Women's Health Strategy

Private Members' Business – in the Northern Ireland Assembly at 11:00 am on 13 February 2024.

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Photo of Nuala McAllister Nuala McAllister Alliance 11:00, 13 February 2024

I beg to move

That this Assembly calls on the Minister of Health, working with his Executive colleagues, to bring forward, as a priority, a fully budgeted women’s health strategy that supports women through every stage of their lives, and is focused on education and awareness raising, screening and earlier diagnosis, and support services and care pathways; and further calls on the Minister and his Executive colleagues to include in this strategy a menopause clinic, earlier gynaecological cancer screening, a framework of support relating to fertility, birth control, pregnancy, baby loss and post-natal healthcare, an emphasis on menstrual health, including long-term specialist support for endometriosis, and plans to tackle health inequalities experienced by women from different socio-economic and ethnic backgrounds.

Photo of Steve Aiken Steve Aiken UUP

The Business Committee has agreed to allow up to one hour and 30 minutes for the debate. The proposer of the motion will have 10 minutes in which to propose and 10 minutes in which to make a winding-up speech. As an amendment has been selected and published on the Marshalled List, the Business Committee has agreed that 15 minutes will be added to the total time for the debate.

Photo of Nuala McAllister Nuala McAllister Alliance

The motion calls for the creation of a fully budgeted women's health strategy, addressing every aspect of a woman's life from birth as a priority. Many women's organisations, medical organisations and lobby groups have been in touch over the past week but also over the past decade to lobby us and to ensure that we highlight the issue and that we can get support across the Chamber for a women's health strategy. There are many issues that we can talk about today, and each of those organisations has highlighted the matter to me and, I am sure, other MLAs in the Chamber. I pay tribute to one such group, members of which are in the Public Gallery behind me today. Members of Nothing About Us Without Us have been working on the issue for years to ensure that their voices as women are heard when it comes to the commissioning of such a strategy.

I move on to the motion. It is an unfortunate reality that women often face additional barriers in accessing proper healthcare. Health concerns presented by women are still too frequently dismissed or incorrectly attributed to mental health or menstruation and the monthly cycle. Women are more likely to receive incorrect diagnoses for conditions such as strokes or heart attacks, and that leads to a delay in treatment and worse outcomes. Evidence has shown that a lack of research into conditions that specifically affect women can lead to poor health advice, missed diagnoses, delayed or ineffective treatment and overall worse outcomes.

Conditions such as endometriosis often go undiagnosed for years, further exacerbating women's health disparities. Therefore, if we are to tackle the health inequalities facing women, we must take a holistic approach that encompasses all aspects of healthcare. It must begin with ensuring that there is proper health education for women. From puberty to pregnancy and from menopause to mental health, we must ensure that everyone is equipped, not just women, with the facts around the health challenges that specifically impact on women throughout our lives.

Proper screening and early diagnosis is crucial to ensuring improved health outcomes. That includes the need for improved screening for gynaecological cancers. The current delay in smear test results, which can sometimes be up to six months, undoubtedly causes anxiety and could have a devastating impact on a patient's prognosis. We are talking about a cancer that could be eliminated within the lifetime of today's young girls. I am sure that everyone in the Chamber will agree that we all felt the angst around the current issues with the trusts' review of cervical cancer, with some probing back as far as 2008. Any strategy must include lessons learned from those reviews and ways in which we can mitigate late diagnosis in a cancer that we can eliminate.

It is Sexual Health Week, and, through proper factual health and sexual health education, young girls can equip themselves with the proper information about their bodies, their health and how their life can impact on their health. Of course, contraception is a vital element, and it is imperative that any women's health strategy includes raising awareness of the various forms of contraception and the effects that they have on our bodies. Too often, young girls are pointed to specific contraception without knowledge of what is on offer and what may be best suited to their bodies.

Fertility treatment, pregnancy health and post-partum health are also key components of a women's health strategy. I have recently been engaging with the Royal College of Midwives, an organisation that has provided vital representation for midwives and advocacy around maternity issues for years. It highlights the impact of a woman's health on maternity services. The healthier women are at the start of their pregnancies, the better the chances of a more straightforward pregnancy and birth. Pregnancy is an opportunity for women to avail themselves of health services that may impact on and improve their health overall. It is a period of several months in which women will be in contact with healthcare professionals. They are usually younger women, and, therefore, they are at a time in their life when they can change unhealthy habits before those habits have taken an irreversible toll on their bodies. Importantly, maternity care is a moment to spot mental health issues and get them treated. The importance of perinatal mental health cannot be overstated. However, in a women's health strategy, those maternity services, including mental health services, should be part and parcel of a holistic approach.

The motion also discusses the importance of the inclusion of menopause services. We need to see specialist menopause clinics and a distinct menopause strategy in the action plan, because, too often, education and awareness around that has been lacking, with women left unprepared for the realities of menopause. I was glad to see that so many of our male MLAs took the opportunity to wear the MenoVest last week with Over The Bloody Moon and get a taste of what women experiencing menopause will go through. That is important, and any other MLA who would like to avail themselves of that service should do so to get a taste of what it is like for older Members.

I thank the Chartered Society of Physiotherapy for highlighting the crucial role that physiotherapy can play in addressing many of the health inequalities that women face by providing tailored care for women throughout their lifespan. From prenatal care to post-partum rehabilitation, pelvic health, menstrual health, menopausal health, breast health and preventative care, physiotherapy can offer comprehensive support for women's unique health needs. That is just one example of how the strategy can and must take a holistic approach.

It is also important to note that any strategy must take account of the additional issues that women from different socio-economic and ethnic backgrounds face. There are clear disparities in health outcomes and life expectancy between the most and least economically prosperous areas of Northern Ireland. Research has also clearly shown that women from ethnic minorities face additional barriers when accessing healthcare, with particular challenges presenting in maternity care. If we are to properly address that, there must be an intersectional approach.

I welcome the amendment submitted by Linda Dillon and Liz Kimmins. It asks for a reduction in the gender gap in cardiovascular outcomes to be included, and we will support it today. Heart disease is the leading cause of death for women in Northern Ireland, with, according to the British Heart Foundation, around 26,000 women here living with heart disease. There is a clear need for a gendered approach to tackling the prevalence of heart disease and the disadvantage that women face at every stage of the patient pathway.

I was glad to see that the Minister referenced the need for a women's health action plan in his remarks when returning to office last week. That work is long overdue. Work had begun in the Department but, unfortunately, was delayed by the pandemic and the collapse of the Assembly. It is important that any such action plan takes on board a co-design approach with the many organisations and practitioners who are experts in the field. It is crucial that work resumes as soon as possible on the strategy to ensure that women in Northern Ireland can have confidence that their health is a priority for the new Executive.

Photo of Linda Dillon Linda Dillon Sinn Féin

I beg to move the following amendment:

Insert after "healthcare,": "a reduction of the gender gap in cardiovascular outcomes,"

Photo of Steve Aiken Steve Aiken UUP

Thank you. Linda, you have 10 minutes to propose and five minutes to make a winding-up speech. All other Members will have five minutes. Please open the debate on the amendment.

Photo of Linda Dillon Linda Dillon Sinn Féin

I thank the Members for bringing the motion to the Assembly today, and I welcome the opportunity to speak to the issue.

The fact that we have to call for a women's health strategy in 2024 is far from ideal, but I am glad that we are finally getting to the point of having not only the conversation but, hopefully, the opportunity to implement a strategy. I know that the Department has already been doing work, even in the absence of the Assembly. I was given that reassurance by the permanent secretary in the meetings that I had with him prior to the Assembly being restored.

I thank our MLA Órlaithí Flynn, who is chairperson of the all-party group on women's health. She has kept a strong focus on the issues facing women and their health. Órlaithí has hosted excellent events and speakers to give us the detailed information and the uncomfortable truths about the gaps in services for women in many areas of our health service. We have heard from health professionals, women with lived experience and the amazing charities that support women, including Menopause Support NI, endometriosis support groups and the Heart Failure Warriors group, which will be here next week for all MLAs to drop in and have a chat.

I thank our male colleagues across the Chamber who supported the recent event in the Long Gallery and for donning the MenoVest to highlight just some of the symptoms — I stress that they are just some of the symptoms — of the menopause.

That support is very welcome, as inequalities in women's healthcare impact on us all. There is a cost to women, their families, society and our entire economy. It is everyone's responsibility to tackle those inequalities.

I am aware that, when we talk about women's health, people think that we are talking about gynaecological health. If we want to truly make a difference to the health outcomes for and the quality of life of women, we need to ensure that all areas of health where inequality exists are included. It is for that reason that we tabled the amendment. I am glad to hear that the proposer of the motion will support our amendment, and I hope that all MLAs across the Chamber will support it.

A reduction in the gender gap in cardiovascular outcomes must be included in any women's health strategy. There are significant gaps in awareness, diagnosis and treatment of heart disease in women. Heart disease is, in fact, the leading cause of death for women in the North. Approximately 26,000 women here are living with heart disease. It kills twice as many women as breast cancer. In 2022, almost 2,000 women died from heart and circulatory diseases in the North, with 334 of those deaths resulting from heart attack. A heart attack is a medical emergency. As we all know, timely, effective treatment is critical. However, research that was funded by the British Heart Foundation has found that women are less likely to receive guideline-indicated care and that more women than men die following a heart attack. Women are 50% more likely than men to be misdiagnosed or to receive a delayed diagnosis following a heart attack, and they are more likely than men to exhibit longer delays in seeking medical care after the development of symptoms that are suggestive of a heart attack. We can probably attribute that not only to social bias but to the lack of awareness, education and understanding among men and women and in our medical profession, because most of the research on the issue was done on men. We need to make sure that that changes.

Women are dying needlessly from heart disease because our health system has failed to recognise and address the lack of awareness, the misdiagnosis and the delays in getting appropriate treatment. The new Assembly and our new Health Minister have an opportunity to turn that around, to do better and to deliver for women who are being failed by the health system.

I will address some other areas in the motion around women's healthcare and the serious challenges in accessing services and treatment. As a 47-year-old, post-menopausal woman — I am not afraid to say my age, because I still think that I am younger — I have experienced at first hand the gaps in services and treatment and the gaps in basic information and advice about how the menopause can affect you. I was only 40 when my menopause began. I decided that I would tough it out, get through the hot flushes and get to the other end of it and that I would do it without HRT. However, that was due to ignorance about what I was going through. It was due to a lack of understanding of and basic advice around the subject. Last year, I sat at an event in St Joseph's College in Coalisland and listened to Dr Declan Quinn speak. That presentation gave me more information in half an hour than I had had in my whole 47 years of life. That tells us all that we need to know about the information and advice that are out there for women.

My big concern was that, although I knew that I had been through the hot flushes and three or four years of not being able to sleep, I did not know that the brain fog that I was experiencing was due to the menopause. I did not know that it was impacting on my bones. The first thing that I did the next morning was contact my GP about starting HRT. I am very glad that I did, because, as I said, I feel young. I want to feel as young as I can and be as mobile and independent as I can for as long as I can. We need to ensure —.

Photo of Paula Bradshaw Paula Bradshaw Alliance

Does the Member agree that we need to remove the stigma of HRT? If you have any other condition, you will go and get medication, but there is that reluctance in women to go forward to get their patches.

Photo of Linda Dillon Linda Dillon Sinn Féin

Absolutely. That is one of the reasons why I decided to speak here about my experience. It is like anything else: if we do not talk about it, we will not educate our daughters and the other young women who come after us. It is important that we speak about it and normalise the conversation around it. I have talked about the support that women give women, but I have to say that men around us have given us great support. It is not that men did not want to be supportive; they just did not know how to be. That is why we need to talk about it. We need more education.

On that note, education around menopause needs to be included in our curriculum. My daughter is taught in school about periods and pregnancy, but not about menopause. As the Member who spoke previously outlined, the education in relation to menstruation is, quite frankly, inadequate and, in many cases, too late. We need more age-appropriate education around women's health. We are almost entirely reliant on other women and the fantastic work being carried out by charities, like Menopause NI, to offer advice and support around the menopause. Unfortunately, our health service is sadly lacking.

It is likewise lacking in diagnosis and treatment for women and girls who suffer with endometriosis. Again, lack of awareness, delayed diagnosis and lack of access to appropriate treatment means that women suffer needlessly. This is an extremely painful and debilitating disease that can result in limited mobility, regular episodes of violent vomiting and extreme, life-altering pain. Just yesterday, I spoke with a strong, intelligent, motivated woman from my constituency. Anne, who had to be medically retired as a result of endometriosis, openly offered to help and support others who have been diagnosed or await diagnosis, and to speak to MLAs about her experience to help them understand how this terrible disease can impact on women and girls. She is determined to do what she can to ensure that services are improved. However, Anne should not have to fight. That is what we are here to do; that is what we were elected to do. That is why it is so important that the Health Minister gives leadership on the issue, and that he works with health professionals, the community and voluntary sector, charities, support groups and women with lived experience to develop an action plan that is properly resourced, in order to ensure that it can be implemented fully and create the real change that is required.

We do not need to reinvent the wheel. An abundance of work has been done by many different sectors, and the answers are out there. We just need a formulated plan that is properly resourced. We can look at the other plans that have already been developed across these islands. I have spoken with many health professionals who share our concerns about the inequality in women's healthcare and want to play their part in shaping better treatment and health outcomes for women and girls. As I said at the outset, we have waited much too long to see this, but I believe that we have in place a Health Minister who wants to work with us, and we certainly want to work with him. As Committee members, we will hold him to account on a women's health strategy. I hope that we will see that come forward in the very near future.

It is very appropriate that we have the Nothing About Us Without Us group here today. It is no coincidence that these issues are coming to light as there are more women on the Floor of the Chamber. The right decisions will not be made for women unless women are in the rooms where the decisions are taken.

Photo of Diane Dodds Diane Dodds DUP

Mr Deputy Speaker, I offer you my congratulations on your new post. I thank the Minister for coming to respond to the debate. As a new member of the Health Committee, I look forward to working with you and holding you to account but, I hope, working constructively on the important things that we do.

I offer support for the motion and the amendment. These are extremely important issues. As the Member who spoke previously said, at times, they offer an uncomfortable truth about the state of services for women's health in Northern Ireland. On a broad level, I welcome the motion as appropriate and necessary. I will make a few remarks at the outset and, then, address a very specific issue in relation to women's health. In this House, we are very fond of talking about strategies. We talked about a strategy yesterday, and, no doubt, we will talk about another next week, but what we actually need is action. Strategies take years to develop and money to implement, but that is no reason not to have action in the meantime. Minister, if you hear nothing else today, I hope that you hear that loud and clear. I also want to acknowledge that it is important that we look at the link between deprivation, poverty and poor health, particularly for women and, indeed, for families. We need to have a strategy that does not just copy other strategies but is pretty much joined-up and quite specific: that is very important.

In the remainder of my time today, I want to focus on an issue that has impacted on 17,000 women in the Southern Trust area of Northern Ireland, which is the review of cervical smears. These smears are from the period 1 January 2008 to October 2021 and have impacted on 17,000 women who have had letters telling them that they are part of that review and that they may or may not need further action. That has caused huge amounts of worry and poses really important questions as to how we deal with those health issues for women. Before I get any further into the issues, may I just say that the trust is doing some amazing work in relation to this. It has gone out of its way to help, but fantastic work is also being done in the community and support is being given in the community.

Last week, the trust came to the all-party group on cancer and answered some questions on this matter, which was very helpful. However, this is something that has been known about for some considerable time and, if I have written down the figures correctly from the information that was given at the all-party group last week, to date only 1,740 slides have been reviewed and only 1,084 letters have been issued. Progress has been incredibly slow on this matter and, for some people, it will be a matter of life and death: it is massively important. I am asking the Minister today to take charge of the matter and make sure that the trust and, indeed, other trusts, have the capacity to speed up that process.

In closing — I do not want to go over my time too much, with your indulgence, Mr Deputy Speaker — there are things that some of those women have asked me to mention specifically in relation to their tests. Many of those women will want to see the review procedure conducted fully, including not just their HPV status but the cytology behind their tests. Many of them want to know what the process is —.

Photo of Robin Swann Robin Swann UUP

Will the Member give way?

Photo of Diane Dodds Diane Dodds DUP

Of course I will.

Photo of Robin Swann Robin Swann UUP

I want to address that issue and give the Member a little bit of extra time for her speech. The trust and the Public Health Agency (PHA) have developed plans to address the cervical screening review of those samples. Assurances on that and the wider cervical screening programme are being provided to the Department via the cervical screening oversight and assurance group, which is now chaired by the deputy chief medical officer, Professor Lourda Geoghegan, and Peter Toogood, our deputy secretary of social care policy. I just wanted to give the Member a little bit more time on this topic.

Photo of Steve Aiken Steve Aiken UUP

The Member has an extra minute.

Photo of Diane Dodds Diane Dodds DUP

I thank the Minister. I appreciate that this is something that the trust and the Department should take and have taken very seriously. However, a number of issues are still outstanding. We have a remarkably low uptake of appointments in relation to the cervical screening.

Photo of Steve Aiken Steve Aiken UUP

I ask the Member to bring her remarks to a close.

Photo of Diane Dodds Diane Dodds DUP

Yes. We need to address that particular issue. We also need to address the issue of assurance for screeners in future. The national performance level for that is 90%, but the Southern Trust adopted a lower performance level.

Photo of Steve Aiken Steve Aiken UUP

I ask the Member to bring her remarks to a close.

Photo of Diane Dodds Diane Dodds DUP

Minister, you need to ensure, and we need to hear from your Department, that that performance level is reviewed and kept at an appropriate level.

Photo of Alan Chambers Alan Chambers UUP 11:30, 13 February 2024

Thank you, Mr Deputy Speaker. I take the opportunity to congratulate you on your appointment to your new role in the Chamber.

I commend those who tabled the motion for bringing this important topic to the Chamber today. A fact that I often find staggering is that, although women in the UK, on average, live longer than their male counterparts, women spend a far greater proportion of their lives in ill health and disability. That is not just a quirk or a coincidence; there are big and important reasons behind it. For far too long, women-specific health issues were often either ignored or openly disregarded. Certainly, it seems that, until only fairly recent times, the issue of women's health received much less public attention and discussion than it deserved. With such advances in science and understanding, as well as in modern medicine and treatments, there should be no taboo subjects in 2024.

As has been said, women make up 51% of the population, yet, as a man, I freely accept that there remains a misunderstanding — perhaps better described as a lack of understanding — of some really important issues. That includes not only the menopause and menopause symptoms but a slate of other issues. I would be the first to acknowledge that more awareness is needed by me and many of my male peers to highlight just how severely the issues can impact on a woman's life. There have been so many changes over the past 50-odd years, and, thankfully, the contribution made by women to society and to the economy is now better recognised and celebrated, especially compared with how it was so overlooked in years past. Of course, there is much more that could be done.

There are not just perceived barriers to better women's health but actual obstacles. The recent Getting It Right First Time report was really important in highlighting the measures necessary to improve access to gynaecology services. Similarly, whilst some really important progress has been made in recent times on broadening fertility support, as well as critical investment in the likes of perinatal mental health, I think that we can all agree that there is more to be done. With so many problems already weighing down on our health service, we can scarcely afford to be making the situation any worse. Yet, that is exactly what is happening with such profound health and social inequalities. Those inequalities sometimes directly contribute to high unplanned pregnancy rates, a clear gender gap in cardiovascular outcomes, poor maternal outcomes and high obesity rates, to name just a few.

The case for a women's health strategy is well made. Listening to the media last week, I was reassured by the commitment of the Health Minister to move at pace in that regard. The development of an action plan will immediately focus minds and should deliver progress now in the areas where that is possible, while the development of a much higher-level and more strategic women's health strategy runs in parallel.

I suspect that there will be broad political unanimity in the Chamber for the motion, and we should all welcome that. In particular, I suspect that there is also unanimity in the need to adopt a whole-life-course approach, a phrase that, I suspect, we will start to hear more of in the Chamber.

Our health service belongs to us all, so it goes without saying that it must also serve us all. Particularly, that must see the fundamental principle of equal access to treatment, prioritised on the basis of clinical need and not of either personal circumstances or gender. Therefore, I and my party fully support the motion and the amendment before the House today. I look forward to seeing work on the action plan and the strategy getting under way soon.

Photo of Sinéad McLaughlin Sinéad McLaughlin Social Democratic and Labour Party

Thank you, Mr Deputy Speaker, and congratulations on taking up your position as Deputy Speaker.

The SDLP will support the motion and the amendment. Last year, a woman who was waiting for surgery for endometriosis came into my office. Debilitating pain had forced her to leave a job that she loved in the health service. Years later, she was still languishing on a waiting list, weighing up whether to remortgage her family home to pay for private treatment. She is not alone. That is just one of the countless stories from women who face barrier after barrier in accessing healthcare.

Last year, I carried out a survey of women's experiences. I had over 500 responses, which painted a stark picture of a broken and inaccessible service. I have delivered the full report to the Department of Health. Hopefully, the Minister will know that 90% of respondents felt that there was inadequate service provision for the biggest healthcare issues affecting women. They listed gynaecological health, mental health, maternal health, menopause support and many other issues, and I am deeply grateful to them for their personal stories. They were stories of pain that had been dismissed, of conditions that had been misdiagnosed and of a taboo that had set in when discussing menopause, sex education or periods. They were just some of the almost 10,000 women across the North who have been waiting more than a year for their first appointment with a gynae consultant.

That research adds to the mountain of evidence that differences in how women are assessed, diagnosed and treated add up to huge inequalities. For example, research shows that endometriosis affects 1·5 million women in the UK. A similar number of women are affected by diabetes. However, while diabetes services are well established, there is a devastating lack of support for women with endometriosis. It is long past time —.

Photo of Cara Hunter Cara Hunter Social Democratic and Labour Party

I thank the Member for giving way. Does she agree that the length of time that it takes to get diagnosed with either endometriosis or polycystic ovary syndrome (PCOS) is absolutely shocking and that early intervention and diagnosis are key to treatment and quality of life? Does she also agree that it is key that we ensure that our GPs have the appropriate training to highlight and diagnose those issues?

Photo of Steve Aiken Steve Aiken UUP

The Member has an extra minute.

Photo of Sinéad McLaughlin Sinéad McLaughlin Social Democratic and Labour Party

I thank the Member for her intervention. Absolutely: it can take anything from 10 to 15 years to be diagnosed with endometriosis. I suffered my first symptoms of endometriosis when I was about 16, but I was 26 before I was diagnosed. That was back in a different decade — the 1990s — but, unfortunately, our diagnosis process has not moved on since that time; in fact, some of the gaps are getting larger.

It is long past time that the inequalities faced by women accessing healthcare were addressed by following the example of every other part of these islands and agreeing a comprehensive and fully funded women's health strategy. While an action plan is under way — that is to be commended — there is no substitute for a strategy with meaningful timelines and funding attached that can address the inequalities that women face in their lives from puberty through to postmenopause.

I have engaged extensively with grassroots women's organisations across the north-west like Derry Well Women, the Women's Centre Derry and many more. They have been forced to plug the gap in statutory services, delivering programmes on the ground for women who are in desperate need.

Now is not the time to start small. Women deserve ambition. That is why a women's health strategy must end the postcode lottery for services through regional bands. That means rolling out regional women's health hubs, where women from across the North can secure faster access to treatment. That includes abortion services. The Health Minister must fulfil his obligation in providing those services: abortion is healthcare.

A women's health strategy should also introduce better training for healthcare professionals, funded research on gender inequalities in healthcare and the collection of the right data to inform that policy. Our healthcare workers are dedicated, but they need to be supported by the right tools. The development of a women's healthcare strategy must incorporate the voices of all women, particularly those who are black and minority-ethnic, disabled and LGBT. Only by being fully inclusive can the strategy be fully effective. I firmly believe that the work should be led at a senior level. England has appointed a Women's Health Ambassador, and we should follow their lead so that one person can lead on the implementation of the strategy. An ambitious, intersectional, regionally balanced women's health strategy has the power to improve women's lives and their outcomes radically, but women are literally sick and tired of waiting.

Photo of Steve Aiken Steve Aiken UUP

I call Órlaithí Flynn.

Photo of Órlaithí Flynn Órlaithí Flynn Sinn Féin

Go raibh maith agat, a LeasCheann Comhairle. I welcome you to your new position as Deputy Speaker. I am happy to speak in support of the Alliance motion and the amendment.

I will mention some of the work of the all-party group on women's health, which we established three years ago in order for MLAs, organisations and individuals to have the chance to come together and discuss our shared interest in women's health. I give a special mention to Pam Cameron from the DUP, the group's original vice chair. Paula Bradshaw has been brilliant, and she is the current vice chair. Sinéad McLaughlin, Linda Dillon and Robbie Butler also come to the meetings frequently, and I am sorry if I have left anybody out. It has been great that we have already seen genuine cross-party consensus on women's health through the all-party group structure, so I hope that there is full support for the motion when the debate finishes today.

I know that I may be repeating some of what others have already mentioned, but, to give Members a sense of the all-party group's work, since its establishment, we have covered numerous really important topics. The problem is that each topic that we have covered has been as important as the others, and that will be a challenge when we are putting in place a proper and robust women's health strategy. We need to ensure, and it will be difficult, that we are inclusive and aware of all the issues that impact on a woman's health throughout her lifespan.

We are talking about a lot of important topics. Some of the topics that we have covered in the APG structure include human rights and pregnancy; childbirth; maternity services; perinatal mental health services; miscarriage; fertility; baby loss; mesh; menopause; breastfeeding; mental health; pelvic health; and abortion. There is an even longer list of issues that we have yet to cover: gynae services and endometriosis, which have already been spoken about; addiction; cervical cancer; breast cancer; and the more specific issues of gender gaps that Linda touched on with respect to the amendment, which include bone health, heart health, autism, self-harm and eating disorders. I have no doubt that I have missed out a lot of things, but that shows how many massive issues we are talking about and need to grapple with in order to show what the strategy will look like.

I take on board what Diane Dodds said. Practically, we need to deliver things and get things done in the interim, because this will be a vast piece of work. The list gives Members a sense of how much we need to do in order to achieve gender equality in our health system. We know that the health system was designed by men, and, sadly, at different times in history, we have repeatedly seen that it has let women down. There have been scandals and a lack of investment in the issues that we have been talking about. Alan Chambers mentioned the lack of knowledge and understanding of some of the issues that a woman will go through in her life that a man will not. We know that women live longer than men —.

Photo of Sorcha Eastwood Sorcha Eastwood Alliance

I thank the Member for giving way. I pay tribute to Órlaithí, Paula and other colleagues who have worked on the issue of vaginal mesh. The Member and I have been involved with that issue at various points over the years.

Does the Member agree that the plight of women who have been impacted by vaginal mesh is totally unacceptable and that the news that came from GB last week off the back of the Independent Medicines and Medical Devices Safety Review is further proof of that? Does she agree that women in Northern Ireland cannot be left behind when it comes to the issue of vaginal mesh?

Photo of Steve Aiken Steve Aiken UUP

The Member has an extra minute.

Photo of Órlaithí Flynn Órlaithí Flynn Sinn Féin 11:45, 13 February 2024

Yes, I completely agree. I spoke on that issue this morning with regards to the Hughes report. I genuinely hope that we can get cross-party consensus for trying to get some of that work over the line for local women who have been injured by mesh.

Without having an overall strategy, we lack a joined-up approach across our trusts. Again, we are lagging behind other parts of these islands that already have strategies and action plans in place. We need there to be urgency around that.

I come back to Sorcha Eastwood's mention of the mesh implants scandal. I was going to come on to that next. As we know, women make up half of the population and half of our workforce; yet, sadly, we also know that they have been failed miserably over many decades, as multiple scandals have come to light. Those have caused much harm and hurt to women. There are the mesh, thalidomide and mother-and-baby scandals, as well as cervical smears, which have been spoken about. That is to name only a few. Those issues have massive impacts on the health and mental health of our women.

Photo of Steve Aiken Steve Aiken UUP

Can the Member draw her remarks to a close, please?

Photo of Órlaithí Flynn Órlaithí Flynn Sinn Féin

Yes, of course. I will finish with a point about maternity services, as I cannot finish my speech without giving consideration to that. We need the women's health strategy, and, when Mary Renfrew has concluded her reports, we need a renewed maternity strategy. There have been shout-outs to some of the guests in the Public Gallery, and I want to mention the Community Foundation Northern Ireland and the grassroots women who are with them today: I look forward to working with them.

Photo of Steve Aiken Steve Aiken UUP

Thank you. I enjoyed that latitude.

Photo of Deborah Erskine Deborah Erskine DUP

Mr Deputy Speaker, hopefully, I will get some latitude as well. I congratulate you on your new role. I also congratulate the Minister. I am not sure whether he is glad or sad that I am off the Health Committee. I will let him decide.

I thank those who tabled the motion for shining a spotlight on this very important issue. It is undeniable that women and girls have lifelong health needs and risks that are not the same as those of men. That includes managing periods and menopause symptoms and being uniquely predisposed to chronic conditions such as heart disease, particular forms of cancer and diabetes. That is why I am glad that the amendment specifically mentions the gender gap in cardiovascular outcomes.

We must not forget the extra financial cost to women of managing periods and menopause symptoms. It must be pointed out that, without adequate health support, women can often find themselves in need of extra time off work and, in severe cases, having to leave the workforce altogether. Simple intervention and support within our medical professions and workforces could prevent that from happening. The duty is not just on the Health Department; it is a cross-departmental issue, and I am glad that the motion points to that cross-departmental element.

There is a need for women and girls in Northern Ireland to have better, more accurate and more timely information to support their needs as they face these challenges. It is simply unacceptable that women face crippling anxiety and sleepless nights because of being forced to do their own research to figure out how to access the right support.

We know that a women's health strategy is in place in England and that there is a women's health plan for Scotland, and it is my understanding that Ministers are in the process of producing a similar document in Wales. Northern Ireland should not be left behind in identifying the issues and tackling them head on. Furthermore, it is important that any women's health strategy does not fall victim to the pitfalls elsewhere. We need to take account of our unique position in Northern Ireland and the role that our health trusts, education system and the councils can play, as well as that which our community and voluntary sector can play, providing a vital role in our communities, and particularly in deprived communities. It is crucial that we do not raise expectations only to have an eventual strategy fall flat. Clear metric indicators are needed for measuring success, and strong levels of accountability need to be built in. That is even more important if the strategy has a lifetime of three, five or 10 years, to make sure that it does what it says on the tin.

We must ensure that a strategy also complements any forthcoming anti-poverty strategy, prevention of violence against women and girls strategy and any other health strategy, so that there is no divergence in policy. Ultimately, a women's health strategy for Northern Ireland will succeed only if there is wholesale buy-in from our communities, healthcare professionals and women themselves. The stigma that is sometimes associated with menopause and endometriosis must be addressed. Even in primary care, we need to ensure that GPs and other front-line health staff are trained and have a better understanding of the toll that those conditions take from an early age, so that the right care and treatment can be provided to the women and girls who are affected.

Photo of Diane Forsythe Diane Forsythe DUP

I thank the Member for giving way. Does she agree that the education of young girls in this important topic is critical? In the Member's opinion, should that be led by the Department of Health, through schools or through the voluntary and community sector?

Photo of Steve Aiken Steve Aiken UUP

The Member has another minute.

Photo of Deborah Erskine Deborah Erskine DUP

I thank the Member for her intervention. It is cross-departmental. Certainly, the earlier that we can get education for young girls, the easier that it will be to go forward with this.

Most women just want to be listened to and heard. Many of us who have gone to the doctor feared that our concerns and symptoms would not be recognised and that action would not be taken. I hope that today is the start of ensuring that women and girls across Northern Ireland have the right access at the right time with the right education in place, so that we can build healthy communities. I therefore support the motion and the amendment, and I look forward to seeing progress.

Photo of Kellie Armstrong Kellie Armstrong Alliance

Congratulations on your role in the Chair, Mr Deputy Speaker.

Today, we are talking about a women's health strategy. Minister, I know that a motion is a motion and that you do not have to act on it, but I hope that you listen. You said previously that a women's health strategy was within your thinking, which I welcome. Scotland has had its women's health plan since 2021, England has had its women's health strategy since summer 2022, and Wales has had its 'Foundations for a Women's Health Plan' report since November 2022, so I hope that we can take forward a women's health strategy. Any strategy needs to run in time for budgets, which could be a constraint that we will have on this. As others mentioned, it is important that we have a fully funded women's health strategy. In Northern Ireland, women deserve the same level of commitment from this Government as other women have had in other parts of the UK.

My colleagues outlined different key actions that should be included in a women's health strategy, but, as an older woman in this place, I have experience of matters on which I hope that the Minister will listen to me and take seriously. I thank him for attending Órlaithí Flynn's menopause event, at which he wore the MenoVest. I only wish that he had it on now in order to feel how warm it is in the Chamber. It is one of the symptoms that some of us who have been through menopause have suffered.

Photo of Danny Donnelly Danny Donnelly Alliance

I was one of the MLAs who donned the MenoVest — there are a couple of others in the Chamber — at that event, which was very informative and educational. Does the Member agree that we need more education on the symptoms of menopause and on actions that can help women suffering from it, particularly women in employment, to stay in their jobs and careers?

Photo of Steve Aiken Steve Aiken UUP

The Member has another minute.

Photo of Kellie Armstrong Kellie Armstrong Alliance

Thank you. I absolutely agree. I will talk about how many women of my age choose to leave work because of symptoms.

Menopause — including surgical menopause, which many people forget to mention — is life-changing and has an impact on many areas of a women's life, including her physical and mental health. There is an impact on her finances, and there is a proven negative impact on her employment and relationships. A funded women's health strategy must make provision for services that support menopausal women. That needs to include mandatory training for GPs, given that so many women have had to turn to private healthcare just to access treatment. GPs should be instructed to prescribe medicines that have been recommended by private practice. The strategy should include research into the broader benefits of testosterone for women, and resourced menopause clinics must be available in each trust area for every women. To be honest, however, I would prefer that there were a specialist in each GP practice so that all women could get access.

I know that the health system is financially broke, but women are being broken because our health service is not meeting their needs. Many older women like me feel disrespected, ignored and demeaned by a health system that considers many of us to be an annoyance rather than key members of society. I can still imagine the eye-rolls when I phone up to get my HRT prescription.

The Women and Equalities Committee in Westminster confirmed that women felt that there was:

"a lack of awareness or understanding of menopause, even amongst women".

Believe me, some of the most disappointing comments that I have heard about menopause have come from younger female health professionals and other women in the workplace. BUPA confirmed, as part of the Westminster inquiry, that almost one million women have left their jobs because of menopausal symptoms. Given that women have the menopause between the ages of 45 and 55, that is the time when many people reach the peak of their careers. Therefore, by not having a specific menopause strategy delivered through Health, we are sidelining some of the most incredible and skilled people in our workforce at a time when Northern Ireland can least afford to have people not in work and lose such skilled personnel. Therefore, I back a call to have a women's health strategy that will, at long last, provide a plan to invest in resources, including training for health professionals.

Lastly, I wish to address a matter that is very close to my heart, and that is miscarriage and fertility treatment. For many people in Northern Ireland, fertility is not simple or easy. I have never hidden the fact that I have been through miscarriages and IVF, and it was painful in so many ways. A key element of any women's health strategy has to be access to fertility specialists and support, as well as support for women following loss during and soon after pregnancy. Like menopause, fertility support is very limited in our health service. For many, health treatment is not free at the point of use. In Northern Ireland, we have a growing private fertility system on which families spend thousands of pounds to access treatment that is available elsewhere in the UK where NICE guidelines are delivered.

If we are to provide a fair and equitable health service that will deliver for women, we have to consider why, here in Northern Ireland, it is acceptable for women to have to look to private healthcare providers as their only option for treatment. Minister, I will hold you to your word. I hope to see a women's health strategy in this mandate.

Photo of Steve Aiken Steve Aiken UUP

As this is Sian Mulholland's first opportunity to speak as a private Member, I remind the House that it is convention that a maiden speech be made without interruption.

Photo of Sian Mulholland Sian Mulholland Alliance

Thank you, Mr Deputy Speaker, and congratulations on your new role. I proudly rise to support the motion on behalf of the many women in my constituency of North Antrim. First, however, as this is my maiden speech, I am in the unusual position of acknowledging not one but two predecessors. It would be remiss of me not to acknowledge the almost two decades of representation that Mervyn Storey gave to my constituency, and I thank him for his service. Patricia O'Lynn was unable to avail herself of the opportunity to rise in the Chamber on behalf of our constituents, but I thank her for the work that she carried out in the months following her historic election to this place as the first woman elected in North Antrim. Rest assured, I am honoured to represent North Antrim now, and I will do all that is in my power, with passion and heart, to represent those who voted for an alternative.

They say that it takes a village to raise a child, and that is never more true than for the child of a politician. I recognise the support of my family, especially my mother, Harriet, and my husband, Kieran, who have taken over the primary caring responsibilities for our beautiful seven-week-old daughter and our two wonderful sons. I have promised Alfie and Cathal that I will be home for bedtime stories tonight, so I thank them for their patience.

As the first mother to represent my constituency, I am passionate about the voices of women and parents being heard in the Chamber. That brings me to the motion. It is so pertinent not only to my very recent experience but to the experiences of many in my predominantly rural community. That brings its own challenges in access to healthcare, before we even begin to address the inequalities that exist for women in the healthcare arena.

The Maternal Mental Health Alliance (MMHA) recognised in its 2023 briefing that there has been an improvement in service provision across Northern Ireland in recent years. For example, all five health trusts now have a community perinatal mental health team in place. That is a very welcome development. I pay tribute to those professionals and the Minister for their work on developing and rolling out those teams, but we have a long way to go. The MMHA outlines a number of risk factors specific to perinatal mental health in Northern Ireland, including the variations between trusts that make service provision a postcode lottery. Everyone in Northern Ireland should have the opportunity to avail themselves of the same level of service provision and access to perinatal mental health. We also need to see the development of workforce planning and funding to increase training opportunities in order to bolster our workforce. Without properly trained and fairly paid staff, there will be no one to deliver these precious services.

A number of years ago, I was able to engage with the Women's Resource and Development Agency (WRDA) Maternal Advocacy and Support project — the MAs. Through that engagement, I shared my experience of perinatal and postnatal mental ill health. During that most vulnerable time, my abiding memory is of the absolute, crippling fear that my baby would be taken from me, either as a result of me accessing the care and help that I so desperately needed or because I would be deemed unfit for even experiencing the horrendous postnatal anxiety and depression that I felt. That fear would have been somewhat alleviated had there been a specific mother-and-baby unit.

The lack of an Executive has certainly hampered the implementation and delivery of that crucial service, which is definitely regrettable. The commitment and work done to prepare the business case is great, but we need to see funding and commitment to delivery. I call on the Minister to outline a time frame for delivery of the unit. Without the delivery of a mother-and-baby unit, Northern Ireland risks falling further behind the quality and variety of specialist services that are offered in other jurisdictions. Northern Ireland is the only part of the UK without a specialist unit.

In addition to perinatal mental health delivery, we need a properly resourced women's strategy that delivers a comprehensive and multidisciplinary approach to the care pathway for new mothers. The antenatal care received by women can be wonderful and can be focused on the recovery and full support of women at a vulnerable time, but there is also potential for women to fall through the cracks when they are signed off by a community midwife up to two weeks post partum, with care transferred back to the GP and, sometimes, back to the hospital of birth. For women, especially those with a traumatic or surgical birth, wrap-around, multidisciplinary-level care is absolutely essential to ensure that all mothers begin their journey into motherhood feeling valued, seen and cared for.

I do not want Northern Ireland to be a place apart from the rest of these islands because it is falling behind; rather, I want Northern Ireland to be set apart and known as the place where the antenatal and postnatal health of women is prioritised and funded to the extent that our families enjoy world-beating services. A women's health strategy must include those vital components.

Photo of Colin McGrath Colin McGrath Social Democratic and Labour Party

Mr Deputy Speaker, I congratulate you on assuming your role. Our normal contact is through the British-Irish Parliamentary Assembly (BIPA) and pints, and, if there is latitude to be given, I want you to know that I always paid my way. I also congratulate Sian on her maiden speech.

I welcome the opportunity to speak today, as it is timely to discuss such matters. It has long been acknowledged that there is a significant need for a women's health strategy. We are, after all, the only region of these islands that is without such a strategy.

For too long, women's health has been the subject of taboo and stigma across our society. When it has been talked about, it has often been in whispers. I am not embarrassed to say that I am part of the generation that was brought up not really talking about those things. I remember well, in my early 20s, making a phone call to the local hospital. I did not know how to get the words out and eventually asked to be put through to the "female gynae ward", at which point the operator said, "I would hardly put you through to the male gynae ward". That was just the way things were back in the day. I am glad that we have the opportunity to discuss matters and reduce those taboos and, as a result, contribute to addressing the facts that women are 50% more likely to receive the wrong diagnosis when it comes to heart attack, that women here have the worst ovarian cancer survival rates and that gynaecological waiting times are much longer here than anywhere else in the UK.

Last year, my colleague Sinéad McLaughlin conducted a survey of women's health. There were hundreds of responses, 90% of which said that service provision was inadequate for the biggest healthcare issues that affected women. It is not acceptable that that is the perception. When discussing essential healthcare matters such as menstrual health, the menopause or other issues, as mentioned in the motion, we must listen to women. I echo the remarks of my colleague about the fact that there is a Women's Health Ambassador in other parts and that we could and should replicate that here.

The motion gives us the opportunity to set the tone of what the new Assembly term can be about. We are, after all, debating a motion that was proposed by the Alliance Party, with an amendment tabled by Sinn Féin and that calls on the Health Minister from the UUP to bring forward that strategy. There is the potential for all parties to work together to deliver these things.

A question has to be asked, however, about why we do not have one now. Why have we not had a strategy previously? We are also without a violence against women and girls strategy, an anti-poverty strategy and an anti-conversion therapy strategy. There are many strategies that we do not have, and we know that it is because of the stop-go politics that we have in this place. I echo the remarks of the leader of the Opposition, my colleague Matthew O'Toole, in asking the First Minister and deputy First Minister to commit to not collapsing the institutions again and to giving us the opportunity to do the work that we need to do to deliver those strategies.

In the time during which this place was not sitting, we attended many conferences, and I regularly made the comment that the biggest room in Castle Buildings must be the one in which they put all the strategies, because that is all that we seem to do. We launch a strategy, we get all the attention for that, but we do not actually deliver it. We need to see a change in that. I want to see action plans that sit alongside strategies. I want to see costings and timescales alongside those action plans, so that we know that we will see delivery and action on the strategies that are being put forward. Too often, we build up people's hopes by saying that there will be a strategy, but that lack of delivery simply lets them down. We must see this Assembly term as being about rebuilding trust with the public and providing them with the hope that we will deliver on strategies. This is a very important strategy that should be up there to be delivered quickly.

Photo of Steve Aiken Steve Aiken UUP

I call the Minister. The Minister has 15 minutes.

Photo of Robin Swann Robin Swann UUP

Like others, I congratulate you and welcome you to your post, Mr Deputy Speaker.

I thank the Members for tabling this important motion, but I also thank all the contributors to the debate for their openness, honesty and personal contributions. That is the strength of this place: when we debate things that affect all the people of Northern Ireland. I thank everyone for their contributions today and the tenor that we have had.

Many of the issues that have been discussed today are already priorities for my Department, and I assure colleagues that work is actively ongoing to address the challenges, despite the difficult financial position that the health and social care system faces. Progress on those key issues will be high on my list of priorities as Health Minister. That is why, as my party colleague said, as Minister, I am keen to support the motion and the amendment.

I can update the Assembly about the fact that my Department is in the early stages of developing a women's health action plan for Northern Ireland. That will bring all of that work together for the first time in a unified plan to demonstrate what we are trying to achieve and to highlight where greater attention and action will be needed. It will be a similar approach to the one that I took in developing our mental health strategy. We produced the mental health action plan first to allow that time frame to make sure that the strategy was able to engage across the trusts, political bodies and all stakeholders. With your indulgence, Mr Deputy Speaker, I pay tribute to the organisations that are represented in the Public Gallery, but I will not name them all in case I miss one.

I will speak later about the action plan, but first I will pick up on some of the issues that have been discussed and outline the work that my Department is doing in those areas. As Órlaithí Flynn pointed out, each of these topics is worthy of a debate and a discussion in this place rather than just being part of a general motion. I am sure that members of the Health Committee will take that forward, and I look forward to working with those new members. I also pay tribute to those with whom I worked in the past for the way that we were able to approach health in this place.

As has been said, women and girls account for 51% of Northern Ireland's population, yet not enough focus is placed on women-specific issues. As we have heard today, each one of those nearly one million people has their own story. Each has their own experience of our healthcare system, and we hear daily of their challenges and concerns when it comes to getting access to the right care at the right time. As Members have said, that includes getting timely access to GP appointments; specialised healthcare in rural areas; and getting a timely diagnosis, advice and information on female-specific conditions or symptoms to help make those informed choices. All of that can be compounded by ethnicity and socio-economic background and the additional barriers and inequalities faced by the most vulnerable groups of women and girls in our society.

Members are right to outline the key elements that need to be considered in a women's health strategy to improve that provision and access to key services, including services for menopause, for gynaecological cancer screening, for cardiovascular health, for fertility and pregnancy, for baby loss and for postnatal healthcare, to name but a few. We know that, collectively, those issues cover the whole life course, so improving lifelong health experiences and outcomes for women also means better education and awareness from that early age. As has been said, it means learning about the importance of lifestyle and behavioural risk factors; the prevention of illness; living healthily; managing life changes such as menstrual health and menopause; living with health conditions; and knowing how and where to seek help when needed. For the health service, it is about making sure that that help is available and accessible.

I fully acknowledge the challenges across all those areas, many of which have been highlighted by Members today. I am committed to addressing the issues for the women of Northern Ireland, and, while there are probably too many to cover in the time available, I want to mention a number of areas where I see opportunity for progress to be made.

First, I want to prioritise the implementation of the recent Getting It Right First Time or GIRFT report to improve access to our gynaecological services. Our waiting times are simply unacceptable. The report, which was published last month as part of the work that my Department is taking forward under the elective care framework that I published in 2021, sets out recommendations to maximise our capacity, reduce those waiting times and improve patient care and outcomes. As Health Minister, I want to see those waiting lists come down to acceptable levels, and I expect to see real progress on those recommendations in the months ahead. My Department has now written to all trusts about the report and will engage with relevant stakeholders to progress implementation as far as possible with the available resources. It is recognised that some of those recommendations will require additional investment, and that will impact on delivery.

I join colleagues in recognising the impact that the menopause can have on women, who will all go through that change at some stage in their life. I wore the MenoVest for a short time, and Linda Dillon expressed it well when she told me, straight to my face, "Now you know what it feels like". I wore it for only 45 minutes, and I encourage those in the Chamber who did not avail themselves of that opportunity to do so; they should. We are seeing the start of a welcome shift in societal attitudes and understanding of the menopause, and I believe that, as has been said, a new Executive can do much more to support that across all sectors.

Too many women are leaving the workforce early, as Kellie Armstrong said, including in the health and social care system, where the majority of staff are female. We know that changes in policy could make a huge difference to those individuals, their families and the wider economy. I stress that there are many examples of good practice in menopause care in our system. It is important to ensure that that is equitable and that best practice is standardised across the region.

Mrs Dodds mentioned cervical cancer in her contribution. We have a very effective screening programme that has saved many lives over three decades. I was very pleased to see the introduction of full primary HPV screening into the pathway in December last year. Thanks to extensive planning by the Public Health Agency and the trusts, along with departmental officials, that brings our system into line with the rest of the UK by implementing the advice of the National Screening Committee and the Northern Ireland screening committee. That will use a test that is more effective at detecting women who are at risk of developing cervical cancer. That change will help in prevention and early detection, and will ultimately save more lives.

I recognise that there are many people who long for a child and are desperate to hear when the current fertility service can be expanded to offer a second and, indeed, third cycle to eligible women. That is in line with the National Institute for Health and Care Excellence (NICE) guidance and with a commitment in the New Decade, New Approach agreement. During the pandemic, one of my priorities as Minister was to reinstate and stabilise fertility services as quickly as possible. I am pleased to say that the staff at our regional fertility centre have worked extremely hard to bring waiting times down to a level that is better than it was before the pandemic, with a first appointment wait of 23 weeks and new IVF and intracytoplasmic sperm injection (ICSI) patients currently waiting approximately two months. I thank the RFC staff for their hard work and dedication in doing that and for preparing the ground for an increase in provision once capacity can be increased.

I congratulate Ms Mulholland on her maiden speech and look forward to working with her in North Antrim. She mentioned perinatal mental health. In relation to maternal mental health, each trust now has an operational community perinatal mental health team in place. Each team is accepting referrals and providing a consultancy service to women who experience mental health problems during the perinatal period. In addition, a regional implementation team has been established within the Public Health Agency. That team has been instrumental in leading the implementation of the community teams by having oversight and providing guidance. That ensures regional consistency, creating referral pathways and ensuring that our new service is fully integrated and embedded into existing services.

In line with my Department's commitment to establish a mother-and-baby unit, as set out in our mental health strategy delivery plan for 2023-24, I can inform Members that the Belfast City Hospital site has been identified as the most suitable location, and that the Belfast Trust has been invited to prepare an outline business case for the provision of the proposed regional unit. However, delivery of that project remains subject to budget affordability, which, as Members know, has not been confirmed.

Photo of Nuala McAllister Nuala McAllister Alliance 12:15, 13 February 2024

I thank the Minister for giving way. I am conscious that he mentioned the budgetary situation, and we recognise that. However, not progressing the mother-and-baby unit, given the number of women who will need it, would actually increase budgetary pressures elsewhere. That initial spend — yes, of course, we recognise that it would mean initial spend — would save in the long term because those who go without the care that is desperately needed will impact on the health service elsewhere.

Photo of Robin Swann Robin Swann UUP

I concur with the Member's comments. I could say the same thing about many services across Health and Social Care. I therefore look forward to her encouraging her two ministerial colleagues to support my bids in the forthcoming Budget and in all the work that I want to do across healthcare, which includes the development and construction of a mother-and-baby unit, as I set out in the mental health strategy delivery plan for 2023-24.

I could go on, as there are so many other women's health initiatives across primary care, social care, pharmacy services and allied health services, including hugely important areas such as maternal health, sexual health and pregnancy loss, which I do not have time to cover today. I hope, however, that I have assured Members that significant work in those areas is embedded in my Department's work programme as a priority. I am committed to providing greater focus and coordination on women-specific issues and to prioritising limited resources to where they will be most effective in my areas of responsibility as Health Minister. As I mentioned earlier, my Department is in the process of developing a short- to medium-term women's health action plan that builds on ongoing work and identifies the priority actions across women's health services that can be taken forward within our current budget, as well as those actions for which additional investment may be required. That will pave the way for a women's health strategy in the longer term.

Crucially, as a part of that work, I want to listen to Northern Ireland women and hear their views on and experiences of the healthcare system and how it should be shaped. I welcome the fact that, as a society, we hear much more public discourse about women's health issues, and I commend the groups, charities and councils that are helping to bring about that positive shift. I also acknowledge the need for improved public awareness and information. We are working with the Public Health Agency to understand how best we can reach specific groups of women and girls and what that might look like.

Photo of Robin Swann Robin Swann UUP

I apologise, but I want to finish this. We must take note of the fact that awareness raising should go beyond the female population, in order to ensure that everyone has a better understanding of women's health issues and the wider impact that they can have, particularly employers.

In conclusion, I assure Members that we have a strong foundation of work in progress that will form the key components of a women's health action plan. That work is in the early stages, so I cannot say when it will be finalised, but I hope to say more about that in the weeks and months ahead. By putting women at the centre of discussions, we can ensure that their voices are heard and that the limited funds are appropriately aligned with priorities. I am confident that, through the approach that I have outlined today —

Photo of Steve Aiken Steve Aiken UUP

I ask the Minister to bring his remarks to a close.

Photo of Robin Swann Robin Swann UUP

— and the support of Assembly colleagues, we can improve health outcomes for all women and girls in Northern Ireland. I very much welcome today's debate and thank Members for their contributions. If Ms Dillon wants in briefly, I will give way.

Photo of Steve Aiken Steve Aiken UUP

I am sorry, but there is no time for an intervention.

I call Liz Kimmins to make a winding-up speech on the amendment. The Member has five minutes.

Photo of Liz Kimmins Liz Kimmins Sinn Féin

Go raibh maith agat, LeasCheann Comhairle, and congratulations on your new role. I welcome the opportunity to speak on this important motion to improve healthcare for women and to address the health inequalities that many women face. I am pleased to hear the Minister's commitment to deliver for women's healthcare.

We have heard about a broad range of issues that impact on women, including how some conditions that affect both women and men have a much more detrimental impact on women. We must ensure that those issues do not fall between the cracks any longer. It is abundantly clear that significant gaps exist in women's healthcare, but those gaps are far greater for those women who live in areas of high deprivation. Tackling disadvantage in the context of women's healthcare as a result of deprivation must form part of any forthcoming strategy.

Over the past three years, we have seen other parts of these islands bring forward women's health plans. A women's health strategy for England was introduced in the summer of 2022. In the South, the Irish Government have introduced a women's health action plan. The Scottish Government introduced a women's health plan in August 2021. NHS Wales published 'Women's Health in Wales' in November 2022. Unfortunately, we have fallen behind the other jurisdictions at a time that we are aware that, although women on average live longer than men, they spend a significantly greater proportion of their lives in ill health compared with that for men. We are all too aware of the many complex health issues that women and girls face, and those have been described perfectly here today. There needs to be a clear focus on women-specific issues, as is highlighted in today's motion.

We saw headlines at the start of the month that outlined the fact that more than 37,000 women were on waiting lists for gynae services, with many waiting over three years for treatment. Just last week, we heard that breast cancer referral targets were being missed, with only 52·9% of urgent referrals being seen within the 14-day target. That means that, during the quarter ending in September 2023, 1,566 women were not seen within the target date. We need to do better for those women and girls. Early detection of breast cancer is key for targeted treatment and for increasing survival rates for women. That is why we must also see the implementation of the cancer strategy, which will undoubtedly help to tackle those issues.

As others have highlighted, there needs to be a strong focus on maternity services, as we see increasing numbers of women accessing maternity services across the North. The strategy must recognise the need to ensure the delivery of high-quality, safe services for women and families. The progress on the mother-and-baby unit is also very welcome. The needs and health of women who use maternity services are changing rapidly, and, if improving women's overall health is at the heart of the strategy, that will ensure better outcomes for expectant mothers and their babies.

Just a few months back, I had the pleasure of using the fantastic maternity services in Daisy Hill Hospital. I cannot emphasise enough the first-class care that my baby son and I received, from my first scan to the aftercare that I received in the community from the amazing midwives and health visitors. The wide-ranging and growing complexity of the care that maternity services provide cannot be overstated. We now have a real opportunity, as part of this strategy, to underpin improving the health outcomes for mothers and babies, prior to and during the time that they are being cared for by those who are working in maternity services. That will have lifelong benefits for women.

As many Members who spoke today have outlined, there is a clear and immediate need for the development of a women's health strategy. It is important that, as that work is progressed by the Minister and the Department, the voices of women and girls are heard and listened to. Any plan or strategy that is brought forward must reflect their views and seek to address the disparities and inequalities that they face across the health and care sector. While any plan or strategy will be primarily for the Department of Health, I appreciate that there may be some overlap with functions in other Departments. I encourage other Ministers and Departments to work collaboratively with the Department of Health to address this important issue.

As the incoming Chairperson of the Committee for Health, I want to ensure that there is a clear focus on a women's health strategy. The Committee will work with and support the Minister and the Department where it can and, where needed, will hold the Minister and the Department to account on the key priorities that are brought forward. We will see where that balance is, but I trust that it will be a beneficial working relationship. I ask Members throughout the Chamber to support the motion and the amendment.

Photo of Steve Aiken Steve Aiken UUP

Thank you, Liz. I call Paula Bradshaw, who will have 10 minutes.

Photo of Paula Bradshaw Paula Bradshaw Alliance

Thank you, Mr Deputy Speaker. I wish you well in your new role. I support the motion and the amendment. I will focus my remarks on long-term specialist support for endometriosis. Before I make my comments, however, I say that I agree with all the Members who spoke and have covered a wide range of issues. If I have time at the end, I will cover a lot of those.

I will start by focusing on figures and statistics relating to endometriosis, which are, indeed, shocking. Endometriosis is a painful and exhausting condition, which can lead to immense stress and discomfort, yet it is not only when diagnosed with endometriosis — I will call it "endo" — that women suffer a lack of support and recognition; it can take over a decade for the condition even to be diagnosed in the first place. Many women have told me that, in some cases, the entire journey from initial distress to surgery has taken nearly 20 years. As if the pain and exhaustion were not enough, there is the additional strain of uncertainty around diagnosis and a lack of clarity about the likely options for treatment and support, and then the seemingly interminable wait for the appropriate intervention.

We have already heard that, comparatively, far more women face that uncertainty, lack of clarity and wait in Northern Ireland than elsewhere in the UK. In fact, we are not even sure how many. When I asked a question in the Assembly, during the previous mandate, about exactly how many women were waiting for diagnosis and treatment for endo, three trusts were not able to provide an answer. It is evident from the figures alone that it is long past time that those who are suffering such distress have the support that they need.

However, it is the human story that truly tells the tale. The story that I have been told countless times is one of women seeking support and not just being denied it or left to languish on a seemingly endless waiting list but being made to feel like a burden. Female pain and exhaustion are too often overlooked in medical care everywhere, and, when you add in our waiting lists and lack of specialist support, the situation here is, plainly, even worse. At this stage, I wish to pay tribute to the Northern Ireland support group for Endometriosis UK, without which many women would be in an even worse position. Its work is invaluable.

I turn to today's contributions. My colleague Nuala McAllister proposed the motion and called for a strategy to be fully costed and fully developed in a holistic approach that is co-designed with representatives across many sectors. She also highlighted the fact that it is Sexual Health Week.

Linda Dillon raised the issue that, in 2022, 2,000 women lost their lives to heart disease, calling it the leading cause of death for women. She called for more timely and effective awareness raising among women. She spoke of her personal experience —.

Photo of Linda Dillon Linda Dillon Sinn Féin 12:30, 13 February 2024

I thank the Member for giving way. The point that I was going to make to the Minister is that that awareness raising needs to be done in conjunction with the community. Given that Community Foundation NI is here, it is important that we support it to support the community in order to ensure that we reach those people. There are not people who are hard to reach; there are services that are hard to access.

Photo of Paula Bradshaw Paula Bradshaw Alliance

Thank you. I fully endorse that.

Ms Dillon talked about her experience of menopause, and she called for age-appropriate education in schools around menstrual issues to also include this area.

Diane Dodds talked about this debate providing an uncomfortable truth about the state of services and said that we need action on this issue. She talked about the link between deprivation and poor health and went on to talk about the 17,000 women affected by the cervical smear test review in her Southern Trust area. She talked about the question of —.

Photo of Alan Chambers Alan Chambers UUP

Will the Member give way?

Photo of Alan Chambers Alan Chambers UUP

Does the Member agree that, despite the regrettable situation in the Southern Trust area, it should not put off any women in Northern Ireland from seeking an appointment for screening?

Photo of Paula Bradshaw Paula Bradshaw Alliance

Thank you. It is a very important point, and, at the all-party group on cancer, the professionals who came from the trust and from the Public Health Agency wanted us as elected reps to very much endorse that message. Thank you, Mr Chambers, and that leads me to your remarks. Thank you for attending the Chamber. You were the first male to speak in the debate, and it is really important that this is seen as not just a women's issue but a whole of society issue around getting women's health right. You mentioned that women's health issues were disregarded for a long time and said that we have to adopt a whole-life-course approach to the women's health strategy.

My colleague Sinéad McLaughlin talked about the constituent with whom she has engaged who had to leave work due to the debilitating pain from endo, and she mentioned that, at times, the service is broken and inaccessible to women. She talked about the long and painful waiting times for women accessing their first gynae consultant appointment, and she talked about her own diagnosis of endo.

Órlaithí Flynn talked about the APG on women's health, and I very much agree with the Member that all Members who are on that group, from across the House, have come together around these very important issues. There is genuine cross-party consensus on the need for this women's health strategy. I fully agree with her that there are so many issues there that we need to ensure that this women's health strategy is robust and inclusive of all the issues across a woman's health span. We need to catch up with other parts of these islands.

Deborah Erskine talked about the amazing role of the community groups, many of which are represented in the Gallery or are looking on via our internet provision. She said that we need to ensure that they are involved and that we build on the work that they have already done. She said that we need to ensure that the actions that come from the action plan and the strategy are robust. She said that there needs to be wholesale buy-in from women, community groups and healthcare professionals and that training will be essential for GPs.

My colleague Kellie Armstrong highlighted the fact that other parts of these islands — Scotland, England and Wales — already have their women's health strategies in place and that we need to ensure that, when we get ours developed, it runs in time with budgets and is fully funded. She talked about menopause and how it is life-changing, with many women having to give up their jobs and reduce their income at a time when they should be at the "peak of their careers". She also talked about her personal experience of miscarriage and of trying to access fertility treatments.

In her maiden speech, Sian Mulholland, another colleague of mine, provided some insight into her constituency, saying that she is the first mother to represent North Antrim. She spoke in particular about the barriers that her constituents have in accessing healthcare in rural communities. She talked about how important perinatal mental health is and, again, shared her experience of perinatal and postnatal depression and anxiety. I thank her sincerely for that. She also mentioned the need for the specialist mother-and-baby unit and for the Minister to provide the time frame for it.

I am also much indebted to Colin McGrath, who is another male who talked about the fact that we are the only region of these islands that does not have a women's health strategy. He said that we have to remove the taboo and stigma around all the issues. He highlighted the fact that we have the worst ovarian cancer survival rates here. He also referenced his colleague Sinéad McLaughlin's survey, which showed that 90% of women indicated that they feel that services for women are inadequate. He called for a women's health ambassador and said that if we build up hopes that we can take that forward, we need to ensure delivery.

The Health Minister thanked everyone for their contribution. He said that the wider population of women will also have similar stories and that he has placed the issue high on his list of priorities. He explained the process around bringing forward a women's health action plan in the first instance and said that he felt that that was the right approach because it was demonstrated, through the mental health action plan, as a good way of getting the issues together and moving forward. Another point in the Minister's contribution that I felt was important was the mention of ethnicity, socio-economic groups, vulnerable and marginalised women and the need to ensure that the strategy very much takes account of different groups of women. He talked about the opportunities to make progress in the short term that come from the 'Getting It Right First Time' report around access to gynaecological services, and he explained that he is looking at the recommendations on that.

Liz Kimmins closed by talking about health inequalities, gaps in healthcare and how we need to look at areas of high deprivation.

Photo of Steve Aiken Steve Aiken UUP

Thank you very much, Paula, for keeping to the time.

Question, That the amendment be made, put and agreed to.

Main Question, as amended, put and agreed to. Resolved:

That this Assembly calls on the Minister of Health, working with his Executive colleagues, to bring forward, as a priority, a fully budgeted women’s health strategy that supports women through every stage of their lives, and is focused on education and awareness raising, screening and earlier diagnosis, and support services and care pathways; and further calls on the Minister and his Executive colleagues to include in this strategy a menopause clinic, earlier gynaecological cancer screening, a framework of support relating to fertility, birth control, pregnancy, baby loss and post-natal healthcare, a reduction of the gender gap in cardiovascular outcomes, an emphasis on menstrual health, including long-term specialist support for endometriosis, and plans to tackle health inequalities experienced by women from different socio-economic and ethnic backgrounds.

Photo of Steve Aiken Steve Aiken UUP

Members, please take your ease while we transfer the Chair.

(Mr Speaker in the Chair)