Why Scotland’s Women’s Health Plan is progress, but not enough
Scotland has taken important steps toward tackling health inequalities, but systemic challenges and insufficient investment risk holding progress back
When it comes to women's health, I have a soft spot for Scotland. Scottish MSPs were among the first to embrace Pausitivity #KnowYourMenopause and I've worked with several – even having my alter ego 50Sense cited in Holyrood. So I was delighted to hear Scotland’s Women’s Health Plan 2021-2024 had its final report out last week and waited eagerly to see what it said.
The plan promised to tackle health inequalities and improve access to services, such as establishing specialist menopause clinics across mainland NHS boards (hurray!) and creating online resources on conditions like endometriosis and menopause available on NHS Inform.
Sounds great, eh? A landmark moment for women's health!
A mixed bag
Well, not quite. While there are successes to applaud, the plan highlights just how much further there is to go on issues such as limited capacity, insufficient funding and a lack of public scrutiny.
In fact, this plan feels like the bare minimum that can be done and does little to tackle the challenges women face. For example – and the reason I started Pausitivity – too many women don't recognise they're going through menopause before they're faced with one of the well-known symptoms, such as hot flushes.
When I went to the GP to discuss menopause, after four years of suffering symptoms from joint pain to palpitations to depression, he printed out all the information that's now on NHS Inform. I needed that information before I started, not when I'd finally joined the dots and realised I needed help.
Why can't we have a simple poster on display so menopause awareness becomes as everyday as cold awareness? Go on, NHS Scotland – I've even made a poster in Scottish Gaelic to help you out!
Don't get me wrong, the establishment of the menopause clinics is fantastic. But you have to be referred by your GP, so see my earlier point, and there's little (if any) detail on how many women these will support or what the referral times should be.
NHS Tayside's clinic, for example, seems to be tailored mainly to healthcare professionals while in Edinburgh, appointments are on a Friday morning or in West Lothian "by arrangement". In addition, the main complaint about menopause treatment is that it is difficult to get your GP to take it seriously in the first place. Without mandatory GP training, that won't change.
Women’s health – an optional extra
Of course, it's not just menopause. We still lack robust data on key issues like reproductive health and contraception. Endometriosis affects 10% of the population but, as I talked about here, remains underfunded and under-researched and the length of diagnosis times has actually gone up.
If we don't have reliable and up-to-date data, then how can we fully understand and address the scale of women's health challenges? Addressing issues like endometriosis is a vital first step, but meaningful change requires robust solutions backed by investment.
Which brings me to:
"However, it is important that I acknowledge that difficult times remain, as we are now in the most challenging financial situation since devolution. Our health and social care service has been, and continues to be, under significant pressure. Evidence is clear that women are particularly disadvantaged during times of financial difficulty and so I am determined that our focus on the health of women and girls continues."
Jenni Minto MSP, Minister for Public Health and Women's Health
Focussing on women's health should not be a financial optional extra, with the threat of cuts looming over our heads and putting more strain on healthcare professionals already doing vital work under enormous pressure. A Lancet report showed that inequalities are already impacting on women's health outcomes. Our health matters as much as that of the man next to us – and that is true across the whole of the UK.
Read all about it?
I said I'd been waiting for the final report and I've been eagerly scanning the newspapers to find some in-depth analysis and constructive criticism. But apart from a couple of opinion pieces and reports in specialist outlets, which mainly talked about the progress made, there's been nothing.
Without mainstream media coverage, how many women will know about the plan, its achievements or its shortcomings? Without widespread awareness, how will they know these services exist? And how can we end systemic issues like long waiting times or persistent data gaps without scrutiny?
Real progress isn't about what's been achieved; it's about ensuring everyone knows it's happening and that we have the tools to hold our politicians to account.
It's not just the media, however. I watched the debate in Holyrood and was horrified to see only around a dozen MSPs present – the vast majority women. The absence of the Cabinet Secretary for Health and Social Care, Neil Gray, was particularly glaring. Women make up 51% of the population he serves, yet their health seems to remain a secondary concern.
It's not good enough, but it is a pattern we see time and again in women’s health: progress is made, but it’s siloed into the realm of niche interests rather than universal.
A prescription for change
Ultimately, the very fact we need a Women's Health Plan is proof of the systemic inequities of our healthcare system (and I include the whole of the UK in that). If healthcare were truly equitable, there would be no need for a separate plan for half the population – and a half that also pays taxes and NI.
Why does accessing basic healthcare still feel like a battle? We deserve more than one-step-forward or plans without the resources to drive real change. We deserve a system that meets us where we are, not one where waiting times and postcode lotteries dictate our health outcomes.
Scotland has set a real precedent, but without sustained investment, a real commitment to end inequities and a determination to place women's healthcare at the heart of the healthcare system, real change seems as far away as ever.
Women deserve better – and that goes across the UK. It’s time for our healthcare system to recognise that investing in women’s health is not an optional extra, but a fundamental priority.
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