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Cabinet Secretary for Health and Social Care submission of 25 January 2022

PE1924/A - Complete an emergency in-depth review of Women's Health services in Caithness & Sutherland

Thank you for your email of 20 December 2021 inviting me to respond to petition PE1924: Complete an emergency in-depth review of Women's Health services in Caithness & Sutherland.

The petition raises a number of important issues and I understand that as MSP for Caithness, Sutherland and Ross the Minister for Public Health, Women’s Health and Sport is actively engaging with her constituents on these issues.

Women’s Health is key priority for this government which is why we published an ambitious Women’s Health Plan in August 2021. The Women’s Health Plan underpins actions to improve women’s health inequalities by raising awareness around women’s health, improving access to health care for women across their life course and reducing inequalities in health outcomes for girls and women, both for sex-specific conditions and in women’s general health.

The life course approach emphasises the importance of identifying opportunities to prevent disease and promote health at key stages of life from pre-pregnancy through pregnancy, childhood and adolescence, to adulthood and later life. Promoting health and disease prevention can include ensuring women have information about the benefits of building and maintaining a healthy lifestyle including being physically active and maintaining a healthy weight. It also recognises that the social determinants of health shape our health and wellbeing throughout life, and that if we can improve the conditions of daily life we can reduce health inequalities throughout a person's life. A Ministerial portfolio which is sufficiently broad to affect change across the areas which support our ambitions of building and maintaining a healthy lifestyle, and which includes physical activity and public health, is important in promoting a life course approach across healthcare services.

The Women’s Health Plan sets out 66 actions to ensure all women enjoy the best possible health, throughout their lives. It takes on board the real life experiences of women who have told us what is important to them, including those issues highlighted in the petition.

Key actions include:

• appointing a national Women’s Health Champion and a Women’s Health Lead in every NHS board;
• commissioning endometriosis research to develop better treatment and management, and a cure;
• developing a menopause and menstrual health policy and promoting across the public, private and third sector

Menopause is one of the top priorities of the Women’s Health Plan. It is an important transition in women’s lives, but one that many know little about. Women of all ages should know what to expect from menopause, what the symptoms are, and what can help them so they are not taken by surprise by any changes, either physically or mentally. One of our key priorities within the Plan is to ensure that women who need it have access to specialist menopause services for advice and support on the diagnosis and management of menopause.

A Menopause Specialists Network has also been established and is meeting regularly online to provide consistent advice and peer support to healthcare professionals. The Network supports primary care teams by providing access to a menopause specialist for consistent advice, support, onward referral, leadership and training. It is open to all NHS board areas and includes members from NHS Highland.

It is essential that women get the support they need, when they need it and for as long as they need it. Women must be provided with consistent information and care when they seek help for menopause symptoms – however they access this support. In October 2021 we launched a new menopause platform on NHS Inform, which is the first phase in the development of a comprehensive, women’s health platform. We will also be taking work forward to ensure that support is available to women who cannot, or prefer not to, access information online.

Additionally the Scottish Government’s 2021 Manifesto made a range of new proposals in relation to women’s health, including establishing a dignified, compassionate miscarriage service tailored to the needs of women. Work is underway now to develop new actions connected to these proposals. While they are not addressed in this iteration of the Women’s Health Plan, they will be progressed by the Scottish Government during this parliamentary term.

The Women’s Health Plan rightly recognises some of the gynaecological conditions for which women need better mental health support, such as menopause, endometriosis, premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD).

We are currently exploring how best to meet the needs of people whose mental health is affected by long term physical health conditions. This includes signposting appropriate supports that individuals can access, to ensure that we provide the right level of support for individual needs.

Further to this, the latest edition of the International Classification of Diseases (ICD-11) includes the addition of premenstrual dysphoric disorder (PMDD). There are a number of benefits to this, including: PMDD being recognised globally as a legitimate medical condition; ensuring a shared language which will improve data collection and research and PMDD now being differentiated from the less severe collection of premenstrual symptoms known as PMS. The Scottish Government is working with key stakeholders, including the World Health Organisation (WHO), to implement and promote the use of ICD-11 across all mental health services. This is a commitment in our Mental Health Transition and Recovery Plan.

In Parliament, we continue to keep a focus on women’s health by debating key issues. For example, in this new year, a members debate was held on 11 January 2022 shining a spotlight on improving the diagnosis and treatment of endometriosis.

In relation to the issues raised in the petition specific to the Caithness and Sutherland area, we expect all NHS boards to provide maternity services that are delivered as close to home as possible, but this has to be balanced with ensuring the safety of mother and baby.

All NHS Boards are making improvements to the delivery of remote and rural maternity services, including through the roll out of the Best Start programme, through the introduction of the model of continuity of carer and development of community hubs, and through innovations such as the increased use of Near Me technology that allows remote consultations and appointments.

The Scottish Government welcomes the Best Start North review, commissioned by NHS Grampian, Highland and the Island boards, which aims to examine maternity and neonatal services in the North of Scotland and, in consultation with local people, to develop the best possible sustainable model for the future.

In May 2020, the Scottish Government provided capital funding for the creation of a new build community midwifery unit (CMU) at Caithness General Hospital. This work is near to completion, with an opening date expected soon.

In addition, £2.4M was provided in June 2020 for the redevelopment of maternity and neonatal units at Raigmore hospital in Inverness. This will improve the birthing environment for women across NHS Highland, including those who travel from Caithness.

Additionally, within her capacity as MSP for Caithness, Sutherland and Ross, the Minister for Public Health, Women’s Health and Sport has arranged to meet with NHS Highland senior management and clinicians to discuss the delivery of gynaecological services, and will feed back progress to her constituents.

Turning to the comments in the petition about the A9 and A99 roads, transport plays an important role in supporting patients’ access to healthcare appointments. Removing transport barriers will help ensure that patients across Scotland are able to access the right care, in the right place and at the right time.

Scottish Government health officials are working with Transport Scotland, the Mobility and Access Committee Scotland, the Community Transport Association and others to explore how access to healthcare can be improved by removing transport barriers.

Transport Scotland have provided me with reassurance that they recognise the importance of the A9 as a lifeline for the Caithness and Sutherland community. Transport Scotland understand the reliance on this route in order to access vital services further afield such as healthcare and education as well as the daily community essentials provided locally by business and the service sector. As such, the organisation through its contracted Operating Companies manage the trunk roads so as to minimise disruption whenever possible and through Contractors manage improvements to the route where feasible.

I am assured that safety of the public and the workforce is the only reason the A9 and A99 are closed for works due in the main to restricted widths. Cost or convenience for the contractors are not deemed an acceptable reason for closing a road for maintenance. Planned maintenance works always provide for the passage of emergency service vehicles even when a road closure is required. Planned road closures are well publicised and only permitted at night when traffic volumes are extremely low. Where reasonable alternative diversion routes are not available, the work plan includes “amnesties” during which work stops at pre-publicised times to permit any waiting traffic to safely be escorted through the site to continue their journey.

In relation to unplanned incidents recorded by Transport Scotland’s Trunk Road Operating Company and generally attended by Police Scotland that caused the road to be closed, a high level review covering 2017 to 2021 has shown that between Inverness and Thurso/Wick the trunk road was closed for 0.4% of the time. This was on 66 occasions, 180 hours in 5 years due to Road Traffic Collisions (51 times), Fires (6), High Wind (5) and other Police incidents (4).

While being on the road affected when these incidents occur can be inconvenient and occasionally concerning in urgent circumstances, local diversions can be available and even when they are not, the passage of emergency vehicles is generally assured through the normal emergency services led processes.

Additionally, the notorious hairpin bend at Berriedale Braes, which caused delays and was the locus of many vehicle breakdowns, was removed when the £9M improvement of that section of A9 was completed in August 2020. Transport Scotland continue to look at further minor improvements on a national value for money basis when opportunities arise.

Finally, in relation to rural healthcare more generally, the Scottish Government is currently in the scoping stage for the creation of a Centre of Excellence for rural and remote medicine and social care. The Centre of Excellence is a manifesto commitment with a broad aim of improving key areas in rural health and social care. These areas include recruitment and retention, research and innovation, training and education, and best practice and evaluation. I would also refer the Committee to the Deputy First Minister’s recent response to petition PE1915 which sets out some of the work NHS Highland advise they are doing in relation to the delivery of high quality, safe and sustainable services in Caithness.

I hope that this information is helpful.