(2 years, 5 months ago)
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The Secretary of State for Health and Social Care (Steve Barclay)
With permission, Mr Speaker, I will make a statement on the women’s health strategy for England.
I know that many hon. and right hon. Members will agree that, for too long, women’s health has been hampered by fragmented services and women being ignored when they raise concerns about their pain. On too many occasions, we have heard of failures in patient safety because women who raised concerns were not heard, as with the Ockenden review into the tragic failings in maternity care and the independent inquiry into the convicted surgeon Ian Paterson. I also remember the outstanding work of my constituent Kath Sansom and her Sling the Mesh campaign where, once again, the response was too slow when women raised issues with their care.
We are embarking on an important mission to improve how the health and care system listens to women’s voices and to boost health outcomes for women and girls, from adolescence all the way through to later life. This is not only important for women and girls; it is important for everyone. This work is already well under way.
Last month we announced the appointment of Professor Dame Lesley Regan, one of the country’s foremost experts in women’s health, as the first ever women’s health ambassador for England. On top of this, we are investing an extra £127 million in the NHS maternity workforce and neonatal care over the next year, and we are creating a network of family hubs in local authorities in England.
Today we are announcing the next step. We are publishing the first ever women’s health strategy for England, which sets out a wide range of commitments to improve the health of women and girls everywhere. I take this opportunity to pay tribute to the almost 100,000 women who took the time to share their stories with us, as painful as it may have been. Your voices have been heard and were vital in shaping this strategy.
I will now set out the key components of the strategy. First, we are putting in place a range of measures to ensure that women are better listened to in the NHS. Indeed, 84% of respondents to our call for evidence recounted instances where they were not listened to by healthcare professionals. We need to do more to tackle the disappointment and disillusionment that many women feel. We are working with NHS England to embed shared decision making where patients are given greater involvement in decisions relating to their care, including when it comes to women’s health.
Secondly, we want to see better access to services for all women and girls. Women and girls have told us that the fragmented commissioning and delivery of health services can impact their ability to access them. That means they have to make multiple appointments to get the care they need, adding to the NHS backlog. There are better ways to deliver women’s health through centres of excellence in the form of women’s health hubs, designed specifically to holistically assess women’s health issues and where specialist practitioners can be more attuned to concerns being raised. We are encouraging the expansion of those hubs, and indeed I visited Homerton University Hospital this morning to see the benefits these local one-stop clinics bring, enabling women to have all their health needs met in one place.
Thirdly, it is essential that we address the lack of research into women’s health conditions and improve the representation of women’s data in all types of research. Currently, not enough is known about conditions that only affect women, as well as about how conditions that affect both men and women impact them in different ways. The strategy sets out how we will tackle the women’s health data gap to make sure that health data is broken down by sex by default.
Fourthly, we will provide better information and education on issues relating to women’s health. Our call for evidence showed that fewer than one in 10 respondents feels they have enough information about conditions in areas such as the menopause and that many people wanted trusted and accessible information about women’s health. The NHS website is currently a trusted source of health information for many people, and we will transform the women’s health content to improve its existing pages and add new pages on conditions that are not currently there. But we know that the NHS will not be everyone’s first port of call for health information, so we will expand our partnerships, such as the one between YouTube and NHS Digital, who are working together to make sure that credible, clinically safe information appears prominently for UK audiences. It is also important that medical professionals have the best possible understanding of women’s health, and I am pleased that the General Medical Council will be introducing specific assessments on women’s health for medical students, including on the menopause and on gynaecology.
Fifthly, our strategy sets out how we will support women at work. In the call for evidence, only one in three respondents felt comfortable talking about health issues with their workplace, and we also know that one in four women has considered leaving their job as a result of the menopause. So we will be focusing our health and wellbeing fund over the next three years on projects to support women’s wellbeing in the workplace, and we will be encouraging businesses across the country to take up best practice such as the menopause workforce pledge, which was recently signed by the NHS and the civil service.
Sixthly, we will place an intense focus on the disparities in women’s health. We know that although women in the UK on average live longer than men, they spend a significantly greater proportion of their lives in ill health and disability than men. Even among women there are marked disparities and our strategy shows our plans to give targeted support to the groups who face barriers accessing the care they need, for example, disabled women and women experiencing homelessness. It also shows how we are putting an extra £10 million of funding towards 25 new mobile breast screening units that will target areas and communities with the greatest challenges on uptake and coverage.
Finally, as well as these cross-cutting priorities, the responses to our call for evidence also highlighted a number of specific areas where targeted action is needed. Those include fertility care, where we will be removing barriers that restrict access that are not health-based but based, for example, on whether someone has had a child from a previous relationship, and making access to fertility services much more transparent. Another of our priority areas is improving care for women and their partners who experience the tragedy of pregnancy loss. At the moment, although parents whose babies are stillborn must legally register the stillbirth, if a pregnancy ends before 24 weeks’ gestation there is no formal process for parents to legally register their baby, which I know can be distressing for many bereaved parents. So we will be accepting the interim update of the independent pregnancy loss review and introducing a voluntary scheme to allow parents who have experienced a loss before 24 weeks of pregnancy to record and receive a certificate to provide recognition of their tragic loss.
This is a significant programme of work but we cannot achieve the scale of change we need through central Government alone. We must work across all areas of health and care. We will need the NHS and local authority commissioners to expand the use of women’s health hubs; the medical schools, regulators and Royal Colleges to help us improve education and training for healthcare professionals; the National Institute for Health and Care Research to help make breakthroughs that will drive our future work; and many others to play their part. I would like to finish by thanking everyone involved in the development of this important strategy, including the Minister of State, Department for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), who is on the Front Bench with me today, for the determination she has shown in taking this strategy forward. I would also like to pay tribute to my predecessors, my right hon. Friends the Members for West Suffolk (Matt Hancock) and for Bromsgrove (Sajid Javid), the latter of whom is in his place, for their commitment to this important issue, even during the pressures of the pandemic. This is a landmark strategy, which lays the foundations for change and helps us to tackle the injustices that have persisted for too long. I commend this statement to the House.
Wes Streeting (Ilford North) (Lab)
Let me begin by thanking the Secretary of State for advance sight of his statement and adding my thanks to the Minister of State, to his predecessor as Secretary of State, the right hon. Member for Bromsgrove (Sajid Javid), who is sat opposite, and to officials in the Department for the work they have done. I am genuinely glad that this work is out of the door when so much else has been in hiatus because of the wider political change afoot in the Government. I join the Secretary of State in recognising the campaigning efforts of his constituent Kath Sansom, as well as the efforts of my hon. Friend the Member for Swansea East (Carolyn Harris), who has campaigned tirelessly to raise awareness of the menopause and has been a driving force for change on behalf of women everywhere.
For too long, women's health has been an afterthought, and the voices of women have been at best ignored and at worst silenced. Four out of five women who responded to the Government’s survey could remember a time where they did not feel listened to by a healthcare professional, and that has simply got to change. In recent years, we have seen a string of healthcare scandals primarily affecting women: nearly 2,000 reported cases of avoidable harm and death in maternity services at Shrewsbury and Telford; more than 1,000 women operated on unnecessarily by the rogue breast surgeon Ian Paterson; thousands given faulty PIP— Poly Implant Prothèse—breast implants; and many left with traumatic complications after vaginal mesh surgery. Meanwhile, every woman who needs to use the NHS today faces record high waiting times. The NHS is losing midwives faster than it can recruit them. Gynaecology waiting lists have grown faster than those for any other medical specialty. The number of women having cervical screening is falling. And black women are 40% more likely to experience a miscarriage than white women. That is the cost for women of 12 years of Conservatives mismanagement, so I want to address each part of the strategy in turn.
The strategy promises new research, which is of course important. Studies suggest that gender biases in clinical trials are contributing to worse health outcomes for women. There is evidence that the impact of women-specific health conditions such as heavy menstrual bleeding, endometriosis, pregnancy-related issues and the menopause is overlooked. So of course what the Secretary of State has said today about improving data is so important, but will he also set out how exactly the Government intend to make use of this new data to improve outcomes for women?
Improving the education and training of health professionals is essential, because when we do not do that, there are consequences. Almost one in 10 women has to see their GP 10 times before they get proper help and advice about the menopause, and half of medical schools do not teach doctors about the menopause, even though it affects every woman. I challenge the Secretary of State to go further than the proposal he outlined to train incoming medical students and incoming doctors. What plans do the Government have for clinicians who are already practising? We need to upskill the existing workforce, not just the incoming workforce. However, let us be clear: informing clinicians is no good if we do not also improve access to hormone replacement therapy, so where is the action in the strategy to end the postcode lottery for treatment?
Breast cancer is the most common cancer in the UK, and the NHS offers regular breast cancer screening to women aged between 50 and 70. That can prevent avoidable deaths by identifying cancer early, when it is more treatable and survival is more likely. Yet, fewer women in the most deprived areas than in the most affluent areas receive regular breast screening. Even before the pandemic too many women with suspected breast cancer were waiting more than the recommended two weeks to see a specialist. How will the programme announced today make a difference to outcomes for patients if, once diagnosed, they just end up on a waiting list that is far too long and they cannot access the treatment they need?
I welcome what the Secretary of State said about removing barriers to in vitro fertilisation for women in same-sex couples. For far too long they have faced unnecessary obstacles to accessing IVF, for no other reason than that they love another woman. It is high time that we put that right.
I also want to mention endometriosis. Tens of thousands of women provided testimony to the Government about the issues they face with diagnosis and treatment. Will the Secretary of State give the House an assurance that every woman who is treated for this disease will have equal access to specialist services from day one? Will he make sure that they do not have to fight to get the diagnosis in the first place?
On polycystic ovary syndrome, what will the Secretary of State do to make sure that we equalise access to a range of treatments, not least for women for whom the pill is simply inappropriate? We must make sure we end the division between those who receive a prescription on the NHS and those who go private, receiving better treatment.
I also want to raise some points about what has not been mentioned today. In addition to the appalling figures on black maternity deaths, a quarter of black women surveyed by Five X More felt that they received a poor or very poor standard of care during pregnancy, labour and post-natal care. Women who live in deprived areas are more likely to suffer a stillbirth than their richer counterparts. My hon. Friend the Member for Oxford East (Anneliese Dodds), the shadow Secretary of State for Women and Equalities, has pledged a new race equality Act to tackle the structural inequalities in our society, including in healthcare. However, the Government are more interested in stoking culture wars than in acknowledging that these inequalities even exist. Surely that has to change when there is a new leadership of the Conservative party.
In conclusion, the reality that faces women in this country is this: breast cancer waiting times are through the floor, half a million women are waiting for gynaecology treatment, black women are four times more likely to die in pregnancy and childbirth, and too many women still cannot get HRT when they need it. This strategy simply will not solve the depth of the crisis in women’s healthcare after 12 years of Conservative mismanagement. Every day this Conservative Government remain in office is another day when women will have to wait far too long for the care they desperately need.
Madam Deputy Speaker
Oh, I beg your pardon! It is probably a good idea if I allow the Secretary of State to answer the shadow Secretary of State. I am too many steps ahead.
Steve Barclay
I do not want those on the Opposition Front Bench thinking that their points have not been addressed.
I think there is much common ground on both sides of the House on the importance of this strategy and the need for a culture and system change in the NHS to address many of the concerns raised in past debates in the House on issues such as mesh, Paterson and Ockenden. I also think there are a lot of areas where colleagues on both sides of the House will work together to encourage commissioners in our constituencies to reshape services in a way that better reflects the needs set out in this strategy.
The hon. Member for Ilford North (Wes Streeting) is right to highlight the fact that many respondents felt they had not been heard in the past. That is why we have taken the first step of appointing a women’s health ambassador—Professor Dame Lesley Regan, who is an extremely respected figure in women’s health—to better champion women. It is also why I signalled in my statement the importance of data and of breaking it down by sex by default to better target our research on conditions that impact women differently from men or that affect only women and that are often not as well researched as they should be. Again, I think there is common ground on both sides of the House on the issue of research.
I agree with the hon. Gentleman about the need to improve training for existing clinicians as well as for those new to the profession. That is why I signalled in my statement our desire to work with the royal colleges and others to make sure that that continuing professional development is there.
The hon. Gentleman raised the issue of access to HRT. He will be aware that we have put prepayment certificates in place from April next year so that someone will pay only the equivalent of two prescription charges for their HRT supply. Officials in the Department have done considerable work on supply chain issues to tackle some of the difficulties that were there in the past.
On the hon. Gentleman’s point about how we address outcomes for patients, I saw a good illustration this morning at Homerton. Redesigning services avoids the need for invasive and more expensive theatre treatment, and the use of new equipment allows a better service to the patient. In the strategy, Professor Dame Lesley Regan makes the point that the irony is that we could deliver services that are far better for the patient but also cheaper for the taxpayer if we embraced a women’s hub model of the sort we see in Homerton. I very much look forward to taking the data we have forward in conversations with other commissioners around the country.
I am pleased that the hon. Gentleman recognised and welcomed the removal of barriers to IVF, as will Members on both sides of the House who have seen the challenges that that issue presents in constituency cases.
On speed of service, community diagnostic centres have an important role to play. The hon. Gentleman also raised the issue of ethnic minorities. We have put in place a maternity disparities taskforce, and ministerial colleagues have already met three times as part of that taskforce, so the characterisation that Ministers are not engaging on the issue is, I am afraid, wide of the mark.
The hon. Gentleman mentioned breast cancer. He will have noted from my statement that an additional £10 million has been targeted specifically at that issue, with a further 25 mobile units. Again, that is about addressing the disparity in women’s health data in different parts of the country.
Overall this is an important strategy. We have listened to the very large number of responses to the consultation, and that is reflected in the strategy. I think this is an area on which there is much common ground on both sides of the House.
Sajid Javid (Bromsgrove) (Con)
There was a time when I would follow right after the shadow Secretary of State, but not any more. However, I am very pleased to follow my right hon. Friend the Secretary of State, and I welcome him to his new role. He has the privilege of running a fantastic Department that is so important to the British people. He has excelled in every role he has held in Government so far, and I know he will do so again.
I strongly welcome the women’s health strategy—as we heard, it is the first published by any Government. I congratulate everyone involved, including all the officials and especially the excellent Minister of State, Department for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), who is sitting on the Treasury Bench, and the previous Minister of State, my right hon. Friend the Member for Mid Bedfordshire (Ms Dorries).
Does the Secretary of State agree that, when it comes to women’s health, early diagnosis is essential? I absolutely welcome the commitment in the strategy on mandatory training in women’s health issues for new doctors, but will my right hon. Friend say a little more about what can be done on training for existing doctors and clinicians?
Steve Barclay
The work on this strategy was done before I arrived in the Department, so it was down to my right hon. Friend and to the Minister of State, my hon. Friend the Member for Lewes (Maria Caulfield). It is great to have this opportunity to pay tribute to my predecessor for all that he did to drive this agenda forward. He is absolutely right about the importance of training and early diagnosis. That is why addressing the issue of fragmented services is so important. As a respondent said, where women raise concerns, they often feel like a lone voice in the wind—that was a phrase in the strategy that really resonated with me. Having hubs, centres of excellence and the ability to look at that data and identify it early, alongside the other initiatives in which he played a major role as Secretary of State, such as the diagnostic hubs, are all a key part of the delivery of this strategy.
Carolyn Harris (Swansea East) (Lab)
I rise to speak specifically on the menopause services included in the strategy. As co-chair of the Government menopause taskforce, I broadly welcome the strategy but feel that it falls short in some places.
Although better menopause training for doctors of the future is essential, there is not much in the strategy now in terms of upskilling GPs or prescriber medics, such as pharmacists or women’s health nurses. With only 14% of women accessing hormone replacement therapy and menopause care, through medical lack of awareness in diagnosing and prescribing, training medical professionals of the future does nothing for women today.
With 50% of women not even discussing their symptoms, we need a public awareness campaign—outside the one being run by the media and by grassroots and celebrity activists—to ensure that all women get the memo, as it were. We need a commitment to a national formulary for HRT to end postcode lottery in quality, quantity and availability of body identical hormone replacement therapy—I emphasise body identical.
As for HRT costs, I am delighted that my private Member’s Bill that I negotiated with the Government last October now appears as part of the strategy, but I am bitterly disappointed that the timeframe for that once annual charge is delayed until April 2023— 18 months after it was promised—demonstrating to me a lack of urgency in dealing with women’s health issues that affect 51% of the population.
As we are talking about delays and women not being listened to, I am still waiting on responses to six letters to either this Secretary of State or to his predecessor dating back to 5 May asking to discuss all the issues that I have raised today. I would be grateful to have a meeting to discuss them further.
Steve Barclay
The hon. Lady says that she is not being listened to, but my understanding is that she is co-chair of the menopause taskforce, which has been set up to look at these issues. Indeed, she has also had meetings with officials on the subject of HRT. It is slightly remiss of her to suggest that she is not being listened to when Health Department officials are meeting with her and when we have a taskforce under way. There is much consensus around the points that she raises. She has highlighted, quite rightly, the importance of HRT, and we have acted on that. Part of the reason for the delay until April is that the IT systems need to be put in place. I well recall, when I was a Treasury Minister, being asked to move at pace in response to covid, because of the cash-flow pressures on businesses, and sometimes having the same colleagues complaining that forward controls and other issues had not been put in place. We need to put the right IT in place. We will do that for April, and the work is under way. The issues that she raises are being addressed, but in an effective way.
As I said to the shadow Secretary of State, we will work with the royal colleges to address the issue of training. It is a perfectly fair point, and I do not think there is disagreement in the House on that. On the wider issue of addressing disparities, that is exactly what the taskforce is about. That is why we have such a relentless focus on data, why we have a women’s health ambassador to give greater voice to these issues, and why we have brought forward specific measures, such as the family hubs and mobile breast screening units, to better address those disparities.
Dame Maria Miller (Basingstoke) (Con)
I welcome my right hon. Friend’s statement and its recognition of the need to have specific strategies to make sure that women have equal access to services. However, it is silent on the biggest healthcare injustice that women face in our country—that abortion is still treated under Victorian criminal law, with the most draconian laws in the world. Seventeen women in the past eight years have been subject to criminal investigation, including simply because they suffered the appalling issue of stillbirth. This strategy should stop that by expanding the Government’s own change in the law in Northern Ireland to ensure that abortion is an issue between women and their doctors, and that every woman is protected from criminal investigation at a time when what they need from us is care and compassion.
Steve Barclay
My right hon. Friend is right that there is a need for care and compassion, and she highlights an extremely important point. She will be aware that the sexual health review is currently being conducted. That will report later this year and will look into the issue that she raises.
Stephanie Peacock (Barnsley East) (Lab)
How will this strategy address the postcode lottery associated with gynaecological wait times?
Steve Barclay
Again, it is partly by having an ambassador that will be tasked with advocating in that space, by having the data to give visibility to that, and also by working in partnership with commissioning groups, with the NHS, and with the royal colleges on training, that much greater focus will be brought to these issues.
Theresa Villiers (Chipping Barnet) (Con)
I thank the Government for bringing forward this strategy. It really is astonishing that this is the first Government ever to have produced such a strategy. Will my right hon. Friend use this to drive forward improvements in care for endometriosis, including, in particular, updating the National Institute for Health and Care Excellence guidelines NG73 to make sure that people have earlier diagnoses and better access to pain relief for this debilitating condition, of which too many doctors do not have a high enough awareness?
Steve Barclay
That was one of the key issues that came out of the consultation responses. Indeed, in my conversation with Dr Watson at Homerton, we looked at different pathways for treatment that avoid the need for theatre. Key to that is some of the innovation on pain management that physicians are looking at, and how, through NICE, we socialise that innovation across the NHS.
Chi Onwurah (Newcastle upon Tyne Central) (Lab)
The north-east has some of the highest levels of health inequality in the country. North-east women spend more than a quarter of their lives in not good or poor health, which is almost 3 percentage points above the national average. Will the Secretary of State set out the steps that he plans to take to target those areas that already have high levels of inequality? Does he agree that, when he talks about research—I very much welcome the additional research—that should also target areas with high levels of existing inequality, which, unfortunately, is not the case at the moment?
Steve Barclay
We are already doing so on things such as the 75 family hubs that we have put in place. Again, a key part of this strategy is to then look at having women’s hubs, particularly in those areas where there is greatest disparity.
Jackie Doyle-Price (Thurrock) (Con)
I welcome my right hon. Friend to his place and the appointment of Dame Lesley Regan as the women’s health ambassador. I know them both to be very passionate and outcome-focused, and, between the two of them, I hope that we will make some headway. He rightly talks about how women do not feel listened to, and we know that women go for many years suffering from very common gynaecological conditions that do not get diagnosed. What role does he think that more public health education about healthy menstruation and what constitutes a healthy period can play to make sure that women are more empowered to look after themselves and get treatment earlier?
Steve Barclay
I thank my hon. Friend for her warm welcome. I agree with her about empowering patients, women in particular, with information. That is why part of the strategy is to focus on the information provided on the NHS website. There is also the need to work with trusted partners—to look at where people go for their health information, and how we can better empower them. For example, in the consultation, we heard of patients being told that heavy bleeding was normal—that it was something that they had to accept. Again, that was an issue highlighted by respondents in the call for evidence. It is about making sure people realise that, where there are issues, their voices are heard. That is at the heart of the strategy that we have set out.
Hannah Bardell (Livingston) (SNP)
I am delighted to see the UK Government follow in the footsteps of the Scottish Government with a women’s health plan. I am also pleased to see that they have taken on board the Stonewall campaign to bring the rest of the UK into line with Scotland on female same-sex couples’ access to in vitro fertilisation, because for far too long it has been a postcode lottery and lesbians have been discriminated against.
As co-chair, with the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy), of the all-party parliamentary group on endometriosis, I am pleased to see the recommendations for more research and better care for those who suffer from that condition, but can we be certain that that will be backed up by proper support and funding? Women’s healthcare champions are fantastic, but they cannot replace proper funding and a proper strategy. I pay tribute to the work of Sir David Amess: I have no doubt that this strategy and the endometriosis aspects of it would not be there without the great work he did as chair of the all-party group.
Steve Barclay
I thank the hon. Lady in particular for that tribute to the work Sir David contributed to this, and agree with her on the issue of same-sex couples having access to IVF. She is right about better research and how we highlight that; that is a key part of the strategy. It is also interesting from the comments of the health ambassador that services can be reconfigured in a way that gives better outcomes for the patient without leading to higher cost. By having centres of excellence where the woman’s voice is heard, treatment comes more quickly and that delivers better patient outcomes.
Alec Shelbrooke (Elmet and Rothwell) (Con)
May I welcome my right hon. Friend to his place and say how good it is that he has had direct experience with Kath Sansom and the work of Sling the Mesh? I also pay tribute to the hon. Members for Livingston (Hannah Bardell) and for Kingston upon Hull West and Hessle (Emma Hardy); the three of us have worked closely cross-party to bring these issues to the Floor in Westminster Hall debates and in this Chamber, which I think has played a big part in today’s strategy. I thank them across the House for that work.
Within the strategy there is talk of centres of excellence and mesh centres, but those must be carefully monitored, because we are getting a lot of feedback now that mesh centres are perhaps not working in the way we think they are. That must be carefully monitored, and data collections may not be working in the way my right hon. Friend would hope, so that will be important.
I welcome the strategy on listening to women. Anecdotally, too often the words “sexist” and “misogynist” have been used about the NHS’s attitude to women, and we need to move to a stage where those words are no longer used and it is not saying, “Go and take some painkillers,” patting them on the head and saying, “It’s all very normal.”
On that final point, will my right hon. Friend talk to our right hon. Friend the Education Secretary about teaching in school about diseases such as endometriosis? If people do not know a disease exists, how can they know they have it? That is an important point. Overall, I welcome this strategy as a massive step forward, but we must all recognise that we cannot give up. There is much more to do to ensure that what is in the strategy actually works.
Steve Barclay
I am grateful to my right hon. Friend, who I know has campaigned for many years on this; mesh is a particular issue that he and I have spoken about in the past. On the quality of data I am very happy to work with him on any specific examples, and indeed with colleagues across the House, because I know there are others who have worked closely on the mesh campaign, to see how we get the right consistency and the right analysis of data, because that is a shared interest of all of us in the House today.
In terms of the Department for Education, I am very happy to take the matter forward with my right hon. Friend the Education Secretary to look at what schools can do to raise awareness. That ties in with the wider point about ensuring that patients have the right information and that, where issues and concerns arise, they are not fobbed off but taken seriously.
Olivia Blake (Sheffield, Hallam) (Lab)
There have certainly been times, including now, when it has been very difficult for me to talk about my experience of miscarriage—an experience that is shared by one in five women and that happens in one in four pregnancies.
Last year, I held a debate and got the Government to agree to support some of the measures in the review on miscarriage in The Lancet, named “Miscarriage Matters”. The Royal College of Obstetricians and Gynaecologists now supports abandoning the three miscarriage rule in favour of a stepped response and graded model of care.
However, I want to know whether the other things promised at the end of that debate are included in this strategy. The first was access for everyone to 24/7 care. The second was data and recording of miscarriage on medical records; when I was called for my flu jab and asked why I had been called, the nurse said, “Because you’re pregnant,” then looked down and said, “Oh, well, you’re not, are you?” The third was stopping the need for unnecessary miscarriages by making the care better; we can prevent miscarriage in some cases even when it is beginning, and stop people having multiple miscarriages and having to live with this pain, increasing their risk of suicide.
We could do so much more. Miscarriages are taboo and too often they are put in the “too hard to deal with” box. A certificate would be lovely, yes, but that is not enough. We need adequate care that rapidly reduces the need for people to go through this trauma again and again.
Steve Barclay
The heart of the whole House goes out to the hon. Lady, because the trauma of those experiences is so visible; I am hugely grateful for the powerful way she highlights them to the House. She will be aware that we have the pregnancy loss review reporting later this year, and we will be looking at the important issues she raises. I know she met recently with the Minister of State, my hon. Friend the Member for Lewes (Maria Caulfield), to discuss those and, as someone new to post, I will certainly look closely at the points she raises.
Mrs Flick Drummond (Meon Valley) (Con)
I pay tribute to the hon. Member for Sheffield, Hallam (Olivia Blake), because I know exactly what she is feeling. This is the place to make a difference, so I offer her every encouragement to keep going. This is an extremely good strategy and will make a difference to women. I thank the Secretary of State for recognising that domestic violence has a dramatic impact on women’s health, particularly for women who are reluctant or embarrassed to go to their GP. Can he ensure that there is more training in primary care settings to recognise and help those vulnerable women?
Steve Barclay
My hon. Friend is absolutely right about the importance of tackling domestic abuse. Indeed, last year the Government brought forward and the House passed the Domestic Abuse Act 2021 in recognition of that. There is an important read-across from issues of domestic abuse into the wider piece about data and how that in turn links into prosecutions, evidence gathering and empowering those who are victims with the support they need. It is an extremely important issue, and it is important that we take that legislation forward.
Mohammad Yasin (Bedford) (Lab)
We know that midwives and maternity services are struggling across the country. In my own constituency, we have seen Bedford hospital, despite its best efforts, struggling with midwife recruitment and retention. What steps are the Government actively taking as part of the women’s health strategy to ensure that maternity services are well staffed and resourced?
Steve Barclay
While this strategy sets out a number of future steps, there are also steps we have already taken, including on maternity services. The hon. Gentleman will be aware that we have announced an extra £127 million of support for the NHS maternity workforce and £95 million to recruit an additional 1,200 midwives and 100 consultant obstetricians. Steps have been taken, and more steps are set out in this strategy.
Dame Caroline Dinenage (Gosport) (Con)
As one of the former Health Ministers who carried the baton on this strategy for some time, I warmly welcome my right hon. Friend’s words and his commitment. It is so important—not least the commitment to addressing some of the fertility inequalities across the country. I met with his predecessor because my constituency is one of those most severely affected by that postcode inequity.
As my right hon. Friend says, there are some real health inequalities in the services provided—not just for women, but between women, particularly those women who are vulnerable and hardest to reach. It is not just about money, which is why I am pleased with his commitment to hubs, but about ensuring that integrated care systems have a focus on place and on the needs of local communities. I would love him to commit more to that.
Since 2015, there has reportedly been a 42% real-terms fall in contraception spending, so I would also like to have my right hon. Friend’s commitment that this document will align with the sexual and reproductive health action plan. That is important because for every £1 spent on those services, we save £9 on other public health spending.
Steve Barclay
I am grateful for the work that my hon. Friend did as a Health Minister in championing this agenda. She is right to highlight the difficulty, often, of accessing contraception, which is very much at the heart of the responses we had on the fragmented service that many women have experienced. She will be aware that a key part of our approach is the health and wellbeing funds and working with the voluntary and community sector on support in areas such as pregnancy loss.
A key part of this is the visibility of the women’s health strategy. Putting that to the fore in terms of a women’s health ambassador is, as she says, part of these conversations with the integrated care systems to ensure that this gets greater prioritisation within commissioning. A key part of securing that is having the data to demonstrate its importance and benefits.
Munira Wilson (Twickenham) (LD)
I, too, pay tribute to the hon. Member for Sheffield, Hallam (Olivia Blake) for her very powerful and moving personal testimony.
Last year, my constituent Nicola experienced her seventh miscarriage, which was her third in just 12 months. One in 100 women suffers recurrent miscarriage, often without known cause and without effective treatment, and a disproportionate number are black, Asian and other ethnic minority women.
I welcome the Secretary of State’s commitment to boost research in this area, but I am afraid that we have not heard any specifics on how much. Last year, the National Institute for Health and Care Research spent only 5% of its budget on reproductive health and childbirth, yet these issues affect some 17% of the population. Will he give an indication of how much more he is going to spend on research in this area?
Steve Barclay
Through highlighting the tragic case of Nicola, the hon. Lady demonstrates very effectively why research in this area is so important and the fact that it has been insufficient in the past. The amount of funding is, to a large extent, shaped by the research proposals that come forward. A key part of the strategy is the clear signal that we are sending to the research community that we are encouraging those willing to do research in the areas that have not been focused on in the past so that funding can be prioritised to them.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
As joint chair of the all-party parliamentary group on endometriosis, with the hon. Member for Livingston (Hannah Bardell), and as joint chair of the APPG on surgical mesh, with the right hon. Member for Elmet and Rothwell (Alec Shelbrooke), I welcome this strategy, but I want to raise two issues that we would be really keen for the Secretary of State to look at.
First, we would like to see all the recommendations of the Cumberlege review implemented, including redress for the people impacted by vaginal mesh. Secondly, it was good to hear him talk about recognising how women’s health affects women in the workplace, but the charity Endometriosis UK is promoting making workplaces endometriosis-friendly by recognising that women who have endometriosis may have shorter periods of time off more regularly, which, in terms of HR policy, is frowned on and looked on badly, resulting in some women losing their jobs through no fault of their own.
Steve Barclay
I know from my own involvement in the mesh campaign just how central the hon. Lady’s role was in it, and I pay tribute the work that she has done on that and a number of other campaigns over recent years. In respect of mesh, she will be aware that an annual review is published. On the workplace issue, a key thing that comes out of the report is the significance of the time off work that many women are experiencing, with the difficulty, quite often, in having these conversations with employers. It is very welcome that the civil service has taken a lead, as has the NHS, in certain aspects of that, but there will clearly be more to do, and the point she raises will be part of that wider conversation.
Dame Diana Johnson (Kingston upon Hull North) (Lab)
I welcome the appointment of the women’s health ambassador, Dame Lesley Regan. It is an excellent appointment to that role.
The 2020 report on access to contraception by the all-party parliamentary group on sexual and reproductive health found that the current fragmented commissioning arrangements have a severe impact on women’s access to contraception due to a lack of joined-up services. With 45% of pregnancies in England being unplanned, what specific plans does the Secretary of State have to remove the barriers to co-commissioning of reproductive healthcare to require different parts of the system to work together to meet women’s healthcare needs?
Steve Barclay
I welcome the hon. Lady’s acknowledgement of the expertise that Professor Dame Lesley Regan brings as ambassador. I think she will be fantastic in that role. A key part of this strategy is addressing the fragmented health system and how that impacts on areas such as contraception. That is why we are having, for example, the women’s health hubs to provide a one-stop shop and centre of expertise so that we can better identify the services that people need.
Rachel Hopkins (Luton South) (Lab)
Black women are four times more likely to die during pregnancy and childbirth. What targeted preventive solutions will the maternity disparities taskforce apply to address this totally unacceptable position?
Steve Barclay
We are working through the taskforce’s recommendations and will publish our response shortly. Part of the reason the taskforce was set up is the disparity in data, which we clearly need to address.
Ruth Cadbury (Brentford and Isleworth) (Lab)
I really welcome this women’s strategy and hope that it will mean better care for women in relation to gynaecological and reproductive issues, breast cancer and so on, but it needs to go further. Too often, women experiencing severe levels of pain are sent away from their GP with painkillers and find out further down the line, sometimes too late, that they were actually experiencing a real health problem, whether lupus, cancer or one of any number of health conditions. This is backed up by a 2021 study that showed that men and women experiencing the same levels of pain are not treated equally by clinicians. Will the Secretary of State ensure that the focus on clinical training and retraining also addresses gender stereotyping in diagnosis and support?
Steve Barclay
Part of the reason this is a 10-year strategy is that we do need a change of culture as well as a change of systems, and that is what the strategy maps out. A key component of that is how we empower patients through areas such as the NHS website, working with trusted partners who provide health information. The hon. Lady is also right about training, not just for new entrants into the medical profession but for existing clinicians. We will be working with the royal colleges and others to drive that forward.
Jim Shannon (Strangford) (DUP)
Thank you, Madam Deputy Speaker. I have the strongest legs in the Chamber.
I very much welcome the Secretary of State’s announcement of additional moneys for women’s health training. He referred to one-stop clinics. I coincidentally spoke to a medical student who graduated in Cardiff today, who feels that more is needed for the specialty of women’s health, and specifically the menopause, which the hon. Member for Swansea East (Carolyn Harris) mentioned. What training will be extended to GPs, in the context of one-stop clinics, to ensure that each surgery has a trained GP available to advise and to help?
Steve Barclay
One of the key issues highlighted in the response to the call for evidence was how areas such as the menopause were being dealt with by the NHS. That is why we have a menopause taskforce looking at specific recommendations, one of which concerns the training of clinicians.
Madam Deputy Speaker
I thank the Secretary of State and everyone who took part in the statement.