Women’s Health Group minutes: August 2020

Attendees and apologies

Present:

• Marion Bain, Deputy Chief Medical Officer for Scotland
• Grace Beaumont, The Alliance
• Colin Berry, University of Glasgow
• Sharon Cameron, NHS Lothian
• Greig Chalmers, Scottish Government, CMO Directorate
• Nicola Cogan, Scottish Government, Women’s Health Plan 
• Heather Currie, NHS Dumfries and Galloway 
• Ann Holmes, Chief Midwifery Adviser and Deputy Chief Nursing Officer, Scottish Government
• Sigi Joseph, Royal College of GPs
• Anne Lillico, Scottish Government, Women’s Health Plan 
• Corinne Love, Senior Medical Officer, Scottish Government (Vice-Chair)
• Denise McLister, Scottish Government, Women’s Health Plan        
• Lindsey Pope, Royal College of GPs
• Emma Ritch, National Advisory Council for Women & Girls
• Maggie Simpson, Chair of the Scottish Obstetric Cardiology Network
• Alison Scott, NHS Lothian
• Karen Ritchie, Healthcare Improvement Scotland

Apologies:

• Dona Milne, Directors of Public Health
• Irene Oldfather, The Alliance

Items and actions

Welcome, teams housekeeping, declaration of interest and introductions

The Chair welcomed everyone to the second meeting of the Women’s Health Group and acknowledged the significant changes since the last meeting in February, including the requirement to meet digitally and the change in chair after resignation of the former Chief Medical Officer. 

The Chair highlighted to the group that there has also been a  change in Ministerial responsibility from the Cabinet Secretary for Health and Sport to the Minister for Mental Health. 

The Chair highlighted best practice for using Teams and noted that comments posted in the meeting’s chat function will be saved and used to complete the note of this meeting. 

The Chair provided a brief summary of work since the first meeting in February, despite some significant setbacks including: 

• COVID-19 pandemic necessitating the set up and running of remote sub-groups which led to pausing or delay commencing the work of the sub-groups
• the resignation of the Chief Medical Officer and chair of the Women’s Health Group and 
• cancellation of the Women’s Health Group meeting scheduled for 20 May 2020 due to both of the above

The Women’s Health team, Vice-Chair and subgroups have taken forward all possible work to progress the Women’s Health Plan including:

• setting up five sub-groups and supporting sub-group meetings including the development and agreement of remits
• development of an outline structure for the Plan
• development of a draft Equality Impact Assessment
• linking across SG policy areas to ensure policy coherence
• identifying emerging proposals for the WHP and
• development of a Lived Experience survey

The Chair confirmed with participants that all Declarations of Interest have been completed and are still accurate.    

Minutes of meeting held on 5 February 2020

The group agreed the minute of the previous meeting is accurate with no amendments required. The chair noted that this will be published on SG pages. 

Report from chairs of subgroups including summary of proposals so far (See paper ‘Progress and Timeframe’ for further detail) 

Contraception/Abortion/Sexual Health/Preconception Care (Alison Scott)

Alison Scott provided an update on the work of the Contraception, Abortion, Sexual Health and Preconception Care sub-group and highlighted overarching principles, the need for a holistic approach to care and women’s health in particular. Alison Scott then summarised draft proposals and opened to the group for discussion.  

It was noted that COVID, while a challenge, has provided opportunity for innovation. Services which have had to be put into place quickly because of Covid-19 are providing a useful opportunity to test different ways of working and responding to women’s health needs, for example around abortion care. Qualitative and quantitative data is now being collated on these changes which will help to inform services and actions going forward. 

Discussion:

The group discussed decriminalisation of abortion as a recommendation emerging from this group. It was noted that this proposal, while potentially contentious, aligns with international human rights and the UN Convention on the Elimination of Discrimination Against Women and the recommendation of the Royal College of Obstetricians and Gynaecologists in its report “Better for Women”. 

The Sexual Health Standards (SHS) refresh was highlighted, this was paused due to COVID. It will be important to align WHP and the SHS refresh.

Menopause and Menstrual Health including Endometriosis (Heather Currie)

Heather Currie provided an update on work of the Menopause and Menstrual Health including Endometriosis sub-group and opened to the group for discussion.  

It was noted that consistent feedback from women is that there is variable and inconsistent services and information regarding menopause – this is a key area for improvement and proposed actions.  

It was noted that language used to describe menstrual health is often negative, e.g. sanitary/hygiene, there is a need to move away from this to more neutral/positive language. 

Discussion:

It was highlighted that work is being undertaken in other areas of government including Fairer Scotland for Women. Officials are linking to other policy areas on this. 

Women’s Heart Health (Maggie Simpson)

Maggie Simpson provided an update on work of the Heart Health sub-group and opened to the group for discussion.  

Maggie highlighted that the group has met once and plans to meet again early September. 

Data collection was highlighted as an area for improvement, particularly data sharing and disaggregation with other specialities. As was the need for proactive information and advice for women.  

Discussion:

The group again highlighted the need for a holistic approach to women’s health women’s health care, and a more generalist approach to address these issues and ensure avoidance of silo working. 

Lived Experience (Grace Beaumont on behalf of Irene Oldfather)

Grace Beaumont provided an update on work of the Lived Experience  sub-group and opened to the group for discussion.  

Grace noted that the Lived Experience survey has been developed and was now open with a closing date of 14th September. Officials will circulate the survey link to WHG members and sub-group members. 

It was noted that the preference is to hold further development days in person, however due to COVID this will need to be held online. The aim is to hold development days November/December. 

Gender and Health (Emma Ritch)

Emma Ritch provided an update on work of the Gender and Health sub-group and opened to the group for discussion.  

Emma highlighted that the group is developing principles for gendering health policy and reiterated the need for better data collection and disaggregation and a holistic approach to women’s health care.  

Discussion:

The group discussed training for medical professionals as a way to improve gender competence. It was noted that often mandatory courses are not effective.  It was also noted that students are often enthusiastic about equality and diversity training. There is a need for high quality and engaging/challenging training and it would be useful to link with medical schools/royal colleges on this.  

Delivery timescales (paper)

The Chair provided an update on timescales for delivery, acknowledging the timescales are tight but manageable, and opened for discussion. 

The group questioned if there are plans for wider engagement/consultation with those who are likely to be implementing aspects of the plan (NHS Boards/Royal Colleges for example). Officials will consider this, and if a wider public consultation is required.  

Proposed outline of Women’s Health Plan (paper)

The Chair highlighted the proposed outline of the Women’s Health Plan and invited comments and questions on this.

The group highlighted the need to consider cost implications (both potential cost and saving) for proposals and environmental factors. The Women’s Health Team are actively considering this as proposals emerge. 

The group highlighted the need for engagement from NHS finance, particularly when considering implementation. 

Emma Ritch asked if there is an opportunity to highlight the lack of sex disaggregation in the national performance framework and outcomes in the Strategic policy framework section. ER asked if the International context section would include international human rights instruments such as the Convention on the Elimination of Discrimination Against Women (CEDAW). 

Officials noted that this is the intention and highlighted that the plan is a draft outline and welcome suggestions for content and approach. 

The Chair noted that the Minister has asked the group to consider incontinence as an issue which affects women. It was noted that this aligns with the work of the menstrual health, menopause incl. endometriosis sub-group and will be considered. 

PlGF testing for pre-eclampsia (paper)

The Chair noted that, while PIFG was not included as part of the PfG commitments on the WHP the Cabinet Secretary made a commitment in Parliament that the WHP would consider PIGF and would be included as an agenda item at this meeting. 

It was noted that there is a heightened risk for BAME women in pregnancy. Vice-Chair noted that the RCOG has established a race equality task force to consider some of these issues. 

The group noted discussions were underway with the Scottish Perinatal Network on how work can be taken forward, and further information will be provided at the next meeting.  

Any other business

The Chair noted that the Women’s Health Team are undertaking an Equalities Impact Assessment. Emma Ritch agreed to be involved in the EQIA process.

The Chair noted that the Minister and Cabinet Secretary are keen to see three actions which could be delivered in advance of publication of the WHP. Officials will work with sub-group chairs to identify actions which can be implemented quickly. 

Next meeting

The next meeting of the WHG will be 25th November 2020.

Actions

• circulate link to Lived Experience survey - Secretariat