 Can you find me without a mic in your app? Ok good afternoon. Can I remind members that social distancing measures of order? Do you think we'll be on the starts of the debate? Is there any way that we can move decision time, 14 minutes later? Let's see how we get on, I'm grateful for the point of order. Let's see how we get on and I think we can make an assessment about that later on in this afternoon's debate. Can we now continue with the next item of business, which is a debate on motion 366, in the name of Marie Todd, on women's health? I invite members who wish to speak in the debate to press the requested speak buttons now for those joining us remotely. Please put R in the chat function. I call on Marie Todd to speak to and move the motion. You have around 11 minutes, minister. The Covid-19 pandemic has changed and challenged almost all aspects of life, but its impact has not been felt equally across the population. Women have been more adversely impacted. Pre-existing inequalities have been exposed and exacerbated. Let's be clear that women's health is not just a women's issue when women are supported to lead healthy lives and fulfil their potential. Everyone benefits. The majority of unpaid carers are women. Women make up the majority of the health and social care workforce and the vast majority of lone parents are women. The challenges of balancing childcare, paid work and caring responsibilities with the stresses and uncertainties of the pandemic will have been truly daunting for many women and undoubtedly have affected their health. Still, the inequality that women face throughout their lives existed long before Covid. In her thought-provoking book, Invisible Women, Caroline Crearo Perez says so much in the few words. Women are not, to state the obvious, just men. She goes on to explain. Historically, it's been assumed that there wasn't anything fundamentally different between male and female bodies other than size and reproductive function. For many years, medical education has been focused on the male norm, with everything that falls outside that designated as atypical or even abnormal. Let's look at abnormal. Women are more likely to experience violence, to live in poverty, to live alone, particularly in older age and care for others, all of which contribute to poorer mental health. Throughout this year, we've invested £6 million to support mental health. It's vital that we consider the specific mental health needs of women. In October 2020, we launched the mental health transition and recovery plan, which specifically prioritises women and girls' mental health. We are working with our Equalities Forum to deliver a programme of work to address the challenges arising from the pandemic. Women live longer than men and make up a larger portion of the older age population and are more likely to spend more time in ill health. Yet women don't always receive equal healthcare. Their physical and mental health is compromised every day by systems that do not yet fully meet their needs. Healthcare outcomes for women are poorer in important areas such as heart health. Women having heart attacks are often said to have an atypical presentation. That language shines a light on a very important issue. Women are not atypical men, they are women. The way women present is normal for women. That lack of recognition of the presentation is followed by studies showing that women are less likely to be prescribed drugs that reduce the chance of a second heart attack. The British Heart Foundation highlights inequalities at every stage of a woman's medical journey. Health inequalities such as that are unjust and preventable. Let's talk about endometriosis. One in ten women in Scotland have endometriosis, making it as common as diabetes and asthma. We know that women are waiting far too long for a diagnosis, so we are listening to women to understand the barriers that they are facing to achieving a diagnosis to make sure that we can make progress as quickly as possible. We are also ensuring that the individual needs of women are met throughout their treatment. Let's talk about menopause. Women are frustrated that information, particularly in relation to menstrual health and menopause, is unreliable and inaccessible. Many feel unprepared for the impact that menopause can have on their life and feel unsupported to manage symptoms. We are working to raise awareness of the symptoms of menopause and to ensure that all women receive the support and care that they need to sustain their health and wellbeing. Those reasons and many others are why, within 100 days of this new term, we will publish a women's health plan. The plan will reduce avoidable inequalities in health outcomes for women throughout their lives. Central to its development and implementation will be women's voices and experiences. We have already conducted a women's health survey, alongside the health and social care alliance, and spoken directly to women. We want to give women a say in how we shape services for the future, and it is absolutely crucial that we listen to women and that we trust women. Monica Lennon I am grateful to the minister for welcoming her to her new post. I agree with what she said so far. Does she agree that, to get the benefit of all the measures that we need to embed menstrual wellbeing education into the curriculum and what plans? Does she have to speak to colleagues across Government to make sure that that happens? The challenge does not start just in the doctor's surgery. The challenge is a societal one, and we need to change that and ensure that, from a young age, both boys and girls have an understanding of menstrual health and the course of a woman's life and how that will impact her. The idea of education during school is certainly an appropriate one, but there are also other opportunities when women are presenting for breast screening and cervical screening. There are lots of opportunities to talk about menstrual health with women and to raise awareness of the challenges that we face. I certainly will be trying to improve the situation. Developed over the past 18 months by women and experts on women's health, the plans' initial priorities are improving abortion services, contraception and sexual health, menopause and menstrual health, including endometriosis and women's heart health. Through necessity, the pandemic led to new and innovative ways of working and providing patient care, and those are captured in the women's health plan for longer term implementation. To make lasting change, a cultural shift is required. The plan therefore approaches women's health in a holistic way, responding to the many factors that impact on women's health and their ability to access healthcare services. The plan has a life course approach to women's health, emphasising the importance of protecting and promoting health at key stages of life. From preconception to pregnancy, childhood and adolescence to adulthood and later life, it is vital that women have the information that they need, when they need it and in a way that is right for them. That meaningful communication personalises care, improves the safety and effectiveness of care and helps to address health inequalities. At every stage, we must give women the opportunity and support that they need to access and participate in decisions about their care. Moving away from a doctor knows best culture, we will empower women to make informed decisions about their bodies and their health. We will learn from the pandemic and we will build back with equality at the centre of all that we do. We can reduce some health inequalities by identifying gaps in health service provision, considering areas of best practice and developing actions to address those gaps. However, that plan is only one part of a much wider picture when it comes to women's health and wellbeing. The majority of health inequalities are avoidable. They stem from wider inequality in society, income, wealth and power. Work is being undertaken across Government to address these wider social determinants of health, to eradicate poverty and to tackle inequality in all aspects of life. There is a significant amount of work being undertaken right across Government to improve women's health, particularly in... Jackie Baillie. On the point about inequality, could I specifically ask the minister whether she will commit to reforming care allowance as soon as possible to ensure that unpaid carers can earn more from work? I am sure that she will appreciate that they are predominantly women. The member will be aware that that is not my portfolio, but I am absolutely well aware that more women are carers and that is one of the reasons that impacts on their health. I will be working in a cross-governmental approach. I am keen that we can achieve cross-parliamentary consensus today to take that work forward with everyone in agreement that those issues need to be tackled in order to improve women's health. There is a significant amount of work being taken across Government to improve women's health in regard to mesh, maternal health and screening services, and the plan will build on those successes and align with Covid-19 recovery. I am going to finish with another quote from Caroline Criado Perez, a book that I would recommend to everyone in the chamber. The evidence that women are being let down by the medical establishment is overwhelming. Half the world's population is being dismissed, disbelieved and ignored. Our ambition is for a Scotland where health outcomes are equitable right across the population so that all women can enjoy the best possible health throughout their lives. Our women's health plan will provide a foundation for us all in government, health and social care and society as a whole to work together to achieve that. I look forward to listening to the views of the members today, and I hope that across the Parliament we can find common cause in better listening to understanding and meeting the needs of women in Scotland today. Thank you. Thank you, minister. I thank you also for keeping to time as well as taking interventions. I now call on Annie Wells to speak to move amendment 369.1. Ms Wells, you have seven minutes. Thank you, Presiding Officer. I am delighted to be given the opportunity to speak in today's debate. I would first like to take this opportunity to lend my support to the cervical screening awareness week. Cervical screening, also known as a smear test, is a life-saving test. However, many people find this test difficult due to a variety of reasons, such as anxiety or previous trauma. Over a quarter of those who were invited to do the test did not take up their invitation. It is also concerning that figures from Public Health Scotland show that, in 2019 and 2020, there was a lower uptake of cervical screening among those from more deprived areas. That is why campaigns such as Cervical Screen Awareness Week are so important. I would like to hear from this Government as to how they will work to close the gap between the most in the deprived areas when it comes to cervical screening. Joe's Cervical Cancer Trust has launched its own campaign for the week, which aims to encourage open conversation about cervical screening. It also aims to issue clear guidance to women and people with a service on how to access vital support that they may need, and I urge people to visit their website for more information. In the coming months, as more Scots are vaccinated and we look to carefully ease restrictions, there will be an opportunity for us all to reflect on our experiences of the pandemic. What we can immediately recognise is the invaluable role women have and continue to play in protecting the NHS against the virus. Many health and social care professions in Scotland, indeed the world, are dominated by women. We cannot lose sight of the key role women have played in treating and caring for some of the most vulnerable in society against this deadly disease. However, we cannot wait until the pandemic has passed. It is an urgent and renewed focus on improving women's health now. Advocacy Group in Gender has issued a stark warning that there is a concern that women's health problems are being dismissed, underestimated and diagnosed late. In letting me be clear, the Scottish Conservatives are committed to ensuring women's health and wellbeing needs are met across their whole lifetime. As we have heard from the minister, despite making up half the population, as a society we often avoid talking about many of the health issues women face, this must change. In light of that, the Scottish Conservatives have welcomed the Government's commitment to women's health plan. We, on these benches, look forward to the opportunity to carefully scrutinising the Government's plan following its publication. In the NHS recovery plan debate a fortnight ago, I spoke about how, as our healthcare services remobilised following Covid, we need to improve the services that women across Scotland rely on. The NHS needs bolstered with significant financial support if we are to tackle the backlog, which threatens to delay and even deny vital treatment for Scottish women. That is why, as part of the Scottish Conservatives' amendment to the Government's motion today, we are calling for a clinician-led ring-fenced fund with the sole remit of bringing treatment times under control. That moves help to ensure, despite the immense pressure placed upon our healthcare system by the pandemic, that our NHS is responsive to the health concerns and wellbeing of women. Take the condition endometiosis, where the average time for a diagnosis in Scotland is eight and a half years, according to an inquiry by the all-party parliamentary group on the issue. The inquiry also noted that, in Scotland, it has been difficult for some women to access specialist endometriosis centres, even if they are suffering from deep endometriosis. Another area of concern regarding women's health, Presiding Officer, is that of breast cancer, the most common cancer in women in Scotland, accounting for 28.8 per cent of all cancers diagnosed. Only recently, have cancer research UK revealed that 1,000 fewer people have started breast cancer treatment in the last year in Scotland compared to the year before. That highlights the tremendous scale of the NHS backlog in this instance and how the cues for essential treatments are growing at a startling rate. Moreover, I agree with the minister where she stresses the importance of recognising the link between health and income inequality. As is the case that I have already mentioned with cervical skinnings, the figures show that women from the most deprived areas of Scotland are less likely to attest breast screening appointments also. Wether it be endometriosis, breast or cervical cancer, Presiding Officer, I again stress that it is vital that we have targeted resources dedicated to tackling the backlog and addressing lengthy waiting times in these key areas of women's health. Finally, Presiding Officer, on an issue that I know will be discussed passionately across this chamber today is the findings surrounding transvaginal mesh surgery. It is important to praise the efforts of the Scottish mesh survivors group, a group of heroic women, who have worked tirelessly over the years to raise awareness of the dangers of mesh. That scandal, being a traumatic and harmful experience for victims and ball, needs a resolution as soon as possible. I am clear that I stand side by side with the qualities across this chamber to call on this Government to urgently introduce financial support to refunded women who paid for private mesh surgery, often outwith the NHS. Presiding Officer, as I mentioned at the beginning of the speech, women make up half of our population, but serious discussions about our unique healthcare needs are often shied away from. That can be no more. The barriers that women face to good physical and mental health are clear, and the pandemic continues to place significant pressures on the NHS. With a laserised focus, however, let us recommit ourselves to supporting women's health by giving the NHS the proper funding that it needs to tackle the backlog and be responsive to the healthcare needs of women across Scotland. I move the amendment in my name. Ms Wells, I now call on Carol Mocken to speak to and move amendment 369.4. Ms Mocken, you have six minutes. Thank you, Deputy Presiding Officer. It is of course very welcome that women's health is receiving some of the spotlight that it deserves in this chamber today, and I am delighted to be opening for Scottish Labour. I want to focus on the way in which women continue to be treated as second-class citizens in Scotland, whether by neglect or design. There is only so long that the Government can keep turning up with motions, celebrating plans as yet unannounced. People want action, and that is what Scottish Labour continues to focus on, and I will focus on in today's debate. Scottish Labour has pushed for action on women and women's health throughout the last Parliament. An example of action from my colleague Monica Lennon, who did so much to improve the provision of free period products with world-leading legislation. That is action, but I am sure that Monica would agree that there is still a great deal more to do, and we can only achieve that by working together and using the powers of the Parliament. I worked for many years in the NHS and saw first-hand the ways in which medical concerns of women are so often dismissed as a minor consideration or just cast off as a by-product of personal responsibility. It is vital that people in my position and our position speak up for those who are unable to do so. I know from my constituents that the stigma surrounding menopause, access to specialist mental health support and waiting times for breast cancer screening appointments are just a few of the ways in which women do not feel their needs are taken into consideration in Scotland. Menopause symptoms in particular remain heavily stigmatised. Many women are so reluctant to ask for help or share experiences. The specialist services must have greater equality and access to allow women to be confident in coming forward and accessing treatment. However, there is perhaps no greater example in contemporary Scotland of that neglect than the treatment of the survivors of the transvaginal mesh scandal. That is an issue that my Labour colleague Neil Findlay did so much to raise awareness of during the last Parliament. Alongside other MSPs from other parties, there were some successes but still questions left unanswered. The work of the Scottish mesh survivors campaign has repeatedly revealed the extent to which those women trusted the NHS to treat them. They were led to believe that the mesh was safe only to be left with life-changing injuries. We know that many of those women are now left unable to work or live a normal life, suffering from the dreadful social and financial impacts that follow from that. Scottish Labour is pursuing that and so many other issues because we see the advancement of women's health as a core concern of a modern country focused on justice. We believe that by supporting women to live healthy lives, we build the blocks of a national health service. For all the posturing, I am not sure that the same can be said of the SNP. Here is the recent record and it is not even close to acceptable. Over 43,000 breast cancer screening appointments were cancelled in 2020 and at least 180,000 cervical screening tests delayed. Fewer than three-fifths of women from the most deprived areas of Scotland attend breast screening appointments compared to nearly four-fifths of women in the most affluent communities. Scotland only has two mother and baby mental health units, with the Royal College of Physicians in Scotland saying that the mental health treatment for new mothers is akin to a postcode lottery. Finally, and I urge members to remember that statistic, on average, women with endometriosis wait eight years from the condition to receiving a test. Scottish Labour wants to start turning back the tide and as you can see from an amendment today, a first step and an absolutely necessary step is to recognise today as an opportunity to right the wrong suffered by Scotland's mesh survivors. We can give a guarantee that they will be able to access the compensation that they deserve. If we can help this group of women, we can give hope to those who believe that their own concerns have been forgotten, that things can change for the better. Today in this Parliament yet lets use the powers for ones to redress the balance for a group of people who have no institutional power, just their own solidarity, compassion and desire for justice. I know that the SNP claimed to support that in principle, but so far they have come up with more excuses than solutions. It is long past time that we got this done and delivered the vital funding to these women so that they can get back to some sense of normality and not feel left behind by an establishment that seems to distance from their lives. The mesh survivors have campaigned relentlessly for some form of justice for years and years. There probably is not an MSP in this building who has not been contacted by them or listened to their story. Ensuring that they do not have to pay for essential surgery out of their own pocket is the least that we can do to correct this historic injustice. They have experienced it and we can help from within this Parliament. I implore the Scottish Government to join with Scottish Labour today and start a new chapter in our country's history by championing the rights of women to receive fair and effective healthcare. It should not be too much to ask. Support this amendment, which I move in my name. I would like to take this opportunity to congratulate the minister on her appointment. I look forward to working with her over the coming years. Thank you to everyone who has sent in briefings ahead of this debate. Women are more likely to have heart disease misdiagnosed. They are more likely to have their physical symptoms either dismissed entirely or put down to their mental health. My own parents, for example, were told when I first started experiencing symptoms of my disability that I was embellishing my hearing loss and that the dizziness that I was experiencing was probably either linked to my periods or stress. Women need to be believed when they go for help. Being told that your physical pain is all in your mind will undoubtedly stop you from trying to access healthcare in the future. When many healthcare campaigns encourage people to get checked early to ask their doctor if they notice anything unusual, we should be trying our best to ensure that everyone's healthcare concerns are taken seriously. Heart disease is often something that we perceive as being a condition that particularly affects men. Ischemic heart disease kills 2,600 women a year in Scotland. Currently, tests are not as accurate in diagnosing heart attacks on women compared with men and seven women a day will die from ischemic heart disease. That seven families devastated. That does not take into account those who survive and then have to live with long-term conditions, usually on blood thinners for the rest of their lives. Often we look at decisions in this chamber through an economic lens. We look at the loss of the economy from those who cannot work after a heart attack. We look at how much it costs to run a service or a campaign but what we decide here affects actual lives. Preventing a heart attack is the difference between a family keeping or losing a mum, sister or daughter between someone being able to enjoy their life in the way they did and having that irreversibly changed. Any family who has experienced this will tell you that no price can be put on saving a loved one's life. We know, however, that income and deprivation are strongly linked to positive health outcomes. In partnership with promoting good health, we need to tackle poverty and other drivers of poor health. Even though my amendment was not selected, I want to cover some of the issues raised in it. Pregnant women and new mothers have been particularly negatively affected by the pandemic. Women who have been pregnant and given birth during the pandemic have been hit hard by the restriction and loss of some services. During the first lockdown in 2020, restrictions put in place included barring partners from attending antenatal screenings and limiting the time that could be present during labour. Although those restrictions have now largely been lifted, they have had a profound impact on the health and wellbeing of new parents and their relationships with their child. Pregnant women still cannot access all the services that they are entitled to. In-person antenatal classes are still suspended with most health boards offering online e-learning modules instead. Those are a poor substitute for the supportive environment of traditional antenatal groups, which are often a lifeline for first-time parents. Freedental care for new mothers is also something that women are struggling to access. I am aware of a growing number of women who now have to pay for expensive dental treatment because they could not access dental appointments over the last year and have now passed the one-year free window for treatment after giving birth. Freedental treatment is a recognition of the impact that pregnancy can have on the oral health of new mothers, and we should be doing all that we can to ensure that women take this up. My colleague Mark Ruskell has written to the cabinet secretary to ask him to extend the provision to two years post-birth for the foreseeable future, and I would encourage him to reflect on that proposal if it is the cabinet secretary that is summing up. That would be a simple but effective measure to try and redress unequal impact that the pandemic has had on women's health. We would also like to see the Government commit to retaining the provision for early medical abortions at home that was introduced during the pandemic, and we would want to see the end of the two doctor rule and the establishment of buffer zones around abortion clinics and sexual health clinics. No one should be harassed while trying to access healthcare. Elegantly done in incorporating your amendment as well, and I call on Beatrice Wishart for four minutes after which we will move to the open debate. Ms Wishart. Thank you, Deputy Presiding Officer. I'm grateful too for the opportunity to take part in this debate and to help bring issues around women's health in from the sidelines. Many of us scoffed when news broke in 2016 about the trials of male contraceptive pills being called to a halt. They ran aground because the participants were experiencing headaches, mood swings and weight gain, all symptoms that are well known in the female experience of contraception. But that point is worth more than just a roll of the eyes because it clearly shows the inequality that's at the heart of this debate. To this day there's a mainstream expectation that there are levels of pain and discomfort that women should just live with. Risks are excused or normalised for women, while simultaneously seem to be too much for the population at large. Women consistently report experiences of not being listened to in healthcare. As engender set out recently, and I quote, they wait longer for pain medication than men, wait longer to be diagnosed, are more likely to have their physical symptoms ascribed to mental health issues, are more likely to have their heart disease misdiagnosed or to become disabled after a stroke and are more likely to suffer illnesses ignored or denied by the medical profession. So there's a huge amount of work that needs to be done to rectify that situation. The women's health plan will be a start but it's taken such a long time to get the conversation started so we shouldn't underestimate the effort it will take to establish real change. The determined campaign run by mesh survivors is a testament to that. Their experiences of botched treatment are nothing short of a public health catastrophe but the response from the Government has been slow. Presiding Officer, their asks shouldn't be up for debate. We need to do whatever it takes for these women. Funding for removal surgery so women have a choice about where this is done and who by, and a patient safety commissioner and a statutory ban so this never happens again. My amendment, had it been selected, raised the question of dedicated facilities for perinatal loss. Louise Caldwell has campaigned bravely on this issue. She was required to deliver on a labour ward after being told that there was no heartbeat at her 12-week scan. She said and I quote, as soon as you entered the labour ward you were met with newborn baby photos on walls, thank you cards, baby cries and proud partners. It's really difficult to imagine how hard that must be. Official guidance says that separate facilities should be provided. So while there may be recognition, as Louise's experience shows, that recognition does not always translate into reality. There needs to be a standard of care for perinatal loss equivalent to that provided to patients undergoing labour and delivery. Perinatal mental health also needs to be brought to the forefront of the plan. A 2018 report showed that only Glasgow in the whole of Scotland was meeting perinatal mental health requirements. Mothers in half of Scotland couldn't access specialist services. This was years after another report warned of significant gaps. I hope that the minister might address that in her closing remarks, and commit to making perinatal health and mental health a cornerstone of the Government's plan. Thank you, Ms Wishart. That's all the amendments given an airing. We now move to the open debate. The first speaker will be Evelyn Tweed, followed by Craig Hoy. The chamber will be aware that this is Ms Tweed's first speech in the chamber. You have around four minutes, Ms Tweed. Thank you, Presiding Officer, and welcome to your new role. Also, congratulations to Mary Todd. It is a privilege and honour of my life to be standing in Scotland's Parliament making my first speech. I only wish my parents had lived to see this day. I have no qualms in stating that I come from a very poor background and have lived through periods of homelessness and living hand to mouth. Ms Tweed, I don't want to miss any of this, because you might just move your microphone up just a little bit. Is that better? That should be fine. Thank you. Growing up in a council estate in the thatcher years really shaped my views on social justice and led to a 25-year career in housing, building homes for people in need before I was elected as a councillor. I was once told by a friend that I should never go into politics as I cared too much, while I believe that all the best politicians care too much. That is why I got elected to speak up for the most vulnerable, to help people and to be a voice for women who, whilst on average enjoy longer lives, more of our lives are spent in ill health. For too long, women who are our mothers, daughters, sisters and carers have not been adequately supported, and I am so proud that an SNP Government has clearly improved women's lives. For example, Scotland was the first country in the world to have free-period products, and this shows what can be done when we all work in this chamber together. We have the fantastic baby box providing mothers with the essential items that they need for their new baby. We have more GPs per head of population than any UK country, but there is still so much more to do. Many health issues in the past have been described as women's problems, whether that be endometeosis or menopause, both of which I have experienced. I have endured endometeosis all my adult life, resulting in chronic pain and at times misery. This was dismissed as period pain, and it took until my late 30s when I collapsed at work to finally get some support. I don't want any other woman to go through what I went through. There is no cure, and as we have heard today, most women wait over eight years for a diagnosis, which is just not good enough. I am delighted that the SNP Government has committed to reducing the diagnosis time to 12 months by the end of this Parliament. It is also fantastic that we now talk openly about menopause, a process that will affect over half of our population. The SNP will ensure that women have improved access to advice and support on the diagnosis and management of menopause. Let's work together across this chamber to improve services and reduce health inequalities for women and girls. Let's become a global leader in this field. I ultimately believe that independence and having the full fiscal powers to make our own decisions will help us tackle all inequalities and ensure that all our citizens have equal access to food, housing and healthcare. As I draw to a close, allow me to offer my heartfelt thanks to the people who made my being here today possible. My brilliant husband Asan, my rock and love of my life, my daughter Emily, who is a force of nature and a campaigner extraordinaire. Our family and friends, my fantastic campaign team, my predecessor Bruce Crawford, my modern studies teachers at school, for my fierce love of politics and David Shearer, longtime friend and mentor, your advice paid off. Thank you to everyone who voted in the wonderful Stirling constituency. I commit now to listen to you, to be guided by you and to work for you. Well done, Ms Tweet. I call on Craig Hoy, who will be followed by Kenneth Gibson. Mr Hoy, four minutes. Thank you, Deputy Presiding Officer, and I welcome you to your place and also the minister to her new position. Deputy Presiding Officer, the consequences of Covid will live with us for a long time to come, and nowhere will those consequences be more severely felt than in our health and social care services. Failure will be measured in lives lost, life-threatening conditions undiagnosed and mental health problems untreated. The consequences will be acutely felt by patients and their families, but they will also be felt by our front-line health and social care staff, and they are more likely to be felt by women. It will be your gran, your mum, your sister, your daughter, your wife, your civil partner, your aunt or your girlfriend who confronts those consequences and those inequalities. Take mental health. Across Scotland, we are facing an escalating mental health crisis, a crisis made worse by repeated failures by the SNP Government. Women are nearly twice as likely as men to confront the dark cloud of depression. One in five women suffered depression during pregnancy, and it's not just adult women. A study by Mindwell concludes that gender differences which can impact girls' mental health start to emerge at the age of 12. That's why the sudden and shocking surge in treatment times for child and adolescent mental health services must be urgently addressed by ministers. Campaign group Engender warns that women and girls face significant barriers to good mental and physical health for decades. They warn that women are often missed by health services or by public health awareness campaigns. I hope that the Scottish Government's women's health plan comes forward with robust interventions. Looking to social care, again, the shortcomings are more likely to impact women. In Scotland, there are twice as many women as men living in long-term care. The Scottish Conservatives welcome many of the findings of the freely review into social care. However, as we explore the creation of a national care service, we must reach beyond the vague but worthy goal of a system based on human rights. We must look towards a system designed around the needs of the individual, a system that marries traditional approaches with new technology, a system that supports home-based care so that more older women can live independently at home and for longer, a system that tackles the staffing and recruitment crisis, and a system that fixes the funding formula for the long-term. When we talk about recovery, we need to recognise the impact that Covid has had on staff in social care and our NHS, the vast majority of which are women. In fact, 11 per cent of working women in Scotland work in our NHS compared to just 3 per cent of working men. So, when our NHS staff talk of stress and strain, it is women who are most likely to be at the front line. Deputy Presiding Officer, we must do more to close the gender pay gap in our health and social care services. On average, women earn 18.2 per cent less than men in our NHS, and the gap is widest in admin functions and in personal and social care services. My colleague Annie Wells rightly set out the areas where women are being failed both in terms of diagnosis and in terms of access to primary care services. Women's health problems are often dismissed, underestimated or are simply diagnosed too late. Women working in our NHS and our care services are often stressed out, burnt out, undervalued and underpaid relative to men. We need to recognise those problems, and we in this Parliament need to resolve them. If concerted action today is one of the few silver linings of the Covid pandemic, then we must work together to take it. I call Kenneth Gibson, who will be followed by Claire Baker. First, I congratulate my colleague Evelyn Tweed on her excellent first speech in this chamber. Women's health is important to men too. We have mothers, daughters, sisters, wives, partners, female friends and colleagues. In the treatment of illness, women cannot be second best. In 2019, I participated in a meeting of the cross-party group on women's health, ably chaired by Monica Lennon, at which the British Heart Foundation's report, Bias and Biology, was presented. Shockingly, the report showed that ischemic heart disease, the leading cause of death for women in Scotland, is more likely to go untreated, undiagnosed or diagnosed later in women than in men. There is also less awareness of symptoms, signs of heart attacks as they happen and the lower likelihood of receiving scans. A previous BHF-funded 2018 study showed that women who have an instemi, non-ST elevation myocardial infarction, a type of heart attack where the coronary artery is usually partially blocked, are a shocking 34 per cent less likely to receive coronary angiography within the symptoms of the first symptoms than men. My last question in this chamber before Parliament dissolved in March was how much progress had been made in addressing this over the last two years. It was encouraging to hear from the previous public health minister that the women's health plan will include cardiac disease as a key pillar and implementation will align with the heart disease action plan, which highlights the importance of tackling inequalities in access to diagnosis, treatment and care. I look forward to actions evolving from both plans and believe that ministers should strive to ensure equality of health outcomes at the earliest possible date. Women may have a higher life expectancy than men, but quality of life matters too. The SNP-2021 manifesto includes a commitment to improve the experience and diagnosis of women who visit their GPs with menstrual problems. Improved diagnosis and management of the menopause and legislation in aid of transvaginal mesh survivors will also help better the quality of many women's lives. Scottish ministers will explore ways in which the baby box can be used to further promote women's health and support parental mental health. The time is also right to progress the women's health plan since it first appeared in the 2019-20 programme for government. Much of the focus and many resources relating to health understandably shifted during the past 16 months. However, I am glad that the plan is prioritised in the Government's first 100 days. The Indo warriors and other women across Scotland will be pleased to see endometriosis specifically mentioned in the Government's motion. The sad reality is that it is only over the last few years that endometriosis, which Evelyn Tweed described her own experiences, has been recognised as a hugely impactful condition for one in every 10 women. At the opening of the west of Scotland accredited endometriosis unit in April 2019, which I campaigned for, it means that women and girls who live in the west and require specialised treatment no longer have to go to Edinburgh or Aberdeen with travel often prohibitive for financial reasons. Nevertheless, the fact that my February 2017 endometriosis debate was only the second in 18 years of this Parliament, the first being led by Annabelle Goldie in the first Parliament, and it took another two years for NHS Greater Glasgow and Clyde to set up the specialist unit, sales me women's health has not always received the urgent focus, I believe it merits. The SNP manifesto commits to reduce average waiting times for diagnosing endometriosis from eight years to less than one by the end of this Parliament, as we have already heard. This is ambitious, given that such a difficult conditions diagnose, but it is an ambition that is worth striving for and one that I will follow closely. I would finally like to remind any new male MSP that is also your place to these issues concerning women's health. We must all do what we can to improve women's health. It is important for every one of us. Thank you, Mr Gibson. A timely warning to all of us. I now call on Clare Baker, who will be followed by Emma Roddick. Ms Baker, four minutes. Thank you, Deputy Prime Minister. I very much welcome this afternoon's debate on women's health. The creation of a plan which provides a co-ordinated inclusive strategy for women's health is overdue and I am pleased that this session of Parliament is looking to focus on women's health, bringing together many of the issues that MSPs and campaigners have pressed on for years. It is welcome that we recognise the connectedness of all these issues that women's health has been marginalised and acknowledged devalued and that there has been and continues to be systematic or institutional or societal failures and the treatment that women receive and the public health messages and support that they receive. Invisible women, the book referred to by the minister, revealed inequalities of a society which is created for men. From the ridiculous, the temperature within our offices to the dangerous, the design of seat belts and cars, the needs of women were just ignored, perhaps not deliberately or maliciously, but women were treated as second-class citizens, given not even an afterthought in planning or design. That has affected all areas of society, including healthcare. Perez highlights the example of health disease, its perception as a male disease and the consequences of women facing misdiagnosis and disadvantage in treatment. It is also addressed in the British Heart Foundation's bias and biology briefing paper, as mentioned by Kenneth Gibson. It is welcome that the Scottish Government is now recognising the specific needs of women with heart disease, but the study points towards inequalities at every stage of a women's medical journey. The importance of a much broader rethink, which I hope the women's health plan will bring. The lack of support for women experiencing perimenopause and menopause is gaining a higher profile, and that is welcome. We are seeing more open debate and discussions about symptoms that women can experience and more effort to reduce stigma to tackle shame, which is driven by decades, if not centuries, of the representation of women as crazy or barren, simply for experiencing a natural process. In her book, Perimenopausal Power, Maisie Hill makes clear the broader impacts of menopause symptoms and how those can affect relationships and work performance. The average age of menopause is 51, and the age group with the highest suicide rate for women is 50 to 54. That is a stark fact and one that only highlights the importance of evidence-based guidance and support being provided, including the use of HRT. It is vital that women can access proper support and routes to specialist care need to be improved. While there is only one specialist centre in Scotland for menopause, the first poster of call in most instances is a GP. He must ensure that women are confident that their concerns will be listened to by GPs and not be deterred for asking for help. Misdiagnosis is a key issue in women's health, and too often women have felt that they have had their point of view dismissed when approaching their GP. GPs must increase the number of specialists available and training for GPs, reduce waiting times and encourage self-referral so that access to treatment is straightforward and responsive. We need to say workplace strategies that better recognise change throughout women's lives and how they impact on their working lives. The Alliance report on future planning was brought together by the lived experience subgroup of the women's health group. Women highlight difficulties in accessing services, particularly for some marginalised groups. They also highlight that there was no mention of mental health in the plan with the focus on physical health, although I recognise the minister's opening comments on that. Making appointments around work and caring responsibilities is still difficult. The need for GP referrals for specialist services can add up further layer of delay. Requesting female JPs or interpreters can put additional pressure on those seeking appointments. We must have clear, accurate and up-to-date information available online, including in accessible videos and a range of physical locations in other language. I will briefly mention the need for investment into research and women's health. A women's health plan is vital to address inequalities in health provision, to provide standards and deliver expectations for women's health needs and to ensure that when women seek health services they are taken seriously and provided with choices to enable them to live healthy, rewarding lives. Thank you very much. Ms Baker, I now call on Emma Roddick to join us remotely after which it will be Rachel Hamilton. Ms Roddick, four minutes please. Thank you, Presiding Officer. In my first speech, I raised the hope that our new minister for women's health would place importance on improving treatment for endometriosis and menopods. I want to repeat that hope today and also urge the Scottish Government to address in the women's health plan what is more than a shortfall that a result of many years of lack of understanding, concern and care in our society to do anything about substandard care. It is not simply a political problem. It is ingrained. It is an issue in medical research. It is an issue in academia and in society in general. Women's health takes a backseat. We get fewer research grants. We take the birth control. We take the hit. This Parliament must show leadership on this issue. I talk about the value of lived experience a lot and this is an issue where it is necessary. Perception does not always match reality and it is vital that any discussions about these issues are led by those who experience them firsthand or outcomes are going to be ineffective. Particularly when we talk about issues like menstruation and menopause which have historically been ignored or hidden away. To continue the conversation as it is now means to work off outdated assumptions, myths and misbelief. We have to start again. I also hope that while we are describing these issues as women's health issues efforts will be made to make sure that people who are not women but also suffer these issues feel able to enter the conversation and seek better care. Given that we still are not past the point of requiring euphemisms to talk about periods or using blue liquid to denote menstrual blood it is going to be quite a challenge to raise awareness about treatment standards for endometriosis and dysmineria. But we must. As someone who has been hospitalised to my period I hope to see wider recognition that for many who menstruate it is not just a cramp it is not just an annoyance it is something that causes excruciating pain which not even morphine willfully really. It is something that prohibits your mobility and causes chronic pain throughout the month and is often completely misunderstood and stigmatised by workplaces or even doctors themselves. I am really glad to see the Scottish Government aims to reduce waiting times for a diagnosis of endometriosis to 12 months. However, in order to do that we have to recognise and admit that one of the reasons it takes so long at the moment is that those seeking help with their periods are being dismissed. We are accused of exaggerating pain of it being because we are size 14 instead of size 8 and especially if you have mental health issues of being essentially hysterical with doctors suggesting it's all in your head as you're curled up on the bathroom floor screaming in pain and waiting for an ambulance. It's not just that there's a long assessment period or a lack of research and available treatment it is that we are sent home from the GP over and over with a wave of the hand, a pack of paracetamol, a prescription for methanamic acid and then maybe if we're lucky an appointment with someone else in a few months. Given how hard it is to break down assumptions about menopause I realise it's going to be quite a challenge to raise awareness of early menopause but we must do that as well. If an employee approaches their boss and says they're struggling and the reaction is a laugh, a joke or disbelief because they're not old enough that's unacceptable. Presiding Officer we have a long way to go and I'm committed to doing my bit to bring lived experience into the discussion raise awareness and work with the Government to make life better for those suffering issues typically experienced by women but we must begin from a point of understanding just how bad the situation is. Thank you. I call Rachel Hamilton to be followed by Siobhan Brown. Thank you Presiding Officer. Never has there been more pressing time than the present to debate women's health issues. After the past 15 months we have seen waiting times saw an increase in the backlog of cancelled operations and cancer diagnostic tests shelved. Even young pupils have been affected by not receiving either the first or the second HPV vaccine within the 18-month time which is crucial at this stage when these young people are becoming sexually active. In the coming months it is crucial that we have these services fully up and running. Women's health has far too long taken a backseat and I'm keen to see change as are so many people in this chamber. A starting point for me came in 2019 when Monica Lennon and I hosted an event with the British Heart Foundation to discuss women's health inequalities particularly on diagnosing heart disease. At a similar point, Caroline Criado-Perra's book was published addressing a clear gap in women's health treatments as raised by the minister. More recently I was troubled by the experience of a friend from the Borders who has been waiting for an endometriosis diagnosis for years. Without a doubt, urgent action must be taken to address the appalling waiting time length in endometriosis diagnosis. It's very common. It affects 10 per cent of women from puberty to menopause. Although the impact, as Evelyn Tweed has described, may affect you for life. The average time for diagnosis has been stated as eight years. It's not, in Scotland, it's eight and a half, Presiding Officer. We know that access to services for these women is very difficult. The inquiry in the UK APPG attracted 10,000 responses and noted that in Scotland it's been difficult to access treatment. There are specialist units in Edinburgh, Glasgow and Aberdeen, but if you live out with those specific local authority areas, to use this description, it is a postcode lottery. Cabinet Secretary, these women are experiencing physical and emotional suffering and this government needs to act. The report is well worth a read. It commits to reducing the average diagnosis time to four years or less by 2025 and a year or less by 2030. I challenge this government to meet its manifesto commitment because it hasn't met any binding treatment guarantee time yet of 12 weeks. Cabinet Secretary, in Scotland our cross-party support ended period poverty and provided free sanitary products in schools. It's bought plaudits across the globe and therefore a reduction in waiting times access to specialist endometriosis service and menstrual health education in schools should be a key priority. I ask that the minister addresses this issue. Secondly, cancer diagnosis and treatment, especially cervical and breast cancer has fallen by the wayside during the pandemic with women particularly let down. 4,000 fewer people have received cancer diagnosis when cancer screening and detection tests were on hold from April to June last year and breast cancer represents almost a quarter of these missing cases over 70 per cent more than what would be expected, prompting fears that progress by the disease is in jeopardy. We need to see proper funding and I would also ask the minister if the cervical screening awareness campaign has been re-enabled. In conclusion I think I'm going to have to go to the end here but we on these benches today are calling to tackle the NHS backlog through our amendment we want to see a separate clinician led fund so that we can finally bring guarantees under control and we cannot continue on the trajectory that we're on. Women's health is at stake. I call Siobhan Brown to be followed by Martin Whitfield this is Ms Brown's first speech in the chamber. I thank the minister for the important debate today on women's health. It's so important that we do not ignore early signs of disease and early diagnosis can be life saving. As part of the Scottish Government health recovery plan we welcome the opening next week of the early cancer diagnosis centre in Ayr and encourage people not to ignore concerns and get in touch with your doctor. It is the biggest privilege to stand here today as a first SNP member and first woman to be elected to represent the people of Ayrpresswick and Trun at the Scottish Parliament. I would not be here today if it wasn't with the support and commitment of my campaign team and my staff who put their hearts and souls into helping to win this seat. Their extraordinary efforts mean that I am able to join my other four SNP MSPs together representing all the people in South Asia. I'd like to thank all the people that trust me with their vote and I will work hard to repay your trust. For those who didn't vote for me please be assured I'm your MSP too. I'm determined to represent each and every one of my constituents and my abilities in Hollywood. I would also like to pay tribute to my predecessor, John Scott who represented the people of Ayrpresswick and Trun for 21 years. Although our politics are different I have the utmost respect for him. He is a highly regarded member of the Scottish Parliament and I wish him health and happiness. Politics and public life can be somewhat challenging at times to family life so I'd like to thank my husband and I'm lucky to represent a beautiful part of the world on the picturesque west coast of Scotland. It's the air seat but it also includes the neighbouring towns of Presswick and Trun. We have many valuable resources such as our world class golf courses, Robert Burns heritage, Presswick airport and aerospace industries, Trun Port and Yotmarina, a university of west of Scotland campus and in normal times a buzzing restaurant and nightlife. If you've never been before I'd like to visit my constituency whether permitting you might be rewarded with a sunset over Arran which even during a pandemic you will appreciate life. My constituency is fortunate to have many areas of affluence but it also has very high areas of levels of deprivation. Years of Tory austerity have impacted heavily on the resilience of our poorest communities and increased the difference in life chances of our young and our old. A child is twice as likely to be growing up in poverty in some parts of the north as one living in Trun for example and the life expectancy of a child born today is around 10 years less in our poorest areas to our most affluent. Tory austerity and social welfare cuts have exacerbated inequality. This cannot be denied nor excused and more so since they have now been revealed as a deliberate policy choice and not an economic necessity. That's why the Scottish Government's renewed commitment to tackling child poverty is so welcome. Measures like doubling the Scottish child payment of £20 per week in the first year of Parliament already described as a poverty game changer will help give the children in our communities the life chances we wish for them all. There are inequalities in our communities at the other end of the age spectrum too. I'm sure MSPs are aware of the levels of pension of poverty are higher and the state pension is lower in the UK than in most of Western Europe. The stolen pensions from the Waspie women is a national scandal. Given that the proportion of my constituents over 65 is higher than the average for Scotland this is a huge concern to me. In one of the richest countries in the world all our elderly citizens should be able to live in dignity in old age and receive the levels of care they deserve. I'm delighted that the Scottish Government has made it a priority to establish a national care service on par with the NHS and has committed to scrapping charges for non-residential care. Perhaps the most important of our local assets are our young people. Like kids pretty much all around the world the pandemic has had a huge impact on their education their lives in general and even their mental health. As we help our young people get their lives back on track we must take the opportunity to consider what kind of country we want them to grow up in and who we want to lead a fairer, greener recovery. That's something that should be and will be decided by the people of Scotland. They have returned an SNP to government with a landslide victory and their will has to be respected. The Covid pandemic needs to be a priority but when the time is right the people of Scotland should have the choice to determine their future. This is not about being divisive this is about being democratic. Thank you. Thank you. I call Martin Whitfield. I'm grateful presiding officer and it is a true tribute to follow Siobhan Brown in such a powerful first speech and she speaks so powerfully of her community and I think they bode well in her hands although clearly with a slight political disappointment from this side of the chamber. I would like to take the short time that I have in this debate to talk about menopause and to follow on from Claire Baker and indeed Emma Roddick's powerful contributions and also to invite the cabinet secretary at the end to expand on the welcome inclusion of the word menopause in the motion. Back in 2018 on world menopause day I led a backbench debate in Westminster and although the debate itself was supported across the house it is sad that in reality so little has changed since then. I embarked on my new career in the 1950s and I cannot imagine embarking on a new career struggling with some of the symptoms that my female counterparts experience and suffer without help or support. Indeed, I think it is unthinkable that a society would ask men at the height of their careers to simply tolerate the symptoms to carry on. Actually can you do it quietly as well? Why should women? All too often the menopause is seen as something that women need simply to cope with and they are afraid to discuss the symptoms openly with friends, family and sometimes most importantly work colleagues because they are afraid of being undermined and indeed perhaps marginalised. Seventy per cent of women do not discuss their symptoms at work a third do not visit their GP. Fifty per cent report the menopause affects their mental health and their ability to work. To echo the STUC General Secretary Ross Foyer who was called for a sea change in workplace attitudes in order to ensure that women struggle to get simple adjustments to their working conditions. Women workers are being failed by employers. They make no provision for the impact of the menopause. The STUC Women's Committee report back in January 2018 identified that 99 per cent of respondents either did not have or did not know if their workplace had a menopause policy. 32 per cent said the menopause was treated negatively at the workplace and was frighteningly. 63 per cent said the menopause had been treated as a joke. The STUC have called for greater development of menopause workplace policies to better support staff who are experiencing the menopause as well as to educate the wider workforce to help to remove the associated stigma. As my colleague Carolyn Harris MP in Westminster quoted from a call to evidence only a few days ago the experience reported is worth repeating. Simple changes in the workplace such as flexible working hours, relaxed uniform policies, adaptations to the working environment can make all the difference. I commend the Law Society of Scotland for their work with PEPI to develop menopause advice for employers. We on this side have called for the introduction of a right to choose flexible working for all workers for women experiencing the symptoms of menopause. A flexible working could help them manage potential tiredness, work from home where necessary or even take time off to attend appointments. I welcome the SNP manifesto commitment to launch a public health campaign to remove the stigma and raise awareness of symptoms of menopause. I look forward to confirmation that this will appear in the plan. I also welcome the minister's confirmation that women's health is important. Scottish Labour believes that we need to improve access to specialist care in Scotland so that women have access to good advice about the menopause and no longer face long waits for diagnosis. There is good practice to model this on. NHS Dumfries and Galloway, Lothian, Fife, Grampian have all specialist menopause clinics. I stand here in this debate as a man and it has to be said that it is time for men to show their solidarity and to break a taboo about talking about the menopause. So I ask every man in this place, I ask every man who is watching, every man in that, well no, I just ask men, can you be brave enough to say, could you tell me, can you explain, will you share, to do so with sympathy and empathy? So my challenge to this Government is this, little has changed since 2018, can you start that change regarding the menopause in the next 100 days? Thank you. I call on Gillian Mackay. Thank you Presiding Officer and I'd like to offer my congratulations to Evelyn Tweed and Siobhan Brown on their first speeches. Many colleagues have raised the importance of women within the NHS and the social care workforce during this debate and once again my heartfelt thanks go to every single one of them and I really don't think we can ever say it enough. I mention the heroic efforts of transvaginal mesh survivors, the injuries they've faced at appalling and we must ensure that they have the resolution they need and they can be assured of our support going forward. Many colleagues have also noted that women generally live longer. We have to ensure that women receive the later life and end of life care that gives them the dignity and choice they deserve and choice within palliative care is essential. One of the greatest barriers to women receiving healthcare is access. Women report difficulties in accessing appointments and how to fit them around to caring, childcare and other responsibilities. We need to make sure that there are flexible appointments for those that need them and we need to make sure that those flexible appointments are at convenient times. Those difficulties are often exacerbated for women from BAME backgrounds, disabled women or gypsy traveller women. I've spoken several times to work across portfolios to ensure that we deal with both the inequalities and particular services as well as other factors that exacerbate those inequalities. Income inequality is a driver of poor health. With a lower income you're less likely to be able to afford good quality food and more likely to live in poor quality housing and ultimately are likely to die younger than their peers. Food bank uses it at a high and part of that is exacerbated by inequalities. Being on furlough of 80 per cent of what already was poor wages is not making that inequality any better. This is something that we have an obligation to take really seriously this session. Public Health Scotland suggests in the website that this could be done through a universal basic income and this is something that we would obviously support. The national care service will also be important for women's health over the coming session. As we are all aware, providing care and particularly unpaid care is a highly gendered role. The establishment of a national care service will hopefully work to removing some of that burden. Guaranteed minimum respite hours for unpaid carers would give women in particular the ability to plan in breaks. As I said earlier we believe that carers should be entitled to flexible healthcare appointments. Mental health is an area that is not particularly covered when we talk about women's health. As many have talked about at various times mental health support is critical whether that be in supporting those with post-natal depression or women struggling with menopause. We need to see a shift in funding for mental health and more of a focus put on talking therapies and peer support. Many women I have spoken to referenced that particularly with menopause support for women. To finish off, I also wanted to mention the improvements that we need to make as I am erotic outlined in making improvements to trans and non-binary healthcare when we are designing services. Some non-binary and trans people bleed. They will require many of the services that we have spoken about today and we need to ensure that those services are accessible to them as well while ensuring they meet their needs. We need to end the years-long waiting for gender clinics of the often very marginalised community. Thank you. I call on Jackie Baillie. Thank you, Presiding Officer. Can I start by also congratulating Siobhan Brown and Evelyn Tweed on their first speeches in the chamber? I welcome the opportunity to close the debate for Scottish Labour and it has indeed been encouraging to see the contributions across the chamber that point to areas where members can work together and make early progress. Carol Mocken was right to reference Monica Lennon's bill on period poverty as ground-breaking. It was initially opposed by the SNP but we do welcome all converts. There is also unfinished business for mesh survivors and I will turn to that later. Claire Baker talked about the need for specialist menopause services. Martin Whitfield also talked about workplace strategies to support women experiencing menopause and spoken about stigma powerfully as Emma Roddick did in her contribution. There is equally much to welcome in the minister's opening speech and I very much look forward to working with her because we do need more than just a women's health plan in the first 100 days of this Government women need to see action and they need it now because for the first time since modern records began life expectancy in 2015 to 2017 dropped on the SNP's watch. Life expectancy of women from the least deprived areas where you compare that to the most deprived areas there is in fact a 10-year gap and Scottish women have the lowest life expectancy of all the UK countries so we need action action on a catch-up plan for breast cancer screening cervical cancer screening to clear the backlog and identify patients in need of treatment cervical cancer recovery group tell us that they don't know when the 36 month interval will be the norm for breast cancer screening can the minister tell us that in her closing speech they also note that the self-referral process for women over 70 has been paused and remains paused can the minister tell us when this will resume and what about the persistent inequality that exists between poorer households and women in cancer incidents in poorer areas and as Kenny Gibson rightly raised action on endometriosis services and waiting times action on specialist services for women experiencing menopause Presiding Officer there is a significant agenda here and I do look forward to working with the minister to improve services for women and ultimately to improve women's health but I want to use the remaining time survivors campaign the mesh scandal started when I was last shadow health spokesperson I met Elaine Holmes and Olive McElroy founders of the mesh survivors group more than five years ago progress has been glacial despite the considerable efforts of those formidable women and colleagues in the chamber principally Jackson Carlaw Alex Neil and Neil Findlay the latter too have of course so we need to make sure that the focus remains because there are hundreds and thousands of women who are suffering because they have been injured by the use of mesh implants in their surgery the extreme pain that many women suffered was denied by clinicians and denied by the Scottish Government for too long the group have produced a charter of mesh care calling for the suspension of the use of mesh until there is a statutory ban calling for a mesh removal fund to pay the cost of mesh removal to be a surgeon of the patients choosing and that also covers those women who have been forced to pay for removal surgery that was simply not available in Scotland the minister will be aware that doctor Veronica offered to help to remove mesh from Scottish women using a tissue sparing technique his offer appeared to be blocked by the Scottish Government something subsequently confirmed that the women had their own mesh expert that was bad enough but there was a further scandal women operated on by Scottish surgeons were told that their mesh had been completely removed but that simply wasn't true the removal was only partial now we have a Scottish centre of excellence for mesh removal but are they removing all the mesh we don't know we don't even know if there's further muscle or tissue damage that is being monitored and reported on and the minister will be aware that women do not want to see the same surgeons removing the mesh that implanted it in them in the first place doctor Veronica has submitted a tender to carry out mesh removal he did this three months ago but since then nothing has been heard Presiding Officer the women simply cannot wait any longer and I genuinely hope that the minister agrees with me and agrees to take urgent action not just for the mesh women but actually for all women in Scotland I pledge again to work with the minister in the interests of women but there needs to be a greater sense of urgency about the challenges women face and the pace of change needs to be faster thank you thank you I call Sandesh Gohan thank you Presiding Officer declaration of interest I'm a practicing doctor healthcare inequality exists in fact it is rife both in the health service and society at large this is never more true than with regards to gender women's health has long been an issue denied by, dictated by and decided by men now it may seem perverse therefore that I am standing up here about it but when I see the needs of my patients not being addressed then I am forced to speak up and we need to be clear that women includes transgender patients trans men and non binary individuals require access to many of our services in a sensitive and inclusive manner if Scotland is your home then you are one of us the root of our problem is that health and care systems have been designed by men for men white Caucasian men are the default patients research models and target demographic in a lot of cases and sadly very little has been done to alter the status quo of the system since its inception to better represent our current society and values women's health has been marginalised and stigmatised with taboos look at the stigma of the HPV virus in cervical cancer and screening of teaching and research inequalities women also suffer when it comes to work bearing the brunt of childcare and tending to have less job security and the gender pay gap as Craig Hoy just talked about includes the NHS we therefore are already behind the curve when it comes to gender equality as we are rowing against hundreds of years of unequal tides but surely it's better today I hear you say well during the pandemic female staff had significant trouble finding PPE that was fit for purpose because and you guessed it the masks were designed to be fitted on men this literally put women's lives at risk and this is simply not good enough and don't be fooled that newer interventions are ironing out the inequality the digital revolution in healthcare is in fact reinforcing these stereotypes currently used treatment algorithms in primary care are sexist a man presenting with chest pain requires accent and emergency assessment as he could be having a heart problem but a woman presenting with chest pain is thought to be panicking or anxious it is no coincidence that historically the Greek root of the term hysteria pertains to the uterus this is how inculculated such ideas have become they are interwoven into the very fabric of the language we use we need to stop this casual sexism from creeping into our systems and for that we need a bottom-up rethink we need to change the way we teach topics at medical school to include period health, fertility, menopause endometriosis to better represent practical health problems women suffer and on endometriosis Rachel Hamilton and Annie Wells spoke of the distressing eight and a half year wait for diagnosis Evelyn Tweed spoke eloquently on her maiden speech about the misery, pain and cyclical nature of this horrible disease I see all too much of it in my surgeries we need to equip young women with the tools and education they need sex education that includes menstruation pregnancy contraception FGM female genital mutilation termination LGBTQ plus and of course healthy respectful empowered relationships Deliver this to our youth if I get some time back I'm grateful to the member In the last parliamentary session at the cross-party group on women's health we heard time and time again that women are not believed to be informed and feel empowered to raise issues with their GPs and other clinicians What would the member's advice be to GPs about the action they can take to actively listen to what women are telling them? Sandish Gohani Thank you The RCGP and as a new GP what we do is we go through a training programme where it's patient centred and patient focused and patient are believed we have to believe our patients so if a woman feels that they are not being listened to then my advice to them would be to go back and keep going back until they get the help that they need So sex education that includes menstruation, pregnancy, contraception FGM, termination LGBTQ plus and of course healthy respectful empowered relationships Deliver this to our youth and it gives them information and power enabling girls to make the decisions by choice not by chance I wrote an article in Centric magazine in March describing how Covid has disproportionately affected women as recognised by Marie Todd This impacts their mental and physical health and social wellbeing Women are also at an increased risk of getting long Covid As declared earlier I'm a practicing GP having also worked almost a decade in hospital So when last week the cabinet secretary explained to our primary care and secondary care work I would like to point out that the situation on the ground is vastly different to what he sees in the top down view We need long Covid clinics better than England using their best model as our basis Kenneth Gibson, Gilliam McKay and Claire Baker spoke of ischemic heart disease which actually kills three times more women than breast cancer in Scotland and that's been recognised by the British Heart Foundation of Scotland Ischemic heart disease in women, as they say is under aware, under diagnosed under treated and under supported Carol Mocken and Martin Whitfield spoke of menopause ataboo subject in workplaces where women suffer physical and mental issues in silence We need to be more open and I would encourage these women to come to your GP as we can help I would like to congratulate Siobhan Brown on her maiden speech and would agree on the beauty of air having worked in air hospital for a year In conclusion, Presiding Officer there is much to address with regards to women's health there are many wrongs to write and the inertia, resisting change within healthcare systems can be exhausting at times but all these seemingly insurmountable barriers to our sisters, mothers, friends, patients and to my daughter I would like to be able to say nevertheless we persisted Thank you I call on Marie Todd to wind up the debate Minister you have nine minutes Thank you very much Presiding Officer and thank you colleagues I'm very grateful for your contributions today many issues have been raised and I'll try to respond to all of them but let me emphasise first that my door is open and I'm keen to work cross-party on all of these issues I'd like to say well done to Evelyn Tweed and Siobhan Brown on their first contributions in this chamber just wonderful to hear from them and I'm sure there will be many more wonderful speeches from them A number of people said that people want action, women want action, not just warm words so although the plan is yet to be published I thought I'd update you on a number of progresses that we have made in implementing some early deliverables relating to the plan Throughout the development of the women's health plan women have consistently told us that they want information and support to enable them to make informed decisions about their own health and healthcare and we've listened and we've launched two women's health awareness campaigns on the NHS Inform website the first relates to general health throughout the life course and the second is a specific women's heart health campaign as we've heard repeatedly throughout the afternoon that is a specific area that needs attention women have also told us how important access to high quality menopause support and carers a menopause specialist network has already been established and is meeting regularly online to provide consistent advice and peer support the network supports primary care teams by providing access to a menopause specialist for consistent advice, support, onward referral, leadership and training On the issue of cervical cancer I can confirm to Rachael Hamilton that the TV ad campaign on going along for your smear has resumed and just yesterday the Scottish Government lit up the St Andrews House because it is Cervical Cancer Awareness Week To Carol Motion I would say you will be aware that there has been a global pandemic so when that last year one of the toughest decisions that had to be made in the face of that pandemic last year was pausing the bowel breast cervical and abdominal aortic aneurysm and diabetic eye screening programmes the pause was implemented to reduce the risk of participants becoming infected with Covid-19 and to enable physical distancing and to minimise the impact on essential NHS services as they responded to the virus I'm pleased to say that the pause was short so we restarted again in summer last year undoubtedly the infection prevention and control measures and the social distancing have limited capacity but we put in extra money towards cervical screening and there has been an extra £1 million to support capacity in cervical screening in sample taking and culposcopy and there's also two additional mobile breast screening units which have been added to the service to support the breast screening programme and to help it to recovery and there will be further details coming in the remobilisation plan which we've committed to in the first hundred days just how exactly we get back to where we were before with all of these programmes also on cervical cancer Annie Wells raised the issue around health inequality so in many cases women who experience poverty have put out outcomes and one of the things that we're doing to tackle that is running a working group to consider how self-sampling for cervical cancer can be introduced into the screening programme and that could help to significantly tackle inequalities but the UK screening committee hasn't yet approved it so that's why we are developing the evidence through the working group and that's an issue that one of the Labour members raised in terms of contribution to research on the issue of mesh many of us who have been here for some time have been aware of the challenges around this issue and just how profoundly it has impacted on the women affected the Scottish Government committed in the 2021 manifesto to pursue the outcomes that were sought by the Scottish mesh survivors charter the use of transvaginal mesh was formally halted in NHS Scotland in September 2018 and we've committed to continue that halt substantial progress has been made to improve services for women with complications as Jackie Baillie outlined the new mesh removal service will be subject to continual improvement which will be informed by consultation with patients and I hope that will go some way to rebuilding the trust which has been so shattered for those women involved there will also be a bill introduced into Parliament very soon I believe which will allow reimbursement of women who have previously sought private mesh removal so many of the asks that that particular group of women have made to us we will be pursuing and I hope that that will help to bring some closure for those women who have been most profoundly impacted I'll give way Jackie Baillie Thank you very much I welcome much of what the minister has to say but Dr Veronica's submitted a tender to carry out mesh removal surgery to the Government three months ago we haven't heard anything yet the women are desperate for this to happen can she advise whether there will be progress made quickly Minister The short answer is yes NHS Scotland has invited tenders to allow appropriately qualified surgeons to perform mesh removal for patients in Scotland where patients who want it to take place outside the NHS and surgery carried out through this process will be free to patients but there is a tendering process in place and we need to leave that to take its course but yes it will be we are pursuing it on the issue of endometriosis endometriosis affects about one in ten women as many people said it's a very common illness it's as common as diabetes and as common as asthma and yet it is rarely talked about it is dismissed and women are often feel that they are not listened to when they raise the issue of endometriosis it is still taboo even in this day and age to be talking about menstruation and endometriosis I'm glad to say that we are working very closely with Endometriosis UK to improve the situation for these women Endometriosis UK and Public Health Scotland officials have been working together to analyse some of the data so we heard some anecdotal evidence around women's experience absolutely vitally important but the data shows us that there are blockages to treatment and support at primary care level and there's a real opportunity for us to address these blockages and to make improvements by implementing the nice guidelines improving menstrual health resources and education and these opportunities are currently reflected in the women's health plan actions Rachel Hamilton Has that gap analysis been published? Minister I'm not sure but I can certainly update you it certainly won't be we're working very hard to produce this women's health plan it'll be part of the information in there it is certainly public because we are working alongside Endometriosis UK and Public Health Scotland to tackle it so I'm more than happy to share it with you at some point as I said progress is underway to improve implementation of those nice guidelines in the development of a pelvic pain pathway and that support primary care to recognise the symptoms for endometriosis and provide a timely, standardised referral care pathway for women with suspected endometriosis and along with Endometriosis UK we've also recently updated NHS informed pages which is an excellent resource even more widely accessed during the course of the pandemic and I hope that that will support women to recognise the signs and symptoms of endometriosis and speak to their GP now there have been a number of issues raised and covered during this debate I don't think we'll achieve this ambition overnight that is why much of our work around the women's health plan is about building the foundations for change building consensus and striving for long-term change this is our opportunity to address systemic inequalities for women and to build a fairer future where health outcomes are equitable right across the whole population of Scotland so that women enjoy the best possible health throughout their lives and it is now is the time to act for the women of Scotland let's work together to be world leaders in women's health thank you that concludes the debate on women's health and the next item of business is consideration of motion 395 on suspension of standing orders and I call on George Adam on behalf of the Scottish Government to move the motion moved Presiding Officer thank you no member has asked to speak on the motion the question is that motion 395 be agreed are we all agreed the motion is therefore agreed the next item of business is consideration of three parliamentary bureau motions I asked George Adam on behalf of the parliamentary bureau to speak to and move motion 392 on temporary rule changes and to move motions 393 on establishment of committees and 394 on committee remits thank you Presiding Officer initially I would just like to speak on motion 392 which sets out a temporary change to the standing orders in respect of the remit of the mandatory committee European Europe and external relations committee the remit set out in rule 6.8 of standing orders for that committee refers to matters that are no longer accurate following the UK's departure from the European Union the motion before the Parliament today sets out an alternative remit and name for the committee the constitution Europe external affairs and culture committee once committees are established it will be a matter for the SPPA committee to consider and make the recommendation to Parliament on the permanent change to the remit of that committee the temporary rule will therefore apply until either 31 December 2021 or until the Parliament takes a decision on a permanent amendment whichever is earlier for clarity members may wish to note the temporary rule change would take effect immediately after it is agreed by the Parliament and the name and remit set out in the temporary rule are therefore reflected in motion 393 on the establishment of the committees which the Parliament will also be asked to agree today and on that note Presiding Officer I'd like to move the other amendments as well thank you the question on these motions will be put at decision time there are four questions to be put as a result of today's business and the first is the amendment 369.1 in the name of Annie Wells which seeks to amend motion 369 in the name of Marie Todd on women's health be agreed are we all agreed the Parliament is not agreed therefore we will move to a vote and there will be a short suspension to allow members to access the digital voting system