Women's health plan 2021 to 2024: final report

Gender and Health

Priority: Reduce inequalities in outcomes for women’s general health

“Women and girls… are socialised and stereotyped to be mild mannered, to “not make a fuss”… and to “get on with it”^[7]

Aims:

1. Gender and cultural competence will be built into health policy and healthcare services.

2. Undervaluation of caring professions will be addressed.

3. Accountability, transparency and participation should be the basis for budget decisions and public expenditure will be reflective of the needs and rights of women and girls.

4. Clinical training and CPD will include education, training and long term coaching in equality, diversity and human rights.

Scottish Women and Girls in Sport Week

Scottish Women and Girls in Sport Week, first established in September 2017, aims to raise awareness of the benefits for women and girls of sport and physical activity on their physical, mental and social health. It is a Week dedicated to celebrating, motivating and highlighting women and girls in sport no matter their role or ability – it all counts.

The Week throws a spotlight on the many ways in which women and girls are being active. Each year partners come together to celebrate the activity happening at all levels across Scotland that empower women and girls to be more active, more often.

In 2023, Scotland’s Women’s Health Champion, Professor Anna Glasier, took part in a short film highlighting the many benefits that being physically active has on women’s health and wellbeing from social inclusion to self-confidence and the management of health conditions.

Short Term Actions

Action: Establish a Health Equality team within Scottish Government, to pursue intersectional healthcare policy with a particular focus on sex, race, disability and sexual orientation.

• Health Equity team established.

Action: Encourage NHS Health Boards to engage with the Equally Safe at Work (ESAW) employer accreditation programme.

The ESAW accreditation supports employers to improve their employment practice, advance gender equality at work and prevent violence against women.

• The first year (pilot) of employer accreditation programme for the NHS finished in Autumn 2023. Four NHS Boards (Public Health Scotland, Ayrshire and Arran, Dumfries and Galloway and Healthcare Improvement Scotland) took part in the initial pilot which commenced in July 2022 . A further seven NHS Boards were on the Shadow Group, it hoped that these Boards will go onto take part in the programme in future years.

All four Health Boards on the 2022-23 pilot successfully earned development accreditation. In November 2023, an evaluation report was published which includes details on the engagement, activities and key learning from the pilot.

NHS Greater Glasgow and Clyde, NHS Education for Scotland, NHS Lothian and NHS Shetland are confirmed participants in the 2024 roll out of ESAW. Scottish Government will continue to work with Close the Gap and Health Boards to increase NHSScotland participation in the programme going forward.

Action: Ensure National Performance Indicators are disaggregated where appropriate.

• National Performance Indicators reviewed and disaggregated where appropriate.
• All of the 11 National Outcomes have at least one indicator disaggregated by Gender.

Action: Build an intersectional evidence base around women’s health inequalities ensuring women’s healthy life expectancy and quality of life are used as measures in addition to total life expectancy.

• A ‘Women’s Health Data Landscape’ paper has been published alongside this report.

This paper documents some of the routinely published data on women’s health in Scotland. It aims to outline the current landscape of available data on women’s health and highlight key gaps.

Medium Term Actions

Action: Build an evidence base on women’s health inequalities, with specific focus on the impact of sexism, racism, ableism, and other forms of discrimination including homophobia and transphobia on women’s health.

• A two-phase research project was carried out to build an evidence base on women’s health inequalities in Scotland.

Published on 27 June 2023, the report examines the current evidence base on women’s health inequalities and reports on a two-phase research project. The findings in this project have contributed to the evidence base on women’s health inequalities, discrimination and young women through in-depth exploration of women in Scotland’s intersectional experiences.

Action: Develop gender competency across Scottish Government and NHSScotland, starting with the knowledge, information and data workforce and key decision makers such as those in finance and procurement.

• Close the Gap’s employer accreditation programme, Equally Safe at Work, supports employers to progress gender equality in the workplace and to prevent violence against women.
• The programme has supported four boards to receive accreditation and is currently working with a new cohort of public and third sector employers, including NHS Greater Glasgow and Clyde, NHS Lothian, NES and NHS Shetland.

Action: Increase awareness and understanding of how to effectively use and apply the Public Sector Equality Duty within health and social care, and work to close the implementation gap, as a means to improving women’s health.

• The Scottish Government is committed to improving the effectiveness of the Public Sector Equality Duty (PSED) regime in Scotland. Specific work is underway, in collaboration with the Third Sector, to increase awareness and understanding of how to apply the PSED.
• A PSED information session took place with the Women’s Health Leads Network and Close the Gap in September 2024, with the aim of increasing understanding of how effective application of the PSED can be used as a means to improve women’s health.

Action: Encourage greater transparency in budget decision making, through intersectional gender budget analysis, within health-specific budget processes.

• There is continued activity to establish baseline budget data in health level 4 budgets. Work is focussing on areas where data are already collated in a way which facilitates gender budget analysis. Preliminary work suggests that disaggregating data by gender will be achievable across a subset of health budgets.
• Extensive related activity has taken place including development of the Scottish Government response to the recommendations on the Equality and Human Rights Budget Advisory Group which have now been published. This lays out a framework of the intended approach to equality budgeting, including gender budgeting, which will directly inform next steps for this work.
• The structure of the Equality and Fairer Scotland Budget Statement requires every portfolio, including NHS Recovery, Health and Social Care, to examine the impact of their budget by sex and this can be seen in-depth in Annex B of the documents.
• In 2023 and 2024, the OECD undertook work within Scottish Government to review the overall opportunities for improved intersectional gender budget analysis across all budget processes. This includes undertaking two pilot projects. The outputs from this work will help form the basis for improving budgeting, including intersectional gender budgeting.
• More generally, as part of the recent National Advisory Council of Women and Girls (NACWG) accountability activity, the Scottish Government have specifically committed to better gender competence within the budget process.

Action: Establish Gender Equality and Gender-based Violence (GBV) policy lead positions to work within Health Directorates and with NHS Boards.

• This action is being taken forward through maintenance of the GBV team in Public Health Scotland (PHS) and a network of Health Board GBV leads and practitioners across Scotland.

Public Health Scotland has worked with partners to develop a comprehensive programme to support the application of a public health approach to violence against women. The team support developments across GBV policy and practice providing public health advice and expertise through publishing research, briefings, hosting learning events and testing and evaluating interventions.

Working in collaboration with NHS Education for Scotland, the team have scoped the workforce education landscape for the NHS workforce and have fed the results into the development of policy actions.

The GBV Health Leads Network provides a forum for NHS Boards to collaborate and share practice on NHS Scotland’s response to Gender-Based violence. It aims to improve the capacity and capability of local and national NHS Boards to address GBV and provide consistent policy and practice responses across NHS Scotland, supporting the delivery of Equally Safe. 

Long Term Actions

Action: Ensure mental health policy and service provision is gender and culturally competent, and that the implementation of actions in the Mental Health Transition and Recovery Plan takes account of women’s specific mental health inequalities. Ensure gender and cultural competence is reflected in any future mental health policy.

• The Mental Health Strategy was published jointly with COSLA in June 2023 and the Delivery Plan and Workforce Action Plan in November 2023.

The Scottish Government worked closely with stakeholders to gather evidence and develop the Strategy and Delivery Plan, ensuring it has equalities and human rights at its core, recognises the importance of taking a trauma-informed approach, and is informed by lived experience. This has included working closely with our Equality and Human Rights Forum, which members include groups representing the full range of protected characteristics and other marginalised groups, including women and girls.

The Inequality Action Table within the Mental Health Delivery Plan (Appendix 1) highlights actions tackling key mental health inequalities for women. This includes addressing social determinants such as poverty and deprivation; experiences of minority stress, discrimination; and trauma and loneliness; as well as barriers accessing services and support.

The Adult Communities Mental Health and Wellbeing Fund supports grass roots community groups in building resilience and tackling social isolation, loneliness and the mental health inequalities made worse by the pandemic and, more recently, the cost crisis. In the first three years of the Fund, 375 projects supporting women’s mental health were awarded funding, totalling over £4 million. The Scottish Government have also invested in Perinatal and Infant Mental Health services and in 2023/24, over £9 million was invested in NHS Health Boards to fund Community Perinatal Mental Health, Infant Mental Health and Maternity Neonatal Psychological Interventions.

Action: Develop tools, including a toolkit and coaching, to support HR managers in the health and social care sector to develop and implement employment practices and policies which are intersectional and gender-competent.

• Equally Safe at Work provides a framework for driving change by working with organisations to look at their employment practice on data collection, leadership, flexible working, workplace culture, occupational segregation, and violence against women.
• The programme offers a variety of resources to build capacity in employers and employees. This includes line managers guidance on sexual harassment and violence against women, awareness-raising materials, e-learning modules, and tailored support.
• A key part of the programme is also the Applying a Gender Lens training, which all working group members must attend. The training aims to build capacity on developing gender-sensitive employment practice but providing information on barriers to gender equality at work and how to mainstream gender equality through the organisation.

Action: Address undervaluation within health and social care sector pay, taking into account recommendations from the Independent Review of Adult Social Care.

Health

For 2024/25, NHS Agenda for Change staff have accepted a 5.5% pay uplift.

Adult Social Care

Improving pay and conditions for the adult social care workforce, which is around 80% female, is a priority for Scottish Government and work to improve this continues to progress. The Scottish Government is committed to positive action now and this includes increasing pay, developing mechanisms to improve terms and conditions, and improving recruitment and retention efforts by supporting the professionalisation of the adult social care workforce.

Adult Social Care - Pay

• From April 2024, adult social care workers delivering direct care in commissioned services saw their pay increase to a minimum of £12 per hour; in line with the Real Living Wage rate for the 2024/25 Financial Year.
• This policy is to ensure that the Real Living Wage is paid to all adult social care staff delivering direct care as a minimum, and employers and commissioners have the locus to set rates in excess of this where local circumstances allow.
• This pay uplift has been extended to those providing direct care to children and young people in commissioned services for the first time this financial year.