Women’s Health Strategy

Lord Bethell Excerpts

Tuesday 9th March 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, the warm words in this Statement regarding women’s health inequalities are certainly a start, but there is so much to do. Many of us in your Lordships’ House have been working on the Domestic Abuse Bill, where looking at access to health and mental health support for victims—the vast majority of whom are women—has exposed that there is a major problem.

Mental health has been brought into sharp relief, as the noble Baroness, Lady Thornton, has already said. But we know that it has been underfunded, and services pre- pandemic were already at breaking point. The pandemic has really exposed these shortcomings. What are the Government going to do to provide that parity of mental health services they committed to in 2015, which women in particular are finding difficult to access?

The Statement talks about women’s experiences of specific services. For pregnancy and maternity support, the pandemic exposed that, for far too long, pregnant women have been isolated and their partners not permitted to be with them. My own niece had a baby during lockdown and was not particularly well. When she went in for her weekly tests, not knowing whether she would have to stay in until the birth, her husband was not allowed into the hospital with her until she was actually in the delivery suite. That caused tension for far too long.

We have also seen that the vital role of health visitors and community nurses, which has been curtailed somewhat, is absolutely evident when they are not there. Community services for young mothers are really important, and I hope the Government will look at that.

The Statement talks a lot about endometriosis. I was diagnosed with endometriosis well over 40 years ago. I am pleased to say that treatment in hospitals has advanced considerably since those days. But what seems not to have changed is diagnosis and referral. I ask the Minister this: what support is there to train all GPs, primary care nurses and employers to recognise when women have these problems? They should not be dismissed as “a bit of a bother” because all women have a problem at that time of the month. It is not just an information issue for women themselves to recognise it. We need the professionals and the business community to understand that endometriosis is a very serious illness.

The Statement notes that

“77% of the NHS workforce and 82% of the social care workforce are women”.

They are absolutely on the front line but too often have been let down. Despite that enormous ratio of women in the workforce, there are still pay gaps—certainly at a higher level. It would be interesting to see the publication of the percentage of male and female staff at each level and for all trusts and CCGs to publish their pay gaps on an annual basis, as we ask large companies to.

We also know that a higher percentage of BAME women were at risk of serious Covid and death. This was particularly amplified for our front-line NHS and social care staff.

I echo the points raised by the noble Baroness, Lady Thornton, about caring responsibilities. It is not just about care for children who are home from school. The pandemic has brought into sharp relief the unpaid carers of adult family members. I would like to make a call out, and I hope the Minister will support me: when it is time for every one of us to fill in our census form in 10 days’ time, please will unpaid carers tick the box saying that they are carers? We need to know how many people out there are doing this. We know that the majority of them are women.

The Statement talks about issues facing women with disabilities. Yesterday, it was wonderful to see a series of tweets from disabled women about their lived experiences in our society. Some of it, especially on access to health services, was pretty depressing too.

Women with learning difficulties are also often at the end of the queue for health treatments. Ciara Lawrence, who is a Mencap ambassador, is an absolute shining example of how women with learning difficulties can get access to those services. She went for her cervical smear test a year ago. Since then, she has not only been promoting it among other young women with learning difficulties but is teaching the NHS how to work with women with learning difficulties to encourage and support them to have their tests. Women with learning difficulties also say that access to family planning services can often be harder too. Will the Government make sure that these issues for this group of disabled women are addressed?

The paper refers briefly to LBGT women, who also face particular difficulties in accessing services throughout their adult lives. What will the Government do to reach both these groups? I note that, towards its end, the Statement talks formally about working with women’s organisations, but so much will be missed if women who also have other protected characteristics—and their organisations—are not specifically asked.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, the noble Baronesses, Lady Thornton and Lady Brinton, have both made their points incredibly well, and I will not argue the toss about any of them. I completely acknowledge that Covid has hit women harder than men, for all the reasons that the noble Baronesses have given—I could have listed even more. Women who have worked from home have undoubtedly shouldered more of the burden and done more of the teaching, and that has led to adverse mental health outcomes. Those outcomes are a real struggle for a health system to cope with when it is trying to deal with social distancing. We have done our best, using telemedicine to try to bridge the gap, but there is a shortfall and we will have to work extremely hard to catch up. I know from my own experience the challenge that young girls in particular have felt during Covid, and the statistics confirm that.

I agree with the observation made by the noble Baroness, Lady Thornton, about IVF—it has been extremely tough. It has been hard for the HFEA to restart clinics, and there are women for whom the clock is ticking who have no other options. We have worked really hard to try to meet the practicalities of that service but there has been bad news for some people. That is felt very hard indeed.

The noble Baroness, Lady Brinton, spoke very movingly about pregnant women whose partners had not been able to be there for the scan. There are sometimes good reasons for that because the scanning equipment may be in the basement of airless diagnostics rooms where social distancing is not possible and the risk assessment is very tough. That does not detract from the fact that that has massive and distressing mental health consequences.

The noble Baroness, Lady Thornton, mentioned baby loss. There are many aspects to this. Bluntly, deaths during Covid hit all of us hard but women in particular. The noble Baroness spoke movingly of making grief an aspect of health planning; that is a good point, well made.

I completely accept the point made by both noble Baronesses that this plays into a long-term problem—it is not isolated or new. The review by my noble friend Lady Cumberlege paints a very clear picture of a defensive and siloed system that does not always do well for women; the culture is not always right and the practicalities do not always suit women’s lives and women’s bodies. The clinical trials regime has too often suited men. I will not defend every point that the noble Baronesses have made but I pay tribute to those who ran the clinical trials for the vaccines and did an enormously good job of recruiting women and getting a gender balance in those very important trials.

The noble Baroness, Lady Brinton, is, however, also right about data: too often it is skewed towards men. She mentioned in particular data about LGBT and disabled people and the importance of the census, which I completely endorse. But I know from my own work in the data area that too often our data is skewed away from those who belong to gender, disability or ethnicity minorities. The critical example—the one that is quite rightly often cited—is heart attacks, where the male symptoms are cited and the female symptoms are not. That is such a graphic and good example.

The noble Baroness, Lady Brinton, is right to raise pay gaps and representation, as is the noble Baroness, Lady Thornton, to cite the treatments for breast and cervical cancers, which have not always met the need.

I will not defend each and every one of these points. I would like to convey, however, the strong sense that we are trying to get one thing right in particular: listening. Anyone who reads the Cumberlege report, or speaks to my noble friend, will be struck by the really powerful testimony of patient groups who said that what agitated them most—more than almost anything else—was the feeling that they were not listened to. That has many effects, but two in particular. One is that we do not hear the symptoms and diagnostics: we get the health recommendations wrong because we were not listening. The emotional consequences of illness are, therefore, amplified. People feel frustrated and agitated because they can tell that they are not being listened to. We are absolutely determined to get that right.

This is a big exercise—bigger than the mental health exercise, because we have opened it up to the general public. We have had a phenomenal response, even in the day that it has been open, with more than 2,000 responses from the general public—a figure that I expect to grow dramatically.

We want to ensure that this exercise rights the wrongs because we really listen to women: we give them a platform and an opportunity to be heard and our response will be judged by whether we have truly listened to what we have been told.

I urge all noble Peers to put their evidence before the commission. We want a really good response that is truly diverse. There is always an anxiety in these situations that the groups with the loudest voice will predominate, but we are determined to make this evidence-gathering as diverse as possible. So I call on all in the Chamber to submit their evidence and encourage and enable those who have something to say to use this opportunity with vigour.

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[Lord Farmer (Con)]

My Lords, I have constantly argued against the lack of emphasis on prevention in the Domestic Abuse Bill and have been assured that the domestic abuse strategy and guidance will fill that gap. Domestic abuse disproportionately affects women’s mental and physical ill health, so will the new women’s health strategy prioritise its primary prevention, rather than, as usual, simply addressing its terrible harms?

[Lord Bethell (Con)]

I pay tribute to my noble friend for his campaigning on this important cause. It is not the specific focus of the health strategy but it will play a part in it, and I encourage my noble friend to submit the characteristically detailed evidence, for which he is so well known, to this important evidence-gathering process.

[Lord Kakkar (CB) [V]]

My Lords, I draw attention to my declared interests. In taking forward an initiative for clinical research as part of their G7 health agenda, how do Her Majesty’s Government propose to ensure alignment of the clinical research regulatory framework so that the approval of innovative devices and therapies is predicated on clinical trial and registry methodologies with appropriate representation of women, including those from ethnic minorities?

[Lord Bethell (Con)]

The noble Lord makes a really good point. I am not sure whether we have considered the gender aspect of the clinical trials work programme in our G7 agenda. It has been very much about pandemic-preparedness and ensuring that next time we are able to share clinical trial information. Of course, we pat ourselves on the back for our own vaccine clinical trials in the UK, which, I think, have met a new standard for gender representation. He makes a good point, however, about making that case in our G7 work programme, and I will take it back to the department for further consideration.

[Baroness Andrews (Lab) [V]]

My Lords, I welcome the consultation and hearing women speak for themselves. It is very encouraging that there has been such an immediate and very positive reaction. We have known for a very long time that health inequalities affect women specifically and disproportionately, and we can take action without necessarily waiting for the consultation—for example, the 2018 BMA report on women’s health showed that even women’s life expectancy had deteriorated, and it recommended changes in medical training and education. As the Minister says, getting this consultation right is a big challenge, but can he assure me that, however challenging it is, the findings will be heard, followed up, acted on and invested in?

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[Lord Bethell (Con)]

I reassure the noble Baroness that we are committed to getting this right. The Minister of State and Secretary of State are both very committed to this agenda, and the whole healthcare system has tuned in to the importance of getting this right. I pay tribute to some of the fantastic women whom I have worked with during the pandemic at the highest levels of the healthcare system. I will not do a rolling name check now, but I reassure the noble Baroness that there are some phenomenal female leaders at the top of the NHS, social care and science, who will, I am sure, personally drive this agenda forward.

[Baroness Jolly (LD) [V]]

My Lords, the Statement yesterday addressed “taboos and stigmas” around areas of women’s health, and the greatest of these must be FGM, which was not mentioned yesterday. In the year to March 2020, there were over 6,500 women and girls in whom FGM was identified: that is over 15 women a day that we know about. How do these girls and women fit into the national strategy?

[Lord Bethell (Con)]

My Lords, we are of course drafting the national strategy, and we are collecting evidence on what its priorities should be. Undoubtedly, FGM should be in there; it is the most horrific crime, and it still touches far too many girls’ and women’s lives. I would like to see this country rid of it forever as soon as possible, and I encourage the noble Baroness to submit evidence on that point so that we can move clearly on it.

[Lord Bourne of Aberystwyth (Con) [V]]

My Lords, the Statement rightly identifies the concern of mental health. Given the particular challenges experienced by women in the pandemic, from domestic abuse and disproportionate job losses to increased caring responsibilities, I ask my noble friend to give special focus to this area of research. I also applaud addressing the need for proper representation in the research programme of women from ethnic minorities, including from the Gypsy, Roma and Traveller communities .

[Lord Bethell (Con)]

My Lords, my noble friend touches on two very important points. He is entirely right that mental health has previously been underrepresented in the strategies of our healthcare. I hear loud and clear noble Lords who repeatedly make the case for a greater focus on mental health, and I take that message back to the department as much as I can. I reassure him that mental health will be very much a priority in this area. The two facts—that it is often women who are connected with mental health issues and that it is women who are often overlooked—are probably connected. It is extremely challenging for us to get women from ethnic minorities, for instance those from a Gypsy or Roma background—that is such a good example—fully engaged in our healthcare strategy. If the noble Lord has any suggestions or recommendations for how we can better engage with them, I invite him to submit evidence to the consultation.

[Baroness Blackstone (Ind Lab)]

My Lords, I draw attention to my interests as chair of the trustees of the Royal College of Obstetricians and Gynaecologists. I warmly welcome this Statement, but we know that women’s healthcare is too often fragmented and unco-ordinated. So how will the Government ensure that their different strands of work on women’s health—this strategy, the sexual health strategy and the violence against women and girls strategy—are all properly aligned and based on a life course approach to women’s health, avoiding the creation of even more fragmentation for women?

[Lord Bethell (Con)]

My Lords, the question of fragmentation does not affect women alone; it is a problem across the healthcare system. However, the noble Baroness is entirely right: some of the conditions that afflict women in particular are not properly prioritised, and, therefore, the pathways connected with them are not as developed as they should be. That is the kind of challenge that we wish to address. However, the overall macro point is this question of listening: have we really listened to women—their symptoms, needs and health priorities—or are we behind the curve on that? I suspect that, too often, the health priorities that women would like to see emphasised simply have not been heard by the system.

[Lord Wigley (PC) [V]]

My Lords, I draw attention to my registered interest as a vice president of Mencap. In presenting this Statement to the House of Commons yesterday, the Minister stressed that the inquiry that the Government is initiating will specifically include disabled women and those with mental health issues—something that I greatly welcome. Will the Minister confirm that this group will also specifically include, in their own right, women who have learning disabilities, because they are disproportionately vulnerable to illnesses that have no relationship to their disabilities, which places them in potential double jeopardy and needs to be addressed in its own right?

[Lord Bethell (Con)]

Yes, I can reassure the noble Lord that the call for evidence is open to everyone aged 16 and over, which, of course, includes people with disabilities and learning disabilities. The online survey within the call for evidence specifically mentions disabilities throughout, and I reassure the noble Lord that the evidence that we gather with regard to disabilities and learning disabilities will be considered extremely carefully to inform the priorities, content and actions of the strategy.

[Lord Lucas (Con) [V]]

My Lords, should we be looking at leveraging the great success that we have had in developing online medicine during the pandemic to provide women with unmediated, immediate and direct access to specialist services on chronic issues such as menstruation, menopause problems and so on? After all, this is a structure that we have used successfully for many decades for eyes and teeth, and it is one that might also suit the trans community.

[Lord Bethell (Con)]

My Lords, as Minister for Innovation I favour using technology and the latest techniques wherever possible to provide options and choices for all patients, including women, to address their conditions. With women, the delicate question of their bodies, and the different functioning of their bodies to men’s, is one that the health system has to reconcile itself to. I do not regard technology as a panacea to that central challenge; in fact, I think that many of the issues that women face will require face-to-face consultations, and we remain committed to ensuring that that is an option for everyone.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, I will not ask the Minister whether he has read Invisible Women by Caroline Criado Perez—or the medical chapter at least—but, if he has not, I would recommend it. One of the things that it highlights is how many widely and long-used drugs have never been tested for any sex and gender variations in responses. Do the Government have a systematic programme for checking that all drugs have been so appropriately assessed—so that, when the results of this call for evidence are received and acted on, appropriate treatments are available to the newly enlightened medical systems?

[Lord Bethell (Con)]

My Lords, I have previously referred to the challenge of gender-comprehensive clinical trials. There is growing evidence that drug prescriptions should be personalised a great deal more than they are, right across the board—not just on a gender basis but on genomic, ethnic, age and weight bases as well. The noble Baroness makes an extremely good point on this. I cannot guarantee that we will retrospectively conduct gender-specific clinical trials on the full library of medicines in the medicine cabinet, but we are keen to aspire to ensuring a future commitment to gender-specific clinical trials going forwards.

[Baroness Stroud (Con) [V]]

My Lords, in the ministerial foreword to the Women’s Health Strategy, the issue of data gaps has been highlighted. One such data gap I would like the Government to look at is the way in which abortion complication data is gathered. The Minister in the other place confirmed in a recent Written Answer that the only method the department uses to gather this data is via HSA4 forms. Between April and June 2020, from the 23,000 at-home abortions, these forms reported just a single complication, yet FOI requests to just six hospitals during the same period suggested that women were presenting due to complications at a rate five times higher than that reported by the Department of Health and Social Care. Moreover, there were 36 999 calls due to at-home abortion complications every month to the ambulance service. As part of the Women’s Health Strategy, will this gap be addressed, and does the Minister agree that the number of women who present to hospitals due to incomplete abortions requiring surgery or retained products of conception should be collected centrally?

[Lord Bethell (Con)]

My noble friend makes her case extremely powerfully, and the numbers she cites are extremely persuasive. I do not have a full brief on the treatment of abortion complication statistics at my fingertips, but she alludes to exactly the kind of data gaps that we wish to address in this consultation period and in the emerging strategy. If she would like to submit the evidence she has just described, we will definitely take it on board and use it as part of our strategy-drafting exercise.

[Baroness Ritchie of Downpatrick (Non-Afl) [V]]

My Lords, participants in clinical trials for breast and ovarian cancer not only take the medication as part of those clinical trials, whether they are double-blind or whatever, but give information about their genomic background and their ongoing assessments. Would it be possible, subject to their permission, to use that information from women as part of the strategy for updating and improving women’s health?

[Lord Bethell (Con)]

The noble Baroness is way ahead of me on that extremely specific point. I would be very happy to understand it more clearly, and if she could write to me with the details, I would be happy to take it on board.

[Baroness Warsi (Con) [V]]

My Lords, I welcome the Statement and particularly its commitment to ensure that all women’s voices are heard in setting out the health strategy, so can my noble friend confirm what platforms will be used to publicise the call for evidence and what languages it will be promoted in? Particularly in communities where the spoken word is more popular than the writing down of experiences, what efforts will be made to allow women to contribute to this call for evidence via face-to-face interviews, albeit virtually?

[Lord Bethell (Con)]

My Lords, we are largely inviting written submissions from individuals and organisations with expertise in women’s health. It is envisaged that this could largely be done either by individual researchers, royal colleges, think tanks and third sector organisations, as well as the general public. There is an online platform and the online survey accommodates screen reader support, allowing for questions and answers be rendered in other formats, such as spoken language or Braille output. I accept the thrust of my noble friend’s point that we need to do enough to reach ethnic minorities and those from hard-to-reach populations, who should have a voice in this kind of exercise. Let me take that point back to the department and I will write to her accordingly.

[Baroness Stuart of Edgbaston (Non-Afl) [V]]

My Lords, I welcome the Statement and I welcome what the Minister said earlier in response to a question about FGM. I know from the work done in Birmingham hospitals that the problem is probably much wider than any of us appreciate. At the end of this consultation, if the Minister finds that, in some areas where we asked for data, the data was not forthcoming, but we know we ought to seek more data and more information, will he undertake to do so to identify problems where part of the problem is that they are still very much hidden?

[Lord Bethell (Con)]

This debate is, unfortunately, not the place for me to be able to make that sort of commitment, but I completely take on board the point that the noble Baroness makes. There are hidden crimes in our communities and we cannot sit back and wait for them to present themselves; we have to go and find the evidence in order to meet the challenge. I am sorry to repeat this point, but I invite the noble Baroness to make this point in her evidence to the consultation. It is exactly that kind of insight that we are seeking to elicit, and the strategy is exactly the right platform for us to be able to make those kinds of points.