Health, Social Care and Sport Committee

Meeting date: Tuesday, November 21, 2023

Official Report 661KB pdf

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Women’s Health Champion

Our third agenda item is an evidence session with the independent women’s health champion to receive an update on her work since being appointed, and an update on the implementation of the Scottish Government’s women’s health plan.

I welcome to the meeting Professor Anna Glasier, women’s health champion, and Greig Chalmers and Felicity Sung, who are both from the Scottish Government.

We will move straight to questions, and the first ones are from Sandesh Gulhane.

I declare my interest as a practising NHS GP.

Professor Glasier, it is great to see you. Women’s health is something that we need to talk about more. We need to ensure that more than 50 per cent of our population has equality. With that in mind, why is it that we do not seem to have women’s health and equality running through our NHS in the way that we would hope it should?

Good morning, everyone. That issue is possibly historical, in that over the years, the NHS has classically been run by men, and quite a lot of the conditions, as we acknowledge in “Women’s Health Plan: A plan for 2021-2024”, affect women only. Often those are conditions that people find it quite difficult to talk about; even doctors sometimes find it quite difficult to talk about them. Other conditions affect both men and women, but women are often less well managed than men are, clinically.

As members know, women are less likely to be diagnosed as having had a heart attack, and even when they have been diagnosed with a heart attack they are less likely to be on secondary prevention than men are. We have to ask ourselves why that is, and I think that the reason is partly historical, because in the 1950s it was true that men had heart attacks—they smoked, they did manual labour—and people have not moved on from that.

There are a lot of very complex reasons for it, but we are trying our best to change the culture through the women’s health plan and encourage people to think differently about women’s health, and we are having some success. Everybody whom I have spoken to—and I have spoken to a lot of people in the nine months that I have been in post—is extremely enthusiastic about the plan and is committed to trying to improve the health of women and girls in Scotland.

From “Women’s Health Plan”, it seems that there are very large poverty-related disparities in breast and cervical screening rates. Why do you think that is, and what work is being done or can be done to ensure that we even that up?

You are right: there are big differences related to deprivation. Again, the reasons for that are quite complex. We know that women who live in deprived areas find it more difficult to negotiate the NHS than people who live in non-deprived areas. I presume that men in such areas do, as well, but we are talking about a women’s health plan.

I am sure that members are familiar with the deep-end practices, which are the 100 practices that serve the most deprived communities in Scotland. We have talked to some of the GPs in those practices and they tell us that women have confidence in their GP but are much less confident in going elsewhere. It is not just a matter of the practicalities of travelling somewhere for breast screening, for example; it is an issue of trust.

10:45  

We have been looking at a project that we hope will serve as a pilot for deep-end practices. Instead of asking women to go somewhere for women’s healthcare, we will take women’s healthcare to the practice. The pilot study that we are considering will allocate to a handful of deep-end practices a women’s health specialist for one session a week to work alongside the GPs and practice nurses to improve their skills in providing women’s healthcare and to encourage them to take a more holistic view of it. We want to see whether that will serve as a model for improving the quality of women’s healthcare in all the deep-end practices.

As you might know, people are looking at self-testing for cervical screening. My understanding is that a validated screening test has not yet gone through the regulatory authorities, but that should happen fairly soon, and it might improve the uptake of cervical screening.

I just want to take this opportunity to say how important it is for people to take up their screening offers. It really does save lives and makes a big difference.

In the past few years, maternity services in Caithness and Wishaw have been downgraded, while Dr Gray’s in Elgin is still waiting for its consultant-led maternity services to be restored. Are you concerned about the management of maternity services in Scotland? Do you think that they would not have been downgraded and had those problems if it was a men-only issue?

I do not know. If I were a rabid feminist, I would jump on that immediately and say, “Yes, of course. If it was all about men, they would be treated much better” but that is an oversimplification. The reality is that there will always be problems with providing the same level of service in remote and rural areas as exists in a big city such as Edinburgh or Glasgow. I do not think that it is a sexist issue, although I might say that in my worst moments.

I have forgotten the first part of your question.

Are you concerned about—

Am I concerned about the management of maternity services? Yes. The maternity plan is not part of the women’s health plan, but the women’s health plan does not exist in isolation. A lot of people are working on the maternity plan whereas I am concentrating more on the gynaecology side of things. I keep up to date with what is going on with the other plans and policy teams in the Scottish Government, but I am not concerned with them every day, and I do not think that I could speak about that in a helpful manner.

Good morning, and thank you for coming in this morning. I have a few questions about the plan. I think that it is true to say that you came into post a period of time after “Women’s Health Plan” was pulled together and launched. To get a sense of whether the plan covers the areas that you think it should and whether its areas of focus are correct, you helpfully unpicked the fact that some conditions are female only, others are shared, and there are some issues that affect the latter category. Do you think that balance is correct?

It was interesting to read in the plan some of the stuff about how women want to play an active role, share decision making and have access to information. That also applies to men. Could any learning from the plan be applied more widely?

I have some more points to make but perhaps you could pick up on those first.

I am sure that you are right. It is a women’s health plan, but men need health care as well. Often, men are more reluctant to see their GP, which, to answer the earlier question, is another reason why there may be differences from women’s health. Women see their GP with women’s health issues and during pregnancy and they take their children to the GP. Perhaps when a GP sees a man, they think, “Oh, this guy hasn’t been to see me for 10 years, so there must be something seriously wrong.” In contrast, when they see a woman, they may have seen her three times that year about something else. I am not saying that that makes people dismissive, but I think that there is a tendency to think that if a man goes to a GP, the problem must be serious, because they do not go to their GP that often.

There are many things that we could learn from the women’s health plan that are important for men. One of the big areas of work is to improve women’s knowledge of the various women’s health issues. I encourage MSPs, whenever possible when talking to your constituents about health, to encourage them to use NHS Inform. The women’s health team has done a huge amount of work on that platform and it is a great resource for reliable and accurate information, which, I hope, allows women and, where it is relevant to them, men to take charge of their own health and to be better informed about everything. I hope that that serves as a model for when we no longer need a women’s health plan, but a health plan.

On the core question about whether the women’s health plan focuses on the right areas, are you comfortable that it does that?

It does. It is an ambitious plan with 66 actions. It focuses more on reproductive health, rather than maternity, because there is a maternity health plan. There is also a mental health and wellbeing strategy. There are lots of things that overlap, but the women’s health plan focuses on the things that do not appear in other bits of policy. I think that it focuses on the right things and that we will learn from this plan when the next iteration of it is done, so that it becomes even better.

Your observation that because women go to the GP more often, they are less likely to be believed is interesting. If anything, you would have thought that more engagement with the health service would have led to better, rather than worse, outcomes.

I could ask you when you last went to your GP. You probably do not go very often.

You are absolutely correct. My wife tells me that frequently.

When the GP sees you, they will take you very seriously.

It is an interesting observation that more engagement leads to poorer medical outcomes.

The plan has a big focus on inequality, which is great. It is interesting that women’s health outcomes are significantly better than men’s for many headline issues, such as alcohol and drugs, Covid and even heart conditions. I think that I am right in saying that men’s death rates are still significantly worse than women’s. How do you approach those differences, in terms what can be measured?

Typically, when we look at an inequality issue, we would say that one group is performing worse than others and the objective would be to close the gap. In this situation, there are many measures, such as life expectancy, on which women are performing significantly better than men. How would you measure success in closing that inequality gap?

You are right about life expectancy being better for women than for men. However, women live with a lot of unhealthy years of life, which is where there are big differences when you compare deprived areas with those that are more affluent. On your question about how we measure it, do you mean how we measure the success of the plan?

We have the plan and we have your role. How would you look back in a number of years and say, “Yes, we’ve been successful”? How would you measure success?

We need to do better at evaluating the initiatives that we have set up. For example, in our proposal for working with the deep-end practices in deprived communities, we are planning to include quite a sophisticated evaluation. We want to look at whether, if we improve women’s healthcare in those general practices, women are referred less often to specialists.

Fifty-one per cent of Scotland’s population are women and all of them, unless they die prematurely, will go through the menopause. I think that all general practices should have somebody who is good at dealing with menopause and prescribing standard hormone replacement therapy. If that is done better, through the various initiatives that we are setting up, we should see fewer people being referred to specialist services for menopause. That is one example.

We are working with NHS Education Scotland to prepare a package for primary care, GPs and practice nurses to improve their knowledge of menopause and menstrual health. We will need to evaluate that and see whether women feel that they are better informed and feel happier with their consultation with the GP. Eventually, as a very long-term measure, we would need to look at whether the statistics change; we would need quite a sophisticated measurement for that.

Is the plan clear enough on what those measurable deliverables are, or is there still work to be done on that?

No, there is still work to be done. With the next iteration of the plan, we should do better.

I will pick up on one of the issues that Ivan McKee raised with regard to what is or is not in the priorities for the plan. One issue that seems glaringly obvious to me is incontinence. We know that that it is very common in women post childbirth and in later life. We have seen a proliferation of adverts and products in the supermarket that enable women to manage urinary incontinence. Should that be in the plan? Are you considering putting it in? The condition is very treatable, and education and information about pelvic floor exercises would help to alleviate it.

Yes. There is a relatively new section on NHS Inform on urinary incontinence, which the women’s health team has put in—it contains information about pelvic floor exercises and so on. The topic is not mentioned in detail specifically in the plan, but it often comes into discussions about the menopause, and the menopause features in the plan in a big way.

I was not involved in writing the current iteration of the plan, and we will have discussions with a lot of stakeholders to decide what goes into the next women’s health plan. I agree that we should probably have more on incontinence.

Good morning. I would like to ask about progress towards the priority areas of menopause, endometriosis and polycystic ovary syndrome and heart health. Perhaps you can start with menopause.

One of the aims of the women’s health plan was to have a menopause expert in every health board area, and we now have one in every board area, with a buddy system for the island health boards. We have a national clinical network of menopause specialists who meet quarterly. I must say that it is a very impressive group. When I first started, it was a bit of a talking shop, with people generally saying, “Well, we experience this,” and “We experience that.”

There is now a more formal agenda. For example, we can say that we need a national pathway on testosterone replacement for women who complain of loss of libido at the time of the menopause, and consider whether, working together as a group, we can bring that about. I think that we are making progress.

I am an MSP for a constituency in Ayrshire. What difference does the menopause expert in NHS Ayrshire and Arran make to the women whom I represent who are going through the menopause? What has the expert done for them?

If the menopause expert is used appropriately, they can help women who do not respond to standard treatment for menopause.

If someone went along to their GP with flushes and sweats and said that they would like a trial of HRT, I think that the GP would be able to manage that. However, if that does not alleviate their menopause symptoms, or if they have horrible side effects or they are not eligible for HRT because they have contraindications, they should be referred to the menopause expert—

So the menopause expert is a clinical individual to deal with complex cases.

Yes.

What about the standard provision of menopause support for women?

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As I said, we are working with NHS Education for Scotland to provide a primary care module for GPs and practice nurses to better inform them about the menopause. Women themselves are now better informed about it—in particular, if they refer to resources such as the NHS Inform pages, which provide them with a lot of information. Health and Social Care Alliance Scotland has also done a lot of work to prepare webinars for women.

“Trendy” is not the right word to describe the subject of menopause, but everyone is now much more aware of it. More women are going to their GPs and asking, “Could this be the menopause?”, so GPs are feeling overwhelmed.

May I share some reflections from my constituents?

Yes.

Some inequalities and challenges are not so much about individual women’s knowledge of what is happening, but about access to support and, in particular, to HRT. In answer to Sandesh Gulhane’s question about inequality, you said that the issue is not all about process.

Forgive me—I hate it when politicians do this, but I will give an example from my own experience. Last year, I had to make 25 phone calls before I got in to see my GP, then get a repeat prescription and go to every single pharmacy not only in the town where I live but in my area.

Was that because of the shortage?

I am lucky that I can do all that because I manage my own diary. However, I can imagine how things are for someone who has a job where they are working from nine to five or have only an hour for lunch. Some of the challenge is therefore not about women’s knowledge but about supply and having access to professionals. Have you reached out to women to find out exactly what the issues are from their perspective, rather than from the perspective of health professionals and outcomes?

Yes, we have done that. Through the ALLIANCE—the Health and Social Care Alliance Scotland—we have had quite a lot of meetings with women with various health conditions. For example, here in the Parliament we have met women with endometriosis or PCOS, so we do hear from women. Apart from the availability of medicines in pharmacies, which is a specific issue with HRT, all the problems that you mentioned—such as having to make 25 phone calls to get an appointment with a GP—can happen to everyone.

Is the main element of progress having the clinical expert on menopause, then?

It is that, but also the work with NES to improve information among primary care providers.

How will we know that that approach has worked and has improved women’s lives?

We should see fewer referrals to expert menopause services, because GPs should be able to deal with standard HRT.

Are some health boards set up so that the route is not through GPs but through specific clinics for women? Is the situation the same across Scotland?

No, it is not the same across Scotland. For example, where I worked, in Lothian, the Chalmers sexual health centre, which is an integrated sexual health centre, had a thriving menopause service to which women could refer themselves, which was great. We are talking about what in England are called women’s health hubs, but which we call integrated sexual and reproductive health services. The problem with that approach is that it tends to make life better for women who are able to get to the Chalmers centre and negotiate such treatment. There is also a danger that GPs will then say to a woman, “Just get yourself along to the specialist service”, and then they stop providing basic menopause care. The danger of having women’s health hubs is that we might deskill our GPs.

You said that the measure of success would be fewer women being referred to specialist menopause services. Would there be value in measuring women’s own experiences? The fact that someone is referred to a specialist does not necessarily mean that they will have a good outcome.

No, of course. In all our evaluations, and anything that we plan to do, we ask women about their experiences. We also ask providers about theirs, as well as trying to obtain a quantitative measure.

Do you want to say anything about progress on the other two areas: endometriosis and heart health?

A lot of work is going on in relation to endometriosis. A lot of research is going on—particularly in Lothian—that the Scottish Government is funding.

I have a particular interest in heart health, partly because I have never done cardiology and it is always nice to learn something new, and partly because women are more likely to die of a heart attack than they are to die of breast cancer, for example. Through women’s reproductive life course, there are reproductive health conditions that put them at increased risk of heart disease, and we do not currently use the opportunities to try to reduce that risk.

As an example, women with pre-eclampsia have an increased risk of hypertension and heart disease in later life. Maternity services are good at looking after such women but, as soon as a baby is born, the pre-eclampsia goes away, and so does the woman. Many women do not even have their blood pressure checked at the routine postnatal follow-up—if they have one—let alone being made aware that they are at increased risk of hypertension and heart disease in later life.

One thing that I am looking at is that, during Covid, when women were seen in maternity services with pregnancy-induced hypertension or pre-eclampsia, they were given a blood pressure machine to monitor their blood pressure and they did their own urinalysis, which was an effective way of monitoring their blood pressure during pregnancy. After the baby was born, the women were supposed to give the blood pressure machine back, which about half of them did.

I would like to reinstate that self-monitoring system; it has kept going in Lothian, but most health boards have stopped it. I would also like to take it further by asking women to keep the blood pressure machine, linking them to the Connect Me blood pressure website and sending them a text message or an email every six months to ask them to check their blood pressure. I am discussing with Professor Bhattacharya in Aberdeen whether we can do a study to look at the effectiveness of such an intervention at reducing the risk of heart disease in later life.

We are talking not just about pre-eclampsia but about PCOS, premature menopause and even recurrent miscarriage. All the women who are affected could be linked into a system to reduce their risk of heart disease in later life.

Is that holistic way of looking at things uniquely missing from women’s health services or does it reflect how our health service operates in general?

Our health service has always operated in silos but, if we can improve the approach in women’s health, maybe that will spread further.

There are a couple of brief supplementaries before I come to Tess White.

I have a quick supplementary to pick up on what Ruth Maguire said about menopause, endometriosis and PCOS. What work do you do or are you responsible for with women whose first language isnae English? How do we support them to have better care?

You work with the third sector, but I will ask about local authorities. I counted that seven of the 32 councils have a menopause plan. Are you responsible for supporting local authorities to raise awareness about menopause, for instance, with a plan?

I am not involved specifically with local authorities, but every health board now has a women’s health lead who is supposed to work with the board executives to make sure that the plan’s actions are being included in their work.

I think that I am right in saying that NHS Inform is available in a number of languages. There was something on the radio recently about a problem with interpreters, particularly in acute situations. There are issues for women whose first language is not English.

I, too, will pick up on Ruth Maguire’s point about menopause. Being a GP, I am lucky enough to go to multiple different practices. In my experience—although Ruth said that she does not like us giving examples—people in the better-off areas in which I work know about menopause. They come in, having done some reading and thought about it, and having decided that it is likely that that is what is going on. We then have a discussion about menopause, whether it is an appropriate diagnosis and what treatments may be appropriate.

Those from more deprived areas do not come in like that. I have not seen a huge shift in terms of women in deprived areas coming in with more knowledge about menopause. You said earlier that menopause is now more spoken of, but is that what we are seeing? Is that happening in better-off areas rather than in deprived areas? If that is the case, how do we get the message to those women in deprived areas?

I think that that is your job, as the GP. If you see a woman who is aged 45 to 55 and who comes in with insomnia or depression or something like that, and she does not raise the issue of the menopause, it is your job, as the GP, to say, “Well, this could be the menopause,” and then ask specifically about other menopausal symptoms—about her menstrual periods and whether she is having flushes and sweats.

You are quite right—I think that women in deprived areas are less likely to raise these issues. If we look at the prescribing data, we see that women in deprived areas are less likely to be prescribed HRT. However, I think that it is the job of the GP, or the practice nurse, to say, “This could be the menopause” and open up the conversation from there.

Sorry—forgive me, but a lot of women will not present because they are not aware that it could be menopause and that that is something that we could very easily treat.

But they present with other things, surely.

Not necessarily.

So, if a woman of 45 comes to you and complains that she is not sleeping well, would you discuss with her the possibility that she may be menopausal? Because I would.

Potentially. I suppose that the question is about getting that knowledge into communities that traditionally do not have it, so that they are better informed and are able to champion their own health.

Yes, but I do not know how you do that. How do you make sure that women who are living in deprived communities are better informed about the menopause?

We are planning a publicity campaign about the menopause that will take place next year, and we are having meetings to discuss how best to do that. There is a meeting this afternoon with the clinical reference group for the menopause network, to get its advice on what to include in a publicity campaign.

However, I do not know how well publicity campaigns affect certain areas of society or certain strata of the population. I suspect that someone is more likely to be aware of those publicity campaigns if they are in a less deprived area than if they are running around looking after their kids and sorting out their problems with the cost of living.

I do not know what you would do, but I think that it is the GP’s job, when people come to see them, to raise menopause as a possibility.

I get a little bit concerned when we talk about women in deprived areas being less knowledgeable. In my experience as an MSP who represents some areas that are very economically deprived, the issue is not women’s lack of knowledge or confidence. It is simply more challenging for someone to interact with a system if they are an employee rather than self-employed or if they are in a low-income job, or—as you said, Professor Glasier—if they have children to look after and different demands on their time. I just want to reflect—as you did in your answer, to be fair—that it would be quite a dangerous and lazy assumption for us to make in talking about women’s health.

I think that that is right. As I said, if someone is busy looking after 101 things, perhaps they do not take so much notice of their menopausal symptoms.

Shortly after you came into post, Professor Glasier, we had a cross-party group on endometriosis, as you may remember. The women’s health plan has committed to reducing waiting times for diagnosing endometriosis from more than eight years to less than 12 months by the end of the parliamentary session. Is that achievable?

11:15  

I hope that it is achievable, but I know that there are long waiting lists. To make a definitive diagnosis of endometriosis needs a diagnostic laparoscopy, because we need to see the endometriotic deposits. Most doctors are reluctant to submit people to a diagnostic laparoscopy, because it involves a general anaesthetic, and they have to overcome that. As you know, there is also a long waiting list for people with gynaecological conditions that are not cancer. Whether that situation will improve by the end of the parliamentary session, I do not know, but I hope that it will. The Scottish Government is putting money into waiting lists initiatives. The answer is that I hope so.

We are planning a publicity campaign on endometriosis—and I met the marketing people last week. The publicity campaign will be for healthcare professionals, not for women. The marketing people were asking me, “What would be your single message to healthcare practitioners?” I spoke about listening to women with endometriosis talking about their experience, and my single message to practitioners would be, “One in 10 women has endometriosis, and they would like to know that you are thinking about it as a possible diagnosis.”

The issue is the referral—women are saying to me that they are just not being referred.

I think that it is about the referral, but it is also important for a practitioner to explain to women that they are suggesting a particular form of treatment because it is valuable in treating endometriosis. A lot of women feel that they are being fobbed off when GPs put them on the pill. I am a great proponent of the pill, which I think is a great treatment for heavy menstrual periods, for example, and those who take the pill continuously do not have periods, so they do not have dysmenorrhoea. However, GPs need to explain to women why they are putting them on the pill, so that they do not feel fobbed off. If women have systems suggestive of endometriosis, healthcare professionals should tell them that they are considering the diagnosis of endometriosis and will refer them if their symptoms do not settle on the standard treatments.

We know that there are an estimated 100,000 women living with endometriosis in Scotland. The view of Endometriosis UK, based on the data, is that the base level of care for this debilitating condition is currently not being met across Scotland. What action would you propose to improve the situation for all those women?

We need to work our way through the waiting list, so that women wait a shorter time before they are seen by a specialist with an interest in endometriosis.

You have talked about heart health as being the highest priority. Would you say that endometriosis comes a close second?

I would not, no. I do not think that endometriosis is worse than many other conditions. We hear a lot about endometriosis because the people with endometriosis have done a very good job of getting their advocacy going. There is a national endometriosis society that is now called Endometriosis UK that is speaking very well for women with endometriosis, but I would not put it just below heart disease. I might put breast cancer quite high up, and ovarian cancer.

I would just like to say that the women who were talking to me, and those who shared their stories with you at the CPG, have spoken about debilitating pain, breakdown of relationships including marriage and not being able to work. That is not because of the lobby group; it is because of the huge amount of issues that the women are having.

I know, and I agree with that. It is very moving to hear those people talking about their experiences with endometriosis, but this is not just about women with endometriosis. There are a lot of conditions that make women’s lives extremely difficult, and we should do better at tackling all of them.

The difficult thing with endometriosis is that it is a difficult condition to diagnose without doing surgery, and doctors try to avoid doing surgery because it involves a general anaesthetic, which takes time, and because there is a long waiting list for surgical procedures.

Good morning. I have been interested to hear your reflections on working in a different way and on attitudes to approaching women’s health. It is helpful to hear you talk about that.

My question is on funding. I am interested to know whether you have any reflections on how funding is used to support women’s health; whether the plan has enough funding attached to it; and whether there is anything that you think we might have to fund to get it right, such as the training and so on that you talked about.

Of course I would say that there is not enough funding behind the women’s health plan—I would be mad not to. Yes, could we have some more money, please? That would be very nice.

I give the example of long-acting reversible contraception—LARC—methods, such as intrauterine devices and contraceptive implants. Abortion rates have increased by 19 per cent, which is nearly one in five pregnancies, between 2021 and 2022, and it is likely that they will go up again this year.

We know that IUDs and implants are by far the most effective methods of contraception; they have failure rates of less than 1 per cent in comparison with the failure rate for the pill, which is 9 per cent, or for condoms, which is 18 per cent. They are also much more likely to be continued than the other methods, because you have to go and see somebody in order to stop using them, so inertia acts in favour of continuation.

However, we know that we are not nearly meeting the demand for long-acting reversible methods of contraception. We know that many GPs have stopped providing such methods, in particular IUDs, because they are overwhelmed and they do not have the capacity to do so. It takes three appointments, plus it takes up to three appointments for the assistant as well. Although the method lasts for at least five years, so I would see it as a good investment of time, GPs who are faced with hordes of people coming in to be seen with 101 different conditions do not see it in the same light as I do.

We know that sexual and reproductive health services are not meeting the demand. Yes, we need more money for long-acting reversible methods of contraception.

How are you, as the women’s health champion, approaching that with the Government? Have you spoken to it about where the funding might come in, or where we might move money from?

We set up a short-life working group to understand why we are not meeting the demand and to look at options for how to do things differently. In a couple of health boards, people have looked at cluster arrangements. For example, one GP who is skilled at inserting IUDs—to go back to IUDs—and is passionate about doing so provides a service for half a dozen different practices. That works there, but all the initiatives that we have looked at have been funded by soft money, and they depend on one individual person, so they are not sustainable.

I have spoken to the people in St Andrew’s house about the GP contract and whether—this is probably a very unacceptable thing to say—we could move money from the GPs who are not doing LARC any more to sexual health services, so that they are providing LARC.

I have been told that that cannot happen. I am, therefore, just now finalising a paper that says, “This is the bottom line: health boards have to accept that, if they want to reduce unintended pregnancies and abortion rates, they should fund LARC.” I am going to tout that around everybody I can think of—the chief medical officer, the deputy chief medical officer, the national clinical director and the minister—and try to put pressure on whomever, so that boards fund it.

You talked about training staff so that they approach women’s health in the right way. Do you think that there is enough finance in the system to do that, with regard to primary care, GP practices and so on?

Actually, I do not think that that is not so much an issue of finance; it is about thinking differently. I will give you another brief example: the insertion of an intrauterine device when somebody has just had a baby. If somebody has decided that they would like an IUD as a postpartum method of contraception, the best time to insert it is immediately after the baby is delivered. Baby out; placenta out; IUD in.

I think that it needs to be the responsibility of the person who is doing the delivery to put in the IUD, regardless of the mode of delivery. If it is a consultant doing a caesarean section, they should put in an IUD at the time of the caesarean section, and they are doing that now in Scotland. We have achieved that. I think that it is true to say that, if you are a woman who wants an IUD as an immediate postpartum contraceptive, it will be done if you have an elective caesarean section. We are not quite so good at doing it immediately after a forceps or ventouse delivery, and we are very bad at doing it after a spontaneous vagina delivery.

What we need is for the Royal College of Midwives to put IUD insertion on the curriculum for midwives in training. That is not about money but about getting people to think differently about our responsibilities for women’s health. It is about getting GPs to ask women who are aged 45 whether they have any menopausal symptoms. It is about getting people to think differently.

That is lovely. Thanks very much for your time.

One in five women will experience perinatal mental health problems and suicide is, tragically, the leading cause of maternal death in the first year after a baby’s birth. Would you support perinatal mental health being addressed as a priority in the next women’s health plan?

I would need to discuss that with stakeholders. Personally, I think that that probably sits better in the maternity plan than in the women’s health plan, because it is all part of maternity—that is, unless we amalgamate maternity and women’s health, which I am not sure would be a good idea.

I would need to discuss that with whichever stakeholders we are going to discuss the next iteration of the plan with. However, I suspect that it is better for perinatal mental health to stay in the maternity plan.

Do we need better and more support for perinatal mental health?

Yes, I am sure that we do.

Thank you.

Too many women have described to me the dismissive way that they have been and are being treated by clinicians. It is almost as though that is a culture. That experience ranges from menopause to endometriosis. The committee has been given several serious examples in relation to the transvaginal mesh scandal. The women are not believed, which has an impact on their mental health. Have you seen, or are you being told about, any of that dismissive culture? If so, can anything be done about it?

I went to the group on endometriosis, and you hear about it there. However, I have to say that you hear only from those people who are unhappy with the way that they have been treated. I hear only from those people who are unhappy with the way that they have been treated; I do not hear from people who are happy with the way that they have been treated. That is always how it is. You hear from a very small and very biased sample of people, and I think that that colours your view.

I do not think that the majority of doctors are dismissive. The majority of doctors and nurses and everybody else in the national health service do their absolute utmost to provide a really good service.

Sometimes individuals are unhappy with the service that they have received and sometimes individuals do not hit it off with their healthcare provider, but I think—maybe the GP on the committee will agree with me—that people do their best and that people who are very unhappy with their care are very much in the minority. I am sure that we are all unhappy about having to phone at half past 8 in the morning to try to get an appointment but, when we are seen, I think that the majority of us are happy with the care that we get.

I thank the witnesses for their comments so far.

I have a particular concern about the decrease in drugs deaths in 2022. I note that the reduction was far greater in males and that there are evidently particular issues in relation to women who use drugs that mean that their rate is not decreasing at the same level. Do you have a view on why that might be the case and what might be done about it?

11:30  

No. I am not an expert on drug abuse. I read the papers, but I would have to defer to the people who work in that area. I do not think that I can say anything helpful about that. We recognise in the women’s health plan that women’s health—everybody’s health—is intersectional and that there are a lot of things going on in people’s lives, but that is not my area.

Does either of the officials have any comments?

I do not think that we would want to add to what Professor Glasier said. However, it goes without saying that, if any issues come up during the session that you think engage Government policy, we can provide some clarification in writing, if that would help.

Audit Scotland told the Public Audit Committee in September that the mental health transition and recovery plan, which prioritised the mental health of women and girls, did not outline timescales for the actions and that a review of progress had not been carried out. Professor Glasier, is that on your radar as women’s health champion? Do you support calls for further detail on delivery and evaluation?

What was the last bit? Do I support—

Do you support calls for further detail on delivery and evaluation?

Of mental health?

Yes.

In general, yes. The women’s health plan recognises that mental health impacts on women’s health and that women’s health impacts on their mental health. We know that menstrual problems and the menopause affect women’s health. Through the specific issues and actions in the women’s health plan, we are trying to deal with that.

You mentioned that you do not have a particular locus on drug deaths. Do you have a particular locus on alcohol-related deaths?

No, I do not. That does not appear in the women’s health plan.

We will move on to the next theme, which I believe Mr Sweeney has questions on.

I do indeed.

I am a former member of the Citizen Participation and Public Petitions Committee, which quite regularly receives petitions relating to women’s health. Petitions on smear-test age, fertility treatment and abortion are currently being considered by that committee. Professor Glasier, what are you doing to ensure that women’s concerns about issues such as those raised by petitioners through the Citizen Participation and Public Petitions Committee are being addressed by the Scottish Government, the national health service and local government?

As you know, we are doing a lot of work on abortion and smear tests. The issue of infertility is not in the women’s health plan, but I know that a group is looking at infertility services. There is a lot going on. I meet the abortion team quite regularly, and I am very interested in hearing what is going on with the work on late abortions and safe access zones, and hopefully, at some point, on decriminalisation of abortion. I think that the Scottish Government is pretty responsive to those topics.

That is helpful. Do you have any engagement with those petitions?

Not specifically with the petitions, but I am working quite closely with the abortion team, because I have had a lot of experience with abortion and I have done a lot of research on the issue in the past. That and contraception overlap significantly with the women’s health plan.

Our previous evidence session was on remote and rural healthcare. It is clear that there are inequalities in accessing healthcare in Scotland not only on a geographical basis but on the basis of socioeconomic background. What does the women’s health champion do to raise awareness of health inequalities and ultimately reduce them?

We discuss them in everything that we talk about. For example, in our menstrual health network, clinical network, menopause clinical network and with the women’s health leads, we wave at them the women’s health plan, which discusses inequalities, and we talk to them about their awareness of the impact of inequalities on women’s health. As I said earlier, we have a proposal to do a pilot study in the deep-end practices to see whether we can do better at having a more holistic approach to women’s health and in taking more expertise in women’s health to women in those areas of inequalities. I think that we are trying hard.

That is helpful.

There was recently a debate in the Scottish Parliament on protecting an award-winning neonatal unit in University hospital Wishaw. There are concerns about a lack of consultation prior to the decision being made on downgrading the unit, particularly in relation to mothers being separated from their premature babies. What can we do to ensure that local women who have those deep, emotional and upsetting concerns are consulted on decisions that impact them in an intense and visceral way?

Again, I am not concerned with the day-to-day work of the maternity plan or issues in neonatal units. Clearly, that is an issue, and I am sure that those women’s voices are being heard, but I really cannot comment on that.

Some of my questions on implementation and evaluation have already been covered. I am looking at the interim report from August 2023, which, obviously, covers the progress that has been made. I am interested in how you see implementation and evaluation going forward. I know that you do quarterly blogs. I know that there is a lot going on—I find it amazing just looking at the subjects being covered in the Citizen Participation and Public Petitions Committee and elsewhere—but how important is it to communicate the progress that is being made, so that people know what is being achieved?

You are absolutely right—we need to make people aware of the progress that is being made. We need to make healthcare providers aware, too, because we hear all the time that people are demoralised. I think that demoralisation is a self-fulfilling prophecy so, whenever I meet groups, I always emphasise the positive. For example, we have a meeting this afternoon with the menopause network reference group to review what we have achieved in the past year and what we hope to achieve in the next year. We need to congratulate those people on what we have achieved, because we have achieved a lot.

Do you think that there is a role for us, as MSPs, with regard to our connectivity on social media? Sometimes social media is not the best platform for communicating things, but social media could be used in a different, more positive way to support good communication. I was recently at an event in Dumfries and Galloway at which Dr Heather Currie spoke to 100 women in the room about the menopause. She is a total champion for destigmatising menopause and communicating an understanding about what it is all about. As MSPs, do we, too, have a role in communication?

Yes, I think so. It would be great if you could say some nice things about how well the women’s health plan is going. It would be great, too, if you kept reminding people about NHS Inform and that, whenever they have a health condition that they want to find out about, they should go to NHS Inform rather than Google to get accurate information. In any case, it would be really great if you could be positive about the women’s health plan.

I am happy with that, convener.

Finally, Gillian Mackay has a supplementary question.

Professor Glasier, I was struck by your earlier comment about intersectionality versus the siloed way in which the NHS often works. I know that your priorities fall naturally into three large chunks, but how do you see them working across each other? Earlier, you highlighted the example of women with PCOS being at higher risk of heart disease; they are also at higher risk of diabetes and such conditions. Quite often, once you are diagnosed, you are given tablets that have wonderful side effects and are then left without any other form of follow-up. Are you and the team actively looking at such crossovers, and what progress is being made on some of those areas?

Yes, the team is looking at those things. Soon after I started, the team and I went to Aberdeen to meet NHS Grampian. You might know that it is going to open a new hospital in Aberdeen next year—the Baird family hospital. When I spoke to the non-executive director, she said that they really wanted to do things differently. As a result, we have been having discussions with the health board and the professor of obstetrics and gynaecology there, and we have put them in touch with Chest Heart & Stroke Scotland.

For example, I said to them, “Why don’t you, in the waiting area of your nice new shiny hospital that will see a lot of women, have a women’s health information hub?” People’s blood pressure could be checked there; blood could be taken for cholesterol checks; women could be talked to about osteoporosis and so on. All of that could be done with volunteers from Chest Heart & Stroke Scotland—it does not have to cost the NHS money. I think that it is terribly important that we try to broaden our horizons and how we look at health in general and, for us, women’s health in particular.

That is great. Thanks, convener.

I thank Professor Glasier and the officials who have joined her today for their evidence.

At next week’s meeting, we will continue our inquiry into healthcare in remote and rural areas and hear from academics with expertise in rural healthcare.

That concludes the public part of our meeting.

11:40 Meeting continued in private until 12:20.