Endometriosis Education in Schools

Caroline Nokes Excerpts

Tuesday 21st May 2024 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I thank the right hon. Member for Elmet and Rothwell (Sir Alec Shelbrooke) for highlighting the issue in this debate. He has done that in Westminster Hall numerous times, and more times again in the main Chamber. I have heard him on many occasions and I admire his determination to discuss this subject matter and to make people aware of it—I congratulate him on that. The hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) made two significant interventions. Although she did not say so, I suspect they came from a place of personal knowledge.

As Members may be aware, while I am a father to three sons—my wife always wanted a wee girl, but it was just not going to happen—I work in an office with six female staff members and one male. I am certainly a lot more educated than I had been, and let us be honest, that understanding should not have taken that long. Gone should be the days of boys and girls being separated out to discuss those issues. The right hon. Member for Elmet and Rothwell mentioned that in both his introduction and summing-up. Those issues affect entire households and there should be a frank, honest and non-shameful understanding, which, frankly, does not take place at the moment.

The right hon. Member for Elmet and Rothwell referred to a story from one of his constituents which is like mine. When I married my wife, which will be 37 years ago on 6 June, the doctor told Sandra, “If you have a child, this will all go away.” Well, no it did not. Indeed, three boys later and it still had not gone away. My wife suffered with the condition over all those years, and only in the last three or four years, because of life-changing things, has it been slightly different.

I will refer to one of my staff members who suffers from endometriosis. I told the right hon. Member for Elmet and Rothwell beforehand that I was going to tell her story. I am not going to mention her name, because that would be the wrong thing to do, but I want to tell her story. It is a terrible story that she has been through. She was diagnosed in 2019 at the age of 24, after having been referred to gynae in 2012, seven years earlier. It took seven years to get the diagnosis. She has not yet been able to see an endometriosis consultant and she is now 29 years of age. That is 12 years, and she is still on the waiting list.

She has been red-flagged on three separate occasions. Her GP, who is very good—I am not saying all GPs are not good, just to be clear—is one of the few to hold a gynae clinic at GP level and has instigated medical menopause, given oestrogen and implanted a coil all on the basis of her ultrasound. Her doctor has been incredibly helpful to her, but she has been through all sorts of problems. She has worked for me for a fair few years, and I am well aware of some of the problems she has, not from a personal point of view but from watching her and seeing how it affects her days as she works. Most GPs do not offer the facility that her GP does.

There are two specialists in Northern Ireland, and we are left with women who are in pain and afraid for their fertility potential. Their partners do not know how best to support and help with what they cannot see and perhaps cannot understand—I think that is part of it as well. People can offer sympathy and comfort and talk to their partner or wife, or perhaps friend, on these matters, but sometimes they do not really understand, because they cannot really feel what they are going through. I believe that the right hon. Member for Elmet and Rothwell is right. We need an absolute shift in the narrative, away from closed doors, to understanding.

We need to stop the classification of “women’s problems”. My mother probably suffered from something similar to this. She is 92, going on 93. I remember that when she was younger, she had a number of miscarriages and other things that happened. My mother says that they were always referred to as “women’s problems”. That covers very generic subject matter, but it does not really illustrate the issue.

[Caroline Nokes (Romsey and Southampton North) (Con)]

I thank the hon. Gentleman for giving way and I apologise for my late arrival, Ms Vaz. Does the hon. Gentleman agree that this is one of the fundamental problems? When we describe things as “women’s problems”, we are actually shying away from giving conditions and diseases the proper names that they have and, in so doing, are effectively avoiding an informed, intelligent discussion.

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[Catherine McKinnell]

The right hon. Gentleman once again demonstrates how incredibly knowledgeable he is about this issue, and how much that knowledge is lacking among the wider public and in this place. We are grateful to him.

It is so essential that young people are taught about their bodies in school, and that they learn about not just relationships and sex, but health and wellbeing. That must include what is and is not normal throughout puberty, the menstrual cycle and hormones, to set young girls and young people up to live healthy lives, both mentally and physically.

[Caroline Nokes]

The hon. Lady makes an important point about what is and what is not normal. When the Women and Equalities Committee did some work on women’s reproductive health, we got the message from various witnesses that they simply had no comprehension that their periods were not normal, because the message that they got from medics the whole time was, “You just have to get on with it.”

[Catherine McKinnell]

The right hon. Lady makes an important point—her Committee has done so much important work in this area—and it points to the importance of our education system in combating misunderstandings and providing people with the knowledge that they need to be armed with in order to manage what they and those around them will experience through life.

Sex education has been compulsory in English schools since 2017 and initially covered broad elements of sexual and reproductive health. After many years of campaigning, it was revised in 2020, and since then both boys and girls in state schools have been taught about periods and menstrual wellbeing. Of course, as with the rest of relationships, sex and health education, resources need to be tailored to the relevant age group. They need to be sensitive to a young person’s maturity and their needs.

The Government website states:

“Educating all pupils and students about periods is crucial to tackling the stigma which surrounds it.”

Labour very much agrees, and the next Labour Government will ensure that the curriculum taught in all state-funded schools reflects the issues and diversities of our society and ensures that all young people leave school ready for life.

We have already pledged to deliver, in government, an expert-led curriculum and assessment review, which will learn from international best practice and research across all areas, from history to health, to make sure that our curriculum is as strong and relevant as it can be. I look forward to hearing more from Members in this place and from stakeholders when the review gets started, to ensure that we pick up on the issues that have been identified in the debate today.

Part of that will require having enough teachers in the classroom to improve children’s outcomes and ensure that the curriculum can be delivered to every child as intended. Over the past few years, we have seen dire statistics on teacher recruitment, especially in secondary schools. That is why we have made tackling the recruitment and retention crisis a real focus and announced fully funded plans to deliver 6,500 more teachers to fill the gaps across the profession.

However, I recognise that education will only go so far. This is very much a health issue too, and one on which far too many women are being failed. Nearly as many women in the UK have endometriosis as have diabetes, yet it is unseen in everyday life. Women are waiting far too long for treatment; gynaecology waiting lists have seen the biggest increase of all specialisms in the NHS since the pandemic. As the right hon. Member for Elmet and Rothwell painfully set out, that leaves those experiencing endometriosis with years of unrelieved pain in the bowel or bladder, poor mental health, fertility problems—the list goes on.

I was glad to see the women’s health strategy published in 2022, but it must go further. We must address the NHS backlogs, bring waiting lists down and set out a plan to properly address the workplace challenges in the NHS. For those living with endometriosis who are impacted by poor mental health, Labour has committed to establish a mental health hub in every community. We will deliver mental health support in every secondary school and ensure that young people who are experiencing symptoms relating to such conditions, as well as all those struggling with their mental health, can access that support.

For too long, women’s health has been an afterthought. I am glad that debates like these are being held so that there is an opportunity to discuss these issues in Parliament. I reiterate my gratitude to the right hon. Member for Elmet and Rothwell for bringing forward the debate and for all his contributions on this subject. I also thank all the other hon. Members who have attended for their contributions. We have to get the education right. We have to ensure that young people have the information they need to live a healthy life. I look forward to hearing from the Minister what steps the Government will take to improve our education in this important area.

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[Caroline Nokes]

Apologies for not having dug around in any great detail in the very recently released guidance, and I absolutely appreciate that this is a debate about endometriosis, but what we might call problem periods can cover a whole range of conditions. We heard evidence on my Committee from Vicky Pattison, who talked about her severe pre-menstrual stress—I cannot remember the precise acronym—and Naga Munchetty spoke of adenomyosis, which I have finally learned how to pronounce. Are both those conditions also included? Teaching young girls to have the language around what is normal and what is not, and giving them the confidence to speak about it, is about more than just saying, “And you might get endometriosis”. There is a whole range of conditions out there.

[Damian Hinds]

To come back to my earlier point, the secondary curriculum includes more on menstrual and gynaecological health, now specifically including endometriosis, polycystic ovary syndrome and heavy menstrual bleeding. Beyond that, I will have to ask for my right hon. Friend’s forgiveness and ask that I may write to her or that we can follow up separately.

Ofsted will inspect schools on their delivery of the RSHE curriculum. As part of their personal development judgment, inspectors will discuss with schools whether they teach RSHE in line with the RSHE statutory guidance. The guidance is now out for consultation for eight weeks and I have a feeling that colleagues in the Chamber or some of the outside bodies they are in close touch with might take part in that consultation. We will take all responses to the consultation into account in the final version of the guidance.

We are expecting a huge amount of interest in the updated draft guidance and I can confirm from the last time that we had a consultation on draft RSHE guidance that there is, understandably and rightly, a lot of public interest. We hope to analyse that over the summer and publish a final version soon after. Schools will then require time to implement any changes to the curriculum and to consult parents about those changes. It would not be fair to expect them to deliver new content without some time to prepare for it, but where they are ready to deliver new content, they can do so immediately. Indeed, I am sure many schools already cover endometriosis when discussing healthy periods and we have encouraged that.

Following a meeting with the chairs of the all-party parliamentary group on endometriosis in 2021—at the time they were the hon. Member for Kingston upon Hull West and Hessle and our much-loved and much-missed late colleague Sir David Amess—the then Schools Minister agreed to update the Department’s teacher training module on the changing adolescent body so that it too included a direct reference to endometriosis. Once we have finalised the RSHE statutory guidance later this year, we will update the teacher training modules and consider whether any further support is required.

To date, we have invested more than £3 million in a central support package to increase schools’ confidence to teach such subjects, including teacher training modules, non-statutory guidance, a train the trainer programme and teacher webinars on domestic violence, pornography and sexual exploitation. They are all available on a one-stop page for teachers on gov.uk. Of course, there is always more to do to help schools and we will look at that after the publication of the guidance and when we have listened to school leaders, stakeholders and others.

The hon. Member for Newcastle upon Tyne North moved into some parallel important areas of mental health and her party’s concentration on mental health support in secondary school. I remind her that we are already in the process of rolling out mental health support teams across the country. We think that is important for primary as well as secondary schools and it has to be done at a pace at which we can recruit the people required for those teams. As she will know, we have also offered a training grant to all schools—primary as well as secondary—for training for a mental health lead within the existing school staff, with a high level of take-up already.

I am enormously grateful to my right hon. Friend the Member for Elmet and Rothwell for his support in securing the debate. He has raised some very important concerns, as have others. I hope that he is pleased to see the Government’s continued work to improve menstrual and gynaecological health in schools today and for future generations of women. The steps we have taken so far to improve health education are extremely important and we really want to get them right. The Government will continue to make a commitment to support the policy area because it is the right thing to do. I thank my right hon. Friend once more for his continued drive on this important subject and for bringing this crucial debate to Westminster Hall today.