The following amendment has been selected: amendment 1 in the name of Lesley Griffiths.

Item 6 this afternoon is Plaid Cymru's debate on women's health. I call on Sioned Williams to move the motion.

Motion NDM8004 Siân Gwenllian

To propose that the Senedd:

1. Regrets the lack of mention of women’s health—including maternity provision—in the Welsh Government’s existing long-term plan for health and social services, ‘A Healthier Wales’, despite the stated aim of becoming a 'feminist government'.

2. Notes that health conditions which solely affect women and those assigned female at birth, such as endometriosis, menopause, and diseases which disproportionately impact females, including auto-immune and cardiovascular diseases, osteoporosis, and dementia, incur a significant cost burden.

3. Notes that the ONS details that women live fewer years in good health than men and are more likely to be in poverty, requiring both social and financial support.

4. Calls on the Welsh Government to:

a) develop a bespoke Women’s Health Strategy for Wales which should focus on life-long women’s health;

b) provide consistent high-quality services, including specialist tertiary care, accessible to residents the length and breadth of Wales;

c) invest in high quality research into women’s health and treatment;

d) invest in enhanced training for healthcare professionals in Wales on women’s health areas.

Motion moved.

Diolch, Dirprwy Lywydd. I could open this debate by reeling off the statistics that clearly show the need for action on health inequalities and the reason why we have tabled this motion before Members today, and that the lack of a women's health strategy merits scrutiny and debate, especially given the Government's own stated aim of becoming a feminist Government. But I'll save my own words this afternoon and let others speak for me, because I want to share accounts and experiences of women who will put the case for our motion powerfully and overwhelmingly. In fact, giving them the platform of this Senedd Chamber, ensuring that we all hear their voices this afternoon, is vital. Because the sad truth is that the stigmatisation of women's health conditions such as endometriosis, menopause, polycystic ovary syndrome, premenstrual dysphoric disorder and others restrict conversation and isolate women when, in fact, they're experiences that should unite us and spur us into action. These voices are not heard, nor their pleas for more support, for the attention they deserve, for better treatment, because, historically, with limited investment in research into women's health in general, there's been so little research into conditions such as endometriosis that we don't even know what causes it. And without knowing the cause, a cure cannot, of course, be found.

Kate Laska from Gwynedd suffers from endometriosis. She had to travel outside of Wales to get specialist help and pay privately for treatment, after waiting years to get a diagnosis and even longer to get treatment. And she's still in chronic pain now. These are her words:

'Imagine that, for years, you live in a lot of physical pain. You try to get help but you are told that the pain you are feeling is normal. In the meantime, you lose your job, your income and your partner. After changing my doctor, I finally had my diagnosis, but I had no idea that, for the next seven years, I would spend fighting for my right to treatment. Due to very often suboptimal care and a lack of awareness amongst the healthcare workers as well as society, including myself, endometriosis in my case progressed to stage 4 and required numerous complex surgeries. Now imagine you do not find much support around you in times when you mostly need it, because there is a belief in society that women are destined to experience pain. Women with endometriosis suffer in silence and very often alone, because no-one around them can imagine their pain. There is only one specialist clinic in Cardiff where women like myself can hope for relief. However, this clinic is currently overwhelmed with patients. Time is crucial with this chronic condition. This is why there is an urgent need for a local service based in north Wales.'

The lack of investment in treatment for women's health conditions like endometriosis has resulted in cross-border agreements for treatment—for example, women like Kate, who live in north Wales, attend the endometriosis specialist centre in Liverpool. But this does not always happen. One of my own constituents, Becci Smart, has been living with PMDD, premenstrual dysphoric disorder, since the age of 14, but wasn't diagnosed with the condition until age 30. PMDD is a very severe form of premenstrual syndrome, which can cause a range of emotional and physical symptoms every month during the week or two before your period. In her own experience, and from the experiences of others she has spoken to with PMDD, she says that there is a severe lack of mental health support available and a lack of understanding of the condition among GPs. Indeed, she says that sufferers of PMDD are being turned away from mental health services, as they are incorrectly told that it's a purely gynaecological condition, rather than a mental health one. It is, of course, both these things. They are told instead to see their GPs, who are not experts on mental health, every time PMDD severely affects their mental health, which is a week or two every month.

Currently, there are no blood or saliva tests or scans to diagnose PMDD. The only way to diagnose it is to track symptoms alongside the menstrual cycle for at least two full months. There is no cure, only symptom management. Diagnosis takes, on average, 12 years and approaching, on average, six different healthcare professionals. This, while PMDD affects one in 20 menstruators of reproductive age, and those with PMDD are at a 7 per cent increased risk of suicide than those without premenstrual disorders. Seventy-two per cent have active suicidal ideation during every PMDD cycle. That's each menstrual cycle. Thirty-four per cent have made active suicide attempts during PMDD weeks. Fifty-one per cent have self-injured in a non-suicidal way during PMDD weeks. I'm sure we will hear many more of these harrowing accounts as part of Members' contributions this afternoon. I'm glad that our motion means they will be heard, because this suffering is inexcusable, because there can be no doubt that there is gender inequality at play here.

While women in Wales have a longer life expectancy than men, it is clear that they are spending less of their life in good health, and this arises from a lack of medical research into women's health, which means researchers do not have the opportunity to identify and study sex differences in diseases. And it creates assumptions that similar medical treatments will work for both males and females. For example, diabetes, heart attacks, autism are all conditions that can present differently for males and females. There's also still this pervasive belief in parts of the medical community that stems from societal patriarchy and, to some extent, misogyny, that when a woman complains about her health, it's either hormonal, emotional or irrational and is often framed around their reproductive functions as women.

There is a gender health gap that must be better addressed. Why else has there been five times the amount of research into male erectile dysfunction, which afflicts 19 per cent of men, than there has been into premenstrual syndrome, which affects 90 per cent of women? What else can explain why, when there are concerns that some women across the UK were unable to obtain their prescriptions due to shortages of HRT products two years ago, there was a failure to deal with the shortages? And this, coupled with the impact of COVID-related global supply problems, means around 1 million women in the UK, who use HRT to relieve the symptoms of menopause, will be affected, and so will many women in Wales who rely on this treatment.

It is vital that we address the failures within women's health, so that we can open up the conversation and change its constricted culture. To do this, the Welsh Government needs to develop a bespoke women's health strategy for Wales, which should focus on lifelong women's health; high-quality services, including specialist tertiary care; and investment in high-quality and enhanced training for healthcare professionals. I look forward to Members' contributions to this important debate, and I urge all Members to support the motion. We owe it to the women who have told us of their pain and frustration to listen and to act. Diolch.

The Llywydd took the Chair.

I have selected the amendment to the motion, and I call on the Minister for Health and Social Services to formally move amendment 1.

Amendment 1—Lesley Griffiths

Delete all and replace with:

To propose that the Senedd:

1. Acknowledges that women’s health is not specifically mentioned in the Welsh Government’s existing long-term plan for health and social services, ‘A Healthier Wales’, as this is a high-level strategy setting out the framework and key principles for ensuring person-centred care for everyone in Wales and, as such, does not focus on particular groups or conditions.

2. Notes that health conditions which solely affect women and those assigned female at birth, such as endometriosis, menopause, and diseases which disproportionately impact females, including auto-immune and cardiovascular diseases, osteoporosis, and dementia, incur a significant cost burden.

3. Notes that the ONS details that women live fewer years in good health than men and are more likely to be in poverty, requiring both social and financial support.

4. Notes that the Welsh Government have committed to publish a Quality Statement and NHS plan in the summer with a focus on providing consistent high-quality services across all areas of women’s health.

Amendment 1 moved.

Formally.

Can I thank Plaid for tabling this important debate today? When the health committee formed last year, as lots of committees do, it sent out a consultation to relevant stakeholders, and that was one overwhelming response that came back, the need to focus on women's health issues, and, as a result, all committee members agreed that this would be a priority for the health committee in this Senedd. So, can I thank Plaid Cymru for bringing forward the debate? And we will be supporting, as Welsh Conservatives, the Plaid motion as it's laid today as well.

As part of our work as a committee, we asked the Women's Health Wales Coalition to come and speak to us, to give us their perspectives in a public evidence session back in March, so I'm going to outline some of the issues that they raised. And from that, we also took up some of the issues with the Minister, but the evidence that we took on that day will help us to undertake some of our other work as well, across the rest of this term. What the coalition did tell us is that women are more likely to experience poorer health than men, and often symptoms go misdiagnosed or untreated. They said that women experience delays in diagnosis and care as well.

A report published back in December 2019 told all four UK nations that we need a women's healthcare plan, and in Scotland, in fact, they're leading the way, in fairness to Scotland. Their plan came forward in August 2021. The UK Government for England, their plan is currently out for consultation, so, of course, we're concerned that Wales is not left behind in this regard.

One of the issues that the coalition raised with us is the lack of data. One possible reason for this could be the under-representation of women on trials, often an issue that will lead to that lack of information, that lack of data.

Access to specialist services was another issue raised with us. The existing models of healthcare provision in Wales have historically not worked for women because they're being centred or not tailored to specific needs—an issue that the coalition specifically raised with us. Those requiring different specialists that they can find are not adequately being joined up, and the lack of collaboration as well between health boards in developing specialist services and making them universally available.

Information and communication is another issue that was raised strongly with us, as well. Of course, the example there was the recent miscommunication about the cervical screening programme. That's highlighted the importance of clear and accurate communications.

Mental health was, of course, another issue raised with us as a committee by the coalition. A report by the UK women's mental health taskforce found that women are more likely to experience common mental health conditions such as anxiety and depression than men, and they say that this, especially in young women, particularly in younger groups of women, is mainly because their anxiety builds up about their conditions not being identified correctly.

Education and training was another issue raised. What the coalition highlighted to us there was the priority need for improved training for healthcare professionals. Again, they suggested areas of improvement, including improved medical training specifically on women's health to be prioritised in foundation doctors' training, to address unconscious bias and to raise awareness as well.

And then the last point I'd raise is preventative health. I'm sure we all agree with that and the Minister will agree with that as well. But the coalition suggested that, in many cases, alcohol consumption, smoking, et cetera, were quite common mechanisms for dealing with issues in life, including chronic illness as well. What they said is that without better understanding of what is driving girls and women to engage in these behaviours, it would be very difficult to design services to meet those particular needs. So, I hope—.

Thanks very much. My time's run out, I notice, but thanks to Plaid for bringing forward this debate today, and I look forward to the rest of the contributions from Members.

I'll focus my remarks on something that Sioned Williams has mentioned: the normalisation of pain for women in medical procedures and the ways in which girls and women are brought up to expect and tolerate discomfort as part of their daily lives. Perhaps most worryingly, when women complain about experiencing pain, as we've heard, there's ample research to suggest that they are routinely ignored or not taken as seriously as men in medical settings. In January, the cross-party group on women's health held a discussion about pain experienced in gynaecological out-patient settings, and, Llywydd, we heard truly harrowing stories about how some women feel they can't complain when they're in pain. We heard about a resistance amongst some practitioners to introducing more widespread pain relief and about a disconnect between patients and clinicians in terms of how they estimate pain.

On this question in terms of how we estimate pain, the disconnect seems to come about because women and girls are very often told that a level of discomfort will be something like period pain, and there's a significant problem here because period pain will be drastically different for different individuals, and the assumption that period pain will be a constant will mean that some clinicians either give patients an unrealistically low expectation about the kind of pain they should expect or they don't understand how some women's bodies work. And why should women be expected as a matter of course to tolerate pain similar to period pain? Why should there be an assumption that women's tolerance for pain will be higher because of childbirth? Why should that be normal?

Our motion talks about the cost of women's health. The monetary cost is well rehearsed: sanitary products that until relatively awfully recently were taxed as luxuries; over-the-counter pain medication. But, again, what about mental health? It's been mentioned already, the mental health impact of a failure to acknowledge women's health issues, the cost to society and the economy of sustaining a taboo, a veil of shame when it comes to talking about some conditions. How many women feel that they can't tell their employer that they can't go into work because their period pains are debilitating? How many women suffer in silence or can't tell their colleagues that they've had a miscarriage and that they need time off to get over it? How many women are summoned by HR to explain why their sickness record is so long, when, in fact, they're going through the menopause? Society both normalises women's pain and expects us to shut it away, not to mention it, not to consider it as appropriate for polite conversation. That is a double injustice, an intensified injury and a wrong that's wrought upon women.

Now, research suggests that women in acute pain go longer without being treated in hospitals than men suffering from similar conditions. They're also, as we've heard, more likely to be misdiagnosed with mental health problems and given anti-anxiety medication rather than having their pain or the cause of that pain treated. The tendency to dismiss women's pain is rooted in a centuries-old bias. The words for hysterectomy and hysteria have the same root, and this medieval notion that women were made mad or unbalanced because of their wombs, that still has aftershocks today—an ancient, outdated prejudice upheld by modern medical practices.

Chronic pain conditions that affect women, like fibromyalgia and endometriosis, are treated with a lack of seriousness and urgency. Women wait longer to receive pain medication; they face longer waits before being diagnosed with cancer; they're less likely to receive CPR because their symptoms are so often ignored or dismissed. And this isn't just a cognitive bias that we're battling; it's the fact that textbooks tend to focus on the male anatomy. The norm is always male, and not enough funding is put into conditions that affect women. These failures, Llywydd, result in unacceptable numbers of women dying, and before that, horrendously high numbers of women thinking that the level of pain they're going through is normal when it isn't. That's the cost of a lack of attention to women's health: you can count it in bodies or prescription scripts.

So, in closing, Llywydd, instead of normalising women's pain, we should be normalising talking about how we experience pain, talking about gynaecological conditions, improving training, because this gender pain gap has to be closed once and for all.

I'm always pleased to take part in any debate about women's health, but I think that the way the motion has been phrased is a little unfortunate because it isn't either timely nor is it strategic in its approach, so it's going to have limited impact. This is because the health Minister has already announced in the Senedd a few weeks ago that she was working on an equality statement on women's health that she was going to deliver before the summer recess, and she's also told us in the Chamber that she's conducting line-by-line scrutiny of health boards' intermediate development plans. I'm confident that she's looking through the lens of women's health as well as the more general efficiency and effectiveness with which they are deploying their obligations towards women.

Having said that, obviously, all the points that have been made by other Members are really important. It's always going to be a good idea to be focusing the lens on women's health, because women have traditionally never had the same care as men. We have to remember that, before the NHS was founded by the post-war Labour Government, women next to never had any healthcare, because they always put their children and their husband, who was then supposedly the main breadwinner, before them in getting paid-for healthcare. So, the beginning of the NHS was a really, really important event in women's lives.

Focusing on 'A Healthier Wales', published in 2021, that didn't quite do it for me either, because you've got a new Senedd, a new health Minister and several really important plans that I feel we really do need to stay focused on. However, having said all that, we clearly need to focus on these issues. It really shouldn't take eight years to correctly diagnose endometriosis. It was a delight to meet Suzy Davies upstairs today—she's here for her work with the tourism board—because she, above all, put this on the agenda. And now, as a result of Suzy's interventions particularly, we have menstrual well-being education for boys and girls in all our schools so that girls are not suffering in silence about something they don't realise is not normal in the way they menstruate. And boys will be able to support girls in that when they're having those intimate conversations about the person they're in a close relationship with.

We do hope that the appointment of specialist endo nurses in each health board will improve the performance of GPs and, more worryingly, some gynaecologists' understanding of the presenting symptoms of endometriosis, because for me it is inexplicable that something that effects one in 10 women—. It's not some rare disease that only a specialist physician understands, this is one in 10 women. How is it possible that gynaecologists can't see endometriosis symptoms when they come through the door? So, there's clearly a lot of work to do for those endo nurses.

Jane Dodds referred to dementia and her personal experience of that earlier this afternoon. We have to remember that dementia, I read, is the biggest killer of women these days, and that's, obviously, something we really do need to reflect on, because some of it will be to do with loneliness, some of it will be to do with the quality of women's food, exercise, and all manner of other things that we really do need to understand, because this is a veritable pandemic.

On telemedical abortions, Wales has led the way in ensuring that what we developed during the pandemic has now become a permanent feature, so that women can get a telemedical abortion without having to leave the house, safely be able to do it in the privacy of their own home, and not delay getting treatment and have to then have a surgical abortion. So, well done the health Minister for having the guts to do that, because the UK Government has certainly sold the pass.

But there are many more things we need to learn from other countries. For example, in France, you get 10 free sessions of physiotherapy after the birth of a child. That's not because they're very keen to give people free sessions—it's because it's a preventative intervention to ensure that women are not having prolapses, back problems, incontinence, and all the other things that can go with pregnancy. For those of you who've never done it, I can tell you that it is quite a physical as well as mental exercise. So, I think that that is one thing that I would certainly want to come back to.

This cannot be about grandstanding. We need to really have this adult discussion and have it backed by all stakeholders. It's great that Sioned and others have brought the views of stakeholders into the Chamber. There will be an opportunity for anybody else who's interested in this subject to hear from Fair Treatment for the Women of Wales and the British Heart Foundation Cymru in the cross-party group on women's health tomorrow lunchtime, which is being held virtually, so, wherever you happen to be, you can join. Because this is the way we have to go about having this women's health strategy—to ensure that all women are included, and girls. I look forward to having a path-breaking plan, which I'm sure the Minister will be producing in due course. 

I’m pleased that we’re having this very important discussion today. Although we've had a commitment from the Minister, I think the fact that so many constituents continue to contact us demonstrates the importance of raising awareness with every opportunity that we have with regard to women's health, and the health of those assigned female at birth. I know that plans are afoot in this area, but people are living in pain, and knowing that they perhaps have to suffer that pain for years to come whilst a plan emerges is very difficult, because it has a detrimental impact on your ability to live on a daily basis. 

References have been made to endometriosis already, and this is a subject that I raised recently having been contacted by a constituent after she was told by Cwm Taf health board that the vital treatment that she needed, which was supposed to take place before the first lockdown back in 2020, hadn’t just been postponed, but had been cancelled entirely. Since then, she has contacted me again to let me know that she has refused the only option she was given, namely treatment to bring on early menopause, because she also has a bone condition, which could deteriorate severely with menopause medication. Instead of being supportive, the nurse became very angry with her and threatened to release her from the gynaecologist’s care if she wasn’t willing to take the medication, rather than continuing to call for the treatment and surgery that she needs. All this despite the fact that she is in such pain that it is having an impact on her work and personal life. Unfortunately, cases of this kind are far too common, and it isn’t good enough that we expect women to suffer like this. 

I would also, in my contribution today, like to focus on pregnancy and the problems that a strategy must tackle. Although pregnancy in the United Kingdom is, on the whole, considered to be safe, women and babies are still dying unnecessarily as a direct result of complications with pregnancy that could be prevented. Every year, around 5,000 babies in the UK are either stillborn or die soon after birth, and 70 mothers die as a result of specific pregnancy-related conditions. We know that black women are four times more likely to die from complications during pregnancy than white women, and Asian women twice as likely. Older mothers, mothers from deprived backgrounds and women of mixed ethnicity are also more likely to die during pregnancy or soon afterwards. Care for women is being seriously hampered by a lack of suitable medications that we know for certain are safe and effective during pregnancy or while breastfeeding. Over the past 40 years, only two new forms of medication have been approved for use during pregnancy.

Another subject that demands attention, and which builds on Jenny Rathbone's point, is the injuries that women suffer during childbirth, which have a detrimental and long-term impact on a person’s ability to work, leave the house and have sexual intercourse, due to bowel incontinence. They also lose touch with their children, and this has a major psychological impact. This issue is rarely discussed. On Monday I was pleased to be able to attend the launch of a pelvic health hub at Barry Hospital. Led by Julie Cornish, this is the only hub in Wales that supports women with injuries of this kind. I spoke to the MASIC charity about this, and I was told that one in 20 women or people who give birth for the first time suffers a serious injury. Whilst praising to the skies the work of this new hub, the charity said how unacceptable it is that there wasn’t a hub of this kind in every health board area, and that the majority of women in Wales cannot access any support with this issue. This cannot go on.

And this isn’t the only area where improvement is needed. Sixty-five per cent of people living with dementia are women, but 60 to 70 per cent of carers of people with dementia are also women. Also, 20 per cent of female carers have gone from full-time to part-time employment due to their caring responsibilities, and 17 per cent felt that they were being penalised at work.

We also know that there is a whole host of statistics with regard to heart disease, and these are very powerful figures in terms of the fact that women aren't receiving the recognition that they have coronary heart disease. Women are 40 per cent more likely than a man of having an incorrect initial diagnosis of heart attack. So, there are anomalies here in terms of women and men with conditions that are very common. This can be very disheartening in terms of all of the things that we face as challenges. But, the more we talk about these challenges and encourage women to attend surgeries, rather than suffering in silence—I think about the fact that we have whispered about these conditions in the past—the more we will be talking about them and making progress in these areas. I'm pleased that we have an opportunity like this debate and we would, of course, welcome this new strategy, but also the action taken on the ground to support women in Wales.  

I'm pleased to be speaking in this hugely important debate today. We've heard about the number of diseases that are unique to women and also a whole host of other diseases that disproportionately impact women's health and well-being. One of the key focuses of the Welsh Government's 'A Healthier Wales: our Plan for Health and Social Care' is preventative healthcare, and a number of the diseases that impact women's health are largely preventable or have much better outcomes if they're diagnosed at an early stage. 

Cardiovascular disease is an example. Despite cardiovascular disease being the leading cause of death in women, there is often an assumption by some health professionals and the general public that women are at a lower risk of this disease. Whilst this is true to some extent, this difference diminishes with age, particularly over the age of 50, and potentially even earlier in women who experience early menopause. So, here again, the menopause is significant in women's health. That is backed up, of course, by research, and it shows that, when it comes to cardiovascular disease, women are more likely to be diagnosed more slowly or completely misdiagnosed when compared to men. This, of course, can have devastating impacts on the individual's mortality and morbidity. Some of the risk factors associated with cardiovascular disease are preventable, including lifestyle choices, diet, high blood pressure and cholesterol. With that in mind, I believe that health screening can also play an important role in preventing disease in the first place. As I understand it, we were all supposed to, in Wales, receive an annual screening at the age of 50—everybody. And I somehow think that that hasn't happened, first of all because of COVID, but hasn't actually happened after COVID because of the pressures that has brought to bear. That clearly is part of a preventative course of action, and I just hope that we can get that back on track. 

Education, of course, is a major factor in helping to prevent disease and diagnose it at an earlier age. How many women, for example, are aware of cardiovascular disease being the biggest threat to their health? I chose this deliberately because I almost anticipated what everybody else would speak about. It's interesting, isn't it, that it isn't one of the things that has been spoken about. I wasn't aware of this until I started looking for those things that people weren't talking about affecting most women. So, I think those messages need to get out. Of course, there are a number of other relevant illnesses, and ovarian cancer is one of those. That has a number of non-specific symptoms, like abdominal bloating, feeling full after eating, changes in urination and bowel habits, extreme fatigue and tiredness, amongst others. But, many of the symptoms are similar to less serious health conditions, like irritable bowel syndrome, and they go unnoticed. So, education is absolutely vital, because we know that ovarian cancer is called the silent killer. And my question is this: why is it called the silent killer? Is it because people don't know about it and don't recognise it, or is it because people aren't talking about it? So, I think we need a real focus on that.

I'm really pleased, Minister, that you did announce that you're bringing forward a women's health plan, and I really do welcome that move. I hope that you're able to tell us your indication as to when we might be able to debate that in the Senedd. I'm really pleased that we do have a Minister who has committed herself to women's health, to bringing forward what I believe will be the first women's health plan, and I've sat here a few times—others have been here since 1999. So, it's a huge step forward, and I can see by today—and I do welcome this debate being brought forward today—that you have huge support in delivering it. 

Women's health is something that we all need to understand. There is a duty on us to ensure improved awareness, and that there's better care provision available for the various conditions suffered by women of all ages, very often in silence and without sufficient support, as we heard earlier from Sioned Williams.

In the last few months, a number of constituents have contacted me regarding one specific condition, namely endometriosis. It's a condition that causes chronic pain for one in 10 women in Wales—about 300,000 in total. Although I'm aware that the Government has already announced that every health board will employ specialist nurses to care for women suffering from endometriosis—and I welcome that very much—the health gap in gender terms, however, continues. As we've already heard, in Wales it takes nine years to have a diagnosis of the condition, the longest in the whole of the United Kingdom. 

I want to share with you the story of one of my constituents, Emily from Carmarthenshire. She is now 23 years old, but Emily knew things weren't quite right when she started having her periods at the age of 12. Every month, she had unbearable pain. However, for years, her doctor didn't believe the severity of her condition. It was only after Emily collapsed and was rushed to hospital with sepsis in August 2019 that her condition was taken seriously.

Emily has written in harrowing terms the experience she has endured in a recent edition of Glamour magazine, and I quote: 'Doctors told me I was trying to find answers that weren't there, that I was being dramatic, that they were more concerned about my mental health; basically, it was all in my head. I was prescribed antidepressants, which, of course, I knew I didn't need. I had more mental health referrals than I had scans on my ovaries.'

When she was eventually admitted to hospital, a 25 cm cyst was found on her ovaries, and a diagnosis of stage 4 endometriosis—the most advanced stage of all. Emily also suffers from adenomyosis, a condition that goes hand in hand with severe endometriosis, and can cause the womb to swell to three times its normal size.

Emily has proven how inadequate the care available is for young women suffering from this condition through the years she took to get a diagnosis on the NHS. After further pain and severe discomfort, she eventually had to pay for private care across the border in England. This is a sad indictment of the way we support women's health in Wales, in particular the treatment of this debilitating condition. In the three years since the initial diagnosis, she has received several surgeries to alleviate her symptoms, and is now experiencing chemically induced menopause. Yes, sorry, I'll give way.

Thank you very much. I wanted to intervene earlier. It is with regard to the pain, and regarding endometriosis, which does not involve only one organ—it is a multi-organ problem. Pain is just a pointer. It points that you have to see the patient as a whole, which is not happening over the last so many years. We have been treating the symptoms. That is why I have been very vocal about it over the last 15 or 20 years—that we kindly see the patient as a whole, prioritise treatment and the continuation of treatment. These are very important things, and this is not happening. That's why we are suffering, and that is why we are not getting anywhere with these diagnoses, especially in women. My heart goes out. I have a wife, I have a daughter, I have a grand-daughter. Why should they suffer? This is mainly because we don't see them as a whole. Thank you. 

Well, I thank you for that, and I think that we've heard already how the symptoms are treated, not the root cause of the problem. Can I just quote Emily once again? I remind you that she's only 23 years of age:

'I live in everyday pain and try to manage as best I can. My fertility isn't looking great. I just hope all the time for some sort of relief. But because my endometriosis was left to develop to such a severe state, my chances of living a normal, pain-free life are slim. My advice to any other women out there who are being let down by the gender health gap is to not take "no" for an answer. Listen to your body, and don't let anyone gaslight you into thinking that it's all in your head. You know your body better than anyone else. Fight for its right to be heard.'

Listing her concerns regarding the care available to sufferers, Emily's mother was clear in her view that there is a need for more endometriosis centres across the whole of Wales to provide specialist care that is completely necessary for patients. While there is a specialist centre in Cardiff, she is of the view that there needs to be an improvement in the care provided.

Secondly, and I finish with this, the family raised concerns regarding the general awareness of this condition, whether that's in society or in the medical field, and which, unfortunately, leads to a nine-year wait for a diagnosis. The evidence of so many women suggests that too many GPs disregard the seriousness of the condition. Suggesting that 'this is normal for women of your age, and take a few paracetamols' isn't good enough. 

And I am finishing with this, sorry, if I could just have one more second—

A second?

Half a minute, if I may.

No. 'No' is the answer. We are not negotiating today. 

Okay. I'll bring this to a close.

Sarah Murphy.

Diolch, Llywydd. I want to thank you, Plaid Cymru, for bringing this incredibly important debate to the Chamber today. On Monday night, I attended a local menopause cafe event run by Sarah Williams from Equality Counts, where women and those dealing with similar health-related issues came to discuss their experiences. Open spaces like menopause cafes and events like this in my community are undoubtedly so empowering.

At the cafe, women discussed the lack of awareness around menopause. The constituents have asked for a specialty clinic and for more flexible ways to access HRT for those suffering from menopause symptoms. Sarah has said to me that evidence suggests that women from lower socioeconomic backgrounds are less likely to even take up HRT treatment, and that this is perpetuating health inequalities for the most vulnerable. The session also explored how menopause experiences are individual and nuanced. This is why we need compassionate cultural practitioners that practice without assumption of sexual orientation or gender identity, because this type of bias is deterring people from accessing support and treatment.

I want to emphasise that our experience of undiagnosed conditions, unexplained pain, the lack of treatment options are never about us as individuals. They are about a system that has always put the healthcare of heterosexual, straight, white males front and centre. And that's why, via social media, I asked women to share their experiences so I can share their voices here today, just as you have said, Sioned Williams. It is a wonderful opportunity to be able to do that.

One constituent said she wished that she could just feel listened to. Another told me about their experience of going to the GP regarding a chronic urinary tract infection, where they were told that there was nothing that can be done, and that the only thing to do is take paracetamol and have a bath. I have spoken to other women in my constituency who have undergone a late assessment for neurodivergence such as autism and ADHD. The current waiting list for that assessment is two years. Women in their late 30s and 40s have been denied the right to support their entire lifetime, simply because the signals for an assessment have been constructed around the way that young boys display signs of neurodivergence.

On another point, my constituent Samantha said that, 'There is no gynaecology ward at our local hospital.' To hear about a woman going through a late-term miscarriage next to people delivering their full-term babies, on the same ward as people going through an abortion, is not only heartbreaking but unacceptable.

Another constituent told me that she passed out from the pain of an intrauterine device insertion for endometriosis. She was told that the pain would be like a slight period cramp. It was only after attending a meeting with other women facing these same issues that she realised there is pain relief that she could have been administered during the procedure; she was just never told about it. She said to me, 'If you go to the dentist to have a tooth removed, no matter how wobbly, they will numb your gums. My procedure to have an IUD, through my cervix, came with no pain relief. I was so angry to realise that I could have just asked.'

The British Heart Foundation Cymru has found that women sometimes do not realise that they are having a heart attack because the pain of their period is worse than their symptoms—going into what you were saying earlier on, Delyth—because, as we have heard many times today, when you are a woman you are told that pain is something that you just have to live with.

So, whilst I applaud the societal changes that allow us to talk about health more openly, we must be aware that historic shame and bias still haunt our experiences of healthcare. And in addition, women's healthcare has always been seen as a single issue. Consequently, the complexity and diversity of many issues, like we've heard about today that have been raised, are often clustered together into one area, and this has led to that lack of research, awareness and investment, and we must do more to change this.

But I do also want to echo my colleagues today—Jenny Rathbone and Joyce Watson. I do believe that our Welsh Government health Minister gets this. I do believe that you don't see it as a single issue. I do believe that what you're trying to do is really to address this inequality. And I also want to say that we have some fantastic work already taking place across our communities. I don't want to lose sight of that. I am fortunate to have Wings Cymru in Bridgend, which is working to destigmatise period dignity. We have the wonderful menopause cafes, as I've mentioned. They are revolutionising the workplaces to be more inclusive. 

I want to end my contribution by thanking all those healthcare professionals—GPs, nurses, midwives and specialists—who are working tirelessly to listen and support women in these circumstances. We are up against a system, but that does not mean the system cannot change, and women are shouting loud enough. We must listen and we must act. Diolch.

I now call on the Minister for health to contribute to the debate. Eluned Morgan.

Diolch yn fawr, Llywydd. Many thanks for allowing me to reply to this opposition debate around women's health, which I know most people in the Chamber are aware is an issue that I'm passionate about addressing, and it's great to see that there is absolute consensus on the issue, if not on the motion itself.

Now, women, as we know, make up just over half of our population and account for 47 per cent of the workforce. But that evidence is mounting that women don't always receive the health support needed to deliver the improved outcomes we expect. Gender inequalities in terms of health remain very significant. For example, with heart diseases, as we've heard, women are less likely to be aware of their risks and symptoms, less likely to be diagnosed quickly, less likely to be given optimal treatment, and less likely to access rehabilitation. I'm really grateful to the British Heart Foundation for drawing my attention to this in a briefing, which led me to commission a quality statement on women very shortly after I was appointed last year.

Women, we know, are under-represented in clinical trials, and these inequalities come at a huge cost. Research suggests that the deaths of at least 8,000 women could have been prevented through equitable cardiac treatment over a 10-year period in England and Wales. 

People have mentioned different responses of women, for example to autism, to mental health. But, crucially, I think also something that is not talked about is, in an ageing population, the huge impact of incontinence on older women—disproportionately, once again, affecting women rather than men. There is a particular approach taken in 'A Healthier Wales', and that's our long-term plan for health and social services, and the whole ethos of the programme is for the services to be equitable, designed around the individual and around groups of people, based on their unique needs and what matters to them.

But, when it comes to women's health, all too often in the NHS women's healthcare is confined to reproductive health issues. Now, I want a health service in Wales that supports and nurtures women's wider health and well-being, and I've instructed officials to take this broader approach when it comes to developing that quality statement.

Will the Minister give way?

Of course.

Thank you, Minister, for giving way, and I welcome and I commend your efforts in creating a women's health plan. I think it's a fantastic step forward in what you're trying to do. You mentioned about broadening the plan to meet everything—it reminds me of a petition on improving endometriosis healthcare and the petitioner, Beth Hales; we'll be reviewing that again on Monday. But a comment she made to me: this is not just a gender health gap, it's not just a health inequality, it's actually a social justice issue. Would you agree with that?

Absolutely. I think there is an injustice that has been going on for way too long, and the very fact that women are not in trials, that there's a disproportionate amount of money invested in certain research areas rather than others—it's women who lose out almost every time. That has got to be something that we address. It is a social justice issue, absolutely.

In 2019, the Royal College of Obstetricians and Gynaecologists published 'Better for women: Improving the health and wellbeing of girls and women'. Now, this report argues that a strategic approach across the life course of a woman is necessary to prevent predictable morbidity and mortality and to address the determinants of health specific to women. I absolutely agree that our health services need to provide advice and care to girls and women across their whole life course. The NHS in Wales must deliver a model of care that enables women to live healthy and productive lives, and not simply be a service that intervenes when women experience problems.

In recent years, much of our response to addressing issues in women's health has been delivered through the work of the women's health implementation group, which has focused on reproductive issues. Since its establishment, the WHIG has been allocated £1 million per year from the Welsh Government, and this funding has been used to establish a network of pelvic health and well-being co-ordinators in each health board. More recently, this funding has allowed for the recruitment of a network of specialist endometriosis nurses in each health board, and that's to develop national pathways, to reduce diagnostic times and to support women living with endometriosis. And I can assure you in this Chamber today that I've spent more time on the need to improve our response to endometriosis than I have on almost any other health condition.

We have to put a stop to the harrowing experiences of people like Emily, and, I imagine, Beth, and other petitioners as well. We know that taboos and a lack of education about menstruation have tangible negative effects on girls' and women's lives, and, last year, we launched Bloody Brilliant, our online resource and educational platform. It was designed with significant input from young people to help break taboos and enable open conversations about period health, including what is normal and when they should seek help. Welsh Government is also working to help improve services to support women experiencing menopause. A task and finish group is being established, looking to share local best practice and establish an improved care pathway. We're also participating in the UK menopause taskforce, which is taking a four-nations approach to improve knowledge about the menopause and better support women experiencing it.

The recovery plan for planned care has been published and this sets out a number of challenging targets for health boards to achieve across all specialisms, including secondary gynaecological care services. The gynaecological board that has just been formed will develop plans to reach these targets. This will include a variety of actions, including e-advice, better referral and discharge pathways, introducing one-stop shops, responses to symptoms, and responding to patients' concerns.

Now, as Members are aware, I have agreed on a two-step plan to ensure that women receive the best possible care and assistance to remain healthy throughout their lives. As I have noted, the Welsh Government is developing a quality statement for women's health that will enable us to provide a strategic picture of our expectations in terms of the provision of women's healthcare services across Wales. This will describe what good provision should look like, not just in terms of reproductive health for women, but also to tackle the gender bias in our mainstream system at present. Now, this will be published this term, and we will be discussing and debating that statement, I believe in July, in the Senedd.

Secondly, the health service collaborative will lead the work of developing a 10-year plan for women's health. This will outline the steps that the service will take to meet the expectations in the quality statement. The plan will follow the same whole-life course outlined and recommended by the Royal College of Obstetricians and Gynaecologists in their 'Better for Women' report, and the intention is to decrease inequalities in health, to improve the fairness of services and to improve the health outcomes for women in Wales. The plan will include short-term actions and long-term actions, and I will present that in the autumn. I'm eager that service users should be able to contribute significantly to the plan to ensure that the voices of women are at the heart of the plan. So, engagement will take place with stakeholders throughout the process of developing the plan, as well as the usual consultation. I'm very grateful to the Women's Health Alliance for the work that they have done to raise the profile of women's health, and I look forward to meeting and working with them as we develop the plans. I'm aware that there's a great deal to do yet, but I'm certain that the statement and the quality plan, together with the work that is in the pipeline already, will lead to far better care for women across Wales.  

Rhun ap Iorwerth to reply to the debate.

Thank you very much, Llywydd. Thank you for every contribution to this important debate today and for the Minister's response. This is an area that has been neglected for far too long, and it's remarkable that it has been neglected for so long. There has been, I think, some sort of awakening—and I'm not talking about Wales specifically there, but more generally. I note the work in England, for example, on the women's health strategy, which has been welcomed there. We, as the health committee, as we've heard already, are doing work in this area, and I'm grateful to Joyce Watson for pushing to ensure that that happens. Here in Wales, we've heard the Minister today talking about the range of steps that she intends to take. We see in the Government's amendment a reference to the quality statement and the NHS plan that is to come. If I heard correctly, from a Member who has left the Chamber now, we were accused of grandstanding. I was hoping to ask her to explain if that's what she had said, but she's not here to do that.

I understand that Senedd.tv has crashed this afternoon, possibly because so many people are viewing this session—that's how important this is. And the truth is, hearing words from the Minister in itself isn't enough. I welcome the words, but what's important is what's going to happen from now on.

The Member, again who is absent, had suggested that our debate today wasn't timely because the Minister had made comments recently about the plans that she is going to develop. But do you know what? I will take advantage, we'll all take advantage, of those positive messages. There are Labour Ministers in place since 1999, so you can't find fault with us for doubting what's happening under the Ministers here. But what's important is that this is the right opportunity to push a Minister who says that she is determined to make a difference in this field. I know that the Deputy Minister with responsibility for mental health is very keen to make a difference in that field, and that's why I'm pushing so hard on her to do so, because I think that there is an open door there. It is up to you, as a Government, to prove that your words are words that can be turned into reality.

There are so many elements to what we've discussed and heard about this afternoon. We have the conditions that affect women only, and where there have been terrible weaknesses in research and in investment—endometriosis we've heard about already, which means that so many women are living in pain every day. And we haven't even given them the respect of investing in the research that could discover what exactly is causing this so that we can make an investment in finding a way of treating endometriosis.

We can draw attention to support for women who are going through the menopause: half of our population—half of our population—go through the menopause. And until recently, there was not much mention of it, and at best, at best, the provision available in Wales is inconsistent—and that's being kind. There are women in all parts of Wales who cannot access the care that they require.

Three in every four pregnant women take some form of medication during their pregnancy—where is the research in finding out what's safe to take as medication during pregnancy and while breastfeeding? There is a need for investment in that.

Those are some issues that are specific to women. And then you have issues that are relevant to the whole population, but where there is a bigger impact on women, because of lack of attention, lack of investment, lack of taking it seriously, lack of consideration of the specific needs of women—inequality between women and men, as simple as that.

The gender gap in heart disease we've heard about today. It's costing women's lives. And that groundbreaking report in 2019, 'Bias and biology: The heart attack gender gap', by the British Heart Foundation, really opened my eyes to what was happening, or what was not happening, in the treatment of heart disease in women: heart attacks in women being misdiagnosed as anxiety or panic attacks. It was spelt out to me in this way: cardiac specialists have traditionally been overwhelmingly men, so the needs of women amongst the speciality itself have been overlooked for too long. 

Migraine—I was talking to a group interested in pushing the agenda forward on migraine recently. It's far more common in women than in men; perhaps a third of women will experience migraine, compared with 13 per cent of men. There may be some underreporting by men, but the higher level among women is likely to be as a result of hormonal factors, genetic differences and so on. 

One hundred and eighty thousand women in Wales have asthma. Figures suggest that asthma kills twice as many women as men. This is a women's health issue that needs addressing. One charity has said that women have been failed by a lack of research into links between hormone changes and asthma. Asthma + Lung UK said that women are stuck in a cycle of being in and out of hospital and, in some cases, losing their lives because of a lack of research. Research in itself is an area where there needs to be a new focus on women. Russell George touched on this. Clinical trials have traditionally been focused at men, older men, and not enough women taking part.

I can see that time is running out. We as parliamentarians today are making this demand to Government. Despite what it's promised, we're making that demand to insist that the promises made now are put into action. I know that a coalition of organisations has come together to put together its case for a women's health strategy, as we're calling for today. It's time to take action on this. We've talked a lot about health inequalities recently in this Senedd. This is yet another example of inequality, perhaps the most glaring of inequalities that we simply have to stamp out.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] There is an objection, therefore I defer voting until voting time.

Voting deferred until voting time.