We'll move now to item 7, a statement by the Minister for Health and Social Services on women's health. I call on the Minister to make the statement. Eluned Morgan. 

Diolch yn fawr, Dirprwy Lywydd. Thank you for the opportunity to make this important statement today about the publication of our quality statement on women’s and girls’ health. We’ve been working hard to improve the quality of care everyone receives in Wales and to reduce the level of variation in standards between services available in one part of Wales and another. However, there continue to be some very deep-seated and entrenched differences in the way men and women experience healthcare. These are well documented and well researched and are not unique to Wales.

Women make up just over half of our population and account for the majority of the NHS workforce in Wales. Women shoulder the majority of the family caring responsibilities and continue to do most of the work in the home, as well as working outside the home. But all too often, women receive healthcare based on the male experience of an illness, rather than getting the help and care they need, tailored towards their needs as a woman or a girl. Such gender biases and inequalities can mean women often receive poorer services and, in some cases, we are seeing poorer outcomes.

Research by the British Heart Foundation suggests that the deaths of at least 8,000 women could have been prevented if they had received equitable cardiac treatment over a 10-year period in England and Wales. This is just one example, in one area of medicine. Sadly, these inequalities are evident throughout medicine. Llywydd, this isn’t right and it’s not fair. If we are to be true to our overarching aim of providing person-centred care in Wales, then we must change the way we provide healthcare for women and girls so they can access it in a timely way, so the NHS is responsive to their choices and needs and that research and development reflects women's and girls’ lived experiences. That is why, today, I am publishing the quality statement on women’s and girls’ health.

I want to put on record today that when we talk about women’s health and women’s healthcare, we’re not just talking about gynaecological services or reproductive health. These are, of course, important services for women but they are not the beginning and the end of women’s healthcare. There are a wide range of conditions where women may present differently to men or may be disproportionately affected, including autism, asthma, migraine, bone and cardiac disease. Women also experience different patterns of need and presentations across ethnicity and disability, pregnancy and maternity. The NHS must be able to treat people experiencing these conditions appropriately to ensure the best possible outcomes.

The quality statement is the important first step in our plans to transform the care received by women in Wales. It sets out what the NHS is expected to deliver to ensure good-quality health services to support women and girls throughout the course of their lives. It describes what ‘good’ looks like. The quality statement will be followed by the publication of a 10-year women’s health plan in the autumn. The plan is being developed by NHS Wales with significant input from women’s groups. Together, the quality statement and the plan will set the course for the way services for women and girls will be provided and developed in Wales. I have been clear that the plan will follow the same life-course approach that the Royal College of Obstetricians and Gynaecologists set out in its ‘Better for women’ report in 2019. It will advocate an approach where women have access to the right treatment throughout their lives and the NHS must work in a more preventative space.

While these two documents will set the course for the future, we have not been waiting for today to make changes to women's and girls’ healthcare in Wales. We have funded the women’s health implementation group and we’ve introduced specialist endometriosis nurses and pelvic health and well-being co-ordinators into each health board in Wales. They are ensuring women are being signposted to appropriate services and being supported through diagnosis and treatment. 

The Bloody Brilliant awareness resource—

it doesn't translate to Welsh quite so well—

—also funded through the women’s health implementation group, has been widely praised, and has been accessed by people around the world.

Working with clinicians, we have set up a task and finish group to look at best practice to design a new menopause care pathway for Wales. The group's work will support the four-nations menopause taskforce.

We have also set up a gynaecology planned care programme board to modernise and transform the way services are delivered. This work is clinically led and will help services to recover from the impact of the pandemic.

Finally, my officials are exploring the creation of a women’s health research fund. It would be used to fund research opportunities into areas of women’s health where there are known knowledge gaps. Historically, women have been disadvantaged by a lack of research and data about conditions that affect them, or where clinical care is modelled on data and research primarily based on men and their experiences.

Llywydd, it is time we closed the gender gap and removed these gender inequalities from healthcare in Wales. The quality statement and publication of the plan will help us to improve the way women and girls access and experience healthcare in Wales. This will transform the way that the NHS supports and cares for women and girls. Thank you very much. 

Can I thank the Minister for her statement today, and also take the opportunity to pay tribute to the NHS as it marks its seventy-fourth birthday today, and 74 years of remarkable service? Can I thank you, Minister, for the statement today and say I'm very pleased to hear that you, of course, recognise the inequalities that exist, inequalities that perhaps 18 months ago, before I took the health brief on, and before my role on the Health and Social Care Committee, I would have had little understanding of myself. But certainly, I appreciate the need for the plan. I'm not overly impressed with the quality statement itself, but the women's health plan that will flow from that I certainly look forward to in the autumn. 

When it comes to the Health and Social Care Committee, we carried out our own consultation last summer asking our stakeholders about their priorities, and women's health and girls' health was very, very high on the agenda. As a result of that, we made a point of making sure that women and girls' health is a priority for the Health and Social Care Committee for this Senedd term, over the next five years. 

I should also say we also undertook some research when we invited the women's health Wales coalition to come in back in March, and present to us, which was useful in informing certainly my views. What the coalition did say to us—and you touched on this in your statement today—is that when we study hearts and heart attacks, we're studying male hearts and male heart attacks. And actually, women need to be involved in that, and we need to think about these diseases as being something that impacts both. Of course, as you've pointed out yourself, Minister, there's perhaps an under-representation of women in clinical trials. We also know, or certainly the coalition told us, that women are 50 per cent more likely to receive an initial misdiagnosis of a heart attack, and we don't know why that is. So, Minister, can you confirm that the health plan will include a commitment to increasing the representation of women in clinical trials in Wales? 

You also pointed out that the plan will be developed with women groups, and that's very much welcome, of course, but, certainly, when we hear about the experiences of women in developing that implementation plan, can I also ask whether you're going to build into that those women's voices, and into governance and leadership structures within the NHS as well?

We've heard a lot of issues around miscommunication. Changes to the cervical screening programme have highlighted the importance of clear and accurate communication. On that point, I wonder, in terms of improving communication, whether you can clarify how the plan is going to improve communication with women? There was some evidence presented to us as well that, sometimes, as women are recovering, many patients would have their surgery and then the consultant would come around to talk to them whilst they were in recovery, and whilst they were semi-conscious and couldn't remember what had been said. So, on the importance of communication, I'd be interested in your further thoughts about how the plan is going to improve communication in that element as well.

Then, of course, there's the issue about prevention as well. I know that you will probably agree with that assessment, but I'd be interested to know, Minister, how your plan is going to incorporate prevention and how that will fit, also, with 'Healthy Weight: Healthy Wales’.

You also, Minister, mention in your quality statement that

'Health boards will ensure appropriate levels of diagnostic, therapeutic and surgical capacity to enable women who require interventions for health needs specific to women and girls including menstrual...and menopause, to receive care as close as possible to home without significant waits.'

I'm just interested in how that will be developed, bearing rural areas in mind as well. Of course, those might be very easy to roll out in Cardiff, but when we think of rural areas, I'm just interested in how your plan will develop in terms of ensuring that we have enough capacity in rural areas as well. And— 

Russell, can you conclude now, please?

Yes. I will ask my last question in that case, Deputy Presiding Officer. How do you envisage your plan also addressing the short amount of time—I can't even read my own writing here, Minister. [Laughter.] My time is up, so I'll end with that, because I can't read my own handwriting. 

Excellent. Thanks, Russell. First of all, I thank the committee for taking this issue seriously. I guess I've got a little appeal to you, as a committee—I know you're independent and you can do what you want, but it would be really useful if you could do this quite quickly so that you can influence the plan. What I'm really keen to do with this plan is to get everybody to contribute and feel like they can make a difference here, which is why I've been really keen right from the beginning to involve women's groups in things just to make sure that people feel empowered to feed in.

So, if you could do that as a committee—I'm sure you've started on that work already—it would be really useful. We've got quite a tight timetable, but I'm really keen to get this done so it can influence next year's integrated medium-term plan proposals, so that would be very good.

I'm sure you are aware of the finance Minister's statement today, and she was saying that she's

'delighted to share with the Senedd the cross-Government work that is under way to explore the potential for a focused package of work in gender research linked to health.' 

This is really important, I think, to get the data sorted out so we can know exactly what's going on. That's part of the problem; it was a problem that was identified by Caroline Criado Perez in Invisible Women, her book, and I'm sure that the feminists amongst us have analysed that quite carefully and have realised that, you know, we live in a world designed by men for men. We need to rebalance that. It's very difficult to understand how you're going to change it unless you get the data right from the beginning, and I think that's an important thing and something that we're very keen to address.

In terms of women in leadership and governance positions in NHS Wales, I've got to tell you that I've been very impressed by the number of women in leadership and governance positions in the NHS in Wales. I think I'm right in saying that many of the chairs are women, many of the chief executives are women, and certainly, many of the people in middle management are women, so it's not just that the NHS is made up of a very high percentage of women, but they are actually getting to those top positions as well.

In terms of communication, then, the important thing about this programme is that it's got to be owned by the NHS, which is why I really want them to develop it. They've got to own it so that they deliver it. I don't want it to be entirely imposed on them. I'm telling them what the quality of what they need to meet is, but they've got to decide how they're going to go about that. On communication, I do think we need to be very careful around communication—we've got to get this right. I'm really keen to push a lot more on digital. On the other hand, lots of the people in our hospitals, for example, are dementia patients. So, you're quite right, but even if you—. You've just got to be sensitive to different people, and hopefully that is something that will be addressed.

Prevention is an area where we're very keen to make sure that we do some work and I guess just looking at the programmes that we've got through a gender lens, I think, is really important, so things like 'Healthy Weight: Healthy Wales' will be important. And then when it comes to care closer to home, what I'd like to see, and I'll certainly be pushing them to work towards this, is menopause or menstrual expertise in the primary care clusters, so that we get one in each cluster. I've got to make sure that they buy into that, but that's what I'd like to see—that kind of expertise developed and delivered on a local level.

Thank you to the Minister for the statement on the quality statement. It's a significant step, I think. Two months have passed since we in Plaid Cymru tabled a motion to the Senedd emphasising the importance of addressing issues around women and girls' health, and I'm pleased that we have heard this statement this afternoon.

It is astonishing and disgraceful, if truth be told, that it's taken us until now to start seeing things from the perspective of women and girls in healthcare.

I think what we're starting to realise is the importance of gender-specific healthcare in its widest meaning, and the need to tailor healthcare for the needs of more than half the population. It's not just specifically about gender-specific conditions or illnesses, it's the fact that women have not featured enough in our thinking about conditions that affect both men and women, but where there is a specific and a particular women's perspective. The needs of women have even been ignored or not given enough attention even when there is disproportionate impact on women of those conditions. You mentioned some of them. Heart disease is one that comes up quite often. Asthma is another one. Migraine is another one. And those have been referred to by the Minister.

I would, though, point out that whilst the Minister, and I agree entirely with her, says that she wants to put on the record that when we talk about women's health and women's healthcare we're not just talking about gynaecological services or reproductive health, and then she goes on to name the things that are being done already, and following the life-course approach set out by the Royal College of Obstetricians and Gynaecologists, and talking about the specialist endometriosis nurses and pelvic health and well-being co-ordinators that are being put in place, and the Bloody Brilliant awareness resource, and the work on menopause. These are all gender-specific issues, and I just want to make sure that the Government isn't falling already into the trap of listing only those gender-specific issues. I'm confident, given this more wide-ranging look now, that that won't be the case, but we always need to keep sounding that warning.

Two questions, quite simple, at the end from me: what resources are being set aside now for the 10-year plan? Because, as important as the quality statement is today, it's that that I'm excited about, seeing as it's that that's going to actually make the difference in terms of making sure those services are there for women. So, what resources are being set aside for that in terms of people, and, financially, will there be additional resources, or is this just going to be about making sure that our health boards, within their current resources, do enough to ensure that women's health is given the attention that it deserves? And also, so that we can hold Government to account on this, how will women, and how will we as parliamentarians, know that that plan is making a difference? How will women be able to witness and sense and get a feeling that there has been a change and that that is having a clear impact on the care that they receive within our health and care services?

Thanks very much. I think it's really important to make it absolutely clear there's no contradiction in the fact that we have already started to do work in the gynaecological space. What we're doing here is to expand beyond that, and, certainly, this was something that was drawn to my attention very early on after I was appointed, and I just wasn't aware of it, the fact that heart disease is a bigger killer in women than breast cancer.

There's all of these things, and you think, 'Hang on, one in 10 women are also suffering from endometriosis. Where's the funding to go along with that? Would that be the case if it were a traditional men's area?' So, I don't think there's a contradiction here. What I'm making absolutely clear is, when we had the women's health implementation group—. So, this is the point—you're saying, 'Why haven't you got on with it?' The point is that we had got on with it; we were doing things under the women's health implementation group. This is taking a step back from it and really looking at it, the whole system, from a gender perspective. And you'll see a list in the annex, and the poor officials who work for me are getting fed up with me saying, 'I've found another one; I've found another one. This is another area where we haven't looked at the gender aspect of this', and certainly the list in the annex gives you an understanding of how many conditions there are where women are affected differently, and therefore GPs may miss the symptoms because they present differently. So, it's that kind of thing, and then there'll be implications for the training of the workforce and all of these kinds of things, so we just have to bear all of those things in mind.

In terms of resources, this is a plan that's going to be owned by the health boards. They're going to have to meet it from within their resources. The idea is that they take a gender-focused approach to what they're doing already. But what I can tell you is that, actually, in developing the plan itself, we have put aside £160,000 of additional resource and we have seconded to the NHS Wales collaborative somebody who is involved in developing plans elsewhere, working now with the chief nursing officer to help build this plan, so we've got somebody who's kind of been through this before to help us and to make sure that we land in the right place.

I have six Members who wish to speak, and I hope to call all of them, so I would ask you all to be succinct in your contributions, please. And that includes the Minister. Jenny Rathbone.

Thank you very much. Ignaz Semmelweis identified why women giving birth cared by midwives—nearly all women—had a much lower mortality rate than a randomly identical cohort cared by doctors—all men—in 1847, but it took over 100 years in a male-dominated profession for hand washing between patients and before surgery to be mandatory practice. And so that really illustrates just the size of the problems that we face in many areas of our life, and that includes medicine. If men got pregnant, I suggest we wouldn't have such disgraceful attacks on womens' and girls' right to choose in at least half the countries in the world. And happily the Welsh health Minister has protected the right of women in Wales to have rapid access to telemedical abortions, and the innovation that we achieved during COVID to be a permanent feature in the NHS in Wales. 

You mentioned in your statement about endometriosis, and I just wanted to probe a bit further on this. Yes, we've introduced specialist endo nurses into each health board in Wales, and that's very, very welcome, but women do not have equal access to secondary and tertiary care, and so that is obviously a big challenge for us and for the Welsh NHS.

Jenny, you need to ask you question, please. I'm running out of time.

Okay. So, what is the status of the provisional centre at Singleton Hospital, and how do you envisage ensuring that all women in Wales have access to secondary and tertiary care, where required?

Thanks very much. And, Jenny, I'd like to support you in terms of your position on women's right to choose. I'm absolutely despairing in terms of what's happening in the United States, and I think it's been a very sad step backwards for women and, indeed, men in that country.

In terms of endometriosis, you'll be aware that we have now in every health board an endometriosis nurse. I've met them on a few occasions. Their enthusiasm is, I know, very catching. I know that they're doing a great job, and they're training people, I know, because—I declare an interest—my husband was on a course, as a GP, the other day with one of these people, learning about endometriosis. What I recognise is that, when it comes to secondary and tertiary care, there's a lot more work to be done and, of course, we are going to have to look at what more we can do in that space in terms of recruiting surgeons who are able to help with this very, very difficult condition that people live with.

I'm just trying to cut down my speech here. I very much welcome this statement and the opportunity to talk about women's health. For too long in our society, we've seen women's health, safety and well-being neglected and overlooked. I really welcome that there'll be a 10-year women's health plan in the autumn, and I very much welcome lots of parts of this statement. It will be an enormous opportunity for this Senedd to make a significant contribution in many ways to women across Wales.

One major area of concern with me, of course, is perinatal care—something that Buffy and I have both spoken with some passion about, because of the experiences that we had. Due to the significant and long-lasting effects of not treating perinatal health, what, Minister, are you doing in terms of ensuring equality of access to perinatal services across Wales, and what, as Rhun just said, resources have been put aside to address that? 

And I very much welcome your statement about endometriosis, and I commend the work that Suzy Davies, a past colleague, brought to this Chamber about highlighting all those issues. What are you doing to highlight awareness of this issue, endometriosis, working with the Minister for education, with the new curriculum, but also perimenopause and menopause and all women's issues? How are you working with other Ministers to highlight those in Wales? Thank you.

Thanks very much. Certainly, I'm very aware, and I've heard on several occasions you talk about your experiences in terms of perinatal health, and the same with Buffy—very traumatic experiences, and you're representative of so many thousands of women who've been through a very, very traumatic time. And I think it's really important that we think through, and this is why the life-course thing is really important. It's not just about what happens at that moment, it's about what happens, as a result, for the rest of your life, to the point where, for example, lots of people have incontinence issues, for example. We've got to think about what the impact is throughout a person's life cycle. So, these are things, I hope, that will be brought out in the plan, where there will be a focus. What we're talking about here is a quality statement, where the expectation is that there will be access, and there will be an equality of access. 

When it comes to endometriosis, I would like to commend also the work that Suzy Davies did, and I know that one of the last things that she did in this Senedd was to ensure that, actually, this was going to be something that was built into the curriculum, and so people will learn about it in the Welsh school curriculum.

I also really welcome the statement. I'd like to highlight something about the impact of the hormone replacement therapy shortage on women going through the menopause. One constituent has raised something quite specific with me, which is that women going through surgical menopause are being particularly badly affected. So, surgical menopause is when surgery, instead of the ageing process, causes the menopause to happen. My constituent told me that, for women like her with no hormones, going without HRT isn't just a case of making it more difficult to top up your mood, it really makes it almost impossible to function, and suicidal thoughts are just really taking over her life sometimes. So, can anything please be done to prioritise how women who need HRT the greatest can be made to be prioritised, because not everyone's menopause will be the same? And, as I've said before, I realise that the UK Government has responsibility for maintaining supply of medicines, but I would welcome more information on what you're doing cross-governmentally on this, please. 

Thanks very much. Well, what we have seen is an increase of 40 per cent in terms of demand over the past five years when it comes to HRT. And the real problem is that manufacturers haven't kept pace with that demand. So, we are working with the UK Government, who, of course, is responsible for procuring this on our behalf, and, obviously, people are being advised to perhaps go to alternatives that are available. I'll look at that issue in relation to surgical menopause; it's not an issue that I've come across before, but we'll certainly ask officials to take a look at that as well.

Thank you, Minister, for this. I know that women's health is a priority for you and our Welsh Government, and so I very much welcome the statement today.

I don't want to say things that have already been said; I just want to support what you, Minister, and Jenny Rathbone have said about the ruling being overturned in the US—the Roe v. Wade—and I really do believe that it's going to be a very dark time in American society now for, as you said, men and women, because of this decision that has been made. I think it's really terrifying as well for many, many people across the world because this has happened. Our right to autonomy and to healthcare can be taken away from us with political will, and that is why we must keep fighting to protect the rights of women across the world.

I just want to say, though, really—. I'd like to pay tribute to the women in my community who have shared their experiences of healthcare and gender, from cervical screening and menopause to neurodivergence. As I've said before, it is historical, it's engrained in our systems, because the decisions made about our healthcare have not always been made with women in mind, by women. So, I just wanted to ask if you could give us a little bit more about neurodivergence, really, because this is something that I've had an overwhelming response about, and I think just that a lot of women would like that reassurance that it is being taken seriously by our Welsh Government. Thank you.

Thanks very much. In terms of cervical screening, I think it's really important that we also take not just—. It's obviously a gender issue, but there's an inequalities issue within that. So, it's clear that we see fewer people from poorer areas presenting themselves for screening, so we've got to take that into account as well, and make sure that we're making up for that, not just in terms of cervical screening but more broadly in terms of screening. In terms of neurodivergence, you'll see in the annex that neurodiversity is an issue that is listed there that clearly, I think, needs a bit of attention when it comes to understanding that women may present in a different way from men. And I know that my colleague Julie Morgan, who's responsible for that, will be interested in pursuing that as well.

Thank you, Minister, for today's statement. As you know, perinatal mental health support and the heart attack gender gap are extremely important to me, but we need to talk about the menopause too. The menopause is a natural process that all women go through. However, many women find it a very stressful time, like any time of change. I'm really happy to see fewer and fewer women afraid or embarrassed to talk about this change and more and more women opting for treatment, but we need to be ready to meet this demand. I think it's extremely important that we remember that the menopause is a very personal change. We all go on our own journey and it will affect us all differently.

After needing surgery over 11 years ago, I was thrown into the menopause, and, after chatting with my consultant, I opted to go with HRT treatment. I was afraid at first, after hearing some of the potential risks that come with HRT, but it's what worked for me and I wouldn't be without it. Echoing Delyth's contribution, I know that the Minister announced, earlier this year, that she will be taking part in the UK menopause taskforce following the struggle of supply in HRT. Can we please receive an update regarding the work of the taskforce to date? Diolch.

Thanks very much, Buffy, and I know you, too, have had your issues in relation to women's health as well. I think it's really important that people talk about the menopause now, and it's great that people are being a bit more open about it. And I think there's a lot we can do to support women with the menopause and we've got to understand—. In the workplace as well, I think there's a job for unions to do to draw this to people's attention, and I think it's really important that people understand, as you say, that everybody's journey is different. Just in relation to the menopause, we now have a task and finish group in Wales looking at the menopause, and that will feed into the UK menopause taskforce that, of course, Carolyn Harris is very active on and leading the way on in the UK. Diolch yn fawr.

Finally, Joyce Watson.

Diolch, Dirprwy Lywydd. I want to talk about the issue of women who suffer traumatic injuries to their pelvic area as a result of childbirth. I know you said this is wider, but, nonetheless, it's an area that's not been talked about it. Some of them experience severe injury, such as anal sphincter injuries, which can result in faecal incontinence. According to the MASIC Foundation, one in 50 women in the UK suffer from an obstetric and sphincter injury, and the impact on those women is considerable, on their physical and mental well-being, not to mention that of the wider family. I've never heard anybody mention it, and I'm very, very pleased that an individual took me up on an offer to come and talk to me about it.

I'm also aware that Cardiff and Vale University Health Board recently opened a pelvic hub to help improve the care for patients who have experienced those injuries. They're doing extremely fantastic work, and I'm hoping to meet with the surgeon in the summer recess. But that help resides only there, so it's about inequality of access. So, Minister, what discussions are you having, as Welsh Government, with health boards across Wales about the potential of opening up pelvic hubs in other areas of Wales that will treat women who, as a consequence of being women, get fair and equal access? And let's open another debate about the effects that very often happen directly as a consequence of having children.

Thanks very much, Joyce, and this is an area that I think, again, is one of those unspoken areas where it's really important that we start to talk about it in public, because it really is impacting, in particular, older women, many of whom are afraid to leave their homes now because of the social stigma that they feel if they have issues like that. You will, I'm sure, be very pleased to hear that, in fact, we already have a network of pelvic health and well-being co-ordinators in every health board in Wales, and that's come about as a result of the women's health implementation group. So, that's already in place, so if you need to direct people to those, I'm sure I can help you with where those are situated.

Thank you, Minister. Before we move to the Stage 3 debate on the Welsh Tax Acts etc. (Power to Modify) Bill, I will suspend proceedings for 10 minutes in accordance with Standing Order 12.18. The bell will be rung five minutes before reconvening. Please could all Members ensure that they return promptly, so that voting preparations can take place?

Plenary was suspended at 18:04.

The Senedd reconvened at 18:19, with the Llywydd (Elin Jones) in the Chair.