Friday 16 November 2018 / 2:47 PM Jonathan Ashworth / NHS

Jon Ashworth’s speech on women’s health and the gender pain gap

Jon Ashworth MP, Labour’s Shadow Health Secretary, speaking at the National Women’s Health Conference, said:



Good morning, can start by thanking you for your invitation this morning


It’s a privilege to be here at Mary Ward House today, during a momentous year – a year where we are not only celebrating 100 years of women getting the vote, but also the 101st year of the Medical Women’s federation itself, set up near the end of the first world war changing attitudes towards female medics demanding the opportunity to serve their country during the great war. 


For that all of us owe you a debt of gratitude.


So it’s a pleasure to be here and indeed an honour to share a platform with your President and President elect.


It is no exaggeration on my part when I confess that both Henrietta and Neena had a tremendous influence over my thinking and priorities as Labour’s shadow Health Secretary.


I had the privilege of meeting Henrietta earlier this year at the gambling addiction clinic in London where we discussed the nation’s hidden epidemic of problem gambling.


430,000 people in the U.K. have a gambling addiction and 2 million more are at risk of developing one. 370,000 of our children are gambling every single week.


This addiction can be ruinous, for individuals, for families and communities. Some estimate that tragically, there are two suicides a day caused by problem gambling.


Few have done more to expose and treat this problem than Henrietta Bowden Jones, so it’s a pleasure to join you today.


Since my appointment as shadow Health Secretary I’ve signalled my commitment to prioritising addiction treatment whether from gambling, alcohol or drugs.


For me this is indeed personal – some of you may have seen I have told my own story growing up with a father whose life was ravaged by alcoholism – but my commitment isn’t just because of what I’ve seen first hand.


Quite frankly when deaths relating to alcohol consumption are 10 per cent higher than ten years ago, when deaths relating to drug misuse are at their highest on record and when dependency levels are increasing while treatment services are reduced, I believe we have a duty to act and addiction treatment services will be a personal priority of mine as Health Secretary.


And of course let me say a word about your President Elect: Neena Modi.


If I can be honest when one accepts the position of shadow Health Secretary when your party is 20 points behind in the polls, not everyone across the NHS landscape feels it’s quite a priority to meet you. But Neena was banging on my door straight away.


And consequently I think from memory the very first meeting I had with a Royal College President was Neena when she was then President of the Royal College of Paediatrics and Child Health.


She presented me with a detailed analysis that showed across the UK our children were on many, far too many measurements suffering from relatively worse health and wellbeing outcomes than children in equivalent sized nations to us.


It shocked me.


Because it is shocking that we are lagging behind most other high-income countries on for example infant mortality, breastfeeding, obesity rates.


I was so taken with that research it was at that point that I decided that we can’t allow the health and wellbeing of the next generation to be neglected and overlooked.


So today I can tell you improving the health and wellbeing of every child will be my driving mission as Health Secretary – I’ve talked of an ambition for us as a nation to create the conditions where we can nurture the healthiest generation of children in the world. Of course that is a big ambition, but I make no apology for being ambitious for our children.


So thank you Neena, and I think the fact that NHS England’s consultation on the Ten Year NHS Plan has a work stream dedicated to child health is testament to your passion and perseverance in pushing child health up the political agenda.


In both the addiction crisis I believe we face and the relatively poorer child health outcomes I’m determined to confront, deprivation and inequality is the remorseless backdrop.


This is where I want to focus some of my remarks this morning.


We know that rates of premature mortality are twice as high in the most deprived areas of England, compared to the most affluent.


And these stark divisions between rich and poor areas means poorer people die earlier and get ill quicker.


It means women in the most affluent areas live on average seven years longer and enjoy 20 additional years of good health compared to those in the most deprived areas.


Inequality in life expectance is severe and shamefully getting worse with advances in life expectancy stalling, and even going backwards, in some of the very poorest areas.


Moreover, if we consider the international trends in life expectancy, women in the UK have overall seen the lowest rate of life expectancy improvement between 2010 and 2016 of the top twenty most affluent states.


I believe these acute health inequalities should be attracting a greater urgency from government.  Of course we all recognise health inequalities arise from a complex interaction of varied factors from the state of housing people live in, the quality of air we breathe, to income, educational achievement, disability, social isolation, conditions of employment – but it’s my contention that governments have the responsibility to create the circumstances where people can live longer healthier lives.


That’s why an overarching target to narrow health inequalities will be a specific target of the next Labour government running like a golden thread through our whole policy agenda.


When women represent 51 per cent of the population and 44 per cent of the workforce a genuine strategy to tackle health inequalities must include a plan to address the inequalities in women’s health outcomes and unmet health needs as well.


As Sir Michael Marmot found in his landmark study into health inequalities there is indeed ‘systemic gender differences in health outcomes’.


Women live longer than men, but spend a greater proportion of life in poor health.


Too often our health services disproportionately fail women.


Whether it’s access to treatments or broader health outcomes many women have rightly complained of the ‘gender pain gap’ – it’s our commitment to end that gap and put in place a women’s health strategy in government as part of our commitment to target health inequalities.


Today I want to invite you to work with us on producing that women’s health strategy to inform our plans for government. But let me highlight some areas which I believe reinforce the case for a women’s health strategy.


Just this week we learnt of the appalling situation where 48,000 missed out on receiving crucial information relating to cervical screening appointments and test results. This is a scandal and Capita should lose this contract.


This latest screening fiasco comes at a time when cervical-screening rates in England are at their lowest for two decades. When women do decide to get tested, one in eight women find it difficult or even impossible to book an appointment.


Yesterday NHS England announced a review into screening processes as part of the NHS’s long term plan.


I won’t need to remind anyone in here that a woman is diagnosed with cancer every three minutes in the UK. It’s the most common cause of death in women and yet evidence shows women from poorer backgrounds are less likely to take up offers of cancer screening.


We welcome this review- It is long overdue. It comes as we reveal new research showing breast cancer waiting time performance in England falling.


The performance on the crucial ‘two week wait’ to get an appointment with a consultant, after an urgent GP referral, has already fallen below target for the first half of this year.


In just six months, the number of breaches on the two-week wait has exceeded the total breaches from the previous year. That’s an increase of 135 per cent – totally unacceptable when lives are at stake.


Let me offer another example where I believe we have to do more. Maternal health. So through our commitment to improving the health and wellbeing of every child, a Labour government will do more to support and help expectant mothers and mothers with new-born babies.


It’s why we are committed to expanding the Health Visitor workforce and introducing an additional mandated Heath Visitor contact. For mothers who want to breastfeed we want to offer them the right support they need and we would reinstitute the infant feeding survey in England.


Because perinatal mental health is so important and too often neglected with research showing that around half of new mothers’ mental health problems don’t get picked up by a health professional, we would ensure funding is made available for a six week maternal postnatal check.


We must do more to improve our child mortality rates too. The loss of a baby means a lifetime of heart breaking pain. Rates of stillbirth, neonatal and infant mortality have been falling over the 100 years since the Federation was established but we know in recent years rates have decreased more slowly than other countries.


And our resolve to tackle health inequalities and focus on the wider social determinants of ill health is especially urgent in this area, given stillbirth and infant mortality rates in the poorest areas of England are much higher than those in the least deprived.


So Labour shares and commits to the NHS target to halve the number of stillbirths, neonatal and maternal deaths and brain injuries by 2025. And our ambition is to go further learning from best practise from nations like Finland because central to our policy should be a commitment that each baby counts.


And just as I want us to do more to support mothers with their babies, I believe we need to more to tackle inequalities in fertility health and reproductive health too.


Eight years of the most severe funding squeeze in the 70 year history of the NHS has forced CCGs into making some very difficult choices.


The result is it’s getting harder to access fertility treatment. 1 in 6 couples have to deal with infertility, yet treatment is unfairly rationed around the country, creating yet another postcode lottery.  NICE guidelines are ignored and it means that many people forced to spend thousands of pounds for private IVF treatment in the hope of having a child – the mental health toll of which can be devastating.

But of course ensuring reproductive health and wellbeing must also means delivering universal standards of healthcare across a women’s lifetime covering contraception, preconception advice, sexual health screening, and menopause care.


I want to hear from patients and NHS staff as to how we can better integrate services in what has become an increasingly fragmented landscape in order to guarantee women’s reproductive wellbeing.


And finally on women’s mental health I believe we are, in many ways, facing a health crisis in mental health services especially in women’s mental health.


Women are twice as likely as men to suffer from depression. More women are presenting with a common mental disorder, rates of suicide in women are at their highest for a decade and rates of self-harm in women are higher than ever, especially in young women.


Sometimes it’s easy to blame social media pressures as the explanation for the growing trends in lack of mental wellbeing among women, especially young women.


I agree we need to better understand social media pressures but I think newspapers and those politicians who just focus on social media are too eager to jump on a simplistic bandwagon.


Socio- economic factors must be taken into account because again there is a correlation between women in the lowest income brackets – where life is characterised by universal credit or low paid, often part-time, temporary, high strain work- and mental health problems.


Yet, very few mental health trusts offer a specific gender informed approach to the mental health services they provide. So today I’m calling on the NHS in its long term plan for mental health to better take account of gender inequalities when designing service provision and I’m committing the next Labour government to ensuring gender informed mental health services


These are just some of the challenges but of course there are more and I want to work with you on how to best address them.


The starting point must of course be a fully funded NHS. That is Labour’s commitment. If we were in government this year our health service would receive an uplift of five per cent in investment paid for by taxation changes.


Crucially we would fully fund our commitments to the public health prevention budget as well and rescue our social care sector reeling after years of swingeing cuts with an £8 billion investment plan across a Parliament.


Despite what the new Secretary of State’s – and as far as I’m aware he is still the Secretary of State – recent statements about the funding settlement for the NHS, the reality is public health budgets were excluded from that settlement.


I believe this is completely misconceived and will only increase pressures on the wider NHS.


Public health budgets have already seen cuts of around £700 million including millions cut from substance misuse services, sexual health services, smoking cessation services – cuts which will in many instances disproportionately impact on the health outcomes of women.


And there are in fact further public health cuts to come. Indeed taken alongside cuts to capital investment and training there will be next year £1 billion worth of cuts to health services. These cuts should be reversed.


And just as we need a fully resourced NHS to tackle women’s health inequalities and tackle the ‘gender pain gap’ we need to tackle staffing issues too.


Our NHS is struggling to cope with staffing gaps of over 100,000 including for over 40,000 nurses and 10,000 doctors.


Brexit hangs like a sword of Damocles over the NHS and our ability to recruit staff for the future.


Understaffing is so severe that for example, our research recently revealed that around half of England’s maternity units closed to new patients at some point in 2017 because of lack of capacity or staff. A credible solution to understaffing has to be the test of the Secretary of State’s long term NHS plan next month.


We cannot end the gender pain gap while we have an NHS severely understaffed but also where pervasive gender inequalities and imbalances exist within its very core.


When those 9 women came together in 1917 to form the Medical Women’s Federation, the founding members were clear in their message. They wanted women doctors to be treated equally and be afforded the same privileges as their male colleagues.


Today women make up over three quarters of all NHS staff. Almost half of doctors are women, and 82 per cent of adult social care workers are female.


There has been an 11 per cent rise in the numbers of women applying for medical school next year. Surely then, we should be embarrassed that women are still in the minority in senior roles in our health service.


It’s a national shame that female NHS staff in England earn nearly a quarter less than their male colleagues. And this extends across the board, from doctors and managers, to nurses and cleaners. The average full-time female worker is paid £28,702 a year in basic salary. That compares to the £37,470 average pay for men – a gap of more than 23 per cent. Male doctors are earning ten thousand pounds more than their female colleagues. It’s worse for BAME doctors, with black and minority ethnic consultants earning roughly £4,600 less than white doctors.


So I can you give this commitment delivering equal pay will be a priority for the next Labour government.


We know that 87 per cent of our nursing workforce are women and we will continue to campaign against the scrapping of the nurse training bursary.


At a time of a staffing crisis, the number of applicants to nursing courses has fallen by 33 per cent since the bursary was axed.


I would reinstate the bursary for nurses, bring back funding for health related degrees and support more women to get into senior positions.


We will support our health staff to deliver the best care possible by investing in the training, education and development of women throughout their careers. We need to strip away the unfair barriers stopping women from getting from the ward and onto the board which is why we will invest in a new women’s leadership scheme to ensure we are nurturing the female leaders of the future in the NHS.


So thank you again to the Medical Women’s Federation for your contribution to excellence in the delivery of health care, for the leadership you offer and voice to women in the medical profession you provide.


It has been a privilege to have been invited here this morning and I hope you agree we have a shared agenda and I look forward to working closely with you in the future.