covid?
A key point that came out when the strategy was first announced by the Government was the need to listen to women’s voices. That is absolutely vital. The House has been active in expressing the need for this, particularly in support of the report by the noble Baroness, Lady Cumberlege. We have made significant progress in implementing some of her report and I hope that we will see more of it included and embedded in the forthcoming legislative programme on health and social care.
To conclude, I thank all speakers who have taken part in this debate, and I look forward to the Minister’s speech. We live in a patriarchal and deeply unequal society. Covid has highlighted those inequalities, particularly health inequalities, and it must be said that, since 2010, the noble Baroness’s Government have been guilty of cuts and underfunding across the whole of our health system, which has disproportionately affected the poor—and that means it has disproportionately affected women. I hope that the noble Baroness, Lady Jenkin, and the Minister will agree that having the best possible women’s health strategy in the world will, as it were, butter no parsnips if it is not properly resourced and funded.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I join all those who have commended my noble friend Lady Jenkin of Kennington for tabling a debate on this incredibly important matter. I congratulate her on smashing through dozens of anatomical taboos in such a splendid fashion in her extremely important opening remarks.
I believe that, as has been discussed today, the problem statement under debate is very clear—Nadine Dorries said it in another place earlier today, and it was echoed by the noble Baroness, Lady Bull: for generations, women have lived with a health and care system that is mostly designed by men for men. That is the problem. As a result, despite making up 51% of the population, women have been underrepresented in research, face damaging taboos about their health and, despite living longer than men, spend a greater proportion of their lives in ill health and with disabilities. For these reasons, there has never been a better time to put an emphasis on women’s health.
So I am extremely pleased that, on International Women’s Day, the Minister of State for Patient Safety, Suicide Prevention and Mental Health announced in another place the launch of the women’s health strategy for England. As noble Lords have mentioned, it asked for responses across six themes, and I think it is worth mentioning them, because they are the architecture of how we will approach this strategy. The first is
“Placing women’s voices at the centre of their health and care”;
the second is
“Improving the quality and accessibility of information and education on women’s health”;
the third is
“Ensuring the … system understands and is responsive to women’s health and care needs across the life course”,
and this was so articulately explained by my noble friend; the fourth is
“Maximising women’s health in the workplace”;
the fifth is
“Ensuring research, evidence and data support improvements in women’s health”,
as was explained very well by the noble Baroness, Lady Brinton; and the sixth is
“Understanding and responding to the impacts of COVID-19”.
As has been mentioned, we had 112,000 submissions, which is an absolutely remarkable number and speaks well of the engagement that has gone on around this important issue. There have also been focus groups, and departmental Ministers have led a number of engagement exercises. I was delighted to chair two very important and revealing round tables and a series of one-to-ones with leading women in healthcare. This engagement is why we launched the call for evidence in the first place.
There are a number of challenges that cut across the area of women’s health, and I will mention two or three of them. We have a world-class research and development system in the UK, but, as the noble Lord, Lord Hunt, quite rightly pointed out, we know that women have been underrepresented in research and clinical trials, particularly women from ethnic minorities—as the noble Baroness, Lady Uddin, pointed out—older women, women of child-bearing age, women with disabilities and LGBT women.
Women are not a homogenous group, and research must continue to understand and tackle specific dimensions of inequality to ensure equitable health outcomes across the population. While researchers and regulators have historically believed this to be good for women and babies, largely due to legitimate concerns about potential risks to an unborn child, too often women have been excluded from these discussions and have not been given the choice to participate in trials and studies. I agree with the noble Baroness, Lady Ritchie: we absolutely must work hard to change this and give women the choice to partake in clinical trials.
I will say a word about women’s conditions that are not being researched enough, which was highlighted by the noble Baroness, Lady Thornton. She is entirely right: there are still too many conditions about which we know too little. A key example of this is endometriosis, raised by the noble Baroness, Lady Brinton, in her personal testimony. A number of noble Lords have articulated the key fact that it takes seven to eight years for a diagnosis, with 40% of women needing 10 or more GP appointments before being referred to a specialist. If it was a man, I fear that it would be very different indeed. Menopause, mentioned by my noble friends Lady Jenkin and Lady Altmann, is another good example of this.
This lack of understanding of female conditions has implications for the health and care that women receive. Data is key and data saves lives—I am a big believer in that. To reassure my noble friend Lady Fraser of Craigmaddie, that is why
“Ensuring research, evidence and data support improvements in women’s health”
was one of the key themes of the call for evidence, and it will be a key theme of the strategy going forward. I completely agree with my noble friend that we must work hard to ensure that women, and women’s health issues, are included in research and data collection, finally ending the gender data gap that sadly exists.
Men are too often the default, and we do not know enough about the conditions that manifest differently in men and women. This can and does lead to poorer health outcomes, as vividly explained by my noble friend—I think it was Lady Bottomley; I cannot read my own writing. A University of Leeds study showed that women with a total blockage of a coronary artery were 59% more likely to be misdiagnosed than men and found that UK women had more than double the rate of death in the 30 days following a heart attack. I completely agree with the noble Lord, Lord Hunt: this just is not good enough. I would be glad to meet with the noble Lord, Lord Young of Norwood Green, to discuss the issue of mixed wards.
Too often, women are not listened to, and unfortunately we see this at all levels of the healthcare system, whether it be reports of women having their pain ignored during gynaecological procedures—such as IUD fittings or hysteroscopies—or the sobering findings from independent reports such as the Cumberlege review or the Paterson inquiry. One of the driving forces behind the decision to launch a women’s health strategy was the findings of the Cumberlege review; this is one of the manifestations of our response. I am enormously grateful to my noble friend for her work on this report and to many others in the House who have championed its work. The report powerfully highlights how the system did not listen to women. I am aware that today is the review’s first anniversary, and a debate has just taken place in another place to mark the occasion.
The Written Ministerial Statement of 11 January provided an update to Parliament. This included that the department had accepted the report’s flagship recommendation: the establishment of a patient safety commissioner. We also announced in this Statement that we had accepted recommendations concerning specialist mesh centres, MHRA reform and the establishment of a medical devices information system. I reassure the noble Lord, Lord Brooke, the noble Baronesses, Lady Bryan and Lady Brinton, and others who asked that we are carefully considering the remaining recommendations and 50 actions for improvement. It is imperative, for the sake of patients and especially those who have suffered greatly, that we give this independent report the full consideration it deserves. In the January Statement, we announced that we would establish a patient reference group to work alongside the department to develop a full response. I am happy to confirm that the group was established earlier this year and has been working closely with officials to consider the report’s recommendations. I can assure Members that we will publish a comprehensive government response later this year.
On a positive note, can I say a few words about the good things that are happening in this area? The National Institute for Health Research is actively seeking to improve participation of underrepresented groups, and I would like to highlight the work of the NIHR INCLUDE programme. INCLUDE provides a design framework for clinical research proposals and gives examples of good practices and resources. The move towards virtual trials, due mainly to the pandemic, will accelerate that. The NIHR funds a wealth of research on women’s health and their outcomes. A couple of examples are the recently funded £2 million trial on endometriosis and the Policy Research Unit in Maternal and Neonatal Health and Care.
On long Covid, I completely agree with the noble Baroness, Lady Thornton: this is a gender challenge. The statistics are quite clear about that. I reassure the noble Baroness that the Government are doing everything we can to listen to and learn from all those suffering from the long-term effects of Covid, including women. I have heard first-hand the insights and experiences of people living with this new and debilitating condition. The noble Baroness, Lady Chakrabarti, is right: long Covid is a new challenge for healthcare systems around the world. I am proud that the UK is leading the way on excellent research, treatment and care. We are investing heavily in research. REACT Long COVID—REACT-LC—aims to better understand the genetic, biological, social and environmental signatures and pathways for long Covid. Through its efforts, supported by £50 million of research funding, we are learning more every day about long Covid. We have 89 new specialist assessment centres opening up around the country, and they are having a huge impact.
I will say a word about maternity services. The Government are committed to reducing inequalities in health outcomes and experiences of care. This was articulated very persuasively by the noble Lord, Lord Boateng, and the noble Baroness, Lady Uddin. In September 2020, the Minister for Patient Safety established the Maternity Inequalities Oversight Forum to bring together experts to address the inequalities for women and babies from different ethnic backgrounds and socioeconomic groups. We are working to ensure that, by 2024, 75% of black and Asian women, and a similar proportion of women who live in the most deprived areas, will receive continuity of care from their midwife throughout pregnancy, labour and the postnatal period.
Maternal healthcare is absolutely critical, as the noble Baroness, Lady Massey, rightly alluded to, and maternal mental health has been neglected. Five years ago, 40% of the country had no access to specialist perinatal mental health care. I am proud to say, in response to the questions on training from the noble Baroness, Lady Walmsley, that there are now specialist community perinatal mental health services in every CCG area in England, with more than 700 specialist front-line staff recruited in the last two years. We are committed to transforming specialist perinatal mental health services across England.
By way of winding up, and on a personal note, I will point to my own experiences in this area and tell the story of my mother, who was hard hit by postnatal depression. It is a condition that we now recognise to affect 15% of mothers, as the noble Baroness, Lady Thornton, said. In the days when I was born, this condition was neither diagnosed nor treated. My mother developed mental illnesses, drug addiction and alcoholism, and was therefore stigmatised by the healthcare system and separated from her children by the courts. Her treatments were barbaric, including electric shock treatment and drugs that made her bloated and sick. She had a relationship with her GP—something that would absolutely not be tolerated now and did nothing to help her then. No one listened to her, the diagnosis was flawed and the treatments were medieval. The system abused her, and she passed away in her bath. I think it is fair to say that she died of being a woman. It had a profound effect on me, and I would not want that to happen to any woman or child again.
Those times have largely passed. The world has got better, but it has not changed enough. That is why my noble friend Lady Jenkin’s debate is so important: it demonstrates that the outline of the problem definition is very clear. It is why this consultation is so important: it ensures that we really have all the details from the people whose voices have not been heard. It is why this women’s health strategy is so important: it will give us a common plan to do something about a problem that has dogged our healthcare system for too long.
Baroness Jenkin of Kennington (Con)
My Lords, I thank all noble Lords who have participated in this debate and used such a wide variety of their experience to educate us and to plead their different causes—particularly the seven male noble Lords who have supported us. I rather like the idea of it being the seven ages of woman; I will stick with that one. I particularly thank my noble friend the Minister, not only for his comprehensive reply to us today but for his deeply moving description of his and his mother’s experiences. I challenge anyone not to have a lump in their throat hearing this very moving story. He has always been a great supporter of women and of the causes I have supported, and I am extremely grateful to him for that.
I will touch on a couple of the topics we have discussed; they have all been run through by other noble Lords. Like the noble Baroness, Lady Ritchie, I have participated in a clinical trial; it happened to be about endometriosis. I have no idea whether the drug we were testing is currently on the market, but it was a very long time ago so the answer is probably not yet. One of the lessons Covid has perhaps taught us is that clinical trials can be sped through and happen more quickly than we originally thought. I am very glad that other noble Lords raised this as an issue.
A number of noble Lords talked about mental health. The fact that so many people talked about it made us aware of what a big issue it is. Although the noble Baroness, Lady Cumberlege, is not with us today, I suspect that a large number of people—probably more people than are listening to this debate—heard her on the radio this morning. I was very struck by the dignity of the victims: the mother of one victim spoke particularly eloquently and with such dignity about her experience.
A number of noble Lords talked about Sir Michael Marmot and his work on inequality. It is a massive wake-up call for all of us, and the theme of inequality is so clear in the work that he does. It is tempting to think that this debate has been a rather miserable litany of bad experiences, but I think it was my noble friend Lady Bottomley who said—as the Minister has just said—that there have been massive improvements in so many areas. We must not forget that.
I return to the point I mentioned at the beginning. I changed my usual topic of International Women’s Day, but the noble Baroness, Lady Nicholson, raised the hideous plight of so many women across the world. We must remember to count our blessings that we live in such a wonderful country, where we have access to healthcare that is so much better than in so many places across the world.
I will end by again wishing my noble friend Lady Penn good luck. With her typical efficiency, she is actually due on the day we rise, two weeks today—and with her typical efficiency, she will probably have the baby on that day or the day after.
I know the Government are serious about this agenda, and they know that we will be watching them.