Women’s Health Strategy for England

Baroness Penn Excerpts

Thursday 21st July 2022 Lords Chamber

[Baroness Barker (LD)]

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

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

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

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

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

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

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

[Baroness Penn (Con)]

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

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

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

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

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

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

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

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

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

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

[Baroness Benjamin (LD)]

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

[Baroness Penn (Con)]

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

[Baroness Bennett of Manor Castle (GP)]

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

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

[Baroness Penn (Con)]

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

[Baroness Bennett of Manor Castle (GP)]

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

[Baroness Penn (Con)]

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