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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

Suicide Prevention and the National Curriculum

Caroline Nokes Excerpts

Monday 13th March 2023 Westminster Hall

[Nick Gibb]

I will take both of those points under advisement. The hon. Member is talking about the wider issue of parents; we are really talking here about a curriculum for schools. Of course, in due course those children become parents—they become adults and parents. Teacher training is a wider issue. First of all, we need to get the curriculum right, and that is what will come out of this thorough review of the whole RSHE guidance, which we are starting right now.

The Government have also committed to publishing a new national suicide prevention strategy for England this year. The strategy will reflect new evidence and national priorities for preventing suicides. The Department for Education has worked closely with the Department of Health and Social Care throughout the development of the strategy to understand what more we can do to reduce suicide and self-harm among children and young people. In answer to the question from the hon. Member for Bristol East (Kerry McCarthy), my Department and the Department of Health and Social Care are committed to publishing that strategy this year.

In conclusion, the mental health of children is a priority for this Government, and we know that schools can play a critical role in supporting children’s mental wellbeing. We will monitor implementation of the new curriculum and continue to work to improve teacher confidence to deliver these broad-ranging and sensitive topics to the best of their abilities—a point raised by the hon. Member for York Central. We will also continue the roll-out of training for senior mental health leads and mental health support teams to ensure that schools are getting the best support possible on pupil mental health.

I have set out the measures already in place and the ways in which schools can and do support pupils, including those with suicidal feelings. Once the review of the RSHE statutory guidance has concluded, we will be able to consider what more can be done to support pupils further.

[Caroline Nokes (in the Chair)]

I call Nick Fletcher to wind up.

Crisis in Iran

Caroline Nokes Excerpts

Tuesday 25th October 2022 Commons Chamber

[Gillian Keegan]

Even having these debates—this is the second one on this subject in the few weeks I have been in this job—is helpful, and we will continue to raise the pressure, to work with allies and to raise concerns via our participation on the Human Rights Council. We will constantly keep things under review.

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

I congratulate my hon. Friend the Member for Harrow East on securing this important urgent question. There is a large Iranian diaspora in Southampton, and the women and girls who have been to see me have been clear that we must call out the murder of Mahsa Amini as femicide. It is the women and girls of Iran who are bearing the brunt of the repression. I would like to echo the comments about the BBC. Knowledge and information are power, and too little is coming out of and going into Iran to support those brave individuals. Will the Minister please go and talk to colleagues at the Department for Digital, Culture, Media and Sport to ensure that there is sufficient funding for the World Service so that the important work of BBC Persia can continue?

[Gillian Keegan]

I completely agree with my right hon. Friend about the bravery of the women in Iran, which I am sure those in the diaspora in her area are proud of. We will continue to work closely with our like-minded partners to ensure that Iran is held to account for the death of Mahsa Amini, including via the Human Rights Council in Geneva. As I mentioned earlier, the FCDO has put £94 million over the next three years towards supporting the BBC World Service, which is a vital lifeline for people both inside Iran and at home here.

Awarding Qualifications in 2021 and 2022

Caroline Nokes Excerpts

Thursday 22nd July 2021 Commons Chamber

[Nick Gibb]

Teachers have been very well supported by the exam boards, with guidance, training and grade descriptors. We want to try to ensure that we are doing everything we can to support teachers through this process. We know that, despite all that support, it has been a big task for teachers to get these grades, and it is a remarkable achievement that a very high proportion were delivered by schools on time by 18 June. That training and those grade descriptors have ensured, I believe, that we will have consistency and fairness in how grades are awarded in 2021. For 2022, it is our very firm plan that exams will go ahead, because, as I said, it is the fairest way of assessing young people.

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

I welcome my right hon. Friend’s announcement that students will be examined only on what they have actually been taught, in recognition of the acute impact that this year has had on their studies. Both students and teachers need certainty. Will he ensure that teachers will have the materials and resources they need to give their students that confidence?

[Nick Gibb]

Yes. We have set out in the consultation document on 12 July all the different options for the different subjects. For some subjects the adaptation will be optionality of choice of questions, whereas for others it will be advance notice or formulas and aids in the exam room to help students. This is to give students confidence that, despite all the disruption they have had over the past 16 months, they will still do well in that exam. We will respond to the consultation in the autumn so that, as my right hon. Friend requests, teachers have the certainty they need to teach the remainder of the curriculum.

Covid-19: Impact on Attendance in Education Settings

Caroline Nokes Excerpts

Wednesday 30th June 2021 Commons Chamber

[Gavin Williamson]

This is very much why we invested hundreds of millions of pounds in the roll-out of 1.3 million devices to be able to support schools, but most importantly to be able to support children, as the hon. Lady set out.

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

Can my right hon. Friend reassure me, as we look to 19 July and the end of the summer term, that there can be no question of a return to bubbles and self-isolation when children return in the autumn?

[Gavin Williamson]

I do not want to pre-empt the decision across Government on the next stage, but our direction is very clear about lifting the restrictions and ensuring that children are not in a situation where they have to bubble. That is very much part of the course of the road map, and of course we would very much expect that our children would not be facing that in September, as my right hon. Friend has said.

Education Return and Awarding Qualifications in 2021

Caroline Nokes Excerpts

Thursday 25th February 2021 Commons Chamber

[Gavin Williamson]

I refer to my answer to the hon. Member for Brentford and Isleworth (Ruth Cadbury) on the extra support that is being made available to further education colleges.

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

May I put in a plea for this year’s year 10 cohort, who will be taking their GCSE examinations in summer 2022? We have plenty of time to consider what those exams might look like. Will my right hon. Friend set out the details of that as soon as he possibly can to reassure young people and, indeed, their parents?

[Gavin Williamson]

I can very much reassure my right hon. Friend that we are currently working with Ofqual and the exam boards on that exact piece of work right now, and we would hope to be able to share that in the not too distant future.

Support for University Students: Covid-19

Caroline Nokes Excerpts

Wednesday 3rd February 2021 Commons Chamber

[Michelle Donelan]

This hardship fund is on top of the £256 million that we unlocked for universities and higher education providers to utilise for this academic year, and it will help those most in need. It does not provide a blanket rent rebate. But I regularly meet students across England and from different bodies to ensure that we are giving them the support that they need.

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

Many of the halls of residence of Southampton University fall within my constituency. The students there deserve and expect a quantity and quality of education that is commensurate with what they would be receiving if they had online classes. Can my hon. Friend confirm what pressure she is bringing to bear on all universities to make sure that our students are receiving the education for which they are paying?

[Michelle Donelan]

I agree with my right hon. Friend because online does not have to mean inferior, which is exactly why universities have invested a great deal of time and money to produce innovative and dynamic tuition. We are clear that every student deserves to receive quality, quantity and accessibility in terms of their tuition and this is being actively monitored by the Office for Students.

Education: Return in January

Caroline Nokes Excerpts

Wednesday 30th December 2020 Commons Chamber

[Gavin Williamson]

The right hon. Gentleman raises an important point about how vital it is to work with local directors of public health and local authorities. We believe that this will be of enormous assistance to those local authorities in identifying where more covid cases are. It will be an opportunity to deliver more rapid testing than has been delivered so far—not just in County Durham, but across the country. The right hon. Gentleman might have heard that extra support is being provided to schools and colleges so that they can stand up this testing. In some areas where schools and colleges have particular problems, we will look at supporting them with a team to help to get the mass testing up and established. Of course, the data being collected is vital. When youngsters test positive in a lateral flow test, that data will be fed immediately into the test and trace system, which is shared with local authorities.

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

Teachers, parents and pupils all need certainty. They need to be able to plan the return to school and prepare for exams if they are going to happen, and they need to know whether they will need additional childcare. I commend my right hon. Friend for his ability to make changes when required, but will he please assure my constituents that this is a plan that will stick and that it will give them all the certainty that they are desperately calling out for?

[Gavin Williamson]

I certainly hope that it does give people confidence to know that primary schools in my right hon. Friend’s constituency of Romsey will be opening on Monday, that exam year groups will be returning to secondary school and colleges on 11 January, and that all year groups will be returning shortly after that.

Nurseries and Early Years Settings

Caroline Nokes Excerpts

Thursday 3rd December 2020 Westminster Hall

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

It is a pleasure to serve under your chairmanship for the first time, Ms Ali. I add my congratulations to my neighbour, my hon. Friend the Member for Winchester (Steve Brine), on securing this important debate this afternoon.

Hampshire is reasonably well represented here this afternoon, but I do not want colleagues to think that that is because there is a particular problem in Hampshire with early years provision. I can assure everybody that there is not. Indeed, we have some of the highest quality early years provision in the entire country.

Over the last eight months or so, providers have been keen to emphasise to me the challenges that they have faced during the pandemic, and the challenges that they have risen to: making their premises covid-secure and ensuring that they are open for the children of key workers. In the regular Zoom calls that I have had with providers, they have been keen to emphasise the significant financial impact on the sector.

I was struck by the comments that I heard from one provider, who said that each and every month, with the number of reduced places that he could provide allowing for social distancing, he would be running his premises at a loss of £1,000 per month, which is simply unsustainable. When faced with those sorts of economics, providers take very difficult decisions and decide to no longer open their doors, which causes a reduction in the overall spaces available.

I do not intend to do a march around every childcare provider in my constituency this afternoon, but it is fair to say that they are very varied. As constituency Members of Parliament and, in many instances, as parents, we want to make sure that there is variety, whether it be the small village pre-school of the type I attended back in the 1970s or the larger more formal childcare settings, the individual childminders, those attached to schools or the maintained sector. It is absolutely right that there is variety, so that there is choice for parents and so that those facilities can be conveniently located.

I want to pay particular tribute to Lou Simmons of Abbotswood Day Nursery, who has provided me not only with the facts and figures about her business and the challenge it faces, but also a commentary on the wider sector. As she pointed out to me, the costs faced by her setting will not be identical to every setting, precisely because there is such a variety; but they are probably not atypical.

The stark reality is that with staff costs, pension costs, increases in utility costs and personal protective equipment costs all going up, the funding for childcare has not kept pace with the pressures faced. The £4.55 per funded hour per child over the age of three does not meet her operating costs of £6.80, and they have no choice but to make a charge for consumables, which parents do not necessarily understand, having listened very clearly to the Government’s mantra that it is 30 free hours per week. She will still run at a loss for every hour, every child. I know that my hon. Friend the Minister, who is working hard on this, is going to talk about the £44 million early years injection, but that is simply not enough to begin to cover the 75p per child per hour average loss made by providers such as Lou.

There is a stark reality to this. Just like the village pre-schools that have already closed, we will see the loss of childcare provision at a time when we know that women need to be able to access quality childcare to make sure that they do not lose out further in the employment market. Statistics provided by Mumsnet earlier this week, from a survey it conducted post pandemic, show that a significant proportion of mothers who use childcare—70%—were emphasising that they were struggling to balance the requirements of work and childcare at home.

These businesses, as we have heard, are run by women, employing women and providing opportunities for other women to go out to work. As my hon. Friend the Member for Winchester said, there is a social cost, which my hon. Friend Minister needs to step up and address.

Oral Answers to Questions

Caroline Nokes Excerpts

Monday 12th October 2020 Commons Chamber

[Nick Gibb]

I agree with the hon. Member. Good quality religious education can help to develop children’s knowledge of the values and traditions of Britain and other countries, and foster understanding among different faiths and cultures. At a national level, the proportion of time secondary schools spend teaching RE has actually remained broadly stable. It was 3.2% of all teaching hours in 2010 and 3.3% in 2019.

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

What steps his Department has taken to plan and prepare for arrangements for year 11 exams at the end of the 2020-21 academic year.

[The Minister for School Standards (Nick Gibb)]

We continue to believe that exams are the fairest form of assessment. Today we announced our plans for next summer’s year 11 exams to take place—the GCSEs—and we will work with Ofqual to engage the sector in planning for a range of scenarios of potential disruption to exams to ensure students get the results they deserve.

[Caroline Nokes]

I welcome my right hon. Friend’s written statement today and thank him for ending the uncertainty that was facing pupils, teachers and parents alike. Please can he reassure constituents such as one of mine, 15-year-old Charlotte, who wrote to me a couple of weeks ago and inspired this question today, that next year’s exams will take into account the disruption there has been to their learning, while allowing them to demonstrate their ability and what they have learned over the past few years, and please will he reassure her that further detail as to how that will be achieved will be coming very soon?

[Nick Gibb]

My right hon. Friend raises an important point. We do believe that the subject level changes to the content of assessment that was confirmed by Ofqual recently will reduce the pressure on students and free up teaching time. Combined with the timing changes to exams announced today, this does free up more teaching time to help address any unfairness. On top of that, as I have said before, there is the £1 billion catch-up fund, and we will have more to say later in the autumn about the issue of grading.