18-month wait for women's health champion shows 'lack of urgency' in tackling inequality
“I definitely think as a government we need to have more urgency about taking forward the actions that we have in the women’s health plan,” says Labour MSP Carol Mochan, who until the end of last year was her party’s spokesperson on women’s health.
“My concern is that we’re very good at putting plans together, we’re very good at having documents about things, but there seems to be a lack of urgency to actually implement any of the things,” she adds.
Still keen to hold the government’s feet to the fire from the backbenches, Mochan says that while the strategy and dedicated minister is welcome, there is a lack of progress on the ground. She points to the pledge to appoint a women’s health champion as one example.
This commitment was made in August 2021. Last year, government ministers said someone would be in place by the end of the summer. But it wasn’t until late January this year, 18 months on from the pledge, that the government announced Professor Anna Glasier, a world-leading expert in women’s reproductive health, was taking on the role. She formally started on 26 January.
It’s early days for the women’s health champion, but she has her work cut out
The Scottish Government’s defence is that the appointment was a medium-term commitment, and it instead chose to focus on delivering other actions.
Mochan questions why appointing someone to champion the cause was not an early priority. “It seems to me that that was a relatively straightforward thing to do, which could have had big outcomes early on, and yet the process continually just moved and moved and moved.”
Likewise, Tess White, the Scottish Conservative women’s health spokesperson, says the whole saga shows “a complete misunderstanding of even the basics, like how long does it take to recruit somebody”.
She goes on to highlight the strategy only runs until 2024, which she says doesn’t leave a lot of time for Glasier to bring about change.
“The whole landscape needs to be looked at and it’s early days for the women’s health champion, but she has her work cut out. My worry is that if you even look at the website that’s being created from the plan, it’s all words, platitudes, but no substance.”
But Maree Todd, the minister for women’s health, insists the lengthy recruitment process was necessary to ensure the government got “the right person for the job”.
“I am very content with the person that we have appointed. I was in awe when I saw her CV, I was even more impressed when I met her in person, and I absolutely believe she’s been worth waiting for,” she adds.
And despite the delay in appointing Glasier, Todd argues there have been “tangible improvements” elsewhere for women’s health, including the creation of a dedicated platform on the NHS Inform website.
“There are really good resources there. And I’ve said from the very start, information is power. The fact that women are able to access good information and detailed information, and actually have an influence on the content on that platform, I think it’s really important, and I think that will make a tangible difference.”
We are absolutely pushing to make sure that women’s health is at the centre of government’s thinking
She continues: “I’m really delighted actually, that despite the strain we’re feeling in the NHS, there’s been huge passion and commitment to this area, and actually all the things that we set out in our short-term plan, we’ve achieved – which is why opposition are attacking me on not having achieved my medium-term plan commitments.”
She does acknowledge, though, that overturning the huge barriers women can face in accessing healthcare and addressing the root causes of poorer health outcomes for women is no easy task. “I don’t have a magic wand, and I am not going to be able to overturn millennia of discrimination and marginalisation in a click of my fingers, but I’m also really proud that we have a woman’s health plan.
"I’m delighted that we’ve appointed such a high calibre women’s health champion. I’m content that we have the right ingredients to make progress.
“At this moment in time, the NHS is under the biggest pressure and stress it’s ever faced in 74 years. Looking for improvements in service in, for example, elective surgery is difficult. But we are absolutely pushing to make sure that women’s health is at the centre of government’s thinking and at the centre of every health board’s thinking too.”
It’s why the plan also pledged to establish a women’s health lead in every health board, which Todd describes as an “army of women’s health champions, with Anna [Glasier] at the helm”. Four of those are now in place, in Glasgow, Lothian, Ayrshire and Arran, and the Western Isles.
She also says that this plan it merely the first and more will follow. “I’ve had a lot of criticism over the first year or so that the women’s health plan doesn’t cover this, it doesn’t cover X, it doesn’t cover Y, it doesn’t cover Z.
“I’ve always said this is just the first iteration. These are the priorities that were set by women who said these are the most important things we want to tackle first. The job is not done when we’ve worked through this women’s health plan.”
Those early priorities, to be taken on by Glasier, are menopause, endometriosis, polycystic ovarian syndrome (PCOS) and heart health. Naturally, most of these priorities focus on reproductive health, areas historically ignored and often dismissed as ‘lady problems’.
These are only temporary fixes, and at the moment we’re not really seeing them on the ground
Rebecca Wymer, who lives with severe endometriosis, has been at the sharp end of that dismissal. It took her over ten years to get a diagnosis and even now has to battle to get treatment. She lives in the northern Highlands and frequently travels the 100 miles to Inverness because her local hospital in Caithness does not have the facilities.
She has been calling for a review of women’s health services in her region, with the hope that a full gynaecology service could be returned to Caithness General, as was the case prior to 2016. The government confirmed last month that NHS Highland will undertake that review.
“It’s moving in the right direction. The right promises are being made – whether they’re going to be implemented is another question,” Wymer says. Her specific concern is that since she has been raising these issues, the health board has put in place temporary cover for gynaecology.
“If I was a betting woman, I would say that what’s going to happen is NHS Highland will do the review on gynae based on the temporary situation they’ve put in place, based on the cover that they’ve put in.
"That can’t be allowed to happen. They cannot do a long-term review based on a temporary situation. It needs to be based on what we will have in the years to come and what we’re looking at for the future, because these are only temporary fixes, and at the moment we’re not really seeing them on the ground.”
Gynaecology services in Caithness were downgraded alongside maternity services in 2016 following concerns about safe staffing levels. While more acute in the Highlands, that is an issue facing health boards across Scotland.
White says gynaecology is “in freefall” and there needs to be urgent improvements in terms of access. She also points to problems in accessing support for perinatal mental health and menopause.
“I would like to see the dial shift for basic provision for women. I’m a year and a half in – almost two years in, in May – and the dial hasn’t shifted yet at all. My inbox is just filled now, since I became shadow minister for women’s health, my inbox is just women writing to me from all over.”
We suffer from an inequality in power, an inequality in wealth, and an inequality in status
She says there needs to be better workforce planning in women’s health, and more innovative solutions such as NHS Grampian’s mobile breast screening unit (which she used herself earlier this year).
She also says there needs to be a more holistic approach to women’s health, noting in particular that the mental health strategy is “gender blind”. “Despite being more likely to experience anxiety and depression, the mental health strategy only mentions the word ‘women’ four times and that is just disgraceful.
"There is a huge issue dividing the lines of women’s health and mental health, and we need to look at women’s health holistically. Having these dividing lines is actually allowing harm to be caused to women, so it’s just not good enough.”
Glasier, for her part, is keen to widen the focus beyond what are more typically considered women’s issues. “The current plan encompasses much more than reproductive health, recognising as it does the inequalities which affect women in many areas of health,” she has said.
It’s about tackling inequality, no matter what that inequality is
It is these wider health inequalities which brought Mochan into politics in the first place. She previously worked as a dietician in Glasgow, where she witnessed first hand the reality of how inequality impacts health.
She explains: “People [working] in health often think people are unhealthy because of the individual choices that they make, but quite early on in my career I realised that actually people are unhealthy because of the inequalities in society and things that they don’t control themselves.
"What access do you have to shops? What’s the transport access that you have? Or if your home is damp and not able to be repaired, you live in streets that are not kept up properly.
"So quite early on in my career, I realised that actually if I wanted to change health outcomes for people, I had to campaign to change the things around them.”
Likewise, Todd had a similar realisation when she worked as a pharmacist. She says: “The reason that women face health inequalities is that we suffer from an inequality in power, an inequality in wealth, and an inequality in status. And with many of the policies that the Westminster government is pushing and has pushed over the last 13 years, they have widened inequalities, they have disempowered women further, they have made women poorer.”
Mochan agrees that the UK Government takes much of the blame, but she’s also keen for the Scottish Government to do more. “If we want to make the best of devolution – which I absolutely do because I believe in devolution – it means that in Scotland we need to make different choices. In Scotland we need to prioritise the things that will make a difference to health inequalities. There’s absolutely no doubt about that.
“We need to use every pressure that we have and every lever that we have, because I do think overall that will make the biggest difference to those who currently have health inequalities, but also to the rest of the population. If you resolve that, we all benefit, that’s what I believe.”
She argues tackling health inequalities will also help to alleviate some of the pressure currently facing the NHS. That means investing in women’s lives more broadly, from ensuring local sports facilities are available, through to improving pay and conditions in sectors dominated by women, such as care work.
“The bottom line is, it’s all inequality, isn’t it? It’s about tackling inequality, no matter what that inequality is. We need to look at how we make sure services do not operate in a way that disincentivises people to access them, to use them, to get the best out of them.”