1. Struggling to access GP appointments in Nottingham
Case study
“I was really struggling with my mental health and having lots of panic attacks which were stopping me from working. Even though I really didn’t want to call my GP because I felt ashamed, I eventually built up the courage to reach out for help. However, when I did call, the receptionist said there was a month-long waiting list to get an appointment with the doctor which made everything so much worse.”
Long waiting times
Case workers are reporting that women are waiting up to four weeks to see a doctor at their GP surgery in Nottingham city.
Online portal
Some GP practices have asked patients to book through an online portal, rather than booking over the phone. This has caused some women high levels of anxiety, which has been a barrier to accessing GP appointments. One of our clients has been unable to get a repeat prescription due to the new booking system and the anxiety it has caused her.
Online portals can also be a barrier to accessing appointment for women who:
● Do not have the relevant digital skills. 22% of the UK’s population lacks basic digital skills.
● Do not have access to Wi-Fi and/or digital devices. Half of households earning between £6000 – £10,000 do not have access to the internet at home and between 1 – 1.8 million families do not have access to a laptop, desktop or tablet at home.
● Are not able to read and/or write in English. 16.4 % of adults in England have very poor literacy skills, which means they are unlikely to be able to fill out a form, read instructions or easily use the internet. Women who have English as a non-primary language (around 7% of UK population) may struggle to write or understand English easily, which may prevent them from using an online booking portal.
Call backs
GPs don’t give a specific time for ‘call backs’, which can be particularly difficult for women with work and caring responsibilities. Women have reported being forced to use annual leave to wait for a GP ‘call back’ to ensure they’re able to pick up the phone when the GP calls. Women with caring responsibilities have been unable to organise childcare without knowing the time of the call, which has resulted in women missing out on health care.
What NWC is doing about this issue
Our caseworkers can try to book appointments on behalf of clients, when feasible, but this is not a long-term solution. We can also signpost women to Nottinghamshire HealthWatch if they want to make a complaint about their experiences.
What change is needed at a policy level
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Specific times for ‘call backs’ to enable those with caring responsibilities to plan care
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Further investment in reception staff to enable women to call their GPs and book an appointment over the phone, which will avoid discrimination of those living in digital poverty and those with poor literacy.
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For Nottinghamshire CCG to monitor this issue and complete an equalities impact assessment regarding the move to online bookings and longer waiting times to access appointments.
2. Lack of specialist endometriosis clinic in Nottingham
Case study
“I was diagnosed with endometriosis in 2018 after suffering from cripplingly heavy periods, chronic pelvic pain and fatigue for over 12 years. The gynaecologist who diagnosed me did not have the special interest in endometriosis required by the NICE guidelines and told me that I had mild endometriosis which she had removed during my diagnostic surgery. This turned out to be a misdiagnosis I’ve now been diagnosed me with severe endometriosis, which requires a different level of treatment.
My second round of treatment has been delayed due to Covid. My symptoms are worsening all the time and I am now in constant pain. I have gained two stone and I am no longer able to run (due to pain from the endometrioma) which was something which was very beneficial for my mental as well as physical health. Because I rely on strong painkillers to get through the day, I am now opiate dependant and when I do have the surgery I am waiting for (assuming it is successful) I will need to go through an opiate withdrawal programme.
Because I have severe endometriosis, I have to be treated by a specialist endometriosis centre, however Nottingham does not have such a centre so I need to travel to Leicester for my care. This is also where my surgery will take place meaning it is unlikely that any friends or family will be able to visit me while I’m in hospital.”
Background
1 in 10 (1.5 million) women suffer from endometriosis in the UK – a condition where tissue similar to the lining of the womb starts to grow in other places, such as the ovaries and fallopian tubes. It currently takes an average of eight years to get a diagnosis with endometriosis despite the fact that:
● 58% of those diagnosed had visited GP over 10 times
● 21% visited doctors in hospital over 10 times
● 53% visited A&E with symptoms
● 27% went to A&E more than three times
Nottingham
Several our staff and service users are suffering due to the lack of a specialist NHS endometriosis clinic in Nottingham. Women are being forced to travel to Leicester, Peterborough, Birmingham, and other parts of the country for treatment. This is particularly difficult for women with caring responsibilities and those who do not have cars. Women who access social security can claim back travel costs, but women on low wages cannot claim financial support for travel.
We ran a poll through our social media platforms and found that 45% of respondents with endometriosis (7 out of 15 women) said they had to travel to other parts of the country for treatment. Women unanimously agreed that it was “extremely important” that Nottingham gets a specialist endometriosis treatment centre through NHS.
Lack of appropriate and timely treatment can have a serious impact on women’s mental health and has been linked to painkiller addiction. 90% of the women we polled with endometriosis said they would have liked psychological support, but they have not been offered this as part of their treatment.
What is NWC doing about this?
We will continue to raise awareness about endometriosis by sharing information about the condition on our social media channels and we will consider becoming an Endometriosis Friendly Employer.
What we want changed at a policy level
1) We want to see the funding allocated for a specialist endometriosis clinic in Nottingham. There are an estimated 16,000 women who suffer with endometriosis in the city.
2) As outlined in NICE Guidelines, we want anybody who is suspected to be suffering from endometriosis should be seen by a gynaecologist who has a special interest in endometriosis (i.e. specialist training). We have learnt there are currently no gynaecologists with a special interest in endometriosis in Nottingham.
3) Better training and more awareness about endometriosis in Nottingham’s GP practises.
4) Free psychological support for women suffering from endometriosis.
3. Unaffordable childcare provision forcing women out of the workplace
“Before I started getting the free hours when my boys turned three, basically all my wages went on childcare” – A woman from Nottingham
Background
Unaffordable childcare is a key issue that’s been raised multiple times by our service users and staff. Most UK Government spending is targeted at preschool age (3-4 years) which has been shown to limit women’s ability to stay in work after giving birth. England is also one of the most expensive places in the world for childcare (only Japan is more expensive in terms of percentage of household income) with the average cost of a full-time nursery place at £263 a week, which is over half of average wage.
More recently, parents have been unable to work when their child is sent home from school due to a Covid case. Employers have no legal obligation to pay their staff in these circumstances, which means parents have been losing two weeks income in these circumstances. This can quickly push single parents into a financial crisis.
Nottingham
We surveyed 55 women about their experiences of motherhood, childcare and work and found:
● 75% of women said the cost of childcare affects the amount they can work
● 53% of women reported that the pandemic has increased the negative impacts of unaffordable childcare
● 25% of women said they have been affected by redundancy/furlough because of childcare issues
Research by Pregnant then Screwed found that 15% of mothers have either been made redundant or expect to be made redundant since the pandemic and of those, 46% have said that a lack of childcare provision played a role in their redundancy. They also found that 72% of mothers have been forced to work fewer hours because of childcare issues, and 65% of mothers who have been furloughed say a lack of childcare was the reason.
Women told us:
● “One of us has to work part time so that we only use the free hours, but we didn’t get any when one of us couldn’t work”
● “I was part time and freelance. Returning to work was hard as you pay even if you have no work booked.”
● “Childcare costs should be subsidised, but workplaces also need to offer flexibility.”
● “I decided not to go back to work after maternity leave as I would have been getting so little money after childcare costs.”
● “It’s due to the free hours (now she’s 3) that it’s not affecting me financially right now”
● “It’s impossible”
What is NWC doing about this?
NWC used to run an affordable childcare crèche but unfortunately this had to close due to funding restraints.
What we want changed at a policy level
1) Free full-time childcare from 6 months
2) Track and trace isolation grant for parents. Gingerbread and Pregnant then Screwed are calling on the government to extend the Track and Trace isolation grant of £500 to parents who are unable to work when their child is sent home from school due to Coronavirus. There is a petition calling this – https://www.change.org/p/rishi-sunak-mp-parent-isolation-grant
3) An independent review of childcare funding and affordability. There is a petition calling for this – https://petition.parliament.uk/petitions/586700
4. Putting more women in prison
The Ministry of Justice (MoJ) is creating 500 extra prison places for women to “accommodate a growing prisoner population”, some of which will be built at Foston Hall in Derbyshire. MoJ has predicted that the number of women prisoners is expected to rise by 40% over the next five years due to the recruitment of extra police officers and longer sentences.
This plan goes against the Government’s own female offender strategy which envisages more women being given non-custodial sentences as an alternative to prison. It also goes against the Government’s own evidence which has previously shown that prison is more likely to increase reoffending rather than reduce it and actually called for a reduction in the women’s prison population.[1]
What NWC is doing about this issue
We believe prison tears families and communities apart. We’ve joined Women in Prison and many other representatives from housing, domestic abuse, criminal justice, midwifery, and children’s organisations in writing to Justice Secretary, Robert Buckland QC MP and Prisons Minister, Alex Chalk MP. This combined letter makes a clear case for community solutions instead. It was published in the Sunday Times and also warns about the rise of self-harm in prison. It also clearly refutes the Government’s claim that additional places are needed to prepare for a projected rise in the prison population due to the future hiring of more police officers.
We are also circulating a letter template link on our social media and across our networks encouraging more people to write to the Justice Minister to ask him to #Stopthe500 now.
To read the letter in full click here.
What we want changed at a policy level
We would like to see a new model of funding for community-based women’s centres that provides support to women affected by the criminal justice system. We fully support The Case for Sustainable Funding for Women’s Centres report published by Women in Prison together with the Women’s Budget Group, The Nelson Trust, Together Women, Anawim and Brighton Women’s Centre.
The report asks that: “Central Government use the upcoming Spending Review to introduce a New Deal for Women’s Centres which should:
● Provide core funding from central Government with a system of matched funding granted from a local consortium of commissioners.
● Provide mandatory commissioning guidance to local commissioners to ensure a network of appropriate services is available nationwide.
[1] *”In 2018 the Ministry of Justice launched the Female Offender Strategy which set out to reduce the women’s prison population, committing to shifting emphasis from custody to the community, and as part of this abandoning plans to build five new Community Prisons for Women previously announced in 2016.” Women in Prison, July 2021
Who we are
Nottingham Women’s Centre is a charity and community space that empowers women by providing financial and employment support, counselling, training and campaigning in a women-only building in central Nottingham. Our staff and volunteers support around 250 women a week. We know from our work that the pandemic has been a difficult time for everyone but it’s been especially hard for women who were already struggling with their mental health, poverty or discrimination.
Our quarterly Issues Papers outline some of the issues impacting our service users that have been highlighted by our caseworkers and management team. We send this anonymised information to a wide range of decision makers, such as Nottingham’s MPs and Leader of the Council, with the aim of creating change in partnership with other stakeholders.
If you have any questions or feedback, or would like to be added to the Issues Paper distribution list, please email our Policy and Influencing Officer – katie@nottinghamwomenscentre.com