Women’s Health Outcomes

Baroness Brinton Excerpts
Thursday 8th July 2021

(3 months, 1 week ago)

Lords Chamber

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Department of Health and Social Care
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.

Baroness Thornton Portrait Baroness Thornton (Lab)
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My Lords, I declare my interest as the maternity champion for Whittington Health, of which I am a non-executive director. I congratulate the noble Baroness, Lady Jenkin, on bringing forward this debate, which has been of very high quality. Her introduction was both comprehensive and—although I am not sure that I would say Shakespearean —encompassed the whole of life.

I am particularly proud of my nine or 10 noble friends who took part in this debate. My noble friend Lady Massey talked about young women; my noble friend Lord Rooker talked about health inequalities and Marmot; my noble friend Lady Chakrabarti talked about our international responsibilities; my noble friend Lord Hunt talked about heart attacks and discrimination —I will come back to that later—my noble friend Lord Boateng talked about the higher rates of mortality for black people and racial disparities within healthcare; my noble friend Lord Brooke talked about learning the lessons of domestic violence; my noble friends Lord Sikka and Lady Bryan talked about the misdiagnosis of symptoms and inequalities in health; and my noble friend Lord Young talked about single-sex wards. But contributions have come from all sides of the House. I welcome the women’s health strategy consultation: I very much look forward to seeing what comes out of that.

As did the noble Baroness, Lady Jenkin, I want to address the systematic discrimination against women and the gender data gap. She and several other noble Baronesses mentioned Caroline Criado Perez and her work in this area. She said that medical research has traditionally been based around the male body. Indeed, my noble friend Lord Hunt pointed out that women were 50% more likely to be misdiagnosed following a heart attack, but they make up only 25% of the participants across the landmark trials for congestive heart failure. Given that we have a Minister in this House who is very enthusiastic and keen about data and its use and all those things, this issue is very important.

Most medical trials are done on male cells; even female cells react differently. For millennia, medicine has functioned on the assumption that male bodies represent humanity as a whole. As a result, we have a huge historical data gap when it comes to female bodies. That means that women will be dying when they do not need to. The medical world is complicit in this and that needs to change. I am pleased that this was referred to in the women’s health strategy. I hope that it is going to be followed up when the strategy comes to fruition after the consultation process.

It is interesting; I learned, for example, that the first production of the Fitbits that we are all so keen on did not include menstrual cycles in their data, so over 50% of the world was not properly recognised. I am assured that that is absolutely no longer the case. The tech world, of course, is designing the future, so we have to acknowledge the need for diversity in that. If tech is designed by white, middle-class men from America, the future might look very nice to them but not for everybody else. Diversity in the teams and ideas is vital. Artificial intelligence that helps doctors with diagnoses and scans, and with conducting job interviews and so on, is vital, but it all depends on the datasets. If those datasets are designed by those white males in America, then we are all—or at least half of us are—in serious trouble. If you tell an algorithm what a heart attack is based on male symptoms, how are we going to make sure that it recognises female symptoms? These are the issues on which I am particularly interested to know the Minister’s thinking.

I turn briefly to women and Covid. We know that Covid-19 did not strike the sexes equally. Globally, for every 10 Covid-19 intensive care unit admissions for women, there were 18 for men. While men over 50 tended to suffer the most acute symptoms of Covid, there is evidence that women seem to be disproportionately affected by long Covid; one study suggested that women outnumber men by as much as four to one. A study led by the University of Glasgow concluded that

“women under 50 are seven times more likely to be breathless and twice as likely to report fatigue than men, seven months after seeking medical assistance for Covid-19.”

Some academics have linked this to the fact that women have a higher lifetime risk of inflammatory immune conditions such as chronic pain, chronic fatigue and autoimmune diseases. Can the Minister assure us that these issues are a standard part of the ongoing research on the effects of Covid?

A key point that came out when the strategy was first announced by the Government was the need to listen to women’s voices. That is absolutely vital. The House has been active in expressing the need for this, particularly in support of the report by the noble Baroness, Lady Cumberlege. We have made significant progress in implementing some of her report and I hope that we will see more of it included and embedded in the forthcoming legislative programme on health and social care.

To conclude, I thank all speakers who have taken part in this debate, and I look forward to the Minister’s speech. We live in a patriarchal and deeply unequal society. Covid has highlighted those inequalities, particularly health inequalities, and it must be said that, since 2010, the noble Baroness’s Government have been guilty of cuts and underfunding across the whole of our health system, which has disproportionately affected the poor—and that means it has disproportionately affected women. I hope that the noble Baroness, Lady Jenkin, and the Minister will agree that having the best possible women’s health strategy in the world will, as it were, butter no parsnips if it is not properly resourced and funded.