Official Report 857KB pdf
The next item of business is a debate on motion S6M-15382, in the name of Jenni Minto, on progress and next steps on the women’s health plan 2021 to 2024.
14:55
I am extremely passionate about women’s health, so I warmly welcome this debate and the opportunity to bring this important topic back to the chamber.
We know that women’s health is not just a women’s issue. When women are supported to lead healthy lives and fulfil their potential, everyone benefits. Women make up 79 per cent of our national health service workforce, 89 per cent of our teachers, 80 per cent of our social care workers, 59 per cent of our unpaid carers and 92 per cent of single parents. To prioritise women’s health is to prioritise the health of Scotland.
However, we know that women and girls face inequality and disadvantage because they are women. That has to change, and we are determined to create the conditions that we need to improve health outcomes for women and girls.
In August 2021, Scotland became the first nation in the United Kingdom to publish a plan for women’s health. The plan’s ambition—and, I hope, the ambition of us all here today—is for all women and girls to enjoy the best possible health throughout their lives.
The first phase of the plan focused on a set of priorities to address particular inequalities for women, such as heart health, and on areas in which women told us that improvements were needed, such as action on menopause and menstrual health. Healthcare professionals, academics, third sector colleagues, researchers and, most important, women came together to inform the plan, and I am pleased that we have been able to make progress in implementing the actions in it during what has been and continues to be a challenging time for NHS Scotland and for all our public services.
Three years on from the plan’s publication, it is right that we take stock and reflect. In doing so, I will highlight just a few of the achievements of the past three years. In January 2023, we appointed our women’s health champion, Professor Anna Glasier OBE, which was an important milestone in the progress of the women’s health plan. I am very pleased that Professor Glasier joins us in the chamber today. Professor Glasier has had a long and distinguished career in women’s reproductive health and, as the women’s health champion, she plays a pivotal role in raising the profile of women’s health, sharing her unparalleled expertise and challenging the status quo. I thank Professor Glasier for being our women’s health champion and for her leadership and her passion for driving change and innovation. I am delighted that she has agreed to remain our women’s health champion to ensure continuity into the next phase of the women’s health plan.
In addition to our women’s health champion, we now have a women’s health lead in every NHS board. The leads are able to highlight issues that impact women across Scotland, which enables national responses to be taken. Most recently, they have focused on improving access to longer-acting reversible methods of contraception.
During the plan’s development, we heard consistently from women that they wanted a reliable source of information on women’s health. In response, in May 2022, we launched the women’s health platform on NHS Inform, which provides new resources on menopause and menstrual health. The platform offers women and girls access to comprehensive and reliable information, including myth-busting videos, information on symptoms and options for care. As of last month, there had been more than 2.95 million views on the menopause pages alone.
The importance of information on menopause was particularly illustrated to me in April this year when I visited the Maggie’s centre in Edinburgh. I met a group of women experiencing treatment-induced menopause, and they described their personal experiences of menopause during their cancer journey and the importance of good-quality information on treatment-induced menopause. It was a privilege to spend time with those women, and I am very grateful that they felt able to share their experiences. As we move to the next phase of the women’s health plan, I hope that we can continue to learn from women’s experiences and the work that organisations such as Maggie’s do to go even further in our support for women and girls.
We know that endometriosis affects one in 10 women, which is why tackling it featured as a key priority in the women’s health plan. Last year, the national centre for sustainable delivery published the endometriosis pathway for Scotland to improve women’s access to diagnosis and care, and I was delighted to visit the endometriosis specialist centre in Aberdeen a couple of months ago to learn more about how the pathway works in practice.
The minister met me and endometriosis campaigners last April. She looked at a policy paper from the Scottish Conservatives regarding ways to improve access to endometriosis treatment, and she committed to reducing waiting times, which are currently, on average, eight and a half years. Can she provide any updates to the chamber on that?
I will give you the time back, minister.
I thank Rachael Hamilton for her work, specifically in the Borders, on endometriosis diagnosis times. I recognise that diagnosis times for endometriosis are too long and that we need to find ways to address them. That was one of the benefits of my meeting the staff at the centre in Aberdeen and across the health board, because they are passionate about supporting women who live with that challenging condition to access high-quality care. As part of our work, we have jointly funded a £0.25 million research project with Wellbeing of Women, which aims to develop a new treatment option for endometriosis-associated pain. We still have work to do—I recognise that—but the issue is certainly on our radar.
There has also been progress in a range of other areas. A specialist menopause service has been established in every mainland health board, and a buddy support system is in place for island health boards. We have worked with the University of Glasgow on groundbreaking research that asked women who work in NHS Scotland about their experience of menstrual health and menopause in the workplace. Based on that research and the views of more than 6,000 women, we published a menstrual health and menopause workplace policy for NHS Scotland. The recently published final report on our women’s health plan provides more detail on the three years of implementation. Importantly, the report has been published alongside two companion pieces: a review of the data landscape and a report by the Health and Social Care Alliance Scotland on its lived experience programme. That is a key part of the delivery of the women’s health plan, which will ensure that women’s voices are at the heart of our work.
Once again, I note my thanks to everyone who has been involved in delivering the first phase of the women’s health plan. It has been a nationwide, collective effort. I particularly thank those in the chamber who continue to advocate for the health of women and girls. I really value the input that we have had from many members, and I hope that we can continue in the spirit of collaboration and joint effort as we move into the next phase of essential work.
It is important to highlight that the women’s health plan does not exist in isolation. Women make up the majority of our population, at 51.4 per cent of it, and women and girls have particular needs that must be addressed across the breadth of health policy. Work is being undertaken across the Scottish Government and the NHS to progress improvements in women’s health and access to healthcare services. Maternity services have a key role to play in supporting women’s health throughout and after pregnancy. The best start programme is our plan for putting women, babies and families at the centre of maternity and neonatal care. We want all women and their babies in Scotland to receive the best and safest care possible at all times. Working in partnership with NHS boards, including Healthcare Improvement Scotland, clinicians and women, we are committed to continuous improvement in maternity safety.
It is clear to say that, when it comes to specialist neonatal services, the consultants, all the clinicians and the women who are involved are opposed to the minister’s determination to withdraw specialist services from maternity provision at University hospital Wishaw.
We have received advice from clinical experts in the field, and they, as well as the charity Bliss, which advocates for parents, all support the reduction in neonatal intensive care units in Scotland.
Sadly, pregnancy does not always go the way that we would want it to, and the loss of a baby, no matter at what stage of a pregnancy, is a traumatic experience that can have a profound impact on families. Improving miscarriage care and support for women across Scotland is a key priority for me, and we will shortly publish a miscarriage care delivery framework to help NHS boards to drive progress and focus on areas where improvement is required.
Last year, we launched a memorial book and certificate for those who have experienced pregnancy or baby loss prior to 24 weeks, because we know that, for many parents, formally recognising the baby that they lost provides some comfort and validation during an incredibly painful time. The service is free of charge and completely voluntary, and historical applications are welcome. More information on how to apply can be found on the National Records of Scotland website. I thank baby loss charities such as Sands, Held In Our Hearts and others for their considered support on that.
The Government is also determined to see the end of cervical cancer. The World Health Organization director general has announced a global initiative to eliminate cervical cancer, and we are dedicated to supporting that vital cause. As I set out in Parliament in January this year, we have already taken positive steps. We have established an expert group, chaired by Professor Glasier, and three working groups, which will focus on human papillomavirus vaccination, cervical screening and cancer treatment.
Good progress is being made through the HPV vaccination programme, and recent research undertaken by Public Health Scotland, in collaboration with the universities of Strathclyde and Edinburgh, shows that there have been no cases of cervical cancer in fully vaccinated women who received their full course of HPV vaccination aged 12 and 13 years old. The message to girls and young women is clear: get vaccinated. Elimination of cervical cancer is within our grasp.
I will move on to abortion. On 24 September this year, the Abortion Services (Safe Access Zones) (Scotland) Act 2024 came into force. The Government was pleased to support the bill that became that act, which was introduced by Gillian Mackay, and I am sure that women across Scotland were encouraged that it won support from across the Parliament. It has long been the Scottish Government’s ambition to ensure that Scotland is a place that people can look to as a beacon for women’s rights. The women’s health plan committed to a review of abortion services in Scotland to ensure that services are meeting the needs of women. We want abortion to be seen first and foremost as a healthcare matter and as a way by which women make their choices over their health.
That is just some of the work that we are doing to improve the health of women and girls. I am proud of what we have achieved together, and I look forward to what will come next. Supporting women and girls to enjoy the best possible health throughout their lives will continue to be our guiding principle as we develop the next phase of the women’s health plan. We know that it is still the case that many women and girls do not enjoy the best possible health. We know that there are women and girls living in poverty, where inequalities are even greater, and I acknowledge here today that we must do more to address them. That is not something that I have shied away from, and therefore I am happy to support Carol Mochan’s amendment.
To further achieve our ambition for women and girls in Scotland, we will look at what has changed in Scotland, both positively and negatively, since August 2021; build on the plan’s existing priorities; and reflect on where additional focus is needed. We will consider the many factors that make up a healthy life, asking what we can do better or differently to support women and girls of all ages and at all stages of life. Over the coming months, we will continue our conversation with women and girls, healthcare professionals and academics, as well as the third sector across Scotland to ask what they want to see in the next phase of the women’s health plan. We will review and update our evidence base, ensuring that any future work is grounded in the most up-to-date research.
Early discussions indicate that women would like to focus on pelvic health; bone health; postmenopausal health and ageing well; and waits for gynaecology care and treatment. However, we are just at the beginning of that work, and I look forward to hearing proposals from members from across the chamber today.
It is a huge privilege to hold the position of minister for women’s health and to be able to listen to women and girls across Scotland and hear about their ideas and ambitions as to what can be done differently so that all women and girls experience the best health and healthcare throughout their lives. I look forward to today’s debate and hope that, across Parliament, we can find common cause to support that ambition.
I move,
That the Parliament acknowledges the longstanding health inequalities faced by women and believes that it is vital that services and health outcomes are improved for women and girls; notes the progress made through implementation of the Women’s Health Plan as a first step towards addressing these inequalities, in particular the appointment and work of the first Women’s Health Champion; thanks hard-working NHS staff and all those who have contributed to the progress to date; welcomes the commitment from the Scottish Government to work with women and girls across Scotland in developing the next iteration of the plan, and thanks everyone who has contributed their lived experience to the priorities of the Women’s Health Plan.
I invite Annie Wells to speak to and move amendment S6M-15382.1.
15:09
I begin by thanking the many organisations that have provided briefings for the debate. Health is one of the biggest issues in the minds of people across our country, and that is no less true for women, who have their own unique health challenges and needs.
The women’s health plan was first published in 2021 by the Scottish National Party Government. It set out to address women’s health inequalities and the serious barriers that were preventing women and girls from accessing the healthcare services and support that they needed.
The plan included 66 actions focusing on heart health, postnatal contraception, menopause, endometriosis, menstrual health, abortion, and contraception. We all know that women’s health needs such as those are present and evolve throughout each woman’s life, from adolescence to their later years and that, because each woman is different, health policy must be aimed at adopting an approach that accounts for the disparities and barriers that women face in accessing sufficient healthcare services.
In the SNP’s manifesto in 2021, several commitments were made to improving women’s health. Those commitments ranged from reducing endometriosis diagnosis waiting times and establishing a new Scottish institute for women’s health to improving access to services helping women through menopause diagnosis and management. I welcome the £250,000 of funding that the minister said is being provided to address endometriosis.
However, despite the SNP’s manifesto commitment and the women’s health plan, healthcare services, support, and—most importantly—health outcomes for women have shown a downward trend under 17 years of SNP mismanagement.
How are women being failed by the SNP Government? Let us simply look at the numbers for some of the most crucial areas in the women’s health discussion. There are on-going failures in addressing issues surrounding endometriosis, women’s heart health and cancer care, which have devastating impacts on the women that they affect.
For example, 58 per cent of women said that they saw their general practitioners 10 or more times prior to getting an endometriosis diagnosis because of symptoms, with 53 per cent also doing the same with accident and emergency visits. As my colleague Rachael Hamilton pointed out, even when a woman is finally diagnosed with endometriosis, it has taken an average of nearly nine years to get a diagnosis in Scotland. We are talking about women waiting almost a decade just to receive a proper diagnosis—that is not even including the time that it takes to begin treatment.
On the issue of women’s heart health, the situation is no better. The British Heart Foundation notes that 2,600 women die each year in Scotland from coronary heart disease. That makes coronary heart disease the single leading killer of women, even more so than breast cancer. Moreover, the charity Chest Heart & Stroke Scotland has found that, for every day that passes, there are 10 women who die from heart disease and heart attacks across Scotland. There are also 95,000 women across the country who are living with coronary heart disease.
I am highlighting those numbers at a time when waiting times for cardiology have hit record highs. That has resulted in fewer than three in 10 Scots being seen within the echocardiogram six-week waiting time target, with 1,200 people even being forced to wait more than a year for an ECG.
That brings me to the failures of the Scottish Government relating to women’s health and cancer numbers. Although it said in the women’s health plan progress report that it wanted to take an intersectional approach to account for each woman’s life in order to ensure the best outcomes, the truth is the opposite. Women from the most deprived areas across Scotland were less likely to get screenings for breast cancer in 2022-23 and for cervical cancer in 2021-22.
On the issue of breast cancer specifically, the charity Breast Cancer Now says that breast cancer is the most common type of cancer in the UK, with almost 4,770 women being diagnosed annually. The charity also said that the Scottish Government women’s health plan was an opportunity to improve breast cancer outcomes through doing things such as reaching the 80 per cent screening targets for breast cancer and increasing breast awareness.
However, although the women’s health plan was an opportunity to help women overcome barriers and inequalities to receive the highest standards of care and support, that potential has not been fulfilled. The numbers are shameful and they continue into another area that has important effects on women’s health: alcohol consumption and misuse, which also impacts on breast cancer health outcomes for women.
According to Alcohol Focus Scotland, in Glasgow alone, 16 per cent of women drink more than the guidelines set out by chief medical officer. That has the potential to significantly affect women’s health in relation to developing certain types of cancers. Just drinking about a half pint of beer or a small glass of wine daily can increase a woman’s risk of developing pre-menopausal breast cancer by 5 per cent. For post-menopausal breast cancer, the increase is even greater, with the risk rising by 9 per cent. In addition, women often face barriers to accessing alcohol addiction support services, and a good deal of stigma remains around women who misuse alcohol.
Adding to that, in 2022-23 in Glasgow, only 26.5 per cent of people with learning disabilities who were eligible for cervical cancer screenings went to their appointments.
Unfortunately, that grim picture carries over to women’s life expectancy. Scottish women have seen that fall to a lower age than it was before the Covid-19 pandemic, standing at 80.9 years from 2021 to 2023, compared with 81.1 years prior to 2021. In fact, not only is Scotland ranked lower than other nations in the UK for female life expectancy, it is now also ranked 22 out of 29 nations for female life expectancy Europe-wide, according to the National Records of Scotland.
The Scottish Government launched the women’s health plan 2021 to 2024 with the aim of tackling the health inequalities and poor health outcomes that women face and changing the approach that is taken to women’s health. The Scottish Government must acknowledge that the plan is now failing. Not only have the Government’s goals not been realised, women have paid the serious price for its long list of failures.
Going forward, achieving the mission of improving women’s health services, support and outcomes requires the involvement of all sections of society—private individuals, public bodies and individuals who are dedicated to helping address women’s health issues and inequalities. Just as importantly, women need to be heard, healthcare in Scotland needs to see women’s health issues as distinct, and each unique aspect of each woman’s life must be acknowledged and considered.
In my new role, I will work with colleagues from across the chamber and in the Scottish Government to ensure that women finally receive the services that they so desperately need to lead the fullest and healthiest lives that they can.
My colleagues Tess White and Brian Whittle will highlight some other areas, from menstruation and menopause to maternity and neonatal issues. I urge the Scottish Government to work with us to avoid those failures in the future on behalf of the women and girls across our country.
I move, as an amendment to motion S6M-15382, to leave out from “acknowledges” to end and insert:
“agrees that 17 years of Scottish National Party (SNP) administration mismanagement of healthcare in Scotland has worsened longstanding health inequalities faced by women and girls, while challenges facing women’s health services continue to go unaddressed; notes that thousands of women across Scotland have missed out on life-saving screenings for breast and cervical cancer, and that some breast cancer screening centres are at risk of being downgraded or closed entirely under drastic NHS budget cuts by the Scottish Government; further notes that women in the west of Scotland have been forced to pay for their own ovarian cancer treatment due to long and unacceptably high delays; believes that the Scottish Government has failed to recognise and address the underlying preventable factors that contribute to poor mental health for women and girls; notes that the SNP administration made the decision to cut the mental health budget by nearly £20 million for 2024-25, despite the number of people in Scotland who reported to have a mental health condition doubling between 2011 and 2022; acknowledges that women’s life expectancy is lower than it was before the COVID-19 pandemic, with Scotland ranked 22 out of 29 European nations for female lifespan in the 10 years up to 2022; urges the Scottish Government to restore the provision of consultant-led maternity services in rural areas, such as Moray and Caithness, so that women are no longer forced to travel hundreds of miles away from home to give birth; believes that the Scottish Government should abandon its proposed centralisation plans for specialist neonatal units in NHS Scotland, which includes downgrading services at University Hospital Wishaw, Ninewells Hospital in Dundee, and Victoria Hospital in Kirkcaldy, potentially endangering the lives of vulnerable babies and placing additional stress on new and expectant mothers alike; calls on the Scottish Government to prioritise women’s reproductive health, as it currently takes an average of 8.5 years for a woman to get an official diagnosis for endometriosis, despite the fact that one in 10 women in Scotland live with this debilitating condition; believes that the Scottish Government should take steps to reduce cardiology waiting lists, which are at a record high in Scotland, as women are more likely than men to receive the wrong cardiac diagnosis and will receive half as many heart treatments; criticises the SNP administration for continuing to put gender ideology before the safety of women and girls by backing Rape Crisis Scotland, despite an independent review discovering that survivors were being let down, and calls on the Scottish Government to address the specific healthcare needs of women, ensuring that Scotland’s NHS is efficient, reliable and accessible for all women, always.”
I call Carol Mochan to speak to and move amendment S6M-15382.2.
15:17
I am so pleased that Government time has been given to debating women’s health today. We will support the Government’s motion tonight.
If we have learned anything from the women’s health plan, it is that every target in the next women’s health plan must have attached to it a clear action plan and a pathway to deliver it. Otherwise, it will just be more words to women in our communities. When our population desperately needs action, it is incumbent on us to ensure that we have a delivery plan. I am very pleased that the Government will support our amendment at decision time.
Since the introduction of the women’s health plan, it has always been my intention—and, indeed, the intention of the Scottish Labour Party—to scrutinise it fairly, with the genuine hope that it would be a success and that access to and quality of women’s health services would improve across the country.
As the minister indicated, securing a women’s health champion was a significant step forward, supported by Scottish Labour, in achieving some form of progress for women. I welcome Professor Glasier’s account of what the plan has achieved so far and what she hopes it will achieve in the future. Nonetheless, she and others continue to identify where there are problems and where we must strive to do better.
What we all agree is that women’s health must continue to be a priority if we are to have any hope of getting on top of the backlog of pain and misdiagnosis that so many women continue to suffer.
We will all have had meetings or phone calls with women who are unable to access diagnosis and treatment. As other members have said, we must mention those with endometriosis, in particular. I am sure that other members will cover it in their speeches today, but I note that women have suffered over many years, as there has been an absolute void in service for that condition. I welcome the changes, but there is much more to be addressed in the coming years.
We are all pleased with the achievements in women’s healthcare during this session of Parliament in areas such as the introduction of buffer zones to ensure that women can access healthcare free of intimidation and with the roll-out of the human papillomavirus vaccine as part of our fight to eradicate cervical cancer. I have been desperately pleased to see the progress in those areas.
I also want to mention, as the minister brought it up, the online women’s health platform, through which factual information is now available to young girls and women in Scotland. As we go through our life cycle, we can go back to that at the points when we need it. Professor Glasier spoke to us about that at one of the cross-party meetings that the minister pulled together.
However, it is undoubtedly the case that, in other areas, progress has been far too slow and that health inequalities have deepened and are very real for many people in our most deprived communities. All members have a responsibility to acknowledge that and to scrutinise the Government to ensure that the dial can finally be moved on the issue. We cannot have a debate such as this without understanding that life expectancy in our most deprived communities is falling and is far lower than it is in our most affluent areas. Of course, we are all more aware of the issues around unhealthy life expectancy.
Does Carol Mochan agree that there needs to be a separate road map for women and that the women’s health plan needs to be sex specific?
Yes, of course.
I return to my point about unhealthy life expectancy. Not only do our poorest neighbours die younger, they live life in a much poorer state of health for longer. That plays out for women in many ways. They live in poor health, and they care for others in poor health. It is often the case that a heavy weight is placed on the women in our population.
As is the case for other areas that impact directly on women, the issue of rural maternity services has been debated in the chamber many times. However, that has been in members’ time rather than in Government time. The Government’s inadequate response to that cannot be overstated. The health of pregnant women in rural areas is in particular peril, because they are often transported multiple miles at various stages of pregnancy or labour. That must be a women’s health priority in Scotland. Despite the genuine concerns of patients and staff throughout the country in communities such as Wishaw, the Scottish Government has continued with its policy of downgrading key neonatal units at the heart of our most deprived communities. The impact of that on women should be a concern for us all.
In waiting times for cancer treatment, hysterectomies and reproductive healthcare, women in Scotland are waiting far too long to receive the support that they need. We often hear of the lack of training opportunities for staff, which limits development in our services.
Inequality is most pronounced when it comes to cancer screening. As we know, women from the most deprived areas are less likely to attend breast screening—about 20 per cent less likely. The rates of women who are up to date with their cervical cancer screening continue to fall. I am sure that I do not need to remind the Government of the importance of improving those statistics. Many lives will be lost if we do not get on top of that. Again, we cannot debate the issue without some reference to the significant lower uptake of screening by women from more deprived areas.
Although I do not want to dwell too much on this, I cannot contribute to the debate without mentioning the impact of strong cross-departmental working on women’s health services and outcomes. It is absolutely imperative that the Government does better on that. I have raised the issue before in the chamber. All Government departments must see women’s health inequalities as a priority, but there is no clear evidence that that is currently happening—or certainly not in the way that it should.
In many ways, no matter how many iterations of the women’s health plan are brought before Parliament, I argue that a lack of Government willingness to acknowledge its own responsibility plays a big part in the on-going suffering of many women across Scotland. I am glad to hear the minister acknowledge that responsibility here today; that is very welcome.
The lack of urgency from the Government compounds that and it is not unfair to say that the Scottish Government appears to believe that publishing a policy paper completes a task and that it places very little importance on the delivery or outcomes of its plans. We must address that significant issue together. Without serious reform and a change of direction—which we have heard that the First Minister is not committed to—delivery in this policy area will remain largely untouched, and if we debate this again in another three years, we will find the same challenges still being faced by women up and down the country.
Therefore, although the Government will concentrate on the areas where it considers that progress has been made—as we saw in the opening speech—I urge serious caution. The Government is supporting our amendment, which we welcome, and should use that to show that it can be serious about setting out a route to delivery.
I say that because, as all parties will say today, health inequalities still have a stubbornly high impact on women. When it first published its plan, the Scottish Government referred to a British Heart Foundation report that said:
“in Scotland there are inequalities at every stage of a woman’s medical journey”.
As we review the plan and look towards its next iteration, we must ask ourselves whether that has really changed.
The next women’s health plan must set out not only targets but the action plans that will achieve those targets. I look forward to playing my part in making that happen and I know that my party is committed to doing that so that we can change the health outcomes, and the health inequalities, that are seen by women in Scotland today.
I move amendment S6M-15382.2, to insert at end:
“; is concerned by the slow progress in addressing stubbornly high health inequalities experienced by women, and calls on the Scottish Government to ensure that the next plan sets out concisely when and how each of its actions will be fully implemented across Scotland.”
15:27
The women’s health plan that was launched in 2021 marked a significant commitment to addressing the distinct health needs of women across Scotland and aimed to close gaps in care, improve health outcomes and promote health equity. The very existence of that plan has brought much-needed attention to issues that have historically been sidelined and significantly underfunded.
The plan recognised that taking a dedicated approach to women’s health is essential for the wellbeing of women and of our wider communities. It also acknowledged that there is an urgent need for societal and cultural shifts in attitudes to women’s health and that much more must be done to address the long-standing health inequalities that women face. It set out a way to achieve those lasting changes, and I welcome the updates that we have received throughout the life of the plan. The final report that is the topic of today’s debate sets out the important progress that has been made and raises the areas in which work is still to be done.
A number of commitments, and the significant progress that has been made towards them, should be celebrated. I am a little embarrassed to say that, when preparing the “progress” section of this speech, I forgot to mention my own act of Parliament. That might be because it is in my nature to want to move on and do the next thing. I thank the minister for her kind words about my Abortion Services (Safe Access Zones) (Scotland) Act 2024. I also thank the Minister for Social Care, Mental Wellbeing and Sport for her kind words when she had the women’s health role, as well as thanking the ministerial teams, the campaigners, and those with lived experience who gave evidence.
No one will be surprised to hear that I welcome the Scottish Government’s commitment in the plan to review abortion law and its recognition of the importance of having a legal framework that reflects both current practice and the needs of patients and healthcare professionals. Parliament has rightly acknowledged abortion as part of healthcare for those who need it. Law reform is not the only area in which abortion care must progress: late-stage abortion and the recruitment of staff who can carry that out must also be addressed.
I hope that the law review will carefully examine the gaps and inadequacies in current legislation, assess the need for changes and consider how to bring about concrete change. However, that process must be urgent. There is no room for delay, and I hope that we will see progress and a clear path being set out to achieve that before the end of the session. Scotland needs a responsive and timely approach to the issue.
I feel that, so far, the plan has involved a genuinely collaborative approach. The meetings that we have had with ministers and the women’s health champion, Professor Glasier, have been informative, but they have also felt like a genuine dialogue. Although I will move on to discuss some things that we should be doing better on or looking at, I will do so in the context of genuine collaboration and making progress for women. I am pleased to hear that Professor Glasier has agreed to stay on as the women’s health champion.
I would like to ask you whether you—
Through the chair, please, Ms White.
Sorry. Does the member agree that we benefited from working collaboratively in the work that we did as a committee on the buffer zones?
Absolutely. It very much helps us all if we work collaboratively in the sphere of women’s health. I hope that we will have a similar level of conversation in the next stage of the abortion law review, which will take us into a slightly different space from the question purely of access. I thought that the conversation that we had on safe access zones was quite grown up and even tempered, and I hope that that can be taken forward on the next issue.
Although I recognise the strides that have been made between 2021 and 2024, I also want to shed light on some critical areas that remain unaddressed or that require more attention. It is important to highlight issues such as access to fertility services, comprehensive support for endometriosis and systemic inequalities in health outcomes for women from minority and disadvantaged backgrounds. The report demonstrates that a stronger focus is also needed on addressing delays in diagnosis for conditions that uniquely or disproportionately affect women and on ensuring equal access to healthcare services across urban and rural areas. There also remain significant data gaps that act as a barrier to understanding and addressing women’s health needs comprehensively. Conditions such as polycystic ovary syndrome, premenstrual dysphoric disorder, endometriosis and other underresearched areas still suffer from a lack of robust data, which impedes progress on effective diagnosis and treatment.
Several organisations that are directly involved in improving women’s health have reached out to us, and I will use the short time that I have left to highlight some of their very important observations and asks. #MEAction Scotland highlights that myalgic encephalomyelitis or chronic fatigue syndrome is a complex chronic illness in which 80 per cent of patients are women. It is thought that there are approximately 58,000 cases in Scotland, but that remains an estimate because we continue to lack robust data. There are several reports of women being disbelieved and dismissed by doctors, and diagnosis can take years if it happens at all. #MEAction Scotland points to the need for healthcare education to accurately quantify disease burden, along with the urgent need for data to be collated nationally in order to understand the full picture.
As the motion rightly notes, one of the biggest thank yous should go to all those who have spoken to us about their health issues and their often very long journeys to diagnosis. For many, that journey has already happened or concluded. They often give their experience—sometimes at their own cost—to make sure that no one else has to go through what they did. For some, that has been decades of campaigning, and we should rightly take on their wealth of experience from that.
We must continue to build on the momentum of the 2021 plan to increase awareness of women’s health. The first phase of the plan has provided a solid foundation to build on, but the rest of the work must not be delayed. Women across Scotland are counting on us to continue advocating for them and their rights. Continued commitment to the unmet goals is crucial if we are to fully realise the vision of the women’s health plan and deliver a Scotland where all women can achieve the care that they need.
15:34
It gives me pleasure to speak for the Liberal Democrats in what is a vital debate. I am grateful to Jenny Minto for securing Government time to bring the debate to the chamber. We do not speak about the topic often enough in this place, not least given that women make up more than 50 per cent of our society and are vital to our economy, yet many of the health issues that we are talking about today are particularly gendered in nature.
Before I talk about the Scotland-specific picture and the report and plan that we are debating, it would be remiss of me not to recognise the events of last week—in particular, what the election of Donald Trump for a second term means for the reproductive healthcare rights of women in America. That was a dark day. All three branches of Government are now stacked against the freedoms that we take for granted in this country, and we hold those women in our thoughts. I am proud that we have not only resolved to safeguard those rights here in Scotland but committed to enhancing the quality, accessibility and range of healthcare services that are essential to women’s bodily autonomy and wellbeing.
Alex Cole-Hamilton referenced the US in relation to abortion, but will he also applaud the fact that, even though Donald Trump is a controversial figure, he knows what a woman is?
I very much regret that Tess White wants to lower the tone of what has so far been a consensual debate. That problem stems from her, and I ask her to reflect on those remarks.
I want to re-foster, if I can, the atmosphere of consensus by paying tribute to Gillian Mackay, who spoke eloquently just before me and who spearheaded single-handedly the bill that she brought to the Parliament on safe access zones around clinics that offer abortion and other reproductive services. Our commitment must remain steadfast, so that every woman has the right to make informed choices about her health, supported by the highest standards of care and free from abuse, intimidation, stigma and the dog-whistle politics that we have just heard from Tess White.
As we have heard, the women’s health plan, which was introduced in 2021, marked a step in the right direction. The plan rightly acknowledges that advancing women’s health is about not just reproductive rights but treating women’s health needs holistically, giving priority to issues that are often dismissed and stigmatised, and recognising, in particular, the abundant health inequalities that exist in Scotland in 2024. That includes expanding access to menopause care, ensuring rapid support for postnatal contraception and focusing on often-overlooked conditions such as cardiac disease, which affects women differently yet has historically received far less attention and financing than heart disease in men.
I welcome the focus that has been brought by the implementation of the plan and, in particular, the appointment of Professor Anna Glasier as the national women’s health champion, but it is important that we do not rest on our laurels. We must recognise the significant work that is still needed. For example, despite increasing awareness, many women who suffer from endometriosis continue to endure years of severe pain before they are even given a proper diagnosis or a pathway to treatment. The delays disrupt careers, education and family life. We know that such delays only compound endometriosis and make it worse, increasing the chances of it spreading and damaging multiple organs. We need to treat it with the same urgency that we offer at the moment for similar conditions. We are failing in that regard.
Similarly, coronary heart disease is a leading cause of death among women in Scotland, claiming the lives of more than 2,500 every year—twice as many women as are killed by breast cancer. I am pleased that the report has focused on that. The proposed new specialist centre in NHS Forth Valley is especially welcome.
However, we need to go further. We need to ensure that those women who are most at risk are given the advice and support that they need. That includes those who are experiencing early menopause or high blood pressure during pregnancy.
We also need to improve access to menopause care more generally, particularly in rural areas. That is something of a postcode lottery and provision remains inconsistent, with services stretched across the board. Menopause is a condition that will affect every woman in Scotland. It is not a surprise; it is something that we can plan for. However, I am struck by the lack of provision—or the patchy provision—in so many parts of the country. Just this week, I was visited by a constituent who lives in our nation’s capital, who is going through menopause and is unable to access the basic advice and support that she needs.
It goes without saying that the Government has a duty to ensure equal access to treatment for all women, no matter where they live. We need each NHS board to actively prioritise women’s health in its area.
Women’s health can be disproportionately impacted at times of financial strain. That is a gendered issue that highlights the need to remain focused, even as NHS budgets are at full stretch. For the plan to succeed, it needs to be backed fully by the Government, and we need to ensure that we have appropriate staffing—safe staffing—and regular updates on progress. Without those, it risks becoming just another set of promises.
Liberal Democrats remain focused on improving primary care, which is essential to women’s health—indeed, it is essential to the health of all of us. Quick access to general practitioners, mental health specialists and services such as physiotherapy can make all the difference. We want to have world-class mental health services across Scotland, which could provide much-needed support for women who are facing postnatal depression or who are at risk of postpartum psychosis.
We have come so far, but there is still a great distance to go when it comes to supporting perinatal mental health in Scotland. I raised that issue repeatedly during the previous session, but I am dismayed to see that we have made very little progress on it.
I reflect on the cultural change that still needs to take place. Too often, women’s health concerns are met with stigma or outright dismissal, or they are the subject of dog-whistle politics. We saw that clearly in the experience of the survivors of transvaginal mesh, who had to fight for years to have their pain recognised and treated. Health issues that disproportionately affect women deserve to be treated with the same urgency, attention and seriousness as any other condition, and they must be met with dignity and respect. I hope that the health plan that we debate today marks a renewed and invigorated commitment to seeing those changes through, so that we continue to walk the path to a better, healthier future for women in Scotland.
I note that a member who was looking to participate in the debate has not been here throughout the opening speeches, for which I will need an explanation and, probably, an apology.
We move to the open debate. I call Emma Roddick.
15:41
I was glad to hear, in the minister’s opening speech, about the progress that has been made on endometriosis and, in particular, on managing the pain that comes with the condition. Alex Cole-Hamilton also made some good points about the need for cultural change.
There have been changes since the appointment of a women’s health champion. I have felt that change as a member of the Parliament and as someone who keenly listened to debate and discussion in this place on women’s health issues before I was elected. I can see that there is progress in the platform that these issues have and in the willingness of a wide group—not just the usual suspects who champion these issues regularly—to accept that there are problems and to enter conversations about how to solve them. That bodes well for the overall aim of using the fact that Scotland has this role to precipitate wider societal and cultural change. It is always welcome to see real leadership being taken across the parties, which can translate to changing minds and cultures outside.
I credit the minister with the impact that her approach has had. I have also enjoyed regular engagement with Opposition colleagues, as well as with the minister, on a wide range of issues related to women’s health. She has been open, understanding and willing to take on board expertise and knowledge that exists across the chamber. That is certainly contributing to reaching the cross-party consensus on women’s health that Engender and other members who have spoken in the debate have called for.
I will speak about a few issues that will not be new to the minister, as we have had conversations about them already. Mental health remains a significant women’s health issue. It is difficult to see in statistics the different experience that women with mental health issues face compared with those of others who access different services. Being a woman impacts the diagnosis that we will get if we have mental health issues. That is borne out in the statistics around mental health and cardiovascular and chronic pain conditions, which show that women and men often present with the same symptoms but are frequently given different diagnoses.
Being a woman impacts how other conditions will be treated if a person has a mental health issue, chronic pain or fatigue. I bet that every MSP has had a constituent raise evidence supporting that at some stage during the past three years. Being a woman also impacts on the treatment that we receive. There are times when that is justifiable, because our needs may be different, but it is not acceptable that my constituents still feel that they are being brushed aside or that their symptoms are minimised because they are female.
Many chronic conditions often go hand in hand with mental health issues. Living with chronic pain will affect someone’s mood, often clinically, and mental health issues are frequently diagnosed in people with the likes of endometriosis, myalgic encephalitis, multiple sclerosis and other chronic conditions. We have to get better at drawing a distinction between clinical mental illness and reasonable reactions to difficult situations. Almost every patient with a chronic illness and depression to whom I have spoken has said that, at some point, they have been told something along the lines of, “Of course you’re sad—anybody would be.”
People with depression understand the difference between feeling sad and having depression, which are completely different in terms of quality of life, hopelessness and the impact on the ability to function. A few weeks ago, one member of Glasgow Disability Alliance told colleagues in Parliament that they had been told, “I would kill myself if I had your life.” That is the type of stigma and dismissal that people face. It is a lot harder for someone to get help for mental health issues if the people who are assessing them think that they should be feeling depressed.
Given those cross-cutting issues, which touch on both women’s health and mental health, work on the approach to either aspect needs to be done with awareness of the other. North Highland Women’s Wellbeing Hub has done incredible work in sharing resources on many issues affecting women. I am sure that the minister is aware of that work, given that her colleague Maree Todd, as the Minister for Social Care, Mental Wellbeing and Sport, and I both represent the area that the group covers.
At a meeting that I had with North Highland Women’s Wellbeing Hub earlier this year, Kirsteen showed me the leaflets and resources that the group has made up to support women who have been diagnosed with various conditions. It is a shame that it actually felt quite wondrous to see information on endometriosis, menopause and postural tachycardia syndrome laid out clearly and to imagine people, in the moment that they are diagnosed, receiving such helpful and clear information. It is a massive step forward, and I hope that the Government will look at the take-up of post-diagnosis support in NHS Highland that has come from the North Highland Women’s Wellbeing Hub and consider how that type of information can best be made available and standardised.
It is also fantastic to hear about the impact that having an islander in post has had in the taking of sensible approaches. Accepting that we have to do things differently in different places does not mean that the end result has to be difference. The buddy system that exists to ensure that island health providers can still access quality information is a great way to ensure that, no matter where people are, they can access specialist advice.
Before concluding, I will touch on abortion care, which cuts across everything else that I have spoken about. Pregnancy is more dangerous to some than to others. Mental and physical health conditions, when they are combined with pregnancy, can be life threatening, so it is critical that we continue to strongly and frequently defend the right of Scots to access abortions in the face of attacks on those rights around the world. Nothing that we have won is guaranteed, and we must continue to recognise the necessity of quality and accessible abortion care.
I am proud of the steps that the Parliament has taken to protect people who are accessing abortion services through the Abortion Services (Safe Access Zones) (Scotland) Act 2024, which brought in safe access zones. However, there is work to be done to ensure that there are services available to access for everyone, including—for those who need it—up to 24 weeks, which is currently the limit in Scotland in law but not in practice. No matter where people live, they should not be forced to carry a pregnancy that they do not want to go through with, and I look forward to hearing updates on work that is to be carried out to ensure that that is the reality.
I also look forward to seeing what comes of the next iteration of the plan overall. I am hopeful. It can often feel difficult to feel hopeful about the topic of women’s health, so I thank all those with lived experience, who have rightly been at the centre of the work on the plan and of the Government’s motion, and colleagues on all sides of the chamber, including the minister, who have put in the work on the plan.
15:48
As the first women’s health plan comes to an end, I welcome the opportunity to take stock. I thank Jenni Minto and her team for the cross-party working that they have undertaken so far. It has been constructive, so I give praise where praise is due.
I also thank Professor Anna Glasier, who is in the public gallery today, for her leadership. I have enjoyed our lively conversations and I have valued Professor Glasier’s frankness, expertise and insight. Eighteen months—and just four days a month—was precious little time in which to deliver on the ambitions for the women’s health plan, so I am pleased that Professor Glasier will remain in post. If only the SNP had appointed her sooner and had not left the plan in limbo for so long. The minister would probably expect me to say something like that.
Throughout the life cycle, from menstruation to menopause, a woman is adapting and adjusting to major changes in her body. She is also contending with a healthcare system that, as Caroline Criado Perez’s “Invisible Women” describes, is
“systematically discriminating against women, leaving them chronically misunderstood, mistreated and misdiagnosed”.
Too often, women do not feel heard. Too often, their legitimate concerns are dismissed. We should not have to put up and shut up when it comes to pain. Healthcare cannot be one size fits all. The male default bias has dominated the diagnosis and treatment of women for far too long.
MSP colleagues might want to dodge the bullet on this, but healthcare must be sex specific. That is why women’s health needs require a completely separate road map, a dedicated advocate and rigorous oversight in the long term. That is why data in the NHS matters, and it is why objective and immutable biological sex must be recorded on medical records. Terms such as “chest feeders” perpetrate the erasure of women in healthcare in the name of so-called inclusivity.
The Scottish Conservative amendment drills down into the failings in women’s healthcare that have occurred under the SNP Government. The reality is that, under the SNP, women’s healthcare has worsened. Waiting times for vital services such as women’s reproductive health, cardiac care and cancer screening and treatment are unacceptably high. Earlier this year, more than 500 women in NHS Grampian with suspected breast cancer had to travel more than 125 miles for diagnosis because the health board could not meet demand. The centralisation of maternity services in rural areas such as Stranraer and Moray is forcing prospective parents to travel for more than an hour and a half. There is an alarming postcode lottery in the provision of perinatal mental health services, and a simple test for pre-eclampsia is only just being rolled out by health boards, thanks to proactive campaigning by the charity Action on Pre-eclampsia, years after its roll-out in NHS England.
The SNP cannot reduce the gender health gap if healthcare in Scotland is inaccessible, but that is the stark reality for too many. After two years as the shadow minister for women’s health, I recently took on the equalities brief and joined the Equalities, Human Rights and Civil Justice Committee. It is clear from our pre-budget scrutiny that budget decisions are made from a central-belt perspective, without thinking about policy coherence or the bigger picture. The centralisation of NHS services is having a negative impact on women in rural communities, with my constituents having to travel from outlying Forfar to Dundee to have a simple intra-uterine device fitted. Gender and geographical inequalities are becoming further entrenched under the SNP’s centralisation agenda.
I have been working with the north-east endo warriors, and I recently met representatives of Endometriosis UK regarding the distressingly long diagnosis time for endometriosis. There is growing awareness of this debilitating condition, but training and education are not enough. I have been told that the waiting list for diagnostic tools such as laparoscopy is two years at minimum. That urgently needs to change—two years is just not good enough.
As we look to the next iteration of the plan, I welcome Professor Glasier’s commitment to prioritise pelvic floor rehabilitation. From relationships to participating in sport, the physical and emotional impact of pelvic organ prolapse on women is absolutely horrendous. The minister asked for examples, so I would like her to look at countries such as France, where women are automatically offered pelvic floor therapy as part of their post-natal care. In Scotland, women are told to do Kegel exercises and wear Tenor underwear—it is an absolute disgrace.
This is not just about reducing the gender health gap; it is about how women experience the healthcare system and how that system supports them through their whole life cycle so that they can live happy, productive and pain-free lives. To achieve that, Scotland’s NHS must be efficient, reliable and accessible for all women, always. We have a long way to go.
15:55
Over the years, I have raised concerns about a range of women’s health issues, from endometriosis and pre-eclampsia to cardiovascular conditions and breast cancer. Those important female health issues have long required further action, and I welcome the opportunity to discuss them in the context of the women’s health plan.
The plan is undoubtedly a step in the right direction, but I believe that there are still significant gaps to be addressed. I will focus on four key areas that should be central to ensuring that women’s health is properly prioritised and supported. First, I will focus on endometriosis, which several members have mentioned. Seven years ago, I led a members’ business debate that ultimately resulted in significant progress, with the involvement and solid support of the then Cabinet Secretary for Health and Social Care, Jeane Freeman, and the then Minister for Public Health and Sport, Aileen Campbell, securing the opening in Glasgow of a third accredited endometriosis unit to complement those in Edinburgh and Aberdeen.
Although the women’s health plan outlines positive aims through the endometriosis pathway, including improved access to specialist endometriosis centres and reducing diagnosis time, I believe that those actions fall far short of what is needed. In Scotland, it still takes an average of eight and a half years from the onset of symptoms to receive a diagnosis of endometriosis. That is simply not good enough to meet the needs of the more than 100,000 women who live with that debilitating condition.
To truly prioritise women’s health, we need more specialist treatment centres. In Ayrshire, for example, we must reduce the burden of long travel times and journeys and make it easier for families and support networks to be involved in care, expanding access to that care closer to home. The added stress of long journeys only serves to make treatment more difficult. That is important not just to improving healthcare access, but to improving lives.
My second point concerns cardiovascular disease, which remains a leading cause of death among women in Scotland, where 95,000 women currently live with coronary heart disease. The condition significantly impacts quality of life and claims the lives of twice as many women as breast cancer. Thanks to British Heart Foundation research, sex-related differences in presentation and management of heart disease are now much better understood. However, women continue to face significant challenges, such as misdiagnosis, receiving fewer treatments and being underrepresented in clinical trials, which, in many cases, contribute to sub-optimal care that is not tailored to their needs.
Although there has been a 14 per cent reduction in coronary heart disease deaths over the past decade, recent trends show an increase, highlighting the need for sustained and focused action. It is alarming that heart disease accounts for a quarter of maternal deaths in the UK, with 77 per cent of the women who died not knowing that they had a cardiac condition. That underlines a critical failure in our health service to identify, let alone effectively manage, heart disease in women.
However, I am encouraged by the progress that has been made through the women’s health plan, which takes an important step forward in addressing those challenges. The plan’s focus on increasing research funding and recognition of gender-specific health needs, particularly in cardiovascular care, is welcome and much needed. We must build on that momentum and continue to raise awareness of women’s heart health across Scotland, ensuring that women receive vital heart health advice and support at every stage of their lives, with health service interaction at every available opportunity.
Recognition of the need for high-blood-pressure management is vital, as hypertension is a key risk factor for cardiovascular disease, which is responsible for around half of heart attacks and strokes. Clinicians, particularly obstetricians and midwives, must be equipped with the necessary knowledge and resources to offer advice and support to women who are at risk. By prioritising women’s heart health, investing in early diagnosis and developing tailored treatments, we have a real opportunity to improve outcomes.
Pre-eclampsia affects around 5,000 pregnancies in Scotland each year, but it is noticeably absent from the women’s health plan, despite being in the original 2021-24 plan. Perhaps the minister can tell us why it is absent. That life-threatening condition is serious and requires immediate attention, but it remains overlooked in a strategy that is meant to address women’s health needs.
However, I am pleased to note that NHS Lothian has taken a positive step forward by introducing targeted blood tests to reduce the risk for pregnant women. The placental growth factor test, which NHS England has used since 2016, is a significant development in helping doctors to diagnose pre-eclampsia. The test not only helps to reduce the number of unnecessary hospital admissions but, more importantly, ensures that expectant mothers receive the care and support that they need. A roll-out is taking place, but it is slower than it should be. Given the severity of the condition, which is manageable with early detection, I ask the minister, as I have asked her predecessors, when PIGF testing will take place routinely across all health board areas in Scotland, which will ensure that every pregnant woman has access to that vital test.
My son died on his due date. My wife’s liver ruptured, and she then spent 19 days in an intensive care and high-dependency unit because of a failure by midwives and doctors to diagnose pre-eclampsia.
After the event, women who suffered from pre-eclampsia are twice as likely to have heart attacks and strokes as women who did not, but there appears to be no follow-up whatsoever, which is a matter that I have raised previously with the minister. Instead, there is a suggestion that such women—lay members of the public—self-monitor their blood pressure for the rest of their lives. Even the women’s health champion, Professor Anna Glasier, who is in the public gallery, calls that a rather “tall order” in the health plan.
Finally, I turn to primary biliary cholangitis, which is a chronic liver disease that many women across Scotland are living with. Following a round-table meeting at the Scottish Parliament, which Gillian Mackay kindly chaired, a recent report highlighted significant disparities in the experiences of women living with liver conditions. The findings revealed that experiences vary widely, depending on geography, with many women reporting feelings of stigma associated with their liver condition, despite it not being caused by any action of their own, such as alcohol consumption.
The report recommends wider roll-out of the intelligent liver function test, which is currently used routinely to assess liver health in Tayside and Fife. Research by the University of Dundee shows that the test increases diagnosis of liver disease by 43 per cent, which allows for earlier and more effective treatment. Expanding access to the test would improve early diagnosis and care for women living with liver conditions across Scotland. Scottish ministers should also actively raise awareness of PBC.
The women’s health plan provides us with a clear path forward, but much remains to be done. By continuing to build on progress, we can ensure that women across Scotland receive the care and support that they deserve when they need it most.
16:02
I thank the Government for bringing forward this debate on such an important issue. Although I welcome the fact that some progress has been made on the women’s health plan, as the minister and others have set out, and that the Government is looking forward to the next steps, I fear that many women are still unable to access appropriate healthcare as and when they need to.
Women in Glasgow, especially those from more deprived areas in the region, are less likely to attend breast and cervical screening services than women elsewhere on mainland Scotland. Until very recently, women in Glasgow experienced harassment when attending abortion services, and I acknowledge the success of the work of Gillian Mackay and Back Off Scotland on safe access zones. However, there remain barriers to accessing abortions in Glasgow, where a lack of information on what is available still prevents timely access to such services when they are needed. As is the case elsewhere, women in Glasgow still wait far too long for diagnosis of endometriosis or polycystic ovary syndrome, which leaves many living in significant pain.
The situation in Glasgow for women must be turned around, and in order for that to happen, we need the Government to take a different direction. In addition, we need a different direction to be taken for specific groups of women, because, as Engender and others have highlighted, minoritised and marginalised women’s health experiences are still not fully recognised or addressed. I will use the rest of my speech to speak about the need for that to change.
Women continue to face stubborn inequalities in how they experience healthcare. Engender and others, including me and my party, are concerned by the slow progress in that regard. Years on from the publication of the women’s health plan, 65 per cent of respondents to research by the Young Women’s Movement in Scotland stated that being disabled is still associated with a lack of healthcare. They cited various reasons for that, including a lack of understanding of the need to treat multiple conditions holistically and, in some cases, bias and discrimination. The women’s health plan highlights that issue, and an Engender research report that was published in 2018 described how disabled women in Scotland experience specific barriers to accessing a range of health services, including a lack of accessible facilities, specialist equipment and accessible information.
The plan acknowledges the importance of considering how sex, gender and disability intersect, and the specific needs and experiences of marginalised disabled women. It concluded:
“It is important for healthcare professionals, and health policy makers, to recognise that a failure to take an intersectional approach can lead to further discrimination or disadvantage.”
I am concerned that many disabled women still face the same problems that were identified in that 2018 report. It has been brought to my attention that access facilities are not being prioritised as part of the development of new health centres. In fact, it appears that those facilities are deemed to be unimportant, as they are the first thing to be cut when health and social care partnerships are looking to reduce costs. The promised Changing Places toilets, for example, and hoists in GP surgeries were not installed in new healthcare centres in my region. I would have thought that the development of new buildings is the perfect opportunity to ensure that access for disabled women is assured, rather than being something that is considered later. However, that opportunity is being missed.
There also seems to be a lack of awareness among healthcare professionals where specialist equipment is in place. For example, in one of the health centres in the Glasgow region, a hoist was available, but none of the GP practices in the building was aware of it.
A report by Glasgow Disability Alliance that was published in 2022 found that the global pandemic has made it even harder for disabled women in Scotland to access women’s healthcare, because many have more complex needs than can be met through their GP surgery. The report also found that some disabled women felt unable to seek healthcare due to a mix of reasons, including the guilt associated with the need for additional things from an overstretched system. Disabled women should not feel guilty for having more complex needs, which—I should not have to say this—they did not ask for.
The report found lengthy delays in accessing health services and that those have
“significant health and life implications, including loss of function and mobility, missing potential problems or conditions and opportunities for preventative interventions”.
The report recommended that disabled women should have the option to be
“accompanied at medical appointments including on admission to hospital for communications and/or support”,
and that disabled women should have access to the equipment that they require.
Given that access to healthcare is a fundamental human right, it is extremely concerning that that was still a recommendation in 2022 and that, as demonstrated by the examples that have been outlined, it still applies today. Disabled women are being failed, and lives are being lost as a result. I was made aware of a situation in which one of my constituents was sadly unable to receive a smear test due to the fact that no hoist was available when she attended her appointment. Heartbreakingly, my constituent later lost her life due to a rare female cancer. I am cognisant of the fact that, if the correct equipment had been available, that outcome could have been different. My thoughts are with my constituent and her family, who have been failed by the current system.
Something must change. The women’s health plan outlined Government plans to launch a wider programme of work to specifically target inequalities across all screening programmes. However, three years on from its publication, not enough progress has been made. In Scottish Labour’s 2024 manifesto, we recognised that and said that, despite the publication of the plan, women continue to face inequalities. We committed to ensuring greater uptake of and ease of access to screening services, including the roll-out of cervical screening self-sampling. We recognise that local GP surgeries are the first port of call when a health problem starts, and we are committed to ensuring that they provide a range of services and to growing multidisciplinary teams, which are crucial.
Those are some of the ways in which we could ensure that disabled women no longer face barriers to basic healthcare. The next plan must be clearer in setting out solutions for improving all women’s healthcare, including unambiguous timescales for delivering the required change. In the words of Glasgow Disability Alliance’s report,
“Our society must be one in which disabled women participate and have our voices heard, on a full and equal basis, in all aspects of our lives, communities and wider society, with choices equal to others and our human rights upheld.”
16:08
I am pleased to contribute to what has been an informative and excellent debate. I will begin by following on from Pam Duncan-Glancy’s thoughtful contribution on access for disabled women by mentioning that, so far this afternoon, we have perhaps not examined some of the cultural barriers for our black and ethnic minority groups. We know that accessing mental health services can be particularly challenging in some cultures, and the birth mortality rates for black women have been well documented in the UK and abroad.
There needs to be a better understanding of all the cultural barriers for women who are seeking help to get the support that they need. Those need to be examined in further detail. I thank Annie Wells for highlighting the poverty-related aspects of some of the challenges that women have, particularly as she represents a constituency such as mine that has historically low life expectancy for both men and women. I thank my colleague Kenny Gibson for his very personal reflection on his own experience, and not for the first time in the chamber. It is important that we hear about the lived experiences of women and their partners, and the impact that very difficult circumstances can have on the whole family.
I am glad that we are joined in the gallery by Professor Anna Glasier, who has been mentioned on many occasions in the debate for her lead in the area of women’s health. It is worth remembering that the women’s health plan was the first in the world to be published by a Government and it is the first attempt to examine the inequity that women experience in healthcare. It is also worth noting how much we now understand of the risks, many of which have been mentioned in the debate. Alex Cole-Hamilton touched on heart issues, and the risks presented by endometriosis, polycystic ovary syndrome, the mental health challenges associated with menopause and postnatal depression. He also mentioned postpartum psychosis, which can be devastating for the women and families who are affected by it.
The women’s health pathway runs from puberty through to old age. We now know about some of the other issues that may face women beyond menopause, such as osteoporosis. Screening, which is so important, has been mentioned in the debate, includes breast screening and ovarian screening, as well as access to the HPV vaccine, which can now do much to prevent cervical cancer.
It is interesting that we are having this debate and that these issues are commonplace in the media and in our debates in the chamber. I thought that I would look back to see when we first started to talk about such issues, given that the first women’s health plan covered the period 2021 to 2024. In the first session of the Parliament, from 1999 to 2003, there were four mentions of menopause. Three of those were mentioned as ancillary to the main issues that were being discussed, and one was mentioned in relation to men’s health week. Very little changed during the few years after that. In the second session, the word “menopause” was recorded in the Official Report a couple of times. Between December 2003 and 2013, there were only seven entries in the Official Report that mentioned menopause, including in relation to other areas that did not focus on women’s health issues.
In 2017, we had the first real mentions of menopause as having been a cause for women to be dismissed for other health issues, and a petition on thyroid and adrenal issues was lodged. The issue of incontinence was mentioned, and that menopause had been a reason for women’s health problems to be dismissed, which has already been mentioned.
In sessions 1 to 4 of the Parliament, the word “tampon” was mentioned once. We now have the groundbreaking Period Products (Free Provision) (Scotland) Act 2021, which legislates for period products to be provided for free to those who are in need in Scotland. That was another first for Scotland.
From May 1999 to 2016, menstruation was mentioned five times, and three of those times were in the context of female genital mutilation. Most women experience menstruation around once a month and millions of us go through it, so it seems incredible that we were not discussing women’s health issues long before then.
I am really pleased that we have moved on from that. We have a long way to go to address women’s health inequity, but I think that it is worth recognising how far we have come. The debate and the contributions that have been made show that we are taking it seriously, that we understand the challenges and that there is a lot more to do. I am delighted that the women’s health plan is in place and that it has established a pathway. I look forward to hearing how the Government intends to implement it and about the work that has already been done under the current stewardship and leadership of the minister.
16:15
Like my colleagues, I am pleased that we are taking time to debate the subject of women’s health. It is an issue that regularly appears in my constituency postbag, and a number of important points have been raised in the course of the debate.
The motion does not detract from the fact that there is still much work to be done to develop women’s health services further, but the women’s health plan is an important first step towards addressing the inequalities that impact half the population of Scotland. Nowhere are the long-standing health inequalities that impact women more evident than in the justice space, and I will focus on that a little later in my speech.
I am enormously proud of a health system that has, in the past few months, seen me receive my flu jab, my Covid jab, my cervical screening, my free eye test, my well-woman check, my mammogram, my asthma review, my audiology referral and a free prescription for antibiotics. Those are all effective and important preventative approaches that are part of the wider programme of activity to keep women in good health and that intersect with the priority areas in the women’s health plan, which include menopause, menstrual health, pregnancy, contraception and endometriosis.
A few months ago, I had the pleasure of visiting the women’s health services team at Aberdeen Royal infirmary, where I heard about the significant progress that is being made to develop health services for women, including endometriosis services and breast screening. I heard about the fantastic progress that is being made by NHS Grampian, alongside the University of Aberdeen and Kheiron Medical Technologies, to develop Mia—or mammography intelligent assessment—which is a promising artificial intelligence technology that can identify minuscule traces of breast cancer that can be missed through conventional practice. As one of the team acknowledged, even doctors are human, so they get tired, they might have been up all night with a crying baby or they might be full of the cold.
I have a number of constituents who are interested in seeing the women’s health services model extended further to that of a hub. I am grateful to the minister for her previous engagement with me on the issue, with specific regard to menopause services for women. I welcome any further update that she can provide on progress in hub provision in the north-east. I was interested to hear Emma Roddick’s reference earlier to the Highland hub.
The issue of urinary tract infection has been raised with me, and, although the women’s health plan makes reference to recurring UTI, it does not refer to chronic UTI, which we know has a significant impact on women who experience it.
Typically, we are probably all members of the worried well population in society—thankfully, more well than worried—but I welcome that the plan acknowledges what is commonly known as the inverse care law, whereby those, including women, who most need healthcare are often least likely to access it. I commend the work that has been done recently by the universities of Glasgow and Edinburgh on how to tackle the inverse care law in general practice in Scotland.
That brings me to my final point, which is the challenge that women in the justice system face in their health and wellbeing. The women’s justice leadership panel report, “The Case for Gendered and Intersectional Approaches to Justice”, outlines how women typically enter the justice system in different ways from men and for different reasons. Scotland has a relatively high incarceration rate for women compared with other countries, including those in Europe, and it is commonly accepted that the health needs of women in prison are often not met due to a complex layer of factors, including domestic abuse, addiction, trauma and compromised mental health.
For women who have family members in prison, the practical harms that are associated with reduced household income, stigma, the loss of the practical and emotional support that they previously relied on from the imprisoned family member and even the cost of travel for prison visits can take a significant toll on their health and wellbeing, which further drives the health inequalities that we know disproportionately impact women who are caught up in the justice system. To a great extent, women serve a hidden sentence of their own in that regard.
The priorities that are set out in the plan apply equally to women in prison, who do not stop having periods, having the menopause or even being pregnant, so humanising healthcare in that space will help women to be well and more resilient when they leave prison.
Across Scotland, the establishment of trauma-informed community custody units for women, such as the Bella centre and the Lilias centre, is leading the way in preparing women to leave prison. Such units provide a real opportunity to insert even better healthcare services at that crucial release point.
I would be very interested to hear any update that the minister can provide on what opportunities might exist to insert some more focus on women’s health in prisons into the next stage of the women’s health plan. I very much look forward to following, and even contributing to, the plan’s future development.
We now move to closing speeches. I call Gillian Mackay to close on behalf of the Scottish Greens.
16:21
This has been an interesting debate and I will reflect on some of the contributions. In her opening statement, the minister laid out how important it is to look after women’s health because, in doing so, we are looking after the nation’s health. It is important that we point to factors outwith the minister’s portfolio and the women’s health plan that have an effect on women’s health. The minister mentioned unpaid carers—that is the perfect example of how factors in many other portfolios can drive health inequalities, or otherwise. The rate of carers allowance, access to carer support plans and the ability to get respite to attend appointments all have an impact on carers’ health.
Another area that the minister mentioned is pregnancy and baby loss. Several friends have pointed out to me that they found it interesting that, during their pregnancies, almost every symptom that they asked healthcare providers about was described as normal, even when the symptoms were complete opposites—for example, having a higher-than-normal appetite and being concerned about that, or having no appetite at all when they believed that they should have. Both symptoms were totally normal, and I think that we need more information and clear explanations in those areas.
Many women have been told to just battle on with debilitating symptoms in pregnancy that we would not expect anyone else to battle on with, purely because there is a stigma around how early it is okay to tell people about a pregnancy. I know some friends who, after a loss, regretted not telling their family earlier. They had a bereavement without having had the celebration of their happy news. We need to assess whether some of those norms are making losses harder, and I commend Kenny Gibson for sharing his personal experience in that regard.
We need to ensure that employers are aware of all the ways in which they can support pregnant women and that women are supported to reveal their pregnancies whenever they are ready to do so, not when tradition dictates that it is okay, especially if they feel that they need support.
I am glad that the baby loss memorial book is open to those who have historically had a miscarriage. I am sure that many of us have had meetings with those who have historically lost a pregnancy and have heard them speak about the sense of validation of their experience.
Alex Cole-Hamilton, Clare Adamson and others have mentioned postpartum depression and postpartum psychosis, among other issues that are hugely important to address. The Health, Social Care and Sport Committee has undertaken work on perinatal mental health, and it would certainly be worth repeating such work in a future parliamentary session.
Emma Roddick mentioned chronic pain and how not being believed about a multitude of symptoms, but pain in particular, is devastating for many. Why the default is not just to believe that women are experiencing pain and then try to find out what is causing it to manifest, rather than not believing that the pain exists in the first place, boggles my mind.
Kenny Gibson kindly mentioned my chairing of the PBC event last week. Primary biliary cholangitis, which is not easy to say at this point on a Tuesday afternoon, is an autoimmune liver disease that predominantly affects women—women account for around 90 per cent of all cases. The symptoms of PBC, such as itch and fatigue, can have a profound impact on a person’s quality of life and mental wellbeing. Those affected often feel misunderstood and sometimes stigmatised, because, unlike many other liver conditions, PBC is not the result of alcohol or drug consumption. Instead, risk factors may be gender, older age, genetics and where a person lives.
In my opening speech, I spoke of my awe for those women, who shared raw experiences of how PBC has affected, and continues to affect, their lives—how it has affected their families, their experience of transplant and their own mortality. They spoke with passion about what they want to see and how they see their own care. I encourage others to engage with the groups that were represented at that event.
Kenny Gibson and others also mentioned cardiovascular health. We know that heart attacks often manifest with different symptoms in women. Many of us try to raise awareness of those symptoms, but their not being accurately defined in women is potentially a big problem. That is why I will not stop going on about data, and it is why I was really pleased to see a review of the data landscape published alongside the women’s health plan report. Some of the data that we need to see is not just more things that the Government should collate, but specific funded academic work that is done to ensure that we better understand many of the symptoms and causes.
Organisations have asked for other issues to be raised that I did not have time to address earlier, so I will try to race through them now. Breast Cancer Now has underscored the need for a stronger emphasis to be placed on a life-course approach when women interact with the healthcare system. More should be done to provide women with information on how to check their breasts, to remind them when they will be invited for breast screening and to provide them with the tools to make an informed choice to attend.
That organisation also points to the fact that the Scottish Government’s major review of breast screening in 2021 recommended that bringing high-risk screening within the remit of the national screening programme be considered. That project is outside the programme board’s scope and would require a specific business case and funding. Breast Cancer Now advocates for the next iteration of the women’s health plan for Scotland to provide an opportunity to fulfil the review’s recommendations and to conduct a larger piece of work to fully assess the potential advantages, feasibility, benefit and cost of integrating high-risk surveillance with the national screening programme.
Engender has highlighted the need for more details to be provided on how Covid-19 has impacted women’s health outcomes and affected the implementation of the women’s health plan, including whether it has limited the scale of change that has been delivered. Engender has also renewed its calls for future work on women’s health to focus on an intersectional approach that recognises and addresses the health experiences of minority and marginalised women.
I look forward to working with and learning from Professor Anna Glasier on the next iteration of the plan, as well as working with the minister and the rest of Government to achieve the aims that we all hold dear. I hope that we can continue in the largely constructive tone that we have had today.
I call Jackie Baillie to close on behalf of Scottish Labour.
16:27
I welcome the debate and I welcomed the plan, but I have to say that progress has been slow. The report was launched three years ago, yet we have not shifted the dial on the inequality that continues to plague women’s health. I know that it will not happen overnight, but we need to make more progress.
I strike a note of consensus and agree with the minister’s comments that to prioritise women’s health is to prioritise the health of Scotland. That is why the agenda is so important. However, I fear that women’s health is too often treated as an afterthought. Although the Government took more than a year to appoint the women’s health champion, I very much welcome the work that has been undertaken by Professor Anna Glasier. She has certainly been hands-on in her approach and she has a hugely important role in making change, but leadership and resourcing from the Scottish Government are needed.
We are very welcoming of progress on issues such as self-sampling for HIV and sexually transmitted diseases, but what about cervical self-sampling? That was promised in the first year of the plan, but three years on, it appears that only Dumfries and Galloway has a pilot. In the report that was published last week, there is no mention of cervical self-sampling.
When the health plan was published, colposcopy waiting times were so bad that women with a suspicion of cancer were waiting more than 300 days to be seen. It was a real postcode lottery. If someone lived in Lanarkshire, it was fine—they were seen timeously—but if they lived in the NHS Greater Glasgow and Clyde area, they had to wait for up to a year, which simply was not good enough. I understand that matters have improved, and that is welcome, but there is still a long way to go to ensure consistency across Scotland.
I welcome the progress on the HPV vaccine. In fact, my daughter was in the first cohort of young women to receive it, which is great. However, the plan also promised to address wider health inequalities in cancer screening and, as others have mentioned, Public Health Scotland statistics still show a stark inequality in the uptake of breast cancer screening by women from the most and least-deprived backgrounds. There is a shocking 18.8 per cent disparity between the proportions of the richest and poorest women attending routine breast cancer screenings, and Cancer Research UK has estimated that approximately 4,900 cancer cases in Scotland each year can be attributed to deprivation. We must make more progress on that, because thousands of women are being overlooked or put in danger due to their socioeconomic position, which is a shocking indictment of any Government.
Annie Wells was right to talk about waiting times for endometriosis treatment. I recognise the positive steps that have been taken and welcome the new pathway, the research and the specialist centre in Aberdeen. However, women are still waiting as long as nine years for diagnosis and treatment. I cannot begin to imagine the pain and suffering that they experience; I simply note that if that condition affected men, action would have been taken before now.
I do not underestimate the scale of the challenge. Women continue to have the highest levels of poor mental health and more women—45 per cent of women compared with 29 per cent of men—suffer from limiting, long-term conditions. Women are more than twice as likely to die from heart disease as from breast cancer and are also more likely to be given the wrong diagnosis, which means that they receive only half as many heart treatments as men. In part of my constituency, sexual health clinics have been withdrawn and centralised because of a failure to plan for the retiral of a clinician—you really could not make that up. We must do better in all those cases.
Yesterday, I met a number of very impressive women who, because of pregnancy outside marriage, were subject to forced adoption. Some were mothers who had to give up their babies, and some were babies now grown into adulthood. It was a very emotional meeting. I absolutely welcomed the public apology that the former First Minister, Nicola Sturgeon, made to them because of what happened, but there has been no action since and not even any provision of trauma-informed counselling. I know that it is hard to say sorry and I do not in any way diminish the impact of the apology, but to do so little in the way of follow-up shames us all.
I do not want to disrupt the cosy consensus but I must express my disappointment. The SNP cut £10 million from women’s services and reduced funding for the removal of transvaginal mesh. Women who have endured years of crippling agony are the last people who should be paying for the SNP’s mismanagement. The cuts do not stop there, because there will also be cuts of almost £3 million to early years care, breastfeeding and young patient family funds. Those are the very same funds that women have been told to rely on should they give birth to the most premature babies. Some women will be forced to travel for more than three hours to get treatment because of the SNP’s plan to remove specialist neonatal services from Wishaw, which goes against the views of expert clinicians and of families in Lanarkshire.
My mother always used to tell me to follow the money. If something is important, we put resources behind it, so the fact that the SNP has cut funding tells us all that we need to know. The Scottish Government will receive the largest block grant from the Labour Government in the history of devolution. Every single penny given for health must be spent on health, and on women’s health in particular.
I offer the SNP an early win. One of the biggest problems with menopause services is the waiting time for referral to a specialist clinic, which is largely down to the fact that many women have multiple GP appointments before their symptoms are diagnosed. We know that 90 per cent of menopause cases can be dealt with in primary care and that community pharmacies have a key role to play. I am therefore genuinely disappointed to see that that is only a long-term goal when there is already a menopause service on a digital community pharmacy platform that would deliver a better integrated service for women within six to 12 months and would be far more cost-effective for the NHS. I have no idea why the SNP is not interested.
I turn to the comments of Engender, which provided us with a very helpful briefing. I want to pick up on two issues that it has raised. First, we should understand what funding and investment has been provided to help with delivery of the plan and what accountability measures and monitoring are in place. That is the essence of our amendment, and I welcome the fact that the Government will accept it.
The second issue is that a new Scottish institute for women’s health was promised in the plan but it has not been delivered. That body could drive change to improve women’s health outcomes. I ask the minister to consider that, together with Kenny Gibson’s suggestions on local clinical provision for women. Both of those are important.
While the NHS and social care in Scotland remain in crisis, women are overwhelmingly paying the price. We know that one in six Scots is on an NHS waiting list, that long waits at A and E put lives at risk, and that delayed discharge is at a record high. We need to do better. I agree with Professor Glasier that we must make the health of women central to every area of healthcare, but that will be achieved only with the proper levels of planning and funding.
The Scottish Government should also commit to addressing the large data gaps in reproductive health, endometriosis, menopause and contraception. There is no silver bullet for undoing years of inequalities in women’s health, but the pace of change needs to be picked up. Carol Mochan is right. We need more than words—we need delivery. Policy papers do not mark the end of the task. We need reform, and we need to get on with the job. I think that we can all agree that the women of Scotland deserve better.
Before I call Brian Whittle, I advise members that we have a wee bit of time in hand between now and decision time, so I can be extremely generous.
I call Mr Whittle to close on behalf of the Scottish Conservatives.
16:36
I am very grateful, Deputy Presiding Officer.
First, I declare an interest in that I have a daughter who is a midwife.
This has been an excellent debate, with much agreement across the chamber. It is obvious that we all want faster progress towards parity for women’s health. I was struck by the World Health Organization’s statement that
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
We need to consider that against the backdrop in Scotland, where we have significant poor health issues. Despite the SNP’s claim that it spends more on health per head of population than the rest of the UK, we have much poorer outcomes, and that is what matters. Scotland is the unhealthiest country in Europe. We have the highest obesity numbers, the highest drug and alcohol deaths, comparatively low and falling life expectancy, and so on. That impacts on women’s health, of course, which already suffers from significant inequality.
Tess White made a powerful speech. I am paraphrasing, but she said that we know less about how best to treat diseases in women. I am also grateful to Alex Cole-Hamilton for mentioning the fight of the transvaginal mesh women. If anything highlights the inequalities in women’s health, it is that. My overwhelming memory of the previous session of Parliament is sitting in the Public Petitions Committee questioning the CMO and the cabinet secretary while, behind them, sat some 40 or 50 women in wheelchairs, in unimaginable pain, searching for a solution. As I said, if we want to highlight the inequalities in women’s health, that is where we should start.
ME affects four times as many women as men, and it is only fairly recently that we have started to get doctors to recognise the condition. As many members said, coronary heart disease kills twice as many women as breast cancer, and it kills more women prematurely. We know that a third of eligible women did not have a smear test in 2021-22 and that women from deprived areas are significantly more at risk from missing a smear test than those from the most affluent areas. It is the same for breast cancer. That thread has run right through today’s debate.
If the women’s health plan is to be successful, we must consider how the message reaches out to women and, crucially, how we ensure easier access to services. It cannot be right that, as Tess White highlighted, women have to travel for up to 125 miles to access screening, as they do in NHS Grampian, because local services cannot cope. We have a service that is underutilised yet cannot cope with the numbers who are trying to access it.
Rightly, Annie Wells highlighted the fact that the continuing shameful alcohol figures have a significant impact on breast cancer numbers, as well as on other cancers.
As Carol Mochan, Annie Wells and others highlighted, it takes on average more than eight years to get a diagnosis for endometriosis—a condition that will affect one in 10 women. That is not progressive women’s health, in my book.
Given the impact of sport and physical activity on physical and mental health, it would be remiss of me not to mention the disparity between numbers in women’s and men’s participation. Early opportunities to get active are more difficult for girls than boys, and a stigma still exists around girls playing sport, especially around the age of menstruation. Much of that has to do with perception and access to safe and adequate changing and shower facilities.
That situation has not improved much in recent times, despite its being highlighted consistently. Society has not caught up—as is evident from the back pages of any newspaper, in which women seem to be, at best, an afterthought. At the weekend, two netball international matches were played, and I did not see any coverage in the media. You have to be able to see it to believe that you can do it. I know about those matches only because my daughter, who happens to be a netball ex-international, mentioned them to me. Women’s football, cricket, golf and rugby are moving forward globally, and it is time that we in Scotland caught up. However, I note that, in my own sport of athletics, Scottish women are more prominent. It is good to see them buck the trend, and it shows that that can be done. Participation must be tackled and developed to impact the general overall health benefit, which is both physical and mental.
Before entering the Parliament, I worked in a healthcare technology company, developing communication and collaboration platforms for healthcare. One target was to allow a global reach in new medical trials, taking into account the effectiveness of those drugs across different ethnic groups. However, globally, the uptake was in the region of 80 per cent male. To back Tess White’s call for a women-specific treatment plan, the big issue is the efficacy of medicines for women. It is a fact that, mostly, medicines are tested on men, and then the dosage is extrapolated from the results to define dosage and effectiveness for women. However, not only is that an inexact science when it comes to dosage; it does not necessarily take into account the different biology in women, such as their bone density, muscle mass, fat content and menstruation. Mirroring society, whether in its male-female split or in variations in ethnicity, must be a significant goal for medicines, if we are to tackle women’s health inequalities, and I would appreciate the minister’s suggestions on how the Scottish Government might take steps to address what is a long-standing issue.
I listened to the minister discussing the neonatal services at Wishaw. Carol Mochan took that further, into rural neonatal units. I also listened to what Jackie Baillie had to say, and I think that she would agree that we spoke to a different cohort of constituents and healthcare professionals. It seems to me that the downgrading of the services at that maternity unit in Wishaw general hospital, the creation of a specialist unit in Glasgow to the detriment of Lanarkshire mothers, and the fact that the significant specialist skills that were developed at Wishaw are not being used, are based not so much on the delivery of healthcare but on an administrative decision, given the way in which the situation has been discussed many times in the chamber. It is wrong to develop and deliver women’s healthcare in that manner.
As I said, this has been an important debate, shining a light on women’s health and the inequalities that exist. Across the chamber, there is a desire to improve and impact on the health of women and girls. However, we must accept that we are a long way from parity in that healthcare. The debate is welcome, but change will come about only if the Scottish Government listens to members from across the chamber, acts on those suggestions and develops those plans. After all, better outcomes are what we all want.
I invite the minister, Jenni Minto, to close on behalf of the Scottish Government. We still have some time in hand. If the minister could take us to as close to decision time as possible, that would be much appreciated.
16:45
This afternoon’s debate has, once again, highlighted that it is vital to prioritise the health of women and girls. Having listened to the contributions from members, I am greatly encouraged by the progress that we have made, but I am under no illusion that work does not remain to be done. The plan recognises the need for a societal and cultural shift in attitudes towards women’s health, to tackle the inequalities that women have faced for generations, as Carol Mochan and Gillian Mackay both referenced. That does not happen overnight—and it should not, because we need lasting change.
It is clear that there are specific areas where renewed and targeted focus is required—long waiting times for gynaecology are a clear example. The first phase of the women’s health plan has provided a solid foundation for us to build on, but we are not finished. More work needs to be done to ensure that women and girls in Scotland are listened to, informed and supported to enjoy the best possible health throughout their lives. I and the Scottish Government remain committed to that ambition.
I will focus on a few points that have been made. When I came into this role and Ms Todd came into her role, we both felt that it was important to understand the views of people from across the chamber. We have been very open in how we have connected, and I have very much appreciated the comments from other members who appreciate that. Meeting half-yearly with Professor Glasier and having that space where we can talk about concerns and find responses has been very worth while for us all.
A number of members spoke about the stigma of women accessing healthcare. I was well aware of that at one of my very early meetings in this portfolio, with representatives of the Young Women’s Movement, who told me about exactly that. I recognise a lot of the stuff that Pam Duncan-Glancy spoke about, and I recognise, as she does, that that is not an appropriate way to treat disabled women when they are accessing health services. I would very much like to have a further conversation with Pam Duncan-Glancy, to ensure that we incorporate that as well as we can in the next phase of the plan.
On a similar note, I acknowledge Audrey Nicoll’s comments about prison services. Like Audrey, I have visited the Bella centre, and I found it a very inspiring place where women are given the opportunity to step back into life outside prison and are provided with suitable healthcare. The final report mentions progress in improving healthcare for women in prisons by providing additional investment to health boards to enable them to deliver trauma-informed healthcare. A cross-ministerial group is looking at justice and healthcare, and I am very happy to engage further with that group and with Audrey Nicoll to ensure that we have the right connections with women in the justice system as we progress to the next phase of the plan.
Clare Adamson and others mentioned cultural barriers, and I have been very pleased to meet Amma mothers in Glasgow on a couple of occasions to understand the work that they are doing with BAME mothers, whether they are asylum seekers or refugees in the Glasgow area or further afield, to reduce inequalities. I also attended a research outcomes event on maternity care for refugees and asylum seekers, at which some very powerful information was shared that it is helpful for us to consider when we are talking about women’s health.
Gillian Mackay’s Abortion Services (Safe Access Zones) (Scotland) Bill was a great example of the Parliament working incredibly well together. The committee stages were very probing, as Tess White described. In addition, we were able to have conversations, both at stage 2 and prior to stage 3, in which there was a great deal of openness and understanding with regard to the various positions that members were coming from. That was a really good example of the Parliament working well, and I hope that we can use the same structure when we are looking towards the next phase of the women’s health plan.
In that respect, I look forward to engaging with Annie Wells in her new role, and I welcome her along to the six-monthly meetings that we have been having with Professor Glasier.
Gillian Mackay also suggested some ways to move forward, and I am happy to engage with her on those to try to move things on.
I was pleased that Alex Cole-Hamilton recognised the consensus across the Parliament, and he, too, talked about stigma and mental health support. We have taken a number of actions in the “Peer Support in Perinatal Mental Health Action Plan 2020-2023” not only to support practitioners, but to provide peer support in supporting pregnant women, mothers and young babies, as well as partners and fathers, who are facing challenges such as loneliness and isolation. I recognise that we can always go further, but that work is on-going.
I am intervening partly to give the minister a wee minute to get a sip of water. Does she recognise that we need to keep mums well throughout their pregnancy and ensure that they are supported to have the best possible mental health during that journey? In that way, when issues creep up in post-partum situations, there are existing support mechanisms in place for them.
Last week, I visited Home-Start Glasgow South, on the south side of the city, and that is exactly what that organisation has been doing. It supports mums from the time when they are about to give birth all the way through to when the children are at primary school. It provides combined support, and I was pleased to listen to, and learn from, some very powerful mothers who told me about the difference that that support had made to their own mental health.
I will touch briefly on the situation with neonatal units and the decision that was made about them. We made that decision in order to give babies who have been born at the extremes of prematurity the best chance of survival, which I believe is what every parent wants. Evidence shows that such babies do best when they are cared for in large, specialist neonatal units that look after a lot of babies and have specialist staff services available on site to give them the best care. As I said earlier, in response to an intervention, that approach is supported by experts and by Bliss, the charity that represents neonatal families.
Will the minister give way?
If the member does not mind, I will move on to talk about a few other things.
There has been a lot of discussion about remote and rural maternity services. At a national level, we continue to work to address the challenges that are faced by maternity services in rural health boards. The implementation of the best start initiative and the introduction of the continuity of carer model; the development of community hubs; and the increased use of NHS near me, which allows for remote consultations and appointments where appropriate, are all intended to improve the delivery of maternity services in rural areas. I recognise that because I represent Argyll and Bute, which includes a number of islands that use those additional routes. We particularly recognise the importance of patient transport, and work is commencing to develop guidance on pre-hospital maternity and rural interpartum transfers. We will consider any specific needs and challenges that rural communities across Scotland face.
A number of members talked about pre-eclampsia, and I note that it was recognised that the Scottish Government has invested in health boards to ensure that the test, which is an important tool in identifying pre-eclampsia—a condition that can be, as others have said, dangerous or life threatening to pregnant women and babies—is available. Our expectation remains that all NHS boards will work to ensure that the recommendations on PLGF-based testing are implemented effectively and consistently. We are working with NHS boards to navigate any local challenges to their implementation.
In relation to Kenneth Gibson’s mention of PBC, it is later—
Will the minister take an intervention?
I hope that Ms Mackay understands that I will not explain PBC. I was very pleased that Professor Glasier attended the parliamentary round-table discussion in October, as we recognise that that liver disease affects predominantly women.
Do you want me to wind up, Presiding Officer?
You have time, minister, if you are content to continue.
The group heard personal accounts from patients living with PBC and discussed how treatment and care could be improved for people in Scotland with the condition. We absolutely recognise the importance of hearing directly from people living in Scotland as we look to develop the next phase of the women’s health plan. Professor Glasier appreciated very much the opportunity to hear at first hand from people living with PBC and the clinicians supporting them.
I will touch on Jackie Baillie’s points about menopause services. When I was in Aberdeen during the summer recess, I heard about the fantastic work that is being done to support women and men who live with migraine. Primary care and pharmacies are working closely together on that. When I said that that seemed like an excellent way forward, I was asked what my next suggestion for that approach would be—and it is menopause. That is absolutely on my radar, and I am having those discussions. Some incredibly important research work on heart health is also happening at Napier University, which I am keeping across.
As everyone said in the debate, it is our duty to ensure that every girl and woman, regardless of their age and background, has appropriate and timely access to the information, support and services that are required to live a healthy life.
Will the minister take an intervention?
I am just concluding, thank you.
It is a critical part of improving the health of Scotland, so I am very encouraged that we have found some consensus today. I hope that all members who took part in the debate, and perhaps those who will read our contributions after, will continue to work together, because, as we said at the start of the debate, the women’s health plan is important for the health of Scotland as a whole.
I would be very happy to meet people to talk further about their ideas, contributions and suggestions, to ensure that the next iteration of the women’s health plan is as correct as possible.
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