Jenny Rathbone MS
Women have suffered disproportionately from the pandemic in terms of their place in the labour market and the stress of doing three jobs at once from home. But some things have improved in terms of access to health services.
The introduction of telemedical abortions across Wales in the Spring of 2020 suddenly gave women quick and easy access to a phone or video consultation with a midwife or nurse and a mifepristone prescription delivered to them at home.
Clinicians from across Wales attending the June meeting of the Women’s Health Cross Party Group all agreed that this had revolutionised early access to abortion. Within weeks, waiting lists were eliminated and women living in remote communities with little public transport were able to get as good a service as their urban sisters. Any concerns about the accurate gestation of the pregnancy or the risk of an ectopic pregnancy have been managed by ongoing access to ultra-sound scans if needed. Although this innovation is supposed to be “temporary” it would be astonishing if the arrangements were reversed by the new Welsh Health Minister, Eluned Morgan. In the few months since her appointment, Eluned has constantly emphasised the need to bring services closer to people rather than having to traipse off to a hospital unnecessarily.
Women’s Health focus in the Senedd
The Women’s Health Cross Party Group started in 2018 with a review of the consistency of abortion services across Wales. A survey conducted by the British Pregnancy Advisory service (BPAS) revealed that women in only four of the seven health boards could self-refer for an abortion and Cwm Taf women could only access the service via their GP. This unnecessary delay also applied to women in North Wales and Cardiff because the information on how to self-refer was not publicly available.
Today, with patients regularly holding on the phone all morning for an appointment at their GP surgery, such an unholy duplication of service is unimaginable. In future women are going to be able to pick up mifepristone from the high street chemist.
With the NHS now overwhelmed by people seeking medical attention for problems that could not be acted upon in the midst of a pandemic — 17% of the population of Wales is waiting for a hospital appointment — it is not just abortion services that need to undergo a revolution. Women and men are going to have to be trusted to carry out simple procedures on themselves. We already trust people over 60 to provide bowel screening samples; that same trust is going to need to be applied to younger people too.
Cervical Cancer Screening
Cervical cancer is the most common cancer in women under 35 years; screening reduces the risk by 70%. The capacity of the system to catch up on women who have not had a scan for the last 17 months is restricted by the need to sanitise equipment between appointments. And the reluctance of certain groups even pre-Covid — women who are young, disabled, lesbian or ethnic minorities — who disproportionately missed their cervical screening appointments means other strategies are required and we need to research what is causing the reluctance to attend. Research carried out amongst non-attenders in North London indicates that self-testing is an effective way of increasing screening coverage.
Probably the biggest challenge for improving women’s health services is endometriosis care. One in ten women are affected by endometriosis. Improving menstrual education in schools will help prevent women spending years suffering in silence before seeking medical help, but it currently takes an average eight and a half years and 26 GP appointments to get referred to an Endo specialist. Women from North Wales who gave evidence to an expert panel organised by Fair Treatment for the Women of Wales (FTWW) in March said that both gynaecologists and GPs had missed the signs and they only got an Endo diagnosis after they had paid to see a private specialist.
Increasing endometriosis training for clinicians is just a small part of the challenge. Currently there is only one specialist service for treating endometriosis in Wales (in Cardiff) and the ‘one in, one out’ Welsh funding arrangements between health boards mitigates against the development of new specialist centres that have proliferated in the England as a result of money following the patient. Mending one broken leg of a tourist in Tenby simply does not equate to a seven hour operation in Cardiff for complex pelvic surgery involving a bevy of specialist physicians. Different funding mechanism will be needed to ensure equity of access to specialist endometriosis care across Wales.
The next topic for discussion at the Women’s Health Cross Party Group in October is on the menopause. There is growing evidence that employers are getting rid of female staff when they are at their most productive because they are too ignorant to understand the range of side effects some women can suffer whilst going through the menopause. This is discriminatory, bad for women and bad for the economy.
Reshaping Services to better meet people’s needs
Women’s health needs have previously been overlooked as traditionally men have dominated the medical profession. Happily, the days of an artificial ceiling on the number of female medical students are gone — though not that long ago.
The biggest battles ahead are going to be refocussing the NHS to tackle the inequalities of health that have been so rudely exposed by Covid. Transforming the NHS into a wellbeing as well as an ill-health service is required, treating the causes of ill-health — mainly poor diet and inadequate exercise — which, along with poor housing and insecure work, have meant that most Covid fatalities have been amongst deprived communities. Better pre-pregnancy care, and more investment in midwifery and children’s health are key to closing the scandalous gap in healthy life expectancy of up to 10 years in communities living but a few miles apart. The NHS is not responsible for the unequal, obesogenic, unsustainable world that threatens to destroy the planet but it can certainly be part of the solution.
Jenny Rathbone MS is Chair of the Women’s Health Cross Party Group in the Welsh Parliament / Senedd Cymru