Women’s Health Outcomes

Baroness Bottomley of Nettlestone Excerpts
Thursday 8th July 2021

(3 months, 2 weeks ago)

Lords Chamber

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Department of Health and Social Care
Lord Hunt of Kings Heath Portrait Lord Hunt of Kings Heath (Lab) [V]
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My Lords, I very much welcome this debate and commend the noble Baroness, Lady Jenkin, on her opening speech. One of my main concerns is that, historically, women have been underrepresented in clinical research, as both researchers and the subject of research. The noble Baroness, Lady Jenkin, also referred to that. As a result, many diagnostic tests and treatments have been based on data gathered from men. Women are still not taking part in clinical trials to the same level as men. We need to understand the barriers that prevent women taking part in these trials, and encourage and enable them to take part.

This impacts across medical provision, but I will focus on heart attacks. Research into different treatments for men and women has shown that women are more likely to be treated less aggressively in their initial encounters with the healthcare system, until they have to prove that they are as sick as male patients. Once they are perceived to be as ill as similarly situated males, they are likely—but not always—to be treated similarly. This can be seen with heart attacks, where women having a heart attack delay seeking medical help longer than men because they do not recognise the symptoms and believe it is men who get heart attacks, not women. Some 50% are more likely than a man to receive the wrong initial diagnosis for a heart attack. Many are less likely than men to receive a number of potentially life-saving treatments in a timely way and, following a heart attack, are less likely to be prescribed medications to help prevent a second heart attack.

If there was any complacency about women’s health issues, the recent report from the Health Select Committee on the shocking state of many maternity services should be a great warning to us. This has been known for some time now. There has been an endless number of inquiries, yet we have been waiting for action for far too long.

It is not just about research and treatment of disease, as experienced by women. Ensuring women’s safety, privacy and dignity while they are in hospital is vital. Women often favour single-sex wards for very good reason: rates of sexual assault are far higher in mixed-sex wards. The Health Service Journal reported last year that at least 1,000 sexual assaults were reported by female and male patients on mixed-sex mental health wards between April 2017 and October 2019, yet there are indications that the NHS is moving away from giving enough provision to single-sex wards. Could the Minister look into this and see what can be done to ensure the NHS does what Ministers asked of it over the last years?

Baroness Bottomley of Nettlestone Portrait Baroness Bottomley of Nettlestone (Con) [V]
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My Lords, this is an important and timely debate and I give full congratulations to my noble friend Lady Jenkin on introducing it. I start by echoing the noble Baroness, Lady Walmsley, on the requirement for urgent action following my noble friend Lady Cumberlege’s report. It is harder being a Health Minister in the Lords because there are so many experts. I chose my noble friend Lady Cumberlege and we worked together harmoniously. It is time we had a patient safety commissioner. That is part of the recommendations, only one of which has been properly implemented. We need a register of doctors’ interests.

My real purpose in speaking is to relate my experience at the University of Hull. Only one in four medical deans is female. At Hull, Professor Una Macleod is a general practitioner who still works in east Hull. She shapes and fashions the medical school so that it is relevant to the disadvantaged and underprivileged. Many in the House will know that my first job was working for the noble Lord, Lord Field. He went to the University of Hull and, for 16 years, I have been proud to be its chancellor. It is trying to reach out to the disadvantaged and neglected, who I call the inarticulate needy, not the articulate greedy, to whom I was so used in my former constituency.

I applaud much of the research, often by nurses and the professor of nursing, because nurses listen and are where the patients are. We have talked about underrepresentation in surveys, and Professor Lesley Smith has done some magnificent work on why younger women in lower socioeconomic groups are less likely to take part in population surveys. She has fashioned a tool to reach out to underprivileged, disadvantaged, less-connected and younger women so that we can understand what they need and want.

Dr Roger Sturmey talks of one in four women suffering from a miscarriage, but of only 2% of research going into miscarriage. A nursing professor of perinatal mental health said that women’s health outcomes and that of their babies are not good enough. He has designed a new measure, a revised birth satisfaction scale.

Over the years, there has been a dramatic improvement in women’s health. When William Wilberforce lived in Hull, women lived to 44. Now, the overall life expectancy is 82.7 years for women and 78.7 years for men but, as noble Lords have said, this conceals areas of neglect and suffering. It is not the extra years only, but the quality of them. I believe that, by looking more deeply and working with professions other than the traditional medical professions and by focusing our research, we can do more to meet the unmet need that so many in this House are so knowledgeable about and have contributed so strongly on.

Baroness Bennett of Manor Castle Portrait Baroness Bennett of Manor Castle (GP) [V]
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I thank the noble Baroness, Lady Jenkin of Kennington, for securing this debate—a timely update a year on from the brilliant report of the noble Baroness, Lady Cumberlege, as the noble Baroness, Lady Bottomley of Nettlestone, just said.

Today’s debate led me to look back over our debates on the Medicines and Medical Devices Bill, during which the Government conceded, after Scotland led the way, on a patient safety commissioner for England. We were promised then that serious consideration was being given to the report’s other recommendations to support victims of disastrous medical procedures and to prevent future avoidable damage. I follow the noble Baroness, Lady Walmsley, in pointing out that the victims of sodium valproate, pelvic mesh implants and Primodos are still waiting. The First Do No Harm report concluded that thousands of lives were ruined because officials failed to listen to female patients. I hope we might hear some good news on that issue from the Minister.

In three minutes, there are many issues I could cover, but I want to extend the conclusions of the noble Baroness, Lady Cumberlege, to broader issues. I note that women wait longer to be diagnosed for many conditions, including cancer, and that heart disease in women is more likely to be misdiagnosed. Mental health is likely to be the diagnosis for a wide range of conditions that have a clear physical cause, often discovered only after many years of suffering.

I note too that intersectionality is at sometimes deadly and always damaging play here, and that women from BAME backgrounds and the LGBTIQA+ community are more likely to report poor treatment from their GP and receive inadequate support from services.

In the brief time left to me, I thought I would focus on an area still getting far too little attention and, like so many others, that is being exacerbated by the Covid-19 pandemic. That is musculoskeletal disorders. I point the House to the excellent briefing for this debate from the Chartered Society of Physiotherapy, which covers that as well as many other important issues. I should perhaps declare a personal interest here, having relied over many decades on physiotherapists to keep me going and repair damage wrought on the sporting field and in the workplace.

As I read that briefing’s recommendations on preventing musculoskeletal problems through access to occupational health physiotherapy, I thought of some women I met in Sheffield working at picking up baskets for a major supermarket’s home delivery service from midnight to dawn. I heard from them how physically challenging it was and how tough it was in the chiller and freezer sections.

We have to think about the many women who are doing what is often a double shift in the home with child and elder care. They also suffer musculoskeletal damage from that, and would greatly benefit from musculoskeletal first contact physiotherapists in primary care being available to all.