Sir Alec Shelbrooke (Elmet and Rothwell) (Con) I beg to move, That
this House has considered endometriosis education in schools. It is
a pleasure to serve under your chairmanship, Ms Vaz. I have been
trying to raise awareness of endometriosis for several years now. I
am proud of the work done by not just me but other colleagues
across the House, not least our late, great friend Sir David Amess,
on raising the issue of endometriosis—something that,
surprisingly,...Request free trial
Sir (Elmet and Rothwell)
(Con)
I beg to move,
That this House has considered endometriosis education in
schools.
It is a pleasure to serve under your chairmanship, Ms Vaz. I have
been trying to raise awareness of endometriosis for several years
now. I am proud of the work done by not just me but other
colleagues across the House, not least our late, great friend Sir
, on raising the issue of
endometriosis—something that, surprisingly, so many people, men
and women, still do not know about. In various debates,
especially those about endometriosis in the workplace, we have
started to raise the profile of the disease, and more and more
people are speaking about it. But it is surprising how few people
recognise the condition. An e-petition that closed in March 2023,
“Include PCOS & Endometriosis education in the national
secondary curriculum”, gained only 3,105 signatures. Yet the
people who deal with endometriosis know that thousands—in fact,
millions—of women are affected by the disease.
Today, I seek to address the issue by asking my right hon. Friend
the Minister to prescribe the teaching of endometriosis in the
national curriculum, hopefully for this September. I will start
by re-highlighting the disease and its impact, because that is
important. I will highlight some issues from a 2019 report by
Keisha Meek of Northern Endometriosis Sisters Support, because
she summarises things well:
“Endometriosis comes with many symptoms, these symptoms do not
just occur at the time of a woman's period.”
The most common symptoms are abdominal cramps, back pain, severe
menstrual cramps, abnormal and heavy bleeding, painful bowel
movements, pain urinating, painful sex, difficulty becoming
pregnant, nausea and sickness. The impact that can have on
women's lives and relationships is enormous. The report says of
relationships:
“Long term conditions can have a significant impacts on
relationships between family, friends and partners. This can be
due to various different reasons such as not understanding, lack
of information, taboo around the illness, not publically
understood or spoken about. Women who suffer with endometriosis
are regular called liars, told it is ‘just a bad period' and
called dramatic. It is known in other long term illnesses that
people also…struggle to understand.”
That first paragraph emphasises why I have brought this debate
today. The report goes on:
“We have found many women within the endometriosis community have
lost friends, this is due to them having to cancel plans due to
severe pain and bleeding. Sometimes they have been bed bound,
even when they have explained to their friends why they can be
left out, not invited or treated like liars. It can be a very
isolating experience for women or anyone living with a chronic
illness.
As well as friendships we have found women have had issues with
their families, resulting in family members no longer speaking to
them or inviting them to events. Even after trying to educate
their families, the taboo around endometriosis makes this
difficult and lack of understanding/knowledge. This is also an
issue within other long term condition communities.
We have many women with endometriosis who stay single to protect
themselves due to issues in previous relationships. There are
women whose partners have left them due to endometriosis, this
can be due to sex, the woman's psychical health and mental
health, infertility and many other issues that endometriosis can
cause. Women have unfortunately been victims of domestic abuse,
their partners excuse being endometriosis or rape due to them
saying they can't have sex due to pain.”
Then, there are the issues at work:
“Many women work with endometriosis, however this can be a
struggle and there is lack of understanding for endometriosis
sufferers as this is not well known. They are also not protected
under the disability act.”
The hon. Member for Kingston upon Hull West and Hessle () and I recently met some
campaigners, along with the Disability Minister, my hon. Friend
the Member for Mid Sussex (), and we are trying to move
that forward in a separate piece of work. This issue must be
addressed through the work of a wide range of Departments.
Endometriosis results in people having to take a long time off
work. In most cases, women find themselves on sickness plans that
they are unable to adhere to, which can result in the termination
of their employment. A lot of women find themselves moving around
jobs trying to survive and pay bills. Due to sickness, many women
have felt discriminated against. That is at the heart of why I
want the disease to be part of the curriculum. This debate is not
just about women who suffer from endometriosis; it is about
society as a whole understanding this disease.
I give credit to Essex Police: shortly after my debate on
endometriosis in the workplace, it contacted me to ask whether
there was more that it could be doing. There are employers out
there who are proactively moving ahead, but one reason why this
should be on the curriculum is that it is important that
everybody is taught about this disease.
(Kingston upon Hull West and
Hessle) (Lab)
I pay tribute to the work that the right hon. Gentleman has been
doing on this issue. I am slightly concerned about the latest sex
and relationship guidance that the Government have published,
because it removes a previous reference to menstruation on the
curriculum in primary schools, with this “Not before year 4”.
Obviously, the average age for girls to start their periods is
12. However, data shows that some girls start aged eight and
younger, so removing that reference means that some girls could
be starting their periods before actually receiving any education
on what periods are. The same guidance also removes the reference
to males having the education at primary school. Surely the
Government think that it is important for girls and boys to
understand all about periods. Again, I pay tribute to the right
hon. Gentleman's work in securing this debate.
Sir
I am most grateful to the hon. Lady—my hon. Friend; we have done
a great amount of work on this together. This is truly a
cross-party effort, also involving the hon. Member for Strangford
(); I know the hon. Member for Livingston () would want a mention of
the work she has done.
The hon. Member for Kingston upon Hull West and Hessle is right,
and I am going to touch on some of that later on; I have also had
representations from people to touch on that issue. The hon. Lady
mentioned the reason why I am glad we are having this debate: it
is highly relevant, based on the statement made last Thursday. I
am glad that the Minister has been able to find time to respond
to this debate, because it is absolutely right that we try to use
this moment to highlight the point.
People with endometriosis also have a higher risk of the
following diseases. That is important because we educate about
those diseases, but we are not educating about endometriosis.
Compared with the general public, sufferers have: a 37% higher
chance of developing ovarian cancer; a 38% higher chance of
developing endocrine tumours; a 26% higher chance of developing
kidney cancer; a 33% higher chance of developing thyroid cancer;
a 37% higher chance of developing brain tumours; a 23% higher
chance of developing malignant melanoma; and a 62% higher chance
of having a heart attack, and that is a direct result of blood
loss and anaemia.
Another account I have is from a lady who contacted me after I
went to the premiere of “Below the Belt” in 2022, which I
recommend to anybody who has an interest in this subject. I am
going to read her description because it paints the picture of
why this is so important.
“I am a stage 4 endometriosis sufferer, in which it took over 15
years to be diagnosed, in which time my story, in brief, was:
Every month since I started my period I would spend the first day
sat in the toilet holding my bin. So that I could be sick and
completely empty my bowels. I would then 9/10 pass out in the
bathroom or on the hall trying to get to my bedroom. If I wasn't
lucky enough to be out cold, I would have to take enough
painkillers to knock me out. I would then spend two days in bed
having hot sweats in a cycle of being in pain, throwing up and
sleeping. When I hit 30 I started to have mid cycle pains and
neurological symptoms and extreme fatigue, in which I struggled
to stay awake, and I would have to take daily naps. I started to
have blood in my poo, and bloated stomach, I was having upper
quadrant pain, and getting these weird red dots on my skin,
suffering with night sweats and random fast heart palpitations. I
thought I was going to die.
From the age of 13 being called a liar, being shoved pain killers
and anti depressants, being told that it is just a period and to
get over it by GPs…several referrals to gynaecology from the age
of 17. Being told I have a low pain tolerance and to just have a
baby as that will sort everything out. Also reassuring me that
nothing was wrong at all with my fertility (how wrong they
were)…Being misdiagnosed with anxiety, depression, IBS, piles,
querying bowel cancer and Crohn's…Being told I had a tiny cyst on
my ovary that meant nothing, and that I have dramatised and
medicalised the situation as I know it is there.
Suffering early-stages miscarriages/chemical pregnancies…Handing
my notice into a job I loved due to the lack of support and
workplace ‘banter' over me being sensitive…Passing out at work,
being called lazy at work for having to sit down, getting into
trouble for spending too long in the toilets/disappearing…Waking
up in the uni toilets five hours later by myself, after passing
out in pain. I had to pay over £100 to get a cab back from
Eastbourne to London. A cab driver had to deal with my
endometriosis flare-up on a motorway until I passed out in pain.
When he got me home, I woke up to random people around me, as he
started to bang on all the doors to get help/get to someone that
I know.
I have lost friends due to ‘letting them down', being ‘sick' for
no reason at all…Once I paid privately (over £5,000) to find out
what was wrong with me and get me help, in which I was told I
could lose my bowel, my womb and bowel are twisted, and my organs
had been shoved to the left-hand side of my body. I then had a
fight with my GP to get access to the help I needed. In which I
was sent as a routine patient to a general gynaecologist who told
me to have a baby and go on the pill. It then took me weeks to be
asked to be sent to Guy's endometriosis clinic, in which I was
given an urgent appointment after I sent them through my scans.
They then gave me an urgent MRI and told me that they believe
that it is worse than expected and I would lose my tubes and
ovary, and require a stoma. Although I would have to wait over
two years for surgery and to go to pain management to help
medicate the pain (this is a nine to 12 months wait list).
I paid over £15,000 for private robotic surgery to completely
remove all the endo. Best choice of my life, I have my life
back…I now have mild pain during my periods, which I can manage
with exercise or occasional paracetamol…My periods do not rule my
life…I have my life back.”
The reason I wanted to give those examples is that they describe
the trauma of this disease. As many as 10% of women in this
country have this disease. I have a report from a lady called Nel
at Hey Endo!; I think the hon. Member for Kingston upon Hull West
and Hessle knows her quite well. I am exceptionally grateful for
the information she sent me about what they are doing in schools.
The statistics are quite shocking.
When asked, “Have you heard of endometriosis?”, 54% said no.
“Have you heard of adenomyosis?”; 98% said no. “Have you heard of
PCOS?”; 57% said no. “Do you talk to your family about period
health?”; 52% said no. “Do you talk to your friends about period
health?”; 60% said yes and 38% said no. “Do you feel like you can
approach your education setting about period health?”; 54% said
no. “Did you learn about periods in school?”; 16% said no and 82%
said yes. That is important, because we are educating them about
periods but not about the diseases. “Did you learn about
endometriosis in school?”; 88% said no. Before the presentation,
only 30 students could state a fact that they knew about
endometriosis.
The right hon. Gentleman is absolutely right. As he has pointed
out, the figure is 10%. That means that in every classroom, three
or four girls potentially have endometriosis, and yet the subject
is still not covered. I strongly suggest that we look at covering
it specifically, as mentioned, and as early as possible, because
this has an impact on girls taking exams. It is exam season right
now, when they are in the middle of their GCSEs. Some girls will
be sitting their GCSEs now, suffering from endometriosis. It
should stop being a taboo subject; it happens to lots of us. Let
us make it more publicly known.
Sir
On the hon. Lady's point, I am rather concerned about reports in
the press about schools not allowing girls to use the toilets,
saying that they have period passes and that they should plan
around it. All those policies are set up around normal periods.
That goes to show that there is a distinct lack of understanding
throughout, not just in the curriculum but throughout the
school's policies. That is why it is vital to move this issue
forward quickly.
I did some research, which I am sure the Minister is well aware
of, about what happens at each key stage, and how physical health
education is taught. At key stages 4 to 5, lessons on fertility
and pregnancy choices include how an individual's fertility
changes over a lifetime, and where to seek medical help and
emotional support. Key stages 3 to 5 include “The Truth,
Undressed” lessons, in collaboration with Canesten—a set of four
lessons promoting understanding of vulval and vaginal health. Key
stages 3 to 4 include lessons on breast cancer, in collaboration
with breast cancer charity CoppaFeel!, to encourage young people
to get to know their bodies and adopt healthy behaviours from a
young age. This lesson includes essential knowledge about breast
cancer, information on healthy lifestyle choices that may reduce
a person's risk of getting cancer, guidance to help them get to
know their bodies, and guidance on what to do if they find
something that is not normal for them. Key stages 3 to 5 include
lessons on testicular health, with information on testicular
torsion, orchidectomy and testicular cancer.
I am sure everyone here agrees that that is highly important
education, and that cancer is a terrible disease. That is the
word: it is a disease. Endometriosis is a disease, and it should
be getting exactly the same treatment in the curriculum as other
diseases. I noted the Secretary of State's comments about a range
of diseases that are being looked at with a view to bringing them
into the curriculum, but I am specifically talking about
endometriosis today to push the issue forward.
As I have pointed out, it is vital that we teach this to boys and
girls, as the information can be important to them later as
adults when, for example, they might be bosses running a company
or business. I genuinely do not believe that people are of bad
mind. I do not believe that people want to be evil to people or
to bully them. It always comes down to a lack of education and
knowledge, and not understanding situations. Maybe I am a naive
politician, but I do believe in the good in people. I do not
believe that people want to treat others badly, but they just do
not know anything about this, and that comes down to education
and the curriculum.
I have received a note, drawing on what the hon. Member for
Kingston upon Hull West and Hessle has said, from Endometriosis
UK, which asks whether I could raise these points in this debate
directly with the Minister. The Government proposal is to remove
a previous reference to covering menstruation in the curriculum
in primary schools before the onset of puberty, and to introduce
a not-before-year-4 age limit on when pupils learn about
menstruation. Endometriosis UK is concerned that the proposed new
age restrictions may prevent some children learning about periods
before they start having periods, and it seeks further
consideration of this matter.
The Government propose the introduction of a specific reference
to children being taught the more appropriate language of
“periods and menstrual products”, rather than “sanitary items” or
“hygiene products”. Endometriosis UK fully supports that.
Outdated language and a focus on “hygiene” and “sanitary
products” feeds a myth that menstruation is dirty and unhygienic,
rather than a natural and normal process.
The Government propose the removal of a previous reference to
male pupils when learning about menstruation in primary school.
Endometriosis UK would like to see all pupils, including male
pupils, learn about menstruation in primary school.
The Government propose the introduction of a new requirement to
cover gynaecological health for pupils and secondary schools,
including what an average period is, period problems such as
premenstrual syndrome, heavy menstrual bleeding, endometriosis,
polycystic ovary syndrome—PCOS—and when to seek help from
healthcare professionals. Endometriosis UK is extremely
supportive. Endometriosis being on the curriculum for all pupils
in secondary school would be a major step forward. Endometriosis
UK is delighted to see plans for specific content focusing on
when to seek help from healthcare professionals, which will help
to drive down diagnosis times for endometriosis.
Finally, the Government propose the introduction of a new
requirement to cover reproductive health, fertility and menopause
to pupils in secondary schools. Endometriosis UK supports
that.
To conclude, I have some questions to ask the Minister. This
disease affects 10% of women. That is millions of women. Symptoms
can be anything from mild to horrific. Tragically, dozens of
women every year take their life over this disease because they
cannot cope any longer with the pain.
It is a very difficult disease to solve, but knowledge of what
the disease is at the start, may provide a head start in
improving the eight to 10 years' waiting time for a diagnosis. I
believe that that is because people just do not know enough about
it. I gave the example of that poor woman who experienced pain
from the start of her periods. My hon. Friend the Member for
Kingston upon Hull West and Hessle spoke about menstruation now
starting in nine-year-olds. One of the questions I have for the
Minister is what work he will be doing with health professionals
to consider when we should be putting endometriosis education
into the curriculum. I believe it is important that girls know
about the potential problems that could affect them before they
start menstruation—maybe boys can be taught later. I seek the
Minister's guidance, and maybe he will need to take the question
away, on what work he will do to find out when we can put that in
the curriculum. There is obviously a lot of science about what
the average age is to start menstruation. We heard the example of
the woman who from the moment her periods started was in pain.
Girls need to understand what it is.
I really want to push for endometriosis to be in the curriculum
on sex education in the way that breast cancer is included in
personal health education. Endometriosis is another terrible
disease, and it does result in death. There is no getting round
that. Everybody needs to understand the disease, which is where
education becomes the responsibility of the Government. I will
finish with this: if someone does not know a disease exists, how
do they know they have got a disease?
5.06pm
(Strangford) (DUP)
I thank the right hon. Member for Elmet and Rothwell (Sir ) for highlighting the issue
in this debate. He has done that in Westminster Hall numerous
times, and more times again in the main Chamber. I have heard him
on many occasions and I admire his determination to discuss this
subject matter and to make people aware of it—I congratulate him
on that. The hon. Member for Kingston upon Hull West and Hessle
() made two significant
interventions. Although she did not say so, I suspect they came
from a place of personal knowledge.
As Members may be aware, while I am a father to three sons—my
wife always wanted a wee girl, but it was just not going to
happen—I work in an office with six female staff members and one
male. I am certainly a lot more educated than I had been, and let
us be honest, that understanding should not have taken that long.
Gone should be the days of boys and girls being separated out to
discuss those issues. The right hon. Member for Elmet and
Rothwell mentioned that in both his introduction and summing-up.
Those issues affect entire households and there should be a
frank, honest and non-shameful understanding, which, frankly,
does not take place at the moment.
The right hon. Member for Elmet and Rothwell referred to a story
from one of his constituents which is like mine. When I married
my wife, which will be 37 years ago on 6 June, the doctor told
Sandra, “If you have a child, this will all go away.” Well, no it
did not. Indeed, three boys later and it still had not gone away.
My wife suffered with the condition over all those years, and
only in the last three or four years, because of life-changing
things, has it been slightly different.
I will refer to one of my staff members who suffers from
endometriosis. I told the right hon. Member for Elmet and
Rothwell beforehand that I was going to tell her story. I am not
going to mention her name, because that would be the wrong thing
to do, but I want to tell her story. It is a terrible story that
she has been through. She was diagnosed in 2019 at the age of 24,
after having been referred to gynae in 2012, seven years earlier.
It took seven years to get the diagnosis. She has not yet been
able to see an endometriosis consultant and she is now 29 years
of age. That is 12 years, and she is still on the waiting
list.
She has been red-flagged on three separate occasions. Her GP, who
is very good—I am not saying all GPs are not good, just to be
clear—is one of the few to hold a gynae clinic at GP level and
has instigated medical menopause, given oestrogen and implanted a
coil all on the basis of her ultrasound. Her doctor has been
incredibly helpful to her, but she has been through all sorts of
problems. She has worked for me for a fair few years, and I am
well aware of some of the problems she has, not from a personal
point of view but from watching her and seeing how it affects her
days as she works. Most GPs do not offer the facility that her GP
does.
There are two specialists in Northern Ireland, and we are left
with women who are in pain and afraid for their fertility
potential. Their partners do not know how best to support and
help with what they cannot see and perhaps cannot understand—I
think that is part of it as well. People can offer sympathy and
comfort and talk to their partner or wife, or perhaps friend, on
these matters, but sometimes they do not really understand,
because they cannot really feel what they are going through. I
believe that the right hon. Member for Elmet and Rothwell is
right. We need an absolute shift in the narrative, away from
closed doors, to understanding.
We need to stop the classification of “women's problems”. My
mother probably suffered from something similar to this. She is
92, going on 93. I remember that when she was younger, she had a
number of miscarriages and other things that happened. My mother
says that they were always referred to as “women's problems”.
That covers very generic subject matter, but it does not really
illustrate the issue.
(Romsey and Southampton
North) (Con)
I thank the hon. Gentleman for giving way and I apologise for my
late arrival, Ms Vaz. Does the hon. Gentleman agree that this is
one of the fundamental problems? When we describe things as
“women's problems”, we are actually shying away from giving
conditions and diseases the proper names that they have and, in
so doing, are effectively avoiding an informed, intelligent
discussion.
Yes, I absolutely agree with that. When people refer to “women's
problems”, they do not bring into the open the painful issue;
they almost push it aside. The right hon. Lady is absolutely
right to make that point. It is an issue that deserves medical
attention, and significant attention at some times. We need to
encourage medical students to take up this speciality by
providing help with tuition, as has been done in colleagues'
constituencies in Wales. I understand that Wales has done some of
these things. There has been a shortage of physiotherapists and
other things. Therefore the question I ask the Minister—I am ever
mindful that he is always responsive to the questions we ask, and
we appreciate that because it makes our job of putting questions
to him a wee bit easier when we know we are going to get a decent
answer—is this. How do we encourage medical students to take up
this speciality? We do so by normalising the conversation around
reproductive health and by removing boundaries to conversations.
That must start in education, at the very beginning—at school
level, secondary school level, and college level—and the
conversation should then continue right through life. That is
what the right hon. Member for Elmet and Rothwell is asking for,
and I support him.
I will finish with this comment. The NHS is failing young women,
but more than this, it is failing families. We do a disservice by
taking a silent stance. It is right that today we bring
endometriosis out of the silence and into the conversation, but
only if action follows.
5.13pm
(Newcastle upon Tyne
North) (Lab)
It is a pleasure to serve with you in the Chair, Ms Vaz. I
congratulate the right hon. Member for Elmet and Rothwell (Sir
) on securing this
incredibly important debate on this incredibly important topic.
He has campaigned tirelessly on the subject over many years, and
he spoke incredibly passionately today, sharing very painful
testimonies but really shining a spotlight on endometriosis and,
in particular, highlighting how workplaces, Governments and
schools can all provide better support to those experiencing the
condition.
As the right hon. Gentleman rightly set out, endometriosis can be
an incredibly challenging condition to live with and can impact
every aspect of a person's life. There is no way of preventing
it, and its cause is not yet understood, yet it affects around
one in 10 women in the UK. As he rightly pointed out, that means
that on average at least one girl in every classroom will go on
to experience it. The symptoms can start very early on in
adolescence.
Thinking of the disease primarily as a barrier to pregnancy or as
simply making a girl's or woman's periods more painful is a gross
oversimplification and, in many cases, incredibly inaccurate,
which is why this debate is so crucial. The disease can vary
widely in severity in the way it manifests. For example, 12% of
endometriosis cases target women's lungs and can cause symptoms
beyond chronic pain—symptoms that can shatter a woman's
confidence and have a debilitating effect on her mental health.
Endometriosis can also cause chronic bowel and bladder-related
symptoms. That can lead to depression, which the right hon.
Gentleman has also highlighted.
Sir
It would be remiss of me not to mention the fact that
endometriosis continues for many people after the menopause. It
is not a disease just for women who menstruate; it can continue
after the menopause, and it can start before menstruation. As the
hon. Lady points out, this disease is not restricted to
gynaecology.
The right hon. Gentleman once again demonstrates how incredibly
knowledgeable he is about this issue, and how much that knowledge
is lacking among the wider public and in this place. We are
grateful to him.
It is so essential that young people are taught about their
bodies in school, and that they learn about not just
relationships and sex, but health and wellbeing. That must
include what is and is not normal throughout puberty, the
menstrual cycle and hormones, to set young girls and young people
up to live healthy lives, both mentally and physically.
The hon. Lady makes an important point about what is and what is
not normal. When the Women and Equalities Committee did some work
on women's reproductive health, we got the message from various
witnesses that they simply had no comprehension that their
periods were not normal, because the message that they got from
medics the whole time was, “You just have to get on with it.”
The right hon. Lady makes an important point—her Committee has
done so much important work in this area—and it points to the
importance of our education system in combating misunderstandings
and providing people with the knowledge that they need to be
armed with in order to manage what they and those around them
will experience through life.
Sex education has been compulsory in English schools since 2017
and initially covered broad elements of sexual and reproductive
health. After many years of campaigning, it was revised in 2020,
and since then both boys and girls in state schools have been
taught about periods and menstrual wellbeing. Of course, as with
the rest of relationships, sex and health education, resources
need to be tailored to the relevant age group. They need to be
sensitive to a young person's maturity and their needs.
The Government website states:
“Educating all pupils and students about periods is crucial to
tackling the stigma which surrounds it.”
Labour very much agrees, and the next Labour Government will
ensure that the curriculum taught in all state-funded schools
reflects the issues and diversities of our society and ensures
that all young people leave school ready for life.
We have already pledged to deliver, in government, an expert-led
curriculum and assessment review, which will learn from
international best practice and research across all areas, from
history to health, to make sure that our curriculum is as strong
and relevant as it can be. I look forward to hearing more from
Members in this place and from stakeholders when the review gets
started, to ensure that we pick up on the issues that have been
identified in the debate today.
Part of that will require having enough teachers in the classroom
to improve children's outcomes and ensure that the curriculum can
be delivered to every child as intended. Over the past few years,
we have seen dire statistics on teacher recruitment, especially
in secondary schools. That is why we have made tackling the
recruitment and retention crisis a real focus and announced fully
funded plans to deliver 6,500 more teachers to fill the gaps
across the profession.
However, I recognise that education will only go so far. This is
very much a health issue too, and one on which far too many women
are being failed. Nearly as many women in the UK have
endometriosis as have diabetes, yet it is unseen in everyday
life. Women are waiting far too long for treatment; gynaecology
waiting lists have seen the biggest increase of all specialisms
in the NHS since the pandemic. As the right hon. Member for Elmet
and Rothwell painfully set out, that leaves those experiencing
endometriosis with years of unrelieved pain in the bowel or
bladder, poor mental health, fertility problems—the list goes
on.
I was glad to see the women's health strategy published in 2022,
but it must go further. We must address the NHS backlogs, bring
waiting lists down and set out a plan to properly address the
workplace challenges in the NHS. For those living with
endometriosis who are impacted by poor mental health, Labour has
committed to establish a mental health hub in every community. We
will deliver mental health support in every secondary school and
ensure that young people who are experiencing symptoms relating
to such conditions, as well as all those struggling with their
mental health, can access that support.
For too long, women's health has been an afterthought. I am glad
that debates like these are being held so that there is an
opportunity to discuss these issues in Parliament. I reiterate my
gratitude to the right hon. Member for Elmet and Rothwell for
bringing forward the debate and for all his contributions on this
subject. I also thank all the other hon. Members who have
attended for their contributions. We have to get the education
right. We have to ensure that young people have the information
they need to live a healthy life. I look forward to hearing from
the Minister what steps the Government will take to improve our
education in this important area.
5.21pm
The Minister for Schools ()
May I say what a pleasure it is to see you in the Chair, Ms Vaz?
I think this is the first time I have spoken under your
chairship. I join others in congratulating my right hon. Friend
the Member for Elmet and Rothwell (Sir ) on securing this important
debate. I also thank everybody who has taken part, including the
hon. Members for Kingston upon Hull West and Hessle () and for Strangford (), my right hon. Friend the Member for Romsey and
Southampton North (), and the hon. Member for
Newcastle upon Tyne North (), who spoke for the
Opposition.
There is clearly strong cross-party support and drive to improve
understanding of women's health issues and ensure that young
people are able to both navigate any issues they may face and,
crucially, understand and support others. This has been an
important follow-up to the debate that my right hon. Friend the
Member for Elmet and Rothwell led in this Chamber in 2022 on the
importance of raising awareness of endometriosis and the support
needed in the workplace, including to tackle the many everyday
challenges it can bring for employers and staff, which he
outlined so powerfully.
I have seen at first hand the excellent work that my right hon.
Friend has been doing to improve information and education on
endometriosis more generally. I applaud his dedication to keeping
the issue in the spotlight. He made a prominent remark during the
previous debate:
“It would take 20 days, at 24 hours a day, to name every woman in
this country who suffers from endometriosis.”[—[Official Report,
9 February 2022; Vol. 708, c.
394WH.]](/search/column?VolumeNumber=708&ColumnNumber=394WH&House=1&ExternalId=959EBAF7-5963-423D-A2BD-79FB72F66999)
That really brings home the scale of what we are talking about,
as he said again.
Colleagues in the Department of Health and Social Care are
particularly engaged in these issues. The Government have made
women's health a top priority, and we are driving forward a
women's health strategy that is delivering a better standard of
care for women and girls. Care for menstrual problems, including
endometriosis, is one of the Government's top delivery priorities
for this year. We are investing £25 million to establish women's
health hubs, which will improve access to services for menstrual
problems including endometriosis, contraception, menopause and
more. Women's health hubs will also take pressure off secondary
care waiting lists.
Ensuring that women and girls have access to high-quality,
trusted information is a top priority, too. We have created a
women's health area on the NHS website, which brings together
over 100 pages of information, including on periods and
endometriosis, and we have launched a video series on
endometriosis on the NHS YouTube channel. In April, we ran a
campaign in national media titles, supported by the women's
health ambassador for England, encouraging women not to suffer in
silence if their periods or menopause symptoms affect their daily
lives. That included a specific focus on endometriosis symptoms,
and we are planning further campaigns across the year.
Sadly, we are all aware of the taboos and stigma that surround
many areas of women's health, with girls and women not feeling
able to talk about issues such as periods. Too many girls and
women are made to feel that very painful or heavy periods are
normal and something they just have to get used to, rather than
told about how they can seek help for those symptoms and
understand what is happening to their bodies. Education can and
does play an important role in complementing the women's health
strategy, and that of course includes education in schools.
Ensuring that there is an early understanding of women's health
issues, including endometriosis, among boys as well as girls—I
will come back to that point—can help in removing remaining
stigmas and taboos.
My right hon. Friend the Member for Elmet and Rothwell will be
aware that last week we published for consultation updated draft
statutory guidance for relationships, sex and health education.
That is part of the Government's plan to deliver a brighter
future for Britain in which our young people are supported and
given the right education at the right time, so they are safe,
happy, healthy and equipped with the information they need to
succeed.
The revised RSHE curriculum includes strong health education,
which focuses on the core knowledge that children and young
people need to thrive as they progress into the wider world. To
get the RSHE guidance right, we have worked with stakeholders in
the sector, faith groups, teachers, academics and young people
themselves. We have also worked with colleagues across Government
to ensure that the content is accurate and up to date, that the
content of lessons is factual and appropriate, and that children
have the capacity to fully understand everything they are being
taught, including about puberty and menstrual and gynaecological
health.
I am pleased to say that that has led us to make significant
additions to teaching in this area, including improvements to
teaching about health and, in particular, menstrual health. That
is in addition to what is already in the national curriculum, in
which the menstrual cycle is taught to pupils between 11 and 14
years of age as part of the key stage 3 science curriculum.
The updated draft RSHE guidance states that primary school pupils
should be taught the key facts about the menstrual cycle,
including physical and emotional changes, from year 4. The
secondary curriculum includes more on menstrual and
gynaecological health, now specifically including endometriosis,
polycystic ovary syndrome, or PCOS, and heavy menstrual bleeding.
Those areas are now specifically set out in the “Developing
bodies” section of the guidance.
Sir
I am most grateful to my right hon. Friend the Minister for his
response; he is outlining a very clear path to improvement. Will
the education about endometriosis, polycystic ovary syndrome and
so on in key stage 3 take place at the very start of year 7? I am
concerned about taking it out of key stage 2, given that girls
will have started their menstrual cycles; in the example I gave,
the lady said that she was in pain from her very first period. I
accept that he might not be able to respond right now, but can I
push him on when the Department thinks it will be appropriate?
Does it think it appropriate for girls who are getting ready to
start their periods, or for girls who have started their
periods?
That was a very important and clear question from my right hon.
Friend, and I will note two important things in response. First,
the guidance is a framework; it is not a week-by-week series of
lessons. Earlier, he read out some examples of things that were
closer to lesson plans and a sequenced curriculum, which is a
further level of detail. The guidance sets out a framework, and
then teaching materials are developed. He mentioned a couple of
the third parties that are involved in that. We do not specify to
schools which third-party material or self-created material they
should use. We do not get into such a level of detail that we
say, “From the first half-term in year 7, this is what should
happen,” but we do not stop it happening either.
The second thing to note is that threaded throughout the RHSE
guidance and, indeed, more broadly, is the flexibility for
schools to respond to their own circumstances and their children,
who they know better than anybody sitting in Whitehall ever
could. The general point is that learning about menstruation from
year 4 does not mean that teachers are unable to talk about it
before year 4 if that is the appropriate thing to do because
girls in the class are already at that stage. I hope that that
helps to give a little more clarity, but, as ever, I would be
happy to follow up with my right hon. Friend the Member for Elmet
and Rothwell separately, if he would like. The revised draft
guidance sets out that curriculum content on puberty and
menstruation should be complemented by sensitive arrangements to
help girls prepare for and manage menstruation, including with
requests for period products. In response to my right hon.
Friend's earlier point, schools should use appropriate language,
such as period pads and menstrual products. The guidance also
sets out how and when to seek support, including which adults
they can speak to in school if they are worried about their
health.
Rightly, the revised guidance supports young people to understand
their changing bodies and feelings, how to protect their own
health and wellbeing, and when a physical or mental health issue
requires attention. We have introduced minimum ages in certain
areas to ensure that children are not being taught sensitive or
complex subjects before they are fully ready to understand them.
But, as I was saying—this comes to the point made by the hon.
Member for Kingston upon Hull West and Hessle—when girls start
menstruating earlier than year 4, schools have the flexibility to
cover that.
The relationships, sex and health education guidance is statutory
and part of the basic school curriculum, so schools must have
regard to the guidance and can only deviate from it with good
reason. I want to take this moment to be totally clear that we do
not mean that the subjects should be taught only to girls or
should not be taught to boys. It is true that in the previous
edition of the guidance, that was there in the rubric. It not
being there does not mean that that is no longer the case; it
should be taken as read that this is for all pupils.
As the hon. Member for Strangford and others said, it is true
that there has sometimes been a tendency—perhaps in generations
past, sometimes in generations present—to use phrases such as
“women's problems” and to generalise things as if it is not
important that everyone can understand and distinguish between
them. That is what we need to move beyond. As I said earlier,
relationships, sex and health education is not only about
understanding what is happening to our bodies; it is also about
understanding the people around us and what we may come into
contact with in future.
In an analogous sense, I was pleased that in the 2019 edition of
the guidance we included the menopause for the first time, which
generations of boys in particular, but also of girls at that age,
did not know about. It was not about saying that that was about
to happen to them, but of course in our wider lives—remember that
this is relationships education as well as sex and health
education—it is important that we are all educated on these
things.
Sir
I am grateful for the Minister's response, but—there is always a
but—will he specify whether endometriosis will be taught in
schools? I cannot dig out whether he said that it will definitely
be taught in schools, so I want clarification on that.
I did. Specifically, in key stage 3, in lower secondary school,
yes, it should be part of the curriculum at that stage.
Apologies for not having dug around in any great detail in the
very recently released guidance, and I absolutely appreciate that
this is a debate about endometriosis, but what we might call
problem periods can cover a whole range of conditions. We heard
evidence on my Committee from Vicky Pattison, who talked about
her severe pre-menstrual stress—I cannot remember the precise
acronym—and Naga Munchetty spoke of adenomyosis, which I have
finally learned how to pronounce. Are both those conditions also
included? Teaching young girls to have the language around what
is normal and what is not, and giving them the confidence to
speak about it, is about more than just saying, “And you might
get endometriosis”. There is a whole range of conditions out
there.
To come back to my earlier point, the secondary curriculum
includes more on menstrual and gynaecological health, now
specifically including endometriosis, polycystic ovary syndrome
and heavy menstrual bleeding. Beyond that, I will have to ask for
my right hon. Friend's forgiveness and ask that I may write to
her or that we can follow up separately.
Ofsted will inspect schools on their delivery of the RSHE
curriculum. As part of their personal development judgment,
inspectors will discuss with schools whether they teach RSHE in
line with the RSHE statutory guidance. The guidance is now out
for consultation for eight weeks and I have a feeling that
colleagues in the Chamber or some of the outside bodies they are
in close touch with might take part in that consultation. We will
take all responses to the consultation into account in the final
version of the guidance.
We are expecting a huge amount of interest in the updated draft
guidance and I can confirm from the last time that we had a
consultation on draft RSHE guidance that there is, understandably
and rightly, a lot of public interest. We hope to analyse that
over the summer and publish a final version soon after. Schools
will then require time to implement any changes to the curriculum
and to consult parents about those changes. It would not be fair
to expect them to deliver new content without some time to
prepare for it, but where they are ready to deliver new content,
they can do so immediately. Indeed, I am sure many schools
already cover endometriosis when discussing healthy periods and
we have encouraged that.
Following a meeting with the chairs of the all-party
parliamentary group on endometriosis in 2021—at the time they
were the hon. Member for Kingston upon Hull West and Hessle and
our much-loved and much-missed late colleague Sir David Amess—the
then Schools Minister agreed to update the Department's teacher
training module on the changing adolescent body so that it too
included a direct reference to endometriosis. Once we have
finalised the RSHE statutory guidance later this year, we will
update the teacher training modules and consider whether any
further support is required.
To date, we have invested more than £3 million in a central
support package to increase schools' confidence to teach such
subjects, including teacher training modules, non-statutory
guidance, a train the trainer programme and teacher webinars on
domestic violence, pornography and sexual exploitation. They are
all available on a one-stop page for teachers on gov.uk. Of
course, there is always more to do to help schools and we will
look at that after the publication of the guidance and when we
have listened to school leaders, stakeholders and others.
The hon. Member for Newcastle upon Tyne North moved into some
parallel important areas of mental health and her party's
concentration on mental health support in secondary school. I
remind her that we are already in the process of rolling out
mental health support teams across the country. We think that is
important for primary as well as secondary schools and it has to
be done at a pace at which we can recruit the people required for
those teams. As she will know, we have also offered a training
grant to all schools—primary as well as secondary—for training
for a mental health lead within the existing school staff, with a
high level of take-up already.
I am enormously grateful to my right hon. Friend the Member for
Elmet and Rothwell for his support in securing the debate. He has
raised some very important concerns, as have others. I hope that
he is pleased to see the Government's continued work to improve
menstrual and gynaecological health in schools today and for
future generations of women. The steps we have taken so far to
improve health education are extremely important and we really
want to get them right. The Government will continue to make a
commitment to support the policy area because it is the right
thing to do. I thank my right hon. Friend once more for his
continued drive on this important subject and for bringing this
crucial debate to Westminster Hall today.
5.40pm
Sir
Clearly, today's debate has shown that this subject is
cross-party. There are no politics in this; it is highly
important for young people's health and the consequences that
that will have through their lifetime. I am grateful for the
Minister's response and I am glad to see the curriculum is moving
forward. However, he can rest assured that I will still be at his
door, nagging to make sure we get exactly what we need to give
young people and people the support and education they need
throughout their lives.
Question put and agreed to.
Resolved,
That this House has considered endometriosis education in
schools.
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