The importance of women in health care – not quite a panoramic view

Last week I had a 38 year flashback moment. It was the time when I first arrived in Manchester. I had got a job at the first NHS forensic secure unit for adolescents. It came at a very turbulent time in my life. Despite my personal troubles, I was going to take up what felt to me to be a dream job. As the Nursing Times described the opportunity at the time, I was going where no RMN had gone before. And I was. There was no rule book, procedures or other services to copy. We had a blank piece of paper and had to start from first principles. I loved those first few months. I went and spent time at various other forensic institutions, from a special hospital near Ormskirk in Lancashire, a prison in Manchester, to a private hospital in Northampton. The service I arrived at was a medium secure service providing treatment and care for troubled and at times, troublesome children and young people. It was a mixed sex unit, which often gave rise to issues as to whether a young person’s behaviour was ‘normal’ adolescent behaviour or as a result of their mental illness. We paved the way for the development of adolescent forensic mental health services nationally. It was a privilege to be part of these hopeful new beginnings.

Six years later I had become the Service Manager for all the regional specialist mental health services located at Prestwich hospital; a hospital managed by Salford Health Authority. One of the services for which I had responsibility, was the adult forensic services at The Edenfield Centre. This was (is) a Medium Secure Unit. Patients came here from special hospitals (High Secure) or from Low Secure Units, or from within the criminal justice system. All those years ago, it was very much the jewel in our crown. The service had a wonderful reputation for compassionate and person-centred care. Unsurprisingly, experienced colleagues working within the field of adult forensic services had been hugely supportive and immensely helpful as we set up the adolescent forensic service.

So, it was great sadness that I watched last week’s Panorama programme. It featured an undercover reporter’s account of the three months he had worked on one of the clinical areas in the Edenfield Centre as a Health Care Assistant. He had worn a hidden camera with which he recorded some very distressing and totally unacceptable incidents of abuse, neglect and cruelty. Much of this behaviour came from qualified mental health nurses. It was a difficult programme to watch. All those featured have been suspended and face both disciplinary action and probable police investigation. I no longer know many of the nurses working there these days, but I do know the Chair, some of the Non-Executive Directors and a couple of the Consultants. All are highly shocked by the revelations and deeply committed to ensuring safe care is being provided. There was no pre-screening of the programme, so I think it will have been very difficult to support colleagues and patients who would have watched the programme and have been affected by what they saw.   

It certainly wasn’t a great day for mental health nursing or mental health care. 

And last week it was the monthly NHS England Regional Office meeting with Chairs and CEOs from across the North West of England. It was an equally sobering meeting in the main, a meeting where good news was hard to find. However, there was one agenda item that really caught my eye and made me think. It was a presentation by folk from the Liverpool Women’s Hospital. The presentation focused on their response to the recently published Women’s Health Strategy for England. Now to be perfectly honest, this strategy passed under my radar completely. I’m not sure whether August was a busy month for me, but I was not sighted on this document at all. You can read the strategy here. It’s a mere 132 pages long, but it will take a lifetime to deliver what’s needed to address many of the issues.  

There are some basic facts that are irrefutable. Women live on average longer than men, but they spend more of their lives in poor health. Women make up 51% of the population but historically the health and care systems have been designed for men by men. Looking at the NHS workforce, 77% are women. Despite the fact that 69% of all posts at 8c – 9 (middle to upper management grades) are filled by women, women do not feature prominently in research, and in the education and training for healthcare professionals. They are seldom included in the design and development of healthcare policy. Only 47% of the most senior roles in the NHS are held by women.

At a national level, the same is true. During the time I have been an active contributor to health and care services in England, (some 40+ years) we have had 16 Secretaries of State (SoS) for health and social care. I have met many of them. Of these, and including the latest SoS, there have only been 3 females to hold the post. So perhaps it’s not difficult to see why women’s health and contribution to wider health care has not been prioritised. The consequence has been a complete failure to place women at the heart of health services. Arguably this has had a huge impact on how we address access to health and social care services and how we address the destructive impact on health inequalities.  

The Women’s Health Strategy adopts a ‘whole life course’ approach to issues facing women today. It focuses on gaining greater understanding of the changing health and care needs of women and girls across their lives.  In so doing, the aim is to both identify the many stages, transitions and opportunities during a women’s life span, where good health can be promoted and where preventive measures can be put in place to help ensure positive health and wellbeing. In a sector mainly populated by women, we simply cannot ignore the notion of recognising what a women-centred service might mean in addressing inequalities close to home. Not to do so risks the NHS featuring in a future Panorama programme, and worst still, the prospect of an ever-deteriorating NHS service for all.