Women’s Health

– in the Scottish Parliament on 15th June 2021.

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Photo of Stephen Kerr Stephen Kerr Conservative

On a point of order, Presiding Officer. Given that we are starting the next item of business 14 minutes later than we thought that we would be, is there any way that we can move decision time back by 14 minutes?

Photo of Liam McArthur Liam McArthur Liberal Democrat

I am grateful for the point of order. Let us see how we get on. We can make an assessment about that later, during the debate.

The next item of business is a debate on motion S6M-00369, in the name of Maree Todd, on women’s health. I invite members who wish to speak in the debate to press their request-to-speak buttons now. For those who are joining us remotely, please put an R in the chat function. I call Maree Todd to speak to and move the motion.

Photo of Maree Todd Maree Todd Scottish National Party

The Covid-19 pandemic has changed and challenged almost all aspects of life, but its impact has not been felt equally across the population. Women have been more adversely impacted, and pre-existing inequalities have been exposed and exacerbated. Let us be clear: women’s health is not just a women’s issue. When women are supported to lead healthy lives and fulfil their potential, everyone benefits. The majority of unpaid carers are women, women make up the majority of the health and social care workforce, and the vast majority of lone parents are women. The challenges of balancing childcare, paid work and caring responsibilities with the stresses and uncertainties of the pandemic will have been truly daunting for many women and will undoubtedly have affected their health.

Still, the inequality that women face throughout their lives existed long before Covid. In Caroline Criado Perez’s thought-provoking book “Invisible Women: Exposing Data Bias in a World Designed for Men”, she says so much in a few words. She says that women are not, to state the obvious, just men. She goes on to explain:

“Historically it’s been assumed that there wasn’t anything fundamentally different between male and female bodies other than size and reproductive function, and so for years medical education has been focused on a male ‘norm’, with everything that falls outside that designated ‘atypical’ or even ‘abnormal’.”

Let us look at abnormal. Women are more likely to experience violence, to live in poverty, to live alone, particularly in older age, and to care for others, all of which contribute to poorer mental health. Throughout this year, we have invested £6 million to support mental health. It is vital that we consider women’s specific mental health needs. In October 2020, we launched the mental health transition and recovery plan, which specifically prioritises women’s and girls’ mental health. We are working with our equalities forum to deliver a programme of work to address the challenges arising from the pandemic.

Women live longer than men and make up a larger portion of the older age population. Women are more likely to spend more time in ill-health, yet they do not always receive equal healthcare. Their physical health and mental health are compromised every day by systems that do not yet fully meet their needs. Health outcomes for women are poorer than those for men in important areas, such as heart health. Women who are having heart attacks are often said to have an “atypical presentation”. That language shines a light on a very important issue: women are not atypical men; they are women, and the way that women present is normal for women. That lack of recognition is then followed by the fact that, as studies have shown, women are less likely to be prescribed drugs that reduce the chance of a second heart attack. The British Heart Foundation has highlighted inequalities at every stage of a women’s medical journey. Such health inequalities are unjust and preventable.

Let us talk about endometriosis. One in 10 women in Scotland has endometriosis, making it as common as diabetes and asthma, yet we know that women are waiting far too long for a diagnosis. We are therefore listening to women to understand the barriers that they face to achieving a diagnosis so that we can make progress as quickly as possible. We are also ensuring that women’s individual needs are met throughout their treatment.

Let us talk about menopause. Women are frustrated that information about menstrual health and menopause is unreliable and inaccessible. Many women feel unprepared for the impact that the menopause can have on their life and feel unsupported to manage the symptoms. We are working to raise awareness of the symptoms of menopause and to ensure that all women receive the support and care that they need to sustain their health and wellbeing.

Those reasons, along with many others, are why, in the first 100 days of the new session of the Parliament, we will publish a women’s health plan, which will reduce avoidable inequalities in health outcomes for women throughout their lives. Women’s voices and experiences will be central to its development and implementation. Alongside the Health and Social Care Alliance Scotland, we have already conducted a women’s health survey and spoken directly to women. We want to give women a say in how we shape services for the future, and it is absolutely crucial that we listen to, and trust, women.

Photo of Monica Lennon Monica Lennon Labour

I welcome the minister to her new post and agree with what she has said so far. Does she agree that, if we are to get the benefit of all those measures, we need to embed menstrual wellbeing education in the curriculum? What plans does she have to speak to colleagues across the Government to make sure that that happens?

Photo of Maree Todd Maree Todd Scottish National Party

It is certainly the case that the challenge does not start only in the doctor’s surgery; it is a societal one. We need to bring about a change and ensure that, from a young age, boys and girls have an understanding of menstrual health and of the course of a woman’s life and how that will impact her.

The provision of education during school is certainly an appropriate idea, but other opportunities exist, such as when women present for breast screening or cervical screening. There are many opportunities to talk about menstrual health with women and to raise awareness of the challenges that we face. I will certainly try to improve the situation.

The plan’s initial priorities, which have been developed over the past 18 months by women and experts on women’s health, are to bring about improvements in abortion services; contraception and sexual health; menopause and menstrual health, including endometriosis; and women’s heart health. Through necessity, the pandemic has led to new and innovative ways of working and of providing patient care, and those are captured for longer-term implementation in the women’s health plan.

To make lasting change, a cultural shift is required, so the plan approaches women’s health in a holistic way and responds to the many factors that impact on women’s health and their ability to access healthcare services. The plan takes a life-course approach to women’s health that emphasises the importance of protecting and promoting health at key stages of life. From pre-conception to pregnancy, childhood and adolescence and into adulthood and later life, it is vital that women have the information that they need when they need it and in a way that is right for them. Such meaningful communication personalises and improves the safety and effectiveness of care, and it helps to address health inequalities.

At every stage, we must give women the opportunity and support that they need to access and participate in decisions about their care. By moving away from a doctor-knows-best culture, we will empower women to make informed decisions about their bodies and their health. We will learn from the pandemic and build back, putting equality at the centre of all that we do. We can reduce some health inequalities by identifying gaps in health service provision, considering areas of best practice and developing actions to address those gaps.

However, the women’s health plan is only one part of a much wider picture when it comes to women’s health and wellbeing. The majority of health inequalities are avoidable. They stem from wider inequalities in society—inequalities of income, wealth and power. Work is being undertaken across the Government to address those wider social determinants of health, to eradicate poverty and to tackle inequality in all aspects of life. A significant amount of work is being undertaken right across Government to improve women’s health, particularly—

Photo of Jackie Baillie Jackie Baillie Labour

On the issue of inequality, will the minister commit to reforming care allowance as soon as possible, to ensure that unpaid carers—who, as I am sure that she will appreciate, are predominantly women—can earn more from work?

Photo of Maree Todd Maree Todd Scottish National Party

Jackie Baillie will be aware that that issue does not fall within my portfolio, but I am well aware of the fact that more women are carers, and that that is one of the factors that impact on their health. I will take a cross-Government approach to that work. I am very keen for us to achieve cross-parliamentary consensus on the need for such issues to be tackled so that we can progress the work to improve women’s health

, with everyone in agreement.

A significant amount of work is being undertaken across Government to improve women’s health with regard to mesh, maternal health and screening services. The plan will build on those successes and align with Covid-19 recovery.

I finish with another quote from Caroline Criado Perez’s book, which I recommend to everyone in the chamber:

“The evidence that women are being let down by the medical establishment is overwhelming ... half the world’s population are being dismissed, disbelieved and ignored.”

Our ambition is for a Scotland where health outcomes are equitable right across the population so that all women can enjoy the best possible health throughout their lives. Our women’s health plan will provide a foundation for us all—in Government, health and social care, and society as a whole—to work together to achieve that. I look forward to listening to members’ views and I hope that we can find common cause across the Parliament in better listening to, understanding and meeting the needs of women in Scotland.

I move,

That the Parliament welcomes that the Scottish Government will publish a Women’s Health Plan within the first 100 days of the current parliamentary session; notes that the plan will seek to improve support and services for the health and wellbeing needs of women and girls at every stage of their lives; believes that it is vital that health and care services for menopause, endometriosis and heart healthcare need to substantially improve; recognises that the causes of many healthcare issues facing women and girls are rooted in health and income inequalities, and that actions to address these are needed alongside the enhancement of services, and believes that, if a broad consensus on women’s health can be realised, Scotland has the opportunity to become a global leader in this field.

The Deputy Presiding Officer:

Thank you for keeping to your time as well as taking interventions, minister.

Photo of Annie Wells Annie Wells Conservative

I am delighted to have the opportunity to speak in the debate. First, I take the opportunity to lend my support to cervical screening awareness week. Cervical screening, which is also known as smear testing, is life saving. However, many people find the test difficult for a variety of reasons including anxiety and previous trauma. Indeed, over a quarter of those who are invited to take the test do not take up their invitation.

It is also concerning that figures from Public Health Scotland show that, in 2019-20, there was a lower uptake of cervical screening among those from more deprived areas. That is why campaigns such as cervical screening awareness week are so important. I would like to hear from the Government how it will work to close the gap between the most and least deprived areas when it comes to cervical screening.

Jo’s Cervical Cancer Trust has launched its own campaign for the week, which aims to encourage open conversation about cervical screening and to issue clear guidance to women and people with a cervix on how to access vital support that they may need. I urge people to visit its website for more information.

In the coming months, as more people in Scotland are vaccinated and we look to carefully ease restrictions, there will be an opportunity for us all to reflect on our experiences of the pandemic. We can immediately recognise the invaluable role that women have played and continue to play in protecting the national health service against the virus. Many health and social care professions in Scotland—and indeed the world—are dominated by women. We must not lose sight of the key role that women have played in caring for some of the most vulnerable people in society and treating people for this deadly disease.

However, we cannot wait until the pandemic has passed to have an urgent and renewed focus on improving women’s health. The advocacy group Engender has issued a stark warning that there is concern that women’s health problems are being

“dismissed, underestimated and diagnosed late.”

I make it clear that the Scottish Conservatives are committed to ensuring that women’s health and wellbeing needs are met across their whole lifetime. As we heard from the minister, women make up half of the population, yet as a society we often avoid talking about many of the health issues that they face. That must change.

In the light of those concerns, the Scottish Conservatives have welcomed the Government’s commitment to a women’s health plan, and we look forward to carefully scrutinising it following its publication.

In the debate a fortnight ago on the NHS recovery plan, I said that, as our healthcare service is remobilised following Covid, we will need to improve the services that women across Scotland rely on. The NHS needs to be bolstered with significant financial support if we are to tackle the backlog, which threatens to delay and even deny vital treatment for Scottish women. That is why, in our amendment to the Government’s motion, the Scottish Conservatives are calling for a clinician-led, ring-fenced fund with the sole remit of bringing treatment times under control. That would help to ensure that, despite the immense pressure placed on our healthcare system by the pandemic, the NHS is responsive to women’s health and wellbeing concerns.

Take the condition endometriosis, for which the average time for a diagnosis in Scotland is eight and a half years, according to an inquiry by the all-party parliamentary group on endometriosis. The inquiry noted that, in Scotland, it has been difficult for some women to access specialist endometriosis centres, even if they are suffering from deep endometriosis.

Another area of concern regarding women’s health is breast cancer, which is the most common cancer in women in Scotland, accounting for 28.8 per cent of all cancers diagnosed. Only recently, Cancer Research UK revealed that a thousand fewer people in Scotland started breast cancer treatment last year than did the year before. That highlights the tremendous scale of the NHS backlog, and how the queues for essential treatments are growing at a startling rate.

I agree with the minister when she stresses the importance of recognising the link between health and income inequality. As is the case with cervical screenings, the figures show that women from the most deprived areas of Scotland are less likely to attend breast screening appointments.

Whether it be endometriosis, breast cancer or cervical cancer, I again stress that it is vital that we have targeted resources dedicated to tackling the backlog and addressing lengthy waiting times in those key areas of women’s health.

An issue that I know will be discussed passionately across the chamber today is the failings surrounding transvaginal mesh surgery. It is important to praise the efforts of Scottish Mesh Survivors, a group of heroic women who have worked tirelessly over the years to raise awareness of the dangers of mesh. The scandal, which has been a traumatic and harmful experience for the victims involved, needs a resolution as soon as possible. I am clear that I stand side by side with colleagues across the chamber in calling on the Government to urgently introduce financial support to refund the women who paid for private mesh surgery outwith the NHS.

As I mentioned at the beginning of my speech, women make up half of our population, but serious discussions about our unique healthcare needs are often shied away from. That must happen no more. The barriers to good physical and mental health that women face are clear, and the pandemic continues to place significant pressure on the NHS. With a laser-eyed focus, let us recommit ourselves to supporting women’s health by giving the NHS the proper funding that it needs to tackle the backlog and be responsive to the healthcare needs of women across Scotland.

I move amendment S6M-00369.1, to insert at end:

“; notes that women face significant barriers to good mental and physical health, including unreasonably long waiting times for a diagnosis of conditions such as endometriosis, where the average waiting time is eight and a half years in Scotland; believes that women from the most deprived areas of Scotland are less likely to attend breast screening appointments, and, with breast cancer referrals declining during the COVID-19 pandemic, calls on the Scottish Government to bring treatment times under control by having a separate, clinician-led fund to tackle the NHS backlog.”

Photo of Carol Mochan Carol Mochan Labour

It is very welcome that women’s health is receiving some of the spotlight that it deserves in the chamber today. I am delighted to be opening for Scottish Labour.

I want to focus on the way in which women continue to be treated as second-class citizens in Scotland, whether by neglect or design. There is only so long that the Government can keep coming up with motions celebrating plans as yet unannounced. People want action—that is what Scottish Labour continues to focus on, and that is what I will focus on in the debate.

Scottish Labour pushed for action on women and women’s health throughout the previous parliamentary session. An example was the action of my colleague Monica Lennon, who did so much to improve the provision of free period products with world-leading legislation. That was action, but I am sure that Monica would agree that there is still a great deal more to do. We can do that only by working together and using the powers of the Parliament.

I worked for many years in the NHS and saw at first hand the ways in which women’s medical concerns are so often dismissed as minor considerations or cast off as by-products of personal responsibility. It is vital that people in our position speak up for those who are unable to do so.

I know from my constituents that the stigma surrounding menopause, access to specialist mental health support and waiting times for breast cancer screening appointments are just a few of the ways in which women in Scotland feel that their needs are not taken into consideration. Menopause symptoms in particular remain heavily stigmatised, and many women are reluctant to ask for help or share their experiences. Specialist services must have greater equality in access to allow women to be confident in coming forward to access treatment.

There is perhaps no greater example in contemporary Scotland of such neglect than the treatment of the survivors of the transvaginal mesh scandal. During the previous parliamentary session, my Labour colleague Neil Findlay, along with MSPs from other parties, did much to raise awareness of the issue. They had some success, although there are still questions left unanswered.

The work of the Scottish Mesh Survivors campaign has repeatedly revealed the extent to which those women trusted the NHS to treat them. They were led to believe that the mesh was safe, only to be left with life-changing injuries. Many of those women were left unable to work or live a normal life and they suffered all the dreadful social and financial impacts that followed.

Scottish Labour is pursuing that and many other issues, because we see the advancement of women’s health as a core concern of a modern country that is focused on justice. We believe that by supporting women to live healthy lives, we build the blocks of a national health service.

For all the posturing, I am not sure that the same can be said of the Scottish National Party. Its recent record is not even close to acceptable. In 2020, more than 43,000 breast cancer screening appointments were cancelled, and at least 180,000 cervical screening tests were delayed. Less than three fifths of women from the most deprived areas of Scotland attend breast cancer screening appointments, compared with nearly four fifths of women in the most affluent communities. Scotland has only two mother-and-baby mental health units, and the Royal College of Psychiatrists in Scotland has said that mental health treatment for new mothers is akin to a postcode lottery. I urge members to remember that, on average, women with endometriosis wait eight years to receive a test.

Scottish Labour wants to start turning back the tide. As members can see from our amendment today, a first— and absolutely necessary—step is to recognise that we have an opportunity to right the wrong suffered by Scotland’s mesh survivors, and give a guarantee that they will be able to access the compensation that they deserve. If we can help that group of women, we can give hope to those who believe that their own concerns have been forgotten that things can change for the better.

For once, let us use the Parliament’s powers to redress the balance for a group of people who have no institutional power, only their own solidarity, compassion and desire for justice. I know that the SNP claims to support that idea in principle but, so far, it has come up with more excuses than solutions. It is long past time that we got it done and delivered the vital funding to those women, so that they can get back to some sense of normality and do not feel left behind by an establishment that seems so distant from their lives.

For years, the mesh survivors have campaigned relentlessly for justice. There is probably not an MSP in the building who has not been contacted by them or listened to their story. Ensuring that they do not have to pay for essential surgery from their own pockets is the least that can be done to correct the historical injustice that they have experienced, and we in the Parliament can help.

I implore the Scottish Government to join Scottish Labour today and start a new chapter in our country’s history by championing the right of women to receive fair and effective healthcare. It should not be too much to ask. I ask all members to support Labour’s amendment.

I move amendment S6M-00369.4, to insert at end:

“; acknowledges that, historically, the health concerns of women have been too easily ignored or dismissed; deeply regrets the life-changing damage to women as the result of transvaginal mesh surgery; commends the Scottish Mesh Survivors group, which has determinedly fought to raise awareness of the dangers of mesh and prevent further women being injured by its use, and supports the asks of its Charter for Mesh Care, which is calling for funding to be immediately made available to cover the costs of mesh removal for women having to undergo private surgery.”

Photo of Gillian Mackay Gillian Mackay Green

I take the opportunity to congratulate the minister on her appointment. I look forward to working with her over the coming years. I also thank everyone who sent in briefings ahead of the debate.

Women are more likely to have heart disease misdiagnosed, and to have their physical symptoms either dismissed entirely or put down to their mental health. When I first started experiencing symptoms of my disability, my parents were told that I was embellishing my hearing loss, and that the dizziness that I was experiencing was probably linked to my period or to stress.

Women need to be believed when they go for help. Being told that their physical pain is all in their mind will undoubtedly stop them from trying to access healthcare in the future. Given that many healthcare campaigns encourage people to get checked early and to ask their doctor about anything unusual that they notice, we should be trying our best to ensure that everyone’s healthcare concerns are taken seriously.

Heart disease is often perceived as a condition that affects men in particular, but ischaemic heart disease kills 2,600 women a year in Scotland. Currently, tests to diagnose heart attacks are not as accurate for women as they are for men. Seven women a day will die from ischaemic heart disease; seven families will be devastated. That does not take into account women who survive and then have to live with long-term conditions, usually on blood thinners, for the rest of their lives.

Often, we in Parliament look at our decisions through an economic lens. We look at the loss to the economy of those who cannot work after a heart attack or we look at how much it costs to run a service or a campaign. However, what we decide here affects actual lives.

Prevention of a heart attack is the difference between a family keeping and losing a mum, sister or daughter and between a person being able to enjoy their life in the way that they used to and having that irreversibly changed. Any family who has experienced that will tell us that no price can be put on saving a loved one’s life.

However, we know that income and deprivation are strongly linked to positive health outcomes. We need to tackle poverty and other drivers of poor health, in partnership with promoting good health.

Even though my amendment was not selected for debate, I will cover some of the issues that were raised in it. Pregnant women and new mothers have been particularly negatively affected by the pandemic. Women who have been pregnant and have given birth during the pandemic have been hit hard by the restriction or loss of some services.

During the first lockdown in 2020, restrictions included barring partners from attending antenatal screenings and limiting the time during which they could be present during labour. Although those restrictions have largely been lifted, they have had a profound impact on the health and wellbeing of new parents and on their relationships with their child.

In addition, pregnant women still cannot access all the services to which they are entitled. In-person antenatal classes are still suspended, with most health boards offering online e-learning modules instead. Those are a poor substitute for the supportive environment of traditional antenatal groups, which are often a lifeline for first-time parents.

Women are also struggling to access free dental care for new mothers, and I am aware that there is a growing number of women who now have to pay for expensive dental treatment because they could not access dental appointments over the past year and have passed the one-year window for free treatment after giving birth. Free dental treatment is a recognition of the impact that pregnancy can have on the oral health of new mothers, so we should be doing all that we can to ensure that women take it up.

My colleague Mark Ruskell has written to the Cabinet Secretary for Health and Social Care to ask him to extend that provision to two years post birth, for the foreseeable future. I encourage the cabinet secretary to reflect on that proposal, if he is summing up. It would be a simple but effective measure to redress the unequal impact that the pandemic has had on women’s health.

We would also like the Government to commit to retaining the provision for early medical abortions at home, which was introduced during the pandemic; to ending the two-doctor rule; and to establishing buffer zones around abortion clinics and sexual health clinics. No one should be harassed while trying to access healthcare.

The Deputy Presiding Officer:

Your incorporation of your amendment was elegantly done, Ms Mackay.

I call Beatrice Wishart to speak for four minutes, after which we will move to the open debate.

Photo of Beatrice Wishart Beatrice Wishart Liberal Democrat

I, too, am grateful for the opportunity to take part in the debate and to help to bring women’s health issues in from the sidelines.

Many of us scoffed when news broke in 2016 about trials of male contraceptive pills being called to a halt. They ran aground because the participants were experiencing headaches, mood swings and weight gain—all of which are symptoms that are well known in the female experience of contraception.

However, that point is worth more than just a roll of the eyes, because it clearly shows the inequality that is at the heart of the debate.

To this day, there is a mainstream expectation that there are levels of pain and discomfort that women should just live with. Risks are excused or normalised for women, while simultaneously being regarded as being too much for the population at large.

Women consistently report the experience of not being listened to in healthcare settings. As Engender said recently, they

“wait longer for pain medication than men, wait longer to be diagnosed, are more likely to have their physical symptoms ascribed to mental health issues, are more likely to have their heart disease misdiagnosed or to become disabled after a stroke, and are more likely to suffer illnesses ignored or denied by the medical profession.”

A huge amount of work needs to be done to rectify the situation. The women’s health plan will be a start. However, it has taken a long time to get the conversation started, so we should not underestimate the effort that it will take to effect real change.

The determined campaign that mesh survivors ran is a testament to that. Those women’s experiences of botched treatment are nothing short of a public health catastrophe, but the response from the Government has been slow. Their asks should not be up for debate; we need to do whatever it takes for those women. There should be funding for removal surgery, so that women have a choice about where it is done and by whom. There should be a patient safety commissioner and there should be a statutory ban on mesh, so that such things never happen again.

My amendment, which was not selected for debate, raised the question of dedicated facilities for perinatal loss. Louise Caldwell has campaigned bravely on the issue. She was required to deliver on a labour ward after being told, at her 12-week scan, that there was no heartbeat. She said:

“As soon as you enter the labour ward you are met with newborn baby photos on walls, thank you cards, baby cries and proud partners.”

It is difficult to imagine how hard that must be. Official guidance says that separate facilities should be provided, but as Louise’s experience shows, recognition of the issue does not always translate into reality. There needs to be a standard of care for perinatal loss that is equivalent to that which is provided to patients who are undergoing labour and delivery.

Perinatal mental health, too, needs to be brought to the forefront of the women’s health plan. A 2018 report showed that Glasgow was the only place in the whole of Scotland that was meeting perinatal mental health requirements. Mothers in half of Scotland could not access specialist services—years after another report had warned of significant gaps.

I hope that, in her closing remarks, the minister will address the issue and commit to making perinatal health and mental health a cornerstone of the Government’s plan.

The Deputy Presiding Officer:

Thank you, Ms Wishart. I think that all the lodged amendments have now been given an airing.

We move to the open debate. The first speaker will be Evelyn Tweed. Members will want to be aware that this will be Ms Tweed’s first speech in the chamber.

Photo of Evelyn Tweed Evelyn Tweed Scottish National Party

Thank you, Deputy Presiding Officer, and welcome to your new role. My congratulations go to Maree Todd, too.

It is the privilege and honour of my life to be standing in Scotland’s Parliament making my first speech. I only wish that my parents had lived to see this day. I have no qualms about saying that I come from a very poor background and have lived through periods of homelessness and living hand to mouth. The experience of growing up on a council estate in the Thatcher years shaped my views on social justice and led to a 25-year career in housing and building homes for people in need, before I was elected as a councillor.

I was once told by a friend that I should never go into politics, because I care too much. Well, I believe that all the best politicians care too much. This is why I was elected: to speak up for the most vulnerable people, to help people and to be a voice for women.

Although, on average, women enjoy longer lives, more of our lives are spent in ill health. For too long, women—our mothers, daughters, sisters and carers—have not been adequately supported. I am so proud that an SNP Government has so clearly improved women’s lives.

For example, Scotland was the first country in the world to have free period products. That shows what can be done when we all work in the chamber together. We have the fantastic baby box, which provides mothers with the essential items that they need for their new baby, and we have more general practitioners per head of population than any other UK country. However, there is still so much more to do.

Many health issues in the past have been described as “women’s problems”, whether the problem is endometriosis or the menopause—both of which I have experienced. I have endured endometriosis all my adult life. It has resulted in chronic pain and, at times, misery. The pain was dismissed as period pain and it took until I was in my late 30s, when I collapsed at work, for me to finally get some support. I do not want any other woman to go through what I went through. There is no cure and—as we have heard today—most women wait more than eight years for diagnosis, which is simply not good enough. I am delighted that the SNP Government has committed to reducing the diagnosis time to 12 months by the end of this session of Parliament.

It is also fantastic that we now talk openly about menopause—a process that will affect more than half of our population. The SNP will ensure that women have improved access to advice and support on diagnosis and management of menopause.

Let us work together across the chamber to improve services and reduce health inequalities for women and girls. Let us become a global leader in the field. I believe that independence and having the full fiscal powers to make our own decisions will, ultimately, help us to tackle all inequalities and ensure that all our citizens have equal access to food, housing and healthcare.

As I draw to a close, allow me to offer my heartfelt thanks to the people who made my being here today possible. They are my brilliant husband, Ahsan, who is my rock and the love of my life; my daughter, Emily, who is a force of nature and a campaigner extraordinaire; our family and friends; my fantastic campaign team; my predecessor, Bruce Crawford; my modern studies teachers at school, for my fierce love of politics; and David Shearer, my long-time friend and mentor, to whom I say, “Your advice paid off.”

I thank everyone in the wonderful Stirling constituency who voted; I commit to listen to you, to be guided by you and to work for you.

The Deputy Presiding Officer:

Well done, Ms Tweed. I call Craig Hoy.

Photo of Craig Hoy Craig Hoy Conservative

Thank you, Deputy Presiding Officer. I welcome you to your place and the minister to her new position.

The consequences of Covid will live with us for a long time to come, and nowhere will those consequences be more severely felt than in our health and social care services. Failure will be measured in lives lost, life-threatening conditions undiagnosed, and mental health problems untreated. The consequences will be acutely felt by patients and their families, but they will also be felt by our front-line health and social care staff. They are more likely to be felt by women. It will be your gran, your mum, your sister, your daughter, your wife, your civil partner, your aunt or your girlfriend who will confront those consequences and those inequalities.

Across Scotland, we are facing an escalating mental health crisis that is made worse by repeated failures by the SNP Government. Women are nearly twice as likely as men to confront the dark cloud of depression. One in five women suffers depression during pregnancy. That is not only adult women. A study by Mindwell concluded that gender differences that can impact girls’ mental health start to emerge at the age of 12.

That is why the sudden and shocking surge in treatment times for child and adolescent mental health services must be urgently addressed by ministers. The campaign group Engender warns that women and girls have faced significant barriers to good mental and physical health for decades and that women are often missed by health services or by public health awareness campaigns. I hope that the Scottish Government’s women’s health plan comes forward with robust interventions.

The shortcomings in relation to social care are also more likely to impact women. In Scotland, twice as many women as men live in long-term care.

The Scottish Conservatives welcome many of the findings of the Feeley review of social care. However, as we explore the creation of a national care service, we must reach beyond the vague but worthy goal of a system that is based on human rights. We must look towards a system that is designed around the needs of the individual, that marries traditional approaches with new technology and that supports home-based care so that more older women can live independently at home and for longer. It should be a system that tackles the staffing and recruitment crisis and fixes the funding formula once and for all.

When we talk about recovery, we need to recognise the impact that Covid has had on staff in social care and in our NHS, the vast majority of whom are women. In fact, 11 per cent of working women in Scotland, compared with just 3 per cent of working men, work in our NHS. When our NHS staff talk of stress and strain, we must remember that it is women who are most likely to be at the front line.

We must do more to close the gender pay gap in our health and social care services. On average, women earn 18.2 per cent less than men in our NHS. That gap is widest in admin functions and personal and social care services.

My colleague Annie Wells rightly set out the areas in which women are being failed in relation to diagnosis and access to primary care. Women’s health problems are too often dismissed, underestimated or simply diagnosed too late. Women who work in our NHS and care services are often stressed out, burnt out, undervalued and underpaid relative to men. We need to recognise those problems, and we in the Parliament need to resolve them. If concerted action today is one of the few silver linings of the Covid pandemic, we must work together to take it.

Photo of Kenneth Gibson Kenneth Gibson Scottish National Party

I congratulate my colleague Evelyn Tweed on her excellent first speech in Parliament.

Women’s health is important to men, too: we have mothers, daughters, sisters, wives, partners, and female friends and colleagues. Women cannot be second best in the treatment of illness.

In 2019, I participated in a meeting of the cross-party group on women’s health that was ably chaired by Monica Lennon and at which the British Heart Foundation’s “Bias and Biology” report was presented. It is shocking that the report showed that ischaemic heart disease, which is the leading cause of death for women in Scotland, is more likely to go untreated or undiagnosed or to be diagnosed later in women than in men, and that there is less awareness of the symptoms and signs of heart attacks as they happen to women. Women are also less likely than men to receive scans.

A BHF-funded study in 2018 showed that women who have an NSTEMI—non-ST-segment elevation myocardial infarction; a type of heart attack in which the coronary artery is usually partially blocked—are a shocking 34 per cent less likely than men to receive coronary angiography within 72 hours of their first symptoms. My last question in the chamber before the Parliament rose in March was about how much progress had been made in addressing that over the past two years. It was encouraging to hear from the previous public health minister that the women’s health plan will include cardiac disease as a key pillar and that implementation will align with the heart disease action plan, which highlights the importance of tackling inequities in access to diagnosis, treatment and care. I look forward to actions evolving from both plans, and I believe that ministers should strive to ensure equality of health outcomes at the earliest possible date.

Women may have a higher life expectancy than men, but quality of life matters, too. The SNP’s 2021 manifesto includes a commitment to improve the experience and diagnosis of women who visit their general practitioners with menstrual problems. Improved diagnosis and management of the menopause and legislation in aid of transvaginal mesh survivors will also help to better the quality of many women’s lives.

The Scottish ministers will explore ways in which the baby box can be used to further promote women’s health and support parental mental health. The time is also right to progress the women’s health plan. Since it first appeared in the 2019-20 programme for government, much of the focus and many resources relating to health have understandably shifted. However, I am glad that the plan is prioritised in the Government’s first 100 days.

The endo warriors and other women across Scotland will be pleased to see endometriosis specifically mentioned in the Government’s motion.

The sad reality is that it is only over the past few years that endometriosis, which Evelyn Tweed eloquently described her own experience of, has been recognised as a hugely impactful condition for one in every 10 women.

The opening in April 2019 of the west of Scotland accredited endometriosis unit, which I campaigned for, means that women and girls who live in the west and require specialised treatment no longer have to go to Edinburgh or Aberdeen. Travel to those places was often prohibitive for financial reasons. Nevertheless, the fact that my February 2017 members’ business debate on endometriosis was only the second such debate in 18 years of this Parliament—the first was secured by Annabel Goldie in the first parliamentary session—and that it took another two years following the debate for NHS Greater Glasgow and Clyde to set up the specialist unit, tells me that women’s health has not always received the urgent focus that it merits.

As we have already heard, the SNP manifesto commits to reducing average waiting times for diagnosing endometriosis from eight years to less than one year by the end of this parliamentary session. That is ambitious, given that it is such a difficult condition to diagnose, but it is an ambition that is worth striving for. I will follow that closely.

I remind the new male MSPs that it is also their place to raise issues concerning women’s health. We must all do what we can to improve women’s health, as it is important for every one of us.

The Deputy Presiding Officer:

That is a timely warning to us all.

Photo of Claire Baker Claire Baker Labour

I very much welcome this debate on women’s health. The creation of a plan that provides a co-ordinated and inclusive strategy for women’s health is overdue, and I am pleased that, in this parliamentary session, the Government is prepared to focus on women’s health and bring together many issues that MSPs and campaigners have pressed it on for many years. It is welcome that we recognise the connectedness of all those issues. Women’s health has been marginalised, unacknowledged and devalued, and there have been, and continue to be, systematic, institutional or societal failures in the treatment, public health messages and support that women receive.

The minister referred to “

Invisible Women: Exposing Data Bias in a World Designed for Men”

. That book revealed the inequalities of a society that is created for men. The needs of women have been ignored in the planning or design of things from the ridiculous, such as the temperature in our offices, to the dangerous, such as the design of car seat belts. Perhaps that has not been deliberate or malicious, but women have been treated as second-class citizens and given not even an afterthought. That has affected all areas of society, including healthcare.

The author of that book—Perez—highlighted the example of heart disease and its perception as a male disease. The consequences of women facing missed diagnosis and disadvantage in treatment are also addressed in the British Heart Foundation’s “Bias and Biology” briefing paper, which Kenneth Gibson mentioned. It is welcome that the Scottish Government now recognises the specific needs of women with heart disease, but the paper points to inequalities at every stage of a woman’s medical journey and the importance of a much broader rethink. I hope that the women’s health plan will bring that.

The lack of support for women experiencing perimenopause and menopause is gaining a higher profile, which is welcome. There is more open debate and discussion about the symptoms that women can experience, and there is more effort to reduce stigma and tackle shame, which has been driven by decades, if not centuries, of the representation of women as crazy or barren simply for experiencing a natural process. In her book “Perimenopause Power”, Maisie Hill makes clear the broader impacts of menopause symptoms and how they can affect relationships and work performance. The average age of menopause is 51, and the age group of women with the highest suicide rate is 50 to 54. That is a stark fact that highlights the importance of evidence-based guidance and the provision of support, including on the use of hormone replacement therapy.

It is vital that women can access proper support, and routes to specialist care need to be improved. There is only one specialist centre in Scotland for menopause, so the first port of call in most instances is a general practitioner. We must ensure that women are confident that their concerns will be listened to by GPs and that they will not be deterred from asking for help. Misdiagnosis is a key issue in women’s health, and women too often feel that their point of view has been dismissed when they have approached their GP. We must increase the number of available specialists and the amount of training for GPs, reduce waiting times, and encourage self-referral so that access to treatment is straightforward and responsive. We need workplace strategies that better recognise changes throughout women’s lives and how they impact on women’s working lives.

The Health and Social Care Alliance Scotland report on future planning was brought together by the lived experience sub-group of the women’s health group. In the report, women highlight difficulties in accessing services, particularly for some marginalised groups. They say that there was no mention of mental health in the plan, with the focus being on physical health—although I noted the minister’s opening comments on that. Making appointments around work and caring responsibilities is still difficult, the need for GP referrals for specialist services can add a further layer of delay, and requesting female GPs or interpreters can put additional pressure on women who are seeking appointments. We must have clear, accurate and up-to-date information readily available online, including accessible videos in a range of physical locations and in other languages.

I will briefly mention the need for investment in research into women’s health. A woman’s health plan is vital to address inequalities in health provision, to provide standards and deliver expectations for women’s health needs, and to ensure that, when they seek health services, women are taken seriously and provided with choices to enable them to live healthy, rewarding lives.

Photo of Emma Roddick Emma Roddick Scottish National Party

In my first speech, I raised the hope that our new Minister for Public Health, Women’s Health and Sport would place importance on improving treatment for endometriosis and menopause. I want to repeat that hope today and to urge the Scottish Government to address what is more than a shortfall in the women’s health plan—it is the result of many years of lack of understanding, concern, and motivation throughout society to do anything about substandard care.

It is not simply a political problem—it is ingrained. It is an issue in medical research, academia and society in general. Women’s health takes a back seat: we get fewer research grants; we take the birth control; we take the hit. The Parliament must show leadership.

I talk a lot about the value of lived experience, and it is necessary in relation to these issues. Perception does not always match reality, and it is vital that those who experience the issues first hand lead any discussions about them, or outcomes will be ineffective. In particular, with issues such as menstruation and menopause, which have been historically ignored or hidden away, to continue the conversation as it is now means to work off outdated assumptions, myths and misbelief. We have to start again.

I also hope that, although we describe these issues as “women’s health”, efforts will be made to ensure that people who are not women but suffer from the same issues feel able to enter the conversation and seek better care.

Given that we still are not past the point of requiring euphemisms to talk about periods or using blue liquid to denote menstrual blood, it will be quite a challenge to raise awareness about, and treatment standards for, endometriosis and dysmenorrhoea, but we must. As someone who has been hospitalised many times due to my period, I hope to see wider recognition that, for many who menstruate, a period is not just a cramp or an annoyance. It is something that causes excruciating pain, which not even morphine will fully relieve; it prohibits mobility; and it causes chronic pain throughout the month. It is something that workplaces—even doctors themselves—often completely misunderstand and stigmatise.

I am really glad to see that the Scottish Government aims to reduce waiting times for a diagnosis of endometriosis to 12 months. In order to do so, however, we have to recognise and admit that one of the reasons that it takes so long now is that those who seek help with their periods are dismissed. We are accused of exaggerating pain; of it being because we are a size 14 instead of a size 8; and—especially if we also have mental health issues—of being, essentially, hysterical, with doctors suggesting that it is all in our heads when we are curled up on the bathroom floor, screaming in pain as we wait for an ambulance.

It is not just that there is a long assessment period or a lack of research and available treatment, but that we are sent home from the GP again and again, with a wave of the hand, a pack of paracetamol, a prescription for mefenamic acid and—if we are lucky—an appointment with someone else in a few months.

Given how hard it is to break down assumptions about menopause, I realise that it will be a challenge to raise awareness of early menopause, but we must do that as well. If an employee approaches their boss and says that they are struggling and the reaction is a laugh, a joke or disbelief because they are “not old enough”, that is unacceptable.

We have a long way to go. I am committed to doing my bit to bring lived experience to the discussion, raise awareness and work with the Government to make life better for those who suffer issues that women typically experience, but we must begin from a point of understanding just how bad the situation is.

Photo of Rachael Hamilton Rachael Hamilton Conservative

Never has there been a more pressing time than the present to debate women’s health issues. After the past 15 months, we have seen waiting times soar, an increase in the backlog of cancelled operations and cancer diagnostic tests shelved. Even young pupils have been affected by not receiving either the first or the second human papillomavirus—HPV—vaccine within the crucial 18-month stage when those young people become sexually active.

In the coming months, it is crucial that we have those services fully up and running. Women’s health has for far too long taken a back seat, and I am keen to see change, as are so many people in the chamber.

A starting point for me came in 2019, when Monica Lennon and I hosted an event with the British Heart Foundation to discuss women’s health inequalities, particularly in diagnosing heart disease. At a similar point, Caroline Criado Perez’s book “Invisible Women” was published, addressing a clear gap in women’s health treatment, as the minister said.

More recently, I was troubled by the experience of a friend from the Borders who has been waiting years for an endometriosis diagnosis. Without a doubt, urgent action must be taken to address the appalling length of waiting times for endometriosis diagnosis. Endometriosis is very common. It affects 10 per cent of women from puberty to menopause, although, as Evelyn Tweed described, the impact might affect them for life. It has been said that the average time to get a diagnosis is eight years, but it is not; in Scotland, it is eight and a half years.

We know that access to services for those women is very difficult. The inquiry by the UK all-party parliamentary group on endometriosis attracted 10,000 responses and noted that it has been difficult to access treatment in Scotland. There are specialist units in Edinburgh, Glasgow and Aberdeen, but it seems that, for people who live outwith those specific health board areas, it is—I loathe to use this description—a postcode lottery. Women are experiencing physical and emotional suffering, and the Government needs to act.

The report, which is well worth a read, commits to a reduction in the average diagnosis time to four years or less by 2025, and to a year or less by 2030. I challenge the Government to meet its manifesto commitment, because it has not yet met its legally binding treatment time guarantee of 12 weeks.

In Scotland, our cross-party support ended period poverty, provided free sanitary products in schools and brought plaudits from across the globe. A reduction in waiting times, access to specialist endometriosis services and the provision of menstrual health education in schools should be key priorities, and I ask that the minister addresses that in her closing speech.

Cancer diagnosis and treatment, especially for cervical and breast cancer, have fallen by the wayside during the pandemic, with women being particularly let down. When cancer screening and detection tests were on hold from April to June last year, 4,000 fewer people received cancer diagnoses. Breast cancer represents almost a quarter of those missing cases—over 70 per cent more than would be expected—which has prompted fears that progress in fighting the disease is in jeopardy. We need proper funding. I also ask the minister whether the cervical screening awareness campaign has been restarted.

The Scottish Conservatives, through our amendment, are calling for the NHS backlog to be tackled by a separate clinician-led fund, so that we can finally bring treatment times under control. We cannot continue on the current trajectory. Women’s health is at stake.

Photo of Alison Johnstone Alison Johnstone Green

I call Siobhian Brown. This is Ms Brown’s first speech in the chamber.

Photo of Siobhian Brown Siobhian Brown Scottish National Party

I thank the minister for leading today’s important debate on women’s health. It is so important that we do not ignore early signs of disease, because early diagnosis can be life saving. I welcome the opening next week of the early cancer diagnosis centre in Ayr, as part of the Scottish Government’s health recovery plan, and I encourage people not to ignore concerns but to get in touch with their doctor.

It is the biggest privilege to stand here as the first SNP member, and the first woman, to be elected to represent the people of Ayr, Prestwick and Troon in the Scottish Parliament. I would not be here today if it were not for the support and commitment of my campaign team. I thank Con, Ian, Alison and Becca, as well as all the local activists who put their heart and soul into helping to win the seat. Their extraordinary efforts mean that I am able to join the other four SNP MSPs in representing all the people of Ayrshire.

I thank all the people who trusted me with their vote. I will work hard to repay their trust. I assure those who did not vote for me that I am their MSP, too. I am determined to represent each and every one of my constituents to the best of my abilities at Holyrood.

I also pay tribute to my predecessor, John Scott, who represented the people of Ayr, Prestwick and Troon for 21 years. Although our politics are different, I have the utmost respect for him. He was a highly regarded member of the Scottish Parliament, and I wish him health and happiness.

Politics and public life can, at times, be somewhat challenging to family life, so I thank my husband and children for their support and patience. I am lucky to represent a beautiful part of the world, on the picturesque west coast of Scotland. I represent the Ayr seat, which includes the neighbouring towns of Prestwick and Troon. We have many valuable resources such as our world-class golf courses, our Robert Burns heritage, Prestwick airport and the aerospace industries, Troon port and the yacht marina, a campus of the University of the West of Scotland and, in normal times, a buzzing restaurant scene and nightlife. If you have never been, I urge you to come and visit my constituency. Weather permitting, you might be rewarded with a sunset over Arran that will make you appreciate life, even during a pandemic.

My constituency is fortunate to have many areas of affluence, but it also has areas with high levels of deprivation. Years of Tory austerity have impacted heavily on the resilience of our poorest communities and have increased the difference in life chances for our young and our old. A child in some parts of Ayr north is twice as likely to grow up in poverty as one living in Troon, and the life expectancy of a child born today is around 10 years less in our poorest areas than it is in our most affluent areas.

Tory austerity and social welfare cuts have exacerbated inequality. That cannot be denied or excused—more so since the cuts have been revealed to be a deliberate policy choice and not an economic necessity. That is why the Scottish Government’s renewed commitment to tackling child poverty is welcome. Measures such as doubling the Scottish child payment to £20 per week in the first year of this parliamentary session, which has already been described as a poverty game changer, will give children in our communities the life chances that we wish for them all.

There are also inequalities in our communities at the other end of the age spectrum. I am sure that members are aware that levels of pensioner poverty are higher and that the state pension is lower in the UK than in most of western Europe. The stolen pensions of the WASPI women—the women against state pension inequality—are a national scandal. Given that the proportion of my constituents who are aged over 65 is higher than the Scottish average, that is of huge concern to me. In one of the richest countries in the world, all our elderly citizens should be able to live with dignity and receive the level of care that they deserve. I am delighted that the Scottish Government has made it a priority to establish a national care service on a par with the NHS and has committed to scrapping charges for non-residential care.

Our young people are perhaps our most important local assets. As it has for kids around the world, the pandemic has had a huge impact on their education, their lives in general and their mental health. As we help our young people to get their lives back on track, we must take the opportunity to consider what kind of country we want them to grow up in and who we want to lead a fairer, greener recovery. That should be—and will be—decided by the people of Scotland. They have returned an SNP Government with a landslide victory, and the people’s will must be respected.

The Covid pandemic must be a priority, but, when the time is right, the people of Scotland should have the choice to determine their future. That is not about being divisive; it is about being democratic.

Photo of Martin Whitfield Martin Whitfield Labour

It is a true privilege to follow such a powerful first speech from Siobhian Brown. She speaks powerfully of her community, which will do well in her hands, although there is a slight political disappointment on this side of the chamber.

I will use the short time that I have to talk about the menopause, following the powerful contributions made by Claire Baker and Emma Roddick. I, too, invite the cabinet secretary to expand on the welcome inclusion of the word “menopause” in the motion. In 2018, on world menopause day, I led a back-bench debate on the subject at Westminster. Although that debate was supported across the house, it is sad that so little has changed since then.

I embarked on my new career in my 50s. I cannot imagine embarking on a new career while struggling with some of the symptoms that my female counterparts experience and suffer without help or support. It is unthinkable that a society would ask men at the height of their careers to tolerate such symptoms and simply carry on—and ask them to do that quietly, too. Why should women do that?

All too often, the menopause is seen as something that women need simply to cope with. They are afraid to discuss the symptoms openly with friends, family and—sometimes most important—work colleagues because they are afraid of being undermined and perhaps marginalised. Seventy per cent of women do not discuss their symptoms at work, a third do not visit their general practitioner and 50 per cent report that the menopause affects their mental health and their ability to work.

I echo Ros Foyer of the Scottish Trades Union Congress, who has called for a sea change in workplace attitudes as mid-life women struggle to get simple adjustments made to their working conditions. Women workers are being failed by employers making no provision for the impact of the menopause. The STUC women’s committee’s report back in January 2018 identified that 99 per cent of respondents said that either their workplace did not have a menopause policy or they did not know whether it did, that 32 per cent said that the menopause was treated negatively in the workplace, and, perhaps most frightening, that 63 per cent said that the menopause had been treated as a joke.

The STUC has called for greater development of menopause workplace policies to better support staff who are experiencing the menopause, as well as to educate the wider workforce, in order to help to remove the associated stigma. At Westminster a few days ago, my colleague Carolyn Harris MP referred to experiences reported after a call for evidence that are worth repeating: simple changes in the workplace such as flexible working hours, relaxed uniform policies and adaptations to the working environment can make all the difference. I commend the Law Society of Scotland for its work with Peppy Health to develop menopause advice for employers.

We, on the Labour side of the chamber, have called for the introduction of a right to choose flexible working for all workers. Flexible working could help women who are experiencing the symptoms of menopause to manage potential tiredness. They could work from home when necessary or even take time off to attend appointments. I welcome the SNP’s manifesto commitment to launch

“a public health campaign to remove stigma and raise awareness of menopause symptoms.”

I look forward to confirmation that that will appear in the plan. I also welcome the minister’s confirmation that women’s health will be looked at holistically and that the involvement of women’s voices on the issue is important.

Scottish Labour believes that we need to improve access to specialist care in Scotland so that women have access to good advice about the menopause and no longer face long waits for diagnosis. There is good practice to model that on, as NHS Dumfries and Galloway, NHS Lothian, NHS Fife and NHS Grampian have specialist menopause clinics.

I stand here, in this debate, as a man, and it has to be said that it is time for men to show their solidarity and break a taboo by talking about the menopause. I ask every man in this place, every man who is watching and every man in—no, I just ask men: can you be brave enough to say, “Could you tell me? Can you explain? Will you share?” and do so with sympathy and empathy?

My challenge to the Government is this: little has changed since 2018, but can the Government start that change regarding the menopause in the next 100 days?

Photo of Gillian Mackay Gillian Mackay Green

I offer my congratulations to Evelyn Tweed and Siobhian Brown on their first speeches.

Many colleagues have raised during the debate the importance of women in the NHS and social care workforces. Again, my heartfelt thanks go to every single one of those women. I do not think that we can ever thank them enough. Annie Wells and Carol Mochan both mentioned the heroic efforts of transvaginal mesh survivors. The injuries that they faced are appalling, and we must ensure that they have the resolution that they need and that they can be assured of our support going forward.

Many colleagues have noted that women generally live longer. We have to ensure that women receive the later-life and end-of-life care that gives them the dignity and choice that they deserve. Choice in palliative care is essential. One of the greatest barriers to women receiving healthcare is access. Women report difficulties in accessing appointments and in how to fit them around caring, childcare and other responsibilities.

We need to make sure that there are flexible appointments at convenient times for those who need them. The difficulties are often worse for women from black, Asian and minority ethnic backgrounds, disabled women and Gypsy Traveller women.

I have spoken several times in the chamber so far about the need to work across portfolios to ensure that we deal with the inequalities in particular services and the other factors that exacerbate those inequalities.

Income inequality is a driver of poor health. Those with a lower income are less likely to be able to afford good-quality food and more likely to live in poor-quality housing and, ultimately, they are likely to die younger than their peers. Food bank use is at a high. The situation has been exacerbated by the pandemic, but it is also exacerbated by inequalities. That inequality is not being lessened for those who are on furlough and getting 80 per cent of an already poor wage. We have an obligation to take the issue seriously this session. Public Health Scotland suggests on its website that a universal basic income could tackle that, which is something that we would obviously support.

In the coming session, the proposed national care service will also be important for women’s health. As we are all aware, providing care, particularly unpaid care, is a highly gendered role. The establishment of a national care service will, I hope, work to remove some of that burden. Guaranteed minimum respite hours for unpaid carers would give women in particular the ability to plan breaks. As I said earlier, we believe that carers should be entitled to flexible healthcare appointments,

Mental health is not an area that is particularly covered when we talk about women’s health. As many members have mentioned at various times, mental health support is critical, whether that be in supporting those with post-natal depression or in supporting women struggling with menopause. We need to see a shift in funding for mental health and more focus on talking therapies and peer support. Many women to whom I have spoken would like to see more peer support built in, particularly in relation to menopause support.

Finally, I highlight the improvements that we need to make, as Emma Roddick outlined, to trans and non-binary healthcare when we are designing services. Some non-binary and trans people bleed and they will require many of the services that we have spoken about today. We need to ensure that services are accessible to them and meet their needs as well. We need to end the years-long wait for gender clinics and ensure that the health service recognises the needs of that often very marginalised community.

Photo of Jackie Baillie Jackie Baillie Labour

I, too, congratulate Siobhian Brown and Evelyn Tweed on their first speeches in the chamber. I welcome the opportunity to close the debate for Scottish Labour. It has, indeed, been encouraging to hear contributions from all parties that point to areas in which members can work together and make early progress.

Carol Mochan was right to reference Monica Lennon’s Period Products (Free Provision) (Scotland) Bill as groundbreaking. The SNP initially opposed the bill, but we welcome all converts. There is also unfinished business for mesh survivors, and I will turn to that later.

Claire Baker talked about the need for specialist menopause services and Martin Whitfield mentioned workplace strategies to support women experiencing menopause. He also spoke powerfully about stigma, as did Emma Roddick.

Equally, there is much to welcome in the minister’s opening speech, and I very much look forward to working with her. However, we need more than just a women’s health plan in the first 100 days of this Government. Women need to see action now.

Between 2015 and 2017, for the first time since modern records began, life expectancy dropped. That was on the SNP’s watch. There is a 10-year gap between the life expectancy of women from the least and most deprived areas. Scottish women have the lowest life expectancy of all the UK countries. We need action on a catch-up plan for breast cancer and cervical cancer screening to clear the backlog and identify patients in need of treatment.

Recent minutes of the national cancer recovery group tell us that it does not know when the 36-month interval for breast cancer screening will be the norm. Can the minister tell us in her closing remarks when that will be? The group also notes that the self-referral process for women over 70 has been and remains paused. Can the minister tell us when that will resume? What about the persistent inequality that exists between poorer households and those in more affluent areas? What about the drop-off in screening rates and the consequent rise in cancer incidence in poorer areas? Those issues also need to be addressed.

Kenny Gibson rightly raised the need for action on endometriosis services and waiting times, and we need action on specialist services for women experiencing menopause. There is a significant agenda here, and I look forward to working with the minister to improve services for women and, ultimately, to improve women’s health.

However, I want to use my remaining time to talk about the Scottish Mesh Survivors campaign. The mesh scandal started when I was previously shadow health spokesperson. I met Elaine Holmes and Olive McIlroy, the founders of the Scottish Mesh Survivors group, more than five years ago. Progress has been glacial, despite the considerable efforts of those formidable women and of colleagues in the chamber, principally Jackson Carlaw, Alex Neil and Neil Findlay. The latter two have of course left the Parliament, so we need to make sure that the focus remains.

Hundreds, if not thousands, of women are suffering because they were injured by the use of mesh implants in their surgery. The extreme pain that many women have suffered was denied by clinicians and by the Scottish Government for far too long. The group has produced a charter of mesh care, which calls for the suspension of the use of mesh until there is a statutory ban, and for a mesh removal fund to pay the cost of mesh removal by a surgeon of the patient’s choosing. That would also cover women who have been forced to pay for removal surgery that was simply not available in Scotland.

The minister will be aware that Dr Veronikis offered to help to remove mesh from Scottish women using a tissue-sparing technique, but it appears that his offer was blocked by the Scottish Government, as was subsequently confirmed by the Government’s own mesh expert. That was bad enough, but there was a further scandal. Women who were operated on by Scottish surgeons were told that their mesh had been completely removed, but that simply was not true—the removal was only partial. We now have a Scottish centre of excellence for mesh removal, but is it removing all the mesh? We do not know. We do not even know whether there is further muscle or tissue damage. Will the minister therefore ensure that the situation is monitored and reported on?

The minister will be aware that women do not want the surgeons who remove the mesh to be the same ones who implanted it in them in the first place. Dr Veronikis has submitted a tender to carry out mesh removal. He did that three months ago, but nothing has been heard since then. The women simply cannot wait any longer. I genuinely hope that the minister agrees with me and agrees to take urgent action, not just for the mesh women but for all women in Scotland.

I again pledge to work with the minister in the interests of women, but there needs to be a greater sense of urgency about the challenges that women face, and the pace of change needs to be faster.

Photo of Sandesh Gulhane Sandesh Gulhane Conservative

I declare an interest, in that I am a practising doctor.

Healthcare inequality exists. In fact, it is rife in the health service and in society at large. That is never more true than with regards to gender. Women’s health has long been an issue denied by, dictated by and decided by men. It might therefore seem perverse that I am standing here talking about it but, when I see the needs of my patients not being addressed, I am forced to speak up.

In talking about women, we need to be clear that that includes transgender patients. Trans men and non-binary individuals require access to many of our services, and they should be given in a sensitive and inclusive manner. If Scotland is your home, you are one of us.

The root of the problem is that health and care systems have been designed by men for men. In a lot of cases, white Caucasian men are the default patients, research models and target demographic. Sadly, since the inception of the system, very little has been done to alter the status quo to better represent our current society and values. Women’s health has been marginalised and stigmatised with taboos. For example, there is the stigma of the human papillomavirus in cervical cancer screening. There is a lack of knowledge and teaching, and there are research inequalities.

Women also suffer when it comes to work. They bear the brunt of childcare and tend to have less job security. As Craig Hoy said, the gender pay gap also exists in the NHS. Therefore, we are already behind the curve when it comes to gender equality, as we are rowing against hundreds of years of unequal tides.

“But surely it’s better today,” I hear members say. Well, during the pandemic, female staff had significant trouble finding personal protective equipment that was fit for purpose because—you guessed it—the masks were designed to be fitted on men. That literally put women’s lives at risk. That is simply not good enough.

Members should not be fooled into thinking that newer interventions are ironing out the inequality. The digital revolution in healthcare is in fact reinforcing existing stereotypes. Treatment algorithms that are currently used in primary care are sexist. A man who presents with chest pain requires accident and emergency assessment, as he could be experiencing a heart problem, but a woman who presents with chest pain is thought to be panicking or anxious. It is no coincidence that, historically, the Greek root of the term “hysteria” pertains to the uterus. Such ideas are so inculcated that they have become woven into the very fabric of the language that we use.

We need to stop casual sexism creeping into our systems and, to do that, we need a bottom-up rethink. We need to change the way that we teach topics at medical school to include period health, fertility, menopause and endometriosis so that it better represents the practical health problems that women suffer.

Rachael Hamilton and Annie Wells talked about the distressing eight-and-a-half-year wait for an endometriosis diagnosis. In her maiden speech, Evelyn Tweed spoke eloquently about the misery, pain and cyclical nature of that horrible disease. I see all too much of it in my surgeries.

We need to equip young women with the tools and education that they need, including sex education that includes menstruation, pregnancy, contraception, female genital mutilation, termination, LGBTQ+ issues and, of course, healthy, respectful and empowered relationships.

Photo of Sandesh Gulhane Sandesh Gulhane Conservative

I will if the Presiding Officer will give me some time back.

The Presiding Officer:

Briefly, please, Ms Lennon.

Photo of Monica Lennon Monica Lennon Labour

At the previous session’s cross-party group on women’s health, we heard time and again that women are not believed, even when they are informed and feel empowered to raise issues with their GPs or clinicians. What would Sandesh Gulhane’s advice be to GPs about the action that they can take to actively listen to what women tell them?

Photo of Sandesh Gulhane Sandesh Gulhane Conservative

New GPs go through a patient-centred, patient-focused training programme with the Royal College of General Practitioners. Patients are believed—we have to believe our patients, because that is at the root of the trust that we hold with our patients. My advice to women who feel that they are not being listened to is to keep going back until they get the help that they need.

Young women should receive sex education that includes menstruation, pregnancy, contraception, FGM, termination, LGBTQ+ issues and, of course, healthy, respectful and empowered relationships. If we deliver that to our youth, it will give them information and power, and it will enable girls to make decisions by choice, not by chance.

In March, I wrote an article for

Centric Magazine in which I described how Covid has disproportionately affected women, as Maree Todd recognised. It has had an impact on their mental and physical health and their social wellbeing. Women are also at an increased risk of getting long Covid.

As I declared earlier, I am a practising GP who also worked for almost a decade in hospital. Last week, the Cabinet Secretary for Health and Social Care explained how primary care and secondary care work, but I would like to point out that the situation on the ground is vastly different from what he sees from his top-down view. We need long Covid clinics that are better than those in England but which use England’s best model as our basis.

Kenneth Gibson, Gillian Mackay and Claire Baker mentioned ischaemic heart disease, which in Scotland kills three times more women than breast cancer does. That has been recognised by the British Heart Foundation Scotland, which says that women with ischaemic heart disease are underaware, underdiagnosed, undertreated and undersupported.

Carol Mochan and Martin Whitfield spoke about the fact that the menopause is a taboo subject in workplaces, where women suffer physical and mental issues in silence. We need to be more open. I encourage affected women to go to their GP—we can help.

I congratulate Siobhian Brown on her maiden speech. As someone who worked in Ayr hospital, I agree on the beauty of Ayr.

In conclusion, there is much to be addressed with regard to women’s health. There are many wrongs to be righted, and the inertia that resists change in healthcare systems can be exhausting at times. However, despite all those seemingly insurmountable barriers, to our sisters, mothers, friends and patients, and to my daughter, I would like to be able to say, “Nevertheless, we persisted.”

Photo of Maree Todd Maree Todd Scottish National Party

I am very grateful to colleagues for their contributions. Many issues have been raised in the debate; I will try to respond to all of them. First, however, I emphasise that my door is open and that I am keen to work on a cross-party basis on all the issues.

Well done to Evelyn Tweed and Siobhian Brown, who made their first speeches in the chamber during the debate. It was wonderful to hear from them; I am sure that there will be many more wonderful speeches from them.

A number of members said that women want action and not just warm words. Although the women’s health plan is yet to be published, I thought that I would update members on a number of areas in which we have made progress in implementing some early deliverables that relate to the plan.

Throughout the plan’s development, women have consistently told us that they want information and support to enable them to make informed decisions about their health and healthcare. We have listened and have launched two women’s health awareness campaigns on the NHS Inform website. The first relates to general health throughout the life course and the second is a specific women’s heart-health campaign. As we have heard repeatedly throughout the afternoon, that specific area needs attention.

Women have also told us how important access to high-quality menopause support and care is. A menopause specialist network has been established and is meeting regularly online to provide consistent advice and peer support. The network supports primary care teams by providing access to a menopause specialist for consistent advice, support, onward referral, leadership and training.

On cervical cancer, I confirm to Rachael Hamilton that the television ad campaign on going for smear tests has resumed. Just yesterday, the Scottish Government lit up St Andrew’s house because it is cervical cancer awareness week.

Carol Mochan will be aware that there has been a global pandemic. One of the toughest decisions that had to be made last year in the face of the pandemic was the decision to pause the bowel, breast, cervical, abdominal aortic aneurysm and diabetic eye screening programmes. The pause was implemented in order to reduce the risk of participants becoming infected with Covid-19, to enable physical distancing and to minimise the impact on essential NHS services as they responded to the virus.

However, I am pleased to say that the pause was short and we restarted the work in summer last year. The infection prevention and control measures and social distancing have undoubtedly limited capacity, but we have put extra money towards cervical screening. There has been an extra £1 million provided to support capacity in cervical screening, sample taking and colposcopy. There are also two additional breast screening mobile units, which have been added to the service to support the breast screening programme and to help it to recover. Further details will be in the remobilisation plan, which we have committed to producing within the first 100 days of the session, to say exactly how we will get back to where we were with all those programmes.

Also on cervical cancer, I note that Annie Wells raised the issue of health inequalities. As is the case in many other respects, women who experience poverty have poorer outcomes. One thing that we are doing to tackle that is that we are running a working group to consider how self-sampling for cervical cancer can be introduced to the screening programme. That could help significantly in tackling inequalities. However, the United Kingdom National Screening Committee has not approved that yet, which is why we are developing evidence through the working group. I think that one of the Labour members raised the issue of contribution to research.

Many of us who have been here for some time have been aware of the challenges around mesh and how profoundly it has impacted on the women who have been affected. In our 2021 manifesto, the Scottish Government committed to pursue the outcomes that are sought in Scottish Mesh Survivors’ charter. Use of transvaginal mesh was formally halted by NHS Scotland in September 2018 and we have committed to continue with its being halted. Substantial progress has been made on improving services for women with complications, as Jackie Baillie outlined. The new mesh removal service will be subject to continual improvement that will be informed by consultation of patients. I hope that that will go some way towards rebuilding the trust that has been shattered for those women.

I believe that a bill will be introduced in Parliament soon that will allow reimbursement to women who have previously sought private mesh removal.

We will pursue many of the requests that that group of women has made of us. I hope that that will help to provide closure for the women who have been most profoundly impacted.

Photo of Jackie Baillie Jackie Baillie Labour

I welcome much of what the minister has to say, but Dr Veronikis submitted to the Government a tender to carry out mesh removal surgery three months ago and we have not heard anything yet. The women are desperate for that to happen. Can the minister advise whether progress will be made quickly?

Photo of Maree Todd Maree Todd Scottish National Party

The short answer is yes. NHS Scotland has invited tenders to allow appropriately qualified surgeons to perform mesh removal for patients in Scotland who want it to take place outside the NHS. Surgery that is carried out through that process will be free to patients. A tendering process is in place, so we need to let it take its course. We are pursuing the matter.

Endometriosis affects about one in 10 women, as many members said. It is a very common illness—it is as common as diabetes and asthma—but it is rarely talked about. When women mention endometriosis, they often feel that they are not listened to and it is dismissed. It is still taboo, even in this day and age, to talk about menstruation and endometriosis.

I am glad to say that we are working closely with Endometriosis UK to improve the situation for those women. Endometriosis UK, Public Health Scotland and officials have been working together to analyse the data. We heard some anecdotal evidence about women’s experiences, which is vital, but the data shows that there are blockages to treatment and support at primary care level. There is a real opportunity for us to address those blockages and to make improvements by implementing the National Institute for Health and Care Excellence guidelines and by improving mental health resources and education. Those opportunities are currently reflected in the women’s health plan actions.

Photo of Rachael Hamilton Rachael Hamilton Conservative

Has that gap analysis been published?

Photo of Maree Todd Maree Todd Scottish National Party

I am not sure, but I will certainly update Rachael Hamilton. We are working very hard to produce the women’s health plan; the information will be part of that. The data is certainly public, because we are working alongside Endometriosis UK and Public Health Scotland to tackle the situation, so I will be more than happy to share it with the member, at some point.

As I said, progress is under way on implementation of the NICE guidelines and on development of a pelvic pain pathway. That will support primary care to recognise the symptoms of endometriosis and to provide a timely and standardised referral care pathway for women who have suspected endometriosis.

With Endometriosis UK, we have recently updated the NHS Inform pages. NHS Inform is an excellent resource that has been even more widely accessed during the pandemic that it was before it. I hope that the updated pages will support women to recognise the signs and symptoms of endometriosis and to speak to their GPs.

A number of issues have been raised and covered during the debate. I do not think that we will achieve our ambition overnight, which is why much of our work around the women’s health plan is about building a foundation for change, building consensus and striving for long-term change. This is our opportunity to address women’s systemic inequalities and to build a fairer future, in which health outcomes are equitable across the whole population of Scotland, so that women enjoy the best possible health throughout their lives.

Put simply, now is the time to act for the women of Scotland. Let us work together to be world leaders in women’s health.