Women's health plan

5 Strategic context

The Women's Health Plan supports work already being undertaken on women's health across the Scottish Government, NHSScotland, Local Authorities and the Third Sector and aims to reduce health inequalities and drive forward improvement in health services for all women in Scotland. It sets out actions to address gaps in service provision, and to reduce the inequalities between women and men as well as between different groups of women.

5.1 National Performance Framework

The Plan is aligned with, and underpinned by, the Scottish Government's National Performance Framework (NPF). The NPF provides a clear long-term purpose and set of outcomes for Scotland's wellbeing. The NPF recognises that Government alone cannot deliver those broad societal outcomes, and that it requires all of us from all sectors - public, private and third – and as individuals to help take this work forward.

Our Purpose: To focus on creating a more successful country with opportunities for all of Scotland to flourish through increased wellbeing, and sustainable and inclusive economic growth

Our Values: We are a society which treats all our people with kindness, dignity and compassion, respects the rule of law, and acts in an open and transparent way

National Outcomes

• Children and Young People: We grow up loved, safe and respected so that we realise our full potential
• Communities: We live in communities that are inclusive, empowered, resilient and safe
• Culture: We are creative and our vibrant and diverse cultures are expressed and enjoyed widely
• Economy: We have a globally competitive, entrepreneurial, inclusive and sustainable economy
• Education: We are well educated, skilled and able to contribute to society
• Environment: We value, enjoy, protect and enhance our environment
• Fair Work and Business:We have thriving and innovative businesses, with quality jobs and fair work for everyone
• Health: We are healthy and active
• Human Rights: We respect, protect and fulfil human rights and live free from discrimination
• International: We are open, connected and make a positive contribution internationally
• Poverty: We tackle poverty by sharing opportunities, wealth and power more equally

The Women's Health Plan will contribute to the following National Outcomes:

• Children and Young People – we grow up loved, safe and protected so that we realise our full potential
• Communities – we live in communities that are inclusive, empowered, resilient and safe
• Fair work and Business - We have thriving and innovative businesses, with quality jobs and fair work for everyone
• Human Rights – we respect, protect and fulfil human rights and live free from discrimination
• Health - we are healthy and active
• Poverty - We tackle poverty by sharing opportunities, wealth and power more equally

The Scottish Government is committed to the achievement of the United Nations Sustainable Development Goals. These are 'global goals' and targets that are part of an internationally agreed performance framework. All countries are aiming to achieve these goals by 2030. The First Minister committed Scotland to the global goals in July 2015.^[38]

The NPF and the goals share the same aims and the Plan contributes to the following goals:

• 3. Good Health and Well-being.
• 5. Gender Equality.
• 10. Reduced Inequality

5.2 Other policies

In addition to being underpinned by the NPF, the Women's Health Plan will complement existing health-related strategies and policies in Scotland. It sits alongside activities already underway and sets out actions and activities which will encourage new and innovative approaches to delivering health services for women in Scotland. See Annex B for more detail.

5.3 Pregnancy and Maternity

The Scottish Government is developing a range of improvements in services for pregnancy and maternity, including:

The Best Start: Transforming Maternity and Neonatal Care

In 2017, the Scottish Government published The Best Start: A Five Year Forward Plan which made 76 recommendations which will fundamentally reshape maternity and neonatal services.

Continuity of Carer is a cornerstone recommendation of The Best Start, and the vision is relationship-based continuity of carer, tailored to the individual's needs, and delivered as close to home as possible. As well as improved relationships between the women and midwife, evidenced benefits include reduced preterm and stillbirths, reduced interventions during labour and an increase in breastfeeding. In addition, we are redesigning the pathways for maternity clinical care for women which will support delivery of timely, compassionate and proportionate care for those with complex social and clinical needs. This will improve care for all women, and particularly for those at increased risk of poorer outcomes.

Ready, Steady, Baby and Parent Club

Ready, Steady, Baby is a guide to pregnancy, labour and birth and early parenthood up to 8 weeks and a copy is given to all pregnant women in Scotland. The family support content on Parent Club Family Support Directory | Parent Club sets out the support entitlement for pregnant women and parents with young children.

Miscarriage and Unexpected Pregnancy Complications

The Scottish Government is committed to establishing a dignified, compassionate miscarriage service tailored to the needs of women. This includes supporting the development of individualised care plans after a woman's first miscarriage, taking forward the recommendations made in the Lancet series, "Miscarriage Matters" published on 26 April 2021 and ensuring women's services in NHS Boards have dedicated facilities for women who are experiencing unexpected pregnancy complications.

The Scottish Government will work with patient groups, including women with lived experience, to ensure improved accessible information for women who have a miscarriage is available and signposted across NHS Boards by early 2022.

5.4 Screening

Cancer is one of the major causes of death in Scotland; breast cancer is the most common cancer affecting women.

Over the next year, there are three areas we will focus improvement activity on: self-sampling in the cervical screening programme; the breast screening programme review; and ongoing work to address inequalities.

Self-Sampling

Evidence tells us that there is unequal uptake in the cervical screening programme – women from higher socio-economic areas are more likely to take up cervical screening than those from more deprived areas. We also know that the screening test itself is a barrier to take-up for many reasons, including previous trauma, embarrassment and difficulties accessing screening appointments.

Self-sampling has the potential to overcome many of these barriers by allowing women to take a test in their own homes and at a time that is convenient for them. Introducing it to the cervical programme could therefore reach more people who may not ordinarily engage.

Breast Screening Review

A review of the Breast Screening Programme is underway to ensure it is as effective as it can be, and reaches all women who would benefit from it. The review was recommended by the Scottish Screening Committee, an expert Committee, comprising clinicians, screening programme managers and NHS Board representatives whose aim is to consider strategic policy for all six of Scotland's national screening programmes. This review is expected to report at the end of 2021, and will help shape how the programme is delivered in the future.

Inequalities in screening

We will also launch a wider programme of work to specifically target inequalities across the screening programmes. As a life-saving tool, it is essential that screening is equally accessible to women across Scotland. We know that, at present, issues such as disability, race, age and socio-economic status all impact on how women take up screening, and we also recognise that the Covid-19 pandemic may have exacerbated these existing inequalities.

5.5 Mental health

The importance of mental health, and the specific mental health challenges faced by women, has been raised throughout the development of this Plan, particularly through our lived experience engagement with women themselves. This includes the need for more specific mental health information, support and policy for women.

The inequalities that drive differences in physical health outcomes are the same inequalities that detrimentally impact on mental health. The Scottish Government's guiding ambition for mental health is simple: it must prevent and treat mental health problems with the same commitment, passion and drive as physical health problems.

The Scottish Government recognises that across most aspects of mental health, outcomes for women and girls are poorer than for men and boys.^[39] That is why the Mental Health Transition and Recovery Plan,^[40] published in October 2020 in response to the Covid-19 pandemic, commits to making women and girls' mental health a priority. It sets out specific actions to address women and girls' mental health including engaging with women's organisations to better understand and respond to the gender-related mental health inequalities that have been exacerbated by the Covid-19 pandemic. This includes for example, stressors and trauma experienced by women in key worker jobs and the disproportionate emotional and physical burden on women of caring for relatives of all ages.

A Mental Health Equality and Human Rights Forum has been established to inform the implementation of the Transition and Recovery Plan and wider Mental Health Policy. This group will take into consideration wider health issues, as well as the specific health conditions we have raised throughout this Plan.

Whilst a specific mental health focus was not one of the initial priorities for the Women's Health Plan it is important to recognise the key importance of mental wellbeing in overall health.

Life factors such as being an unpaid carer, a job that falls disproportionately to women, and hormonal changes during menopause can affect women's mental health. There is a feeling that many women 'just get on with it' and may not realise they could benefit from mental health support.

Lived Experience Engagement Report