Women’s Health Outcomes

Baroness Altmann Excerpts
Thursday 8th July 2021

(3 months, 1 week ago)

Lords Chamber

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Department of Health and Social Care
Baroness Ritchie of Downpatrick Portrait Baroness Ritchie of Downpatrick (Non-Afl) [V]
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My Lords, I commend the noble Baroness, Lady Jenkin, for securing this important debate and for depicting the lifecycle of women, with its many challenges. There are life challenges, societal challenges and, above all, gynae- cological challenges, which we have all faced in our lives.

It is quite clear that research has found a gender health gap in the UK, where many women receive poorer healthcare than men. This poses the question: why has this been the case and what measures will be taken to rectify the situation at governmental level, working with communities and the voluntary sector?

Many of the challenges facing women’s healthcare have already been raised in the Paterson Inquiry, and the First Do No Harm report, which found that the healthcare system was

“disjointed, siloed, unresponsive and defensive.”

The Saving Lives, Improving Mothers’ Care report said that, between 2016 and 2018, 217 women, or 9.7 women per 100,000, died during pregnancy or up to six weeks after childbirth

“from causes associated with their pregnancy”.

In academic research, Caroline Criado Perez, to whom the noble Baroness, Lady Jenkin, has already referred, has argued that women have been considered less important in healthcare as far back as ancient Greece. Arguing that the problem still exists due to a patriarchal worldview being prevalent in our healthcare system, she said that women are routinely under- represented in clinical trials and that medical research proposed by women is not allotted the same funding as medical research proposed by men for men. I am not sure about that, as somebody who is on a clinical trial—a double-blind trial for breast cancer.

Research and observations would show that, in many societies, women have provided the caring at the expense of being cared for, thus placing their health needs as secondary to those of men. I look at research from Northern Ireland and a matter that has already been referred to by the noble Lord, Lord Rooker. It shows that women have a 70% chance of providing care, compared with 60% of men. By the time they are 46, half of all women have been a carer—11 years before men. I look forward to the Minister’s response.

Baroness Altmann Portrait Baroness Altmann (Con) [V]
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My Lords, recent ONS figures show that there is a gap of more than 20 years in the healthy life expectancy of women between the least and most wealthy parts of the country. For men, the gap is around 15 years. In the most deprived parts of the country, women will only stay healthy to just over age 50, while for the best-off areas it is around age 70 or a little above. Women are also more prone to poverty, financial insecurity, interrupted and low-paid employment, and mental health problems, all of which obviously impact their health outcomes.

Covid-19 risks accelerating women’s health inequalities, for example due to delays in regular screening that are likely to increase the number of women with pelvic and breast cancers detected and diagnosed too late. Also, as the pandemic has placed so much more strain on women in their family roles as carers, whether combining home schooling with home working or caring for elderly loved ones, the added responsibility and loss of wider support that they had previously relied on will all take a toll on women’s health, in both the short and longer term.

I therefore congratulate my noble friend Lady Jenkin on her excellent timing on this debate, and her most brilliant introduction—what a tour de force. In fact, I have been concerned for a time about older women’s health deteriorating since 2010. Cuts to council budgets have led to reductions and delays in social care provision, as well as the removal of preventive measures in many areas such as meals on wheels, day centres and early-stage care support. This obviously poses a risk to the health of older women both directly, because there are more elderly women than men and they are not receiving the care they need, and indirectly because of the added burdens on family carers, who tend to be predominantly daughters and mothers. Social care reform is important for women’s health outcomes and I hope there is an increased recognition of this.

Finally, problems faced by older women in the workplace are troubling. In certain sectors they face more age discrimination at work than men, particularly women who have challenging health issues when they go through menopause. Even though menopause systems tend to affect women’s health only temporarily, the lack of understanding of the impacts too often lead women to either leave work or lose their jobs. There is insufficient appreciation that a change to performance and efficiency, whether due to a lack of sleep after night sweats or hot flushes and hormonal changes that undermine concentration, will not be permanent. Therefore, I hope my noble friend the Minister will address some of these issues of menopause at work that could allow women to return or stay in their jobs. Currently, they are too often leaving work.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, I echo the thanks of the Chamber to the noble Baroness, Lady Jenkin, for securing this important debate. Along with the noble Baronesses, Lady Jenkin, Lady Massey of Darwen and Lady Walmsley, I was trustee of UNICEF. Its work to help educate and protect girls and young women in dangerous countries across the world—of which the noble Baroness, Lady Nicholson, spoke so movingly, when talking of the horror of rape for girls and women in war-torn communities—demonstrates that we absolutely need to support United Nations projects to protect girls and women throughout the world. The noble Baroness, Lady Nicholson, is right: we need worldwide action to eliminate this scourge.

The noble Baroness, Lady Jenkin, was so right to set this debate in the lifecycle of a woman. She gave us a female equivalent of Shakespeare’s seven ages of man and, while it may not have been in iambic pentameters, it was striking in its arguments.

The noble Baroness, Lady Penn, faces the glorious arrival of a baby. I want to offer, as other noble Lords have done, best wishes for a safe arrival and a hope that, if the baby is a girl, her daughter’s experience of health will be very different from her mother’s and her grandmother’s. Predominantly male medics told us what they thought we had and wanted but, too often, I am afraid, had not listened to us before they spoke. Much has improved over the years, but there is still room for improvement, as this debate has shown.

The noble Baroness, Lady Bull, talked about the incidence of eating disorders, and how important it is that young women are listened to and supported—and, of equal importance, have access to specialist medical help early on.

The noble Baroness, Lady Massey of Darwen, focused on the problems that many women face with mental health today. The Royal College of Psychologists is right to set out the need for an extra £500 million of funding to ensure that they get the tailored support they need, when they need it. There are too many long delays in CAMHS.

My noble friend Lady Walmsley and the noble Baronesses, Lady Bottomley and Lady Bennett, were spot on to remember the failures that fell to the women with valproate and vaginal mesh problems, investigated by the noble Baroness, Lady Cumberlege, in her excellent report. When will the Government implement the key recommendations from that report, particularly the patient safety commissioner?

My noble friend Lady Walmsley also referred to domestic violence. There is no doubt that the healthcare providers can help to spot signs of concern early on. But the BMA has reminded us that healthcare professionals need training early on and support from other agencies to make that happen. That most women wait until in excess of 30 incidents before they go to the police is shocking, but GPs, nurses and midwives are often able to assist women in recognising that they are facing problems early on, and help them to deal with that.

It is extraordinary that women have a much higher level of autoimmune diseases than men. With some diseases, it is 80% higher. Researchers are still trying to understand why, but serious autoimmune diseases can still significantly reduce lifespan, or the patient has to face many years on immune suppressants to prevent the disease progressing. In this year of Covid, that has of course given them further problems. Endometriosis, which happens to be my second autoimmune disease, introduced me as a young woman to the indignity of the mostly male doctors managing my condition and its consequences for fertility, high miscarriage risk and a life of severe pain, which hardly any medics understand. That GPs think it is just like a bad period pain completely misses the point.

The noble Baroness, Lady Greengross, referred to contraceptive services and their supply during the pandemic. She was right to say that women need to be able to access those services all year round, and throughout the United Kingdom, because failures can have serious consequences for young women.

The noble Lord, Lord McColl, ably set out a range of women’s services where other countries are setting us good examples of how we can improve the lives of women, including respite care for the many unpaid carers, mainly women. His point was echoed by the noble Baronesses, Lady Eaton, Lady Fraser and Lady Ritchie. The noble Baroness, Lady Fraser, also gave us an excellent example of combining data to cross-reference women with epilepsy and their medicines. She said, “If you’re not counted, you don’t count”. I am reminded here that the suffragists scrawled “Votes for women” across the 1911 census and are visible to history, whereas the suffragettes chose just to boycott the census, so their contribution is invisible to history.

The noble Baroness, Lady Bennett, and the noble Lord, Lord Hunt, talked about women’s cancer diagnoses coming significantly later than men’s. I know that other Members of your Lordships’ House have faced this, but we have a close family member whose 34 year- old daughter missed her cervical smear test last year because of the pandemic and now is facing terminal cancer. That is really shocking. The noble Lord, Lord Hunt, rightly reminded us of shocking failures at some maternity hospitals. While it is good that reports are now highlighting these failures, is there also a systematic review of the funding and staffing of maternity services across the country, as most of the reports refer to staff shortages as well as problems with the culture?

The noble Lord, Lord Rooker, vitally reminded us of the Marmot report and how it set out the problems that women face in society today, especially in Northern Ireland. One of the topics in the Government’s consultation paper was on using data to improve women’s experiences. How is this sort of data shared and used to understand the disparity between the four nations?

The noble Lord, Lord Brooke, and the noble Baroness, Lady Bryan, talked about the male-female inequality league and how the UK should do better. How do the Government plan to address some of the clear health disparities?

The noble Baroness, Lady Greengross, also talked about continence services. Twenty years ago, discussion of periods in public was pretty taboo. Endometriosis and the menopause have recently become more acceptable issues to discuss but, frankly, continence services remain taboo for many. Women who often face long-term problems after difficult childbirth are unable to seek the help they need when their bladders start to fail in the later years. I hope that this debate will help to start that discussion and encourage women to seek help from their GPs at an early stage.

Recently, I had some discussion with young doctors working with the elderly—mainly women—who fell and broke limbs, imperilling their independence and ability to stay at home. These doctors are looking at best practice on early intervention with these patients, after minor falls, that supports and trains the patient. This has already significantly reduced the serious falls that too many women have later on. It is also saving the NHS a vast amount of money and keeping these women independent for much longer.

The noble Baroness, Lady Uddin, and the noble Lord, Lord Boateng, raised the problems of unconscious bias and the stereotyping of black and Asian women. I am sorry to say that this is also true of LGBT women. My noble friend Lady Barker has often spoken of the need for specialist geriatric services for them. Those who claim to object to the woke agenda need to understand that these biases—conscious or not—are the root of women’s health inequality. The contribution of the noble Lord, Lord Sikka, pointed at how the voices of, and services for, women were invisible in the Budget. Today’s debate has shown that this House is keen to see the eradication of all health inequalities affecting women, and I look forward to hearing the Minister’s response.