Chamber and committees

Does Carol Mochan agree that there needs to be a separate road map for women and that the women’s health plan needs to be sex specific?

As the first women’s health plan comes to an end, I welcome the opportunity to take stock. I thank Jenni Minto and her team for the cross-party working that they have undertaken so far. It has been constructive, so I give praise where praise is due.

I also thank Professor Anna Glasier, who is in the public gallery today, for her leadership. I have enjoyed our lively conversations and I have valued Professor Glasier’s frankness, expertise and insight. Eighteen months—and just four days a month—was precious little time in which to deliver on the ambitions for the women’s health plan, so I am pleased that Professor Glasier will remain in post. If only the SNP had appointed her sooner and had not left the plan in limbo for so long. The minister would probably expect me to say something like that.

Throughout the life cycle, from menstruation to menopause, a woman is adapting and adjusting to major changes in her body. She is also contending with a healthcare system that, as Caroline Criado Perez’s “Invisible Women” describes, is

“systematically discriminating against women, leaving them chronically misunderstood, mistreated and misdiagnosed”.

Too often, women do not feel heard. Too often, their legitimate concerns are dismissed. We should not have to put up and shut up when it comes to pain. Healthcare cannot be one size fits all. The male default bias has dominated the diagnosis and treatment of women for far too long.

MSP colleagues might want to dodge the bullet on this, but healthcare must be sex specific. That is why women’s health needs require a completely separate road map, a dedicated advocate and rigorous oversight in the long term. That is why data in the NHS matters, and it is why objective and immutable biological sex must be recorded on medical records. Terms such as “chest feeders” perpetrate the erasure of women in healthcare in the name of so-called inclusivity.

The Scottish Conservative amendment drills down into the failings in women’s healthcare that have occurred under the SNP Government. The reality is that, under the SNP, women’s healthcare has worsened. Waiting times for vital services such as women’s reproductive health, cardiac care and cancer screening and treatment are unacceptably high. Earlier this year, more than 500 women in NHS Grampian with suspected breast cancer had to travel more than 125 miles for diagnosis because the health board could not meet demand. The centralisation of maternity services in rural areas such as Stranraer and Moray is forcing prospective parents to travel for more than an hour and a half. There is an alarming postcode lottery in the provision of perinatal mental health services, and a simple test for pre-eclampsia is only just being rolled out by health boards, thanks to proactive campaigning by the charity Action on Pre-eclampsia, years after its roll-out in NHS England.

The SNP cannot reduce the gender health gap if healthcare in Scotland is inaccessible, but that is the stark reality for too many. After two years as the shadow minister for women’s health, I recently took on the equalities brief and joined the Equalities, Human Rights and Civil Justice Committee. It is clear from our pre-budget scrutiny that budget decisions are made from a central-belt perspective, without thinking about policy coherence or the bigger picture. The centralisation of NHS services is having a negative impact on women in rural communities, with my constituents having to travel from outlying Forfar to Dundee to have a simple intra-uterine device fitted. Gender and geographical inequalities are becoming further entrenched under the SNP’s centralisation agenda.

I have been working with the north-east endo warriors, and I recently met representatives of Endometriosis UK regarding the distressingly long diagnosis time for endometriosis. There is growing awareness of this debilitating condition, but training and education are not enough. I have been told that the waiting list for diagnostic tools such as laparoscopy is two years at minimum. That urgently needs to change—two years is just not good enough.

As we look to the next iteration of the plan, I welcome Professor Glasier’s commitment to prioritise pelvic floor rehabilitation. From relationships to participating in sport, the physical and emotional impact of pelvic organ prolapse on women is absolutely horrendous. The minister asked for examples, so I would like her to look at countries such as France, where women are automatically offered pelvic floor therapy as part of their post-natal care. In Scotland, women are told to do Kegel exercises and wear Tenor underwear—it is an absolute disgrace.

This is not just about reducing the gender health gap; it is about how women experience the healthcare system and how that system supports them through their whole life cycle so that they can live happy, productive and pain-free lives. To achieve that, Scotland’s NHS must be efficient, reliable and accessible for all women, always. We have a long way to go.

Will the minister take an intervention?

Will the minister give way?

I would like to ask you whether you—

Alex Cole-Hamilton referenced the US in relation to abortion, but will he also applaud the fact that, even though Donald Trump is a controversial figure, he knows what a woman is?

Sorry. Does the member agree that we benefited from working collaboratively in the work that we did as a committee on the buffer zones?

Thank you, convener. I would like to ask two supplementary questions that concern issues that came up in our previous meeting.

Last week, two stakeholders gave us feedback on the pre-budget fiscal update. Sara Cowan from the Scottish Women’s Budget Group noted that we have seen emergency in-year budget changes for the past three years and said that that looks as if it is not now an exception and has instead become the norm. In relation to the budget process, Dr Alison Hosie said:

“There are lots of questions. It was not a very satisfactory process, and it was not transparent.”—[Official Report, Equalities, Human Rights and Civil Justice Committee, 29 October 2024; c 40.]

You have said that it is important for you to understand and scrutinise and that you want to look at areas that are stuck. This is one area that is stuck. How will you change the culture to ensure that such ad hoc in-year budget changes are not the norm?

You said that you can assure me, and you said that it is difficult to measure culture. However, many believe that culture eats strategy and planning for breakfast. If the culture centralises certain services—I gave a small example, but it is huge for a lot of women—you can provide leadership and support change if you say that we need to measure certain outcomes, which come from different committees. You could go into this budget round and say, “We hear from the health committee that this direction of travel has a massively negative impact on ethnic minorities and women. We want to show measurable improvement on those things.” Will you do that and start to make a human rights and equalities approach to budgeting impact on the lives of people in Scotland?

Minister, you talk about visible leadership and urgency. My question is about the reinstatement of targets. Would the reinstatement of targets within the national performance framework support the use of the framework to identify budget priorities relating to tackling inequalities?