Chamber and committees

In some foreign jurisdictions, such as in Victoria in Australia, doctors are restricted from initiating discussions about assisted dying, with patient autonomy often emphasised as being the reason for that. At the opposite end of the spectrum, doctors in Canada are allowed to raise the option proactively. In your opinion, what would be the most appropriate approach to ensure informed decision making in Scotland without undermining patient autonomy? Should the bill explicitly include an obligation to ensure access to assisted dying, if the bill were to be passed?

The variability in palliative care provision and high levels of emergency admissions in the last six months of life highlight the fact that there are very significant gaps in end-of-life care. Does the panel believe that addressing those issues should be a prerequisite for, or a parallel commitment to, the advancement of assisted dying legislation?

This time, I will start at the other end of the line of witnesses and come this way.

Good morning. What are the practical implications of the devolved competence limits for implementation of the bill, particularly around specifying an approved substance for assisted dying? I ask Lynda Towers to comment first.

You have both mentioned the concerns that you have that people with dementia and Alzheimer’s could come under the bill. What additional safeguards should there be for those people?

I will go back to Lynda Towers for a response to my next question. The member in charge of the bill has identified orders under sections 30, 63 and 104 of the Scotland Act 1998 as options for addressing potential competence issues. Do you have any views on the advantages or risks of that approach?

That is great—thank you.

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 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.

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.

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.