Woman's Hour - Harriet Walker, Elika Ashoori, Dr Henrietta Hughes, Sarah Graham, Neil Leitch, Adam Hawksbee

Episode Date: January 3, 2023

There’s a growing trend in women not wearing bras. To talk about this Nuala McGovern is joined by the Fashion Editor of The Times, Harriet Walker. She’ll talk about bra trends up to now, and why this might not be the best of them.According to reports in the Telegraph, Rishi Sunak has shelved plans to reform childcare services put forward by his predecessor, Liz Truss. The plans were looking at increasing free childcare support and changing the staff-child ratio. Nuala McGovern will be looking at what the postponing of these reforms means for parents who need childcare, as well as those working in the industry, speaking to the CEO of the Early Years Alliance Neil Leitch and the Deputy Director of UK Onward, Adam Hawksbee.In our series Finding My Voice we’re talking to women about the moment they realised they had something to say or stand up for. Elika Ashoori was an actor and baker who rarely kept up with politics. That is, until 2017 when her father, Anoosheh, was detained by the Iranian authorities while visiting his mother. Over the next 5 years, she and her family fought for his release and she was forced to go through what she calls a ‘crash course’ in human rights campaigning. We look at the "gender health gap" with the Patient Safety Commissioner for England - Dr Henrietta Hughes. . A GP by training and previously a medical director at NHS England she was appointed in July and took up the post in September. She'll be joined by the health journalist Sarah Graham who has a new book out, Rebel Bodies: A guide to the gender health gap revolutionPresenter: Nuala McGovern Producer: Lisa Jenkinson Studio Manager: Bob Nettles.

This BBC podcast is supported by ads outside the UK. I'm Natalia Melman-Petrozzella, and from the BBC, this is Extreme Peak Danger. The most beautiful mountain in the world. If you die on the mountain, you stay on the mountain. This is the story of what happened when 11 climbers died on one of the world's deadliest mountains, K2, and of the risks we'll take to feel truly alive. If I tell all the details, you won't believe it anymore. Extreme, peak danger. Listen wherever you get your podcasts.

Hello, this is Nuala McGovern, and you're listening to the Woman's Hour podcast. Hello and welcome to Woman's Hour. Happy New Year to you. I'm delighted to say I will be spending the coming months with you in this presenter's chair, Monday, Tuesday and Wednesday each week, taking over from the mighty Emma Barnett while she's on maternity leave. And when I've presented Woman's Hour previously,

I was struck by your generosity, sharing details about your lives and also your experiences. So I'm really looking forward to getting to know you and also bringing the stories that matter to you to this tremendous programme.

And on to today's programme. Well, you may remember in the Liz Truss era, there were promises of big bang reforms. We know how some of the economic ones panned out. But now there are questions

about the Prime Minister potentially shelving the childcare reforms that she proposed. So we're going to get into that in a moment. But also Sarah Graham, she has been calling

for a revolution when it comes to the gender health gap. We're going to speak to Sarah about what would that look like and also why she thinks it's needed. Sarah has specific steps on how to advocate for yourself

if you think your doctor is not listening to you. And with Sarah will also be Dr Henrietta Hughes. Now, she was appointed the first ever patient safety commissioner. That is for England. And that happened in July. Dr Henrietta Hughes. Now she was appointed the first ever Patient Safety Commissioner that is for England

and that happened in July. So she works as a champion for patients and also driving to improve the safety of medicines and also of medical devices. So we're going to hear what progress she feels

she has been able to make so far. And I'm wondering are you up and at it already? Are you dressed? Have you left the house? Are you wearing a bra? Or do you consider bra wearing more of a pre-COVID world occurrence?

Well, maybe you have one on, but without the underwire, because apparently our bra habits are changing. So we're going to be chatting with Harriet Walker about that one. She is asking, when did everyone stop wearing bras? And on the getting out the door scenario, how is it for you this morning?

It's the first day back for so many of us and there are rail strikes and grey skies up above. But how are you motivating yourself to get moving today? Is it an extra cup of coffee? Maybe a bright lipstick? The promise of doing something fun later? Well, I want to hear all your tips to banish those post-holiday blues.

Share them with your fellow listener. They will be appreciated. Now, let's see. We can text the programme. The number to do that is 84844. Text will be charged at your standard message rate. On social media, you may know, we're at BBC Woman's Hour. And you can also email us through our website.

You can send a WhatsApp message or a voice note. That number is 03700 100 444. Data charges may apply depending on your provider. So you might want to use Wi-Fi if you can there and terms and conditions can be found on our website. Start sending them in and we will start firing them out to our

listeners this morning on Woman's Hour. But bra or no bra, turning back to one of the other topics, back to work today may also mean back to nursery if you've got young children. Now we've regularly covered on Women's Hour the cost of childcare. According to a recent report, 26% of parents' joint income in the UK goes toward childcare costs, and that's roughly three times higher than the OECD average

of 9%. So what's been done about it? Well, the former Prime Minister Liz Truss, she had been looking at working on what was described as a big bang shake-up of the whole system. That was during her brief time in Number 10. There are reports in the Daily Telegraph over the weekend claiming that Rishi Sunak has shelved those

plans. There's an estimated 1.7 million women in England prevented from doing more hours of work by child care issues so it's likely to be a key issue in the lead-up to the next general election. Let's discuss what's needed, what can be done. I'm joined by Adam Hawksby, Deputy Director of the centre-right think tank Onward who recently published a report on this topic. Hi Adam. Good morning. And also with us Neil Leitch from the Early Years Alliance, and they represent childcare providers in England.

Hi, Neil. Good to have you with us. Good morning. Adam, let me start with you. How would you paint the picture of the current situation for parents as they look at childcare? So, as you said, the headline is that costs are enormously high, that they've gone up by about 21% in the last five years. And that means that the UK are massively out of step with other countries in terms of how much parents pay. But what our report looked into

is why that's the case and what's happened. And some of that is about limited public subsidies. So the UK does pay less in terms of a share of GDP on childcare than other developed countries. But it's also how the system, the system of subsidy is failing. It's overly complex. You've got eight different forms of support over three different government departments. It's very inflexible in terms of sharing that between parents. And there are huge challenges in the workforce. Some of the organisations that Neil works with and represents are facing huge pressures. And that means many are closing or unable to hire the staff they need to. So it's

a very, very complex picture. And that's why I imagine the government might have stepped away from some of the trustee reforms, which had, to be honest, quite simplistic answers to some of those challenges. So what was she proposing? Because some people may not be aware of it. So there were three things that she was focusing on. The big headline one was around the scrapping of ratios between adults and children in childcare settings. That was going much further than some proposals to shift England's ratios more in line with Scotland. A proposal to expand the amount of powers that would be subsidised, although, if I'm honest, little detail of how that might be paid for. And also the idea that parents would get cash instead of a voucher.

I've got some reasons, both policy and politically, to be worried about that. But those were the headlines. The ratios was the big thing. The very important thing to say is parents are very, very nervous about that reform. And we tested a range of policies. Scrapping childcare ratios was the only policy that had net negative support among parents. Flexibility, cost, the things they really care about. So let me throw that over to you, Neil, instead,

with those plans that were proposed by Liz Truss. How would your members feel about that? Well, I think Adam summed it up absolutely brilliantly, actually, I have to say, because ratios was without a doubt the most volatile, most provocative proposal that was put forward. And it was interesting that the very day this was leaked from number 10, that the proposal maybe moved forward. You had Her Majesty's Chief

Inspector, Amanda Spielman of Ofsted on the airwaves telling us that young children's development had stalled and they needed more time, more effort applied to them than ever before. At the same time, as again Adam alluded to, we have a workforce that's leaving in droves. We have a recruitment retention crisis that we've never witnessed before. And so there is no question, in fact, that that proposal would have been damning. It's interesting as well that we did a survey almost immediately. We had 9,000 responses from our members. Only 2% said that they would consider passing anything across to parents. So the reality is this would not have saved parents

a single penny. It would have damaged the sector and would have, if you like, added further burden onto the workforce that was already struggling. And it sounds like it's not going to happen. Just with the ratios, to spell it out for my listeners, what was the proposal? It was for two-year-olds, basically. At the moment, you have one adult that can care for four two-year-olds. The proposal was to move it to five two-year-olds. And as I said to, dare I say, a minister a little while ago, have you ever tried to walk across the street with five two-year-olds? And he said, why would I want to do that? But that was not the point. The point is, caring for five two-year-olds is a tough, four year, caring for four two-year-olds is a tough four year caring for four uh two-year-olds is a tough

arse never mind five well adam let me turn back to you because there have been reports in the telegraph picked up also by other outlets that rishi sunak is dropping these plans uh the former cabinet minister simon clark also stroud mp siobhan bailey both conservative members of parliament they've suggested they are unimpressed with those reports that the plans have been shelved. How do you see this playing in Westminster and also how the Prime Minister may come under pressure? So I think that the Prime Minister

and the Education Department who have the primary responsibility for this policy area will be thinking about childcare very, very carefully. I would, I'm confident that they will come out have the primary responsibility for this policy area will be thinking about child care very very carefully i would i'm confident that they will come out with some proposals around child care and that the report in the telegraph will be about shelving elements of the trust proposals i think actually them saying we want to pause on this really consider the issue try and work out

if we can invest more in a future fiscal event in some sort of spring budget is the way to go. Because as your introduction talked about, this is going to be a huge issue in the next election. It's really important for voters that are often swing voters that might be considering which party to vote for, young families primarily. And so I think the government will come forward with proposals. They just won't look a lot like the trustee but there is always that question isn't there i know they talk about billions for reform of child care within um the country but women which are primary primary caregivers in so many respects um they are not in the workforce there must be a balance there when it comes to the economic outcome it's not simply the money that's being put into the reforms i think that's right simply the money that's been put into the reforms. I think that's right. And the really important thing is there are two things here. One thing that gets a lot of focus is getting more people that want to work into work. And that is a

huge problem that we need less people that are economically inactive. We need more people in the workforce. But the other is the strain this puts on families and the real harm it does to the family unit. And actually the delay it puts on starting a family. So some of our polling, 51% of people said that they are going to have children later in life because of those really high costs. So there's both that big social impact in terms of families and the economic impact you allude to. And that's why the government will be really considering whether there is more money they can invest on top of the 5.4 billion that is already invested now. But no concrete plans of what would replace what was previously proposed by mistrust?

So I don't think we have got concrete plans from them yet, beyond them saying they're looking very carefully at some of the proposals that our think tank have put forward in our report that you alluded to, and other very good reports. Lots of policy people are looking at it because they know this is a really important issue. We do have a statement from the Department of Education. This is a spokesperson that said,

let me see, we continue to review all options to improve the cost, choice and availability of high quality childcare for working parents, which remains a priority for this government. It goes on to say,

we have spent more than 20 billion pounds over the past five years to support families with the cost of childcare in a number of places available in England, has remained stable since 2015, with thousands of parents benefiting from this support. You hear that, but what would your members who are childcare providers say, do you think, in response to that and what actually needs to be done? I have to say it's a very, very cheap statement.

To say how much you put in doesn't necessarily mean that you're putting enough money in. What they fail to say within that statement is that back in December 2018, when we were tired, frankly, of hearing government trot out exactly the same lines about how much they'd invested, we said if you think that you pay enough money into the sector for these so-called free entitlements, give us your figures. It took us two and a half years,

battle after battle, before the information commissioner made them release that information. And what did it say? Their words, not mine. It said, to adequately fund the entitlements would require an additional two billion pounds. That's not affordable. Now, when you think that they're putting in £4 billion a year and there's a shortfall of £2 billion, that's a pretty big shortfall. They also went on to say, we accept that parents who do not qualify for these entitlements, their prices will increase by 30%, by up to 30%. So it's incredibly disingenuous, and that's a light word, frankly, for the statement that they've issued. They know they are shortchanging the public. They know the public have to make up the difference. And then they're

pretending that they're putting enough money in. Well, the shadow education secretary, that's Bridget Philipson, was tweeting last week and said the Tories have pushed the childcare system to breaking point with parents forced to give up work or pay higher prices. We need a new, modern childcare system that gives parents choices and grows our economy. She also said that childcare has to be part of the country's economic strategy. Do you, I'll throw this to both of you, actually, do you think this is likely to be a key battle of the next general election? Well, shall I just say, it has to be, frankly. I mean, the reality is that show of the policies, I have to say it's a massive relief, because these were idiotic policies that came forward from trust. the reality is this sector needs investment and it needs basically focus but it isn't just about and i have to say this it isn't just about getting

parents back into work this is about young children's development their education this is about creating good citizens for the future kind people we would invest in this we wouldn't be having this debate if we were talking about five-year-old children that walk through the school gate. But education starts at birth, not at the age of five. And let me throw that then over to you, Adam. I mean, how do you see this playing out? So this will be a big issue

in the next election. And both parties are going to want to work on very carefully what their offer is going to be. And I think it will be front and centre of their offer. And that's particularly important for the Conservative Party. A lot of information over the past couple of weeks about them losing millennial voters in droves, those people that might be in their late 20s, 30s, who are thinking about starting a family. They're the people who the government needs to persuade they've got a real offer to support.

That's about childcare. It's about housing. It's about economic opportunity. So yes, we'll be hearing more about this issue. Yes. And I should also say, of course, that we do not have a response specifically from Liz's trust

to defend her policies. They were just plans, but of course they have made a lot of headlines over the past day. Let me turn back to you, Neil. How difficult is it to keep nurseries going? It's pretty difficult, to say the least. We've seen record closures. I mean, in the last sort of seven years, we've seen 20,000 providers go by the wayside. In the last 12 months, nearly five and a half thousand have closed their doors.

I mean, as well as being a representative organisation, we represent, as you alluded to, nurseries, childminders and preschools. But we're also an operator ourselves. We operate settings in areas of deprivation. So at the moment, we operate 61 settings. This time, three and a half years ago, we operated 132. So nobody has to tell me that it is pretty challenging. I understand. I suppose there is a number of issues that are really for the nursery staff,

whether it's in insurance or the staffing. But of course, they're at the heart of people actually having the health care as well. I want to thank both of you for speaking to us. That is Adam Hawksby

and also Neil Leitch. Adam from the Deputy Director of the Centre Right Think Tank Onward and Neil Leitch from the Early Years Alliance, which represents childcare providers in England. Let us continue on Woman's Hour. I see some of your comments are coming in. People talking about how they are keeping upbeat

when it comes to the first day back at work. Let me see, who is this here? I don't see the name but she is from the South West. She says as a public speaker and garden designer based in the West Country, I'm feeling rather upbeat about this year and can't wait to get out giving talks

around the country. Well, that is wonderful. Also, I see with bras. I'm 66 and only on rare occasions have worn a bra. In my opinion, it's one of the worst uncomfortable man-made inventions. I understand that some women may need to wear one,

but definitely not me. Keep those texts coming at 84844. And as I move on to bras, are you wearing one right now? I know it sounds like an intimate question, but I guess we do get intimate on Woman's Hour.

And the reason I ask is because not wearing a bra is becoming apparently more fashionable. Throughout lockdown, there were all sorts of rules, right, about clothes that went out the window.

Lots of women didn't wear bras at all. In fact, a study conducted for two, that's a clothing company, found that 46% of women during lockdown ditched their bras at least once a week. Emma Barnett spoke to none other than Kate Winslet about this. They were talking about the freedom of lockdown. There's an oxymoron. The freedom of lockdown, eating rubbish food and wearing only tracksuit bottoms and the subject of bras came up.

A bra was a real step forward. A real, yeah. Bras became super challenging and really painful when we finally had to put them back on and walk out into the real world. It's like, oh my God, what is this halter we're wearing?

It's a terrible thing that no longer does up in the back. So there you go. Kate Winslet didn't wear a bra during lockdown either. But what about now? Has something changed? Maybe you're going more comfort, if it's more comfortable not to wear one.

Harriet Walker is fashion editor at The Times and has written an article all about this and joins me now. Hi, Harriet. Happy New Year. Hello, hi. So what about this? Our bra's gone, 2023 is not the year of the bra. Well as ever, personal choice but I think it's something that started happening before the pandemic actually and I think it's, I'm delighted to hear that your 66 year old listener isn't wearing one because I do think generally it's

a generational thing and I think it was millennial consumers, millennial bra wearers who started a trend for softer, less structured, no under wiring perhaps and that was pre-Covid. I think lots of young women looked at the sort of bras they had been wearing and just thought these don't seem to have been designed for me to wear so much as other people to look at me wearing if that makes sense and so by the time we got into lockdown there was actually far more on offer in the shops that was a bit softer and a bit less hello boys. Right and so we all remember of course well not all but certain women that are listening of a certain age the wonder bra and everything that followed on from it. But is it more acceptable, do you think, to not wear a bra?

Because I think some people may have felt self-conscious about it. Oh, totally. And perhaps that's something to do with, you know, why most people not wearing bras tend to be a bit younger. I think people are wearing different clothes than they were before Covid. I think we all got used to wearing things that were quite big and baggy. And, you know, during lockdown, when we did manage to socialise, when we were allowed to, we were all wearing coats, of course, because we were doing it outside. So I think people sort of stopped thinking so much

about what their upper half looked like. And maybe that's, and enjoyed the comfort of that. Maybe that's why we've clung on to it. Shall we go through some of the messages coming in? And there are a lot. Thanks so much for getting in touch. 84844. No bra is fine if you're smaller than, say, a D cup.

For anyone with big breasts, going without it is unbelievably uncomfortable and impractical. If you're even thinking about bras as a fashion, they say they're thinking of the wrong thing. Another says, I've always been strapped into huge monster creations having big boobs, but now wear a sharper top which just squishes things down, she says, on top. Kathy says bra wearing hasn't been on my radar for years. I hate them. They're uncomfortable and also unnatural. And one more. I first stopped wearing a bra in my 20s. People told me I would have saggy breasts when I was older.

I'm 60 now and I don't. My reply used to be, so will you if you have kids. But the difference is I have been comfortable. And she talks then also about the social pressure and design of clothes and making it difficult to go without a bra in some situations. Do you think designers are taking note? Yes, I think so. I mean, I think we've fallen into two camps slightly post-lockdown. I think there are those of us

who still want to be comfortable and casual and maybe aren't showing off very much of our bodies. But obviously there's another tribe of people who've come out of lockdown. They want to wear very tight, very clingy things. So I do think that we might see a return to cleavage, which, by the way, Vogue said was over in, I think, 2016.

So that's where, perhaps where the lack of bras started. But I do, I also think that in terms of sizing, it is important to be supported if you have bigger breasts. But the sales figures from places like M&S, but also in Selfridges and across the high street, do bear out that women who take bigger sizes are now buying less structured, less sort of scaffolded styles than they used to.

Here's one. I am 36. I rarely wear a bra, but I'm a teacher and you have no choice Monday to Friday as I'd be in breach of dress code. So I usually wear sports or crop tops now padded bras in the shop scare me, it's so heavily padded and young girls

do wear them all the time, it's a really confusing divide and that's Laura in Leeds, hi Laura What about that? Do you think it changes, she's talking about very young girls then in padded bras with older women kind of throwing them by the wayside Oh yes, sure with older women kind of throwing them by the wayside.

Oh, yes, sure. Yes, that's definitely an age divide. I think that might also be a kind of a nostalgic trend revival of what boobs looked like in the noughties as well. I think, although your listeners might not like to hear it, there is a fashion cycle that determines breast shape as much as the silhouettes that we all wear. And I think when I was growing up in the noughties those very very padded very sculpted I call them robo boob bras because they give you this sort of molded um uh this is a sort of molded shape that doesn't look anything like a female body but actually replicates almost perfectly

some of the um uh quite primitive boob jobs of that era. And I think, unfortunately, lots of trends from the early millennium are coming back. So that might be why younger women are wearing them again. Gosh, I have to say it has definitely touched a chord with our listeners. They're all getting in touch. Harriet Walker, thanks so much. Also an article on not just going with or without bras, but also the different breast shape, which I don't know how that can go in and out of fashion,

but apparently it does. Harriet, thanks for spending some time with us here on Woman's Hour. Thank you. Right, the time is 26 minutes past the hour. I have given you the text number there, but at BBC Woman's Hour, you can also get in touch with us. That is where we are on social media.

So we'd love to hear from you on that or any of the other topics. Here's another one. We've heard this week about the waiting times in A&E over the holidays. You might have heard the head of the Royal College of Emergency Medicine expecting this winter to likely be the worst on record for A&E wait times as hospitals are hit with demand. It's driven by flu and COVID and also Strep A. But this is, when you hear it,

just the latest in a long line of criticism that has been surrounding the NHS and also healthcare. Shortly before the Christmas break, Emma Barnett spoke to Baroness Cumberledge and heard about her frustrations at the slow progress of the implementation of recommendations that she had made in her report called First Do No Harm. And it was to support victims, women and babies in light of harm done by the drugs Primodos,

also sodium valproate you've probably heard of, and a medical device which is surgical mesh, which we've spoken about many times on the programme. There was one recommendation from that report which has come to fruition. The appointment of a patient Safety Commissioner for England. A GP by training and previously a Medical Director at NHS England, Dr Henrietta Hughes was appointed in July and took up the post in September. You're so welcome to the studios of Women's Hour. Thank you so much for having me.

If I was to ask you one word to describe your job. Patience. Very good, patience. What is your remit exactly? So my remit is about the safety of medicines and medical devices. And it's about amplifying patients' voices, because we know that if the views and the experiences of patients and the public are included, then we get better services, we get better outcomes. And it's just a better system for everybody.

I mentioned there promoter sodium valproate and surgical mesh. Are they issues that you are still dealing with? Yes, absolutely. They're still problems that are affecting women, that are affecting their children and they're affecting their families on a daily basis. And I'm hearing regularly from people who are continuing to have problems in these areas. With Surgical Mesh, with the interview that Emma did with Baroness Cumberledge, the issue of financial redress for those that were affected, she said it had been refused outright. She also said that the Health Minister Maria Caulfield was in the process of reconsidering this. Are you

involved in those discussions? Yes, the Minister's asked me to look into this, and I'm really hoping that the government will get confirmation for redress for all of the families and the patients affected. I look at this in terms of speak up, listen up, follow up. The patients have been speaking up for years or even decades. I'm listening up, and what I'm looking for is a commitment from the government to follow up by confirming that redress will be available to everyone who's been affected by this.

Are you hopeful that it will be? I mean, has there been any movement in those discussions? Well, back in May, Jeremy Hunt, when he was the chair of the Health and Social Care Select Committee, wrote to the minister to say that redress was a really important aspect of this in terms of following up the problems that patients are experiencing. And I'm hoping, and I'm hoping if he's listening today, that we can put some time in the diary to talk about it. I think the time would be a great opportunity to actually right the wrongs of the past so that the tens of thousands of people,

mainly women, who've been affected by these scandals actually get the redress that they deserve. So we will put that out. That invite is there. You heard it here on Women's Hour. Another issue that Baroness Cumberledge talked about was the issue of implementation and that it lies with a number of sources. You mentioned NHS England, the Department of Health, there are other organisations also involved. How do you navigate that complex web? Absolutely. I mean, everyone will know how complicated

the health system is for patients and it's no different for me. What I'm looking to do is to identify the key impact actions that are going to be needed whether it's with the Medicines and Healthcare Regulation Authority, whether it's with the Department of Health or NHS England so that we can start seeing some really important changes in the way that we listen to patients, that we listen to women's voices, and then as a result, we make the right actions happen. Do you feel there has been progress, like anything concrete that you could point to so far?

So what I would say, a lot of things have happened since the report was written. But what I'm missing from that is the patient's voices. So mesh removal centres have been set up, but they haven't listened to the women who've been harmed. They haven't included their voices in the way that they've designed the systems and the way they've designed the clinics. When it comes to sodium valproate, we know that three babies a month are still being born to women exposed to sodium valproate. And that is a drug that women who have epilepsy have been prescribed. But why is it still being prescribed to them? It's used for epilepsy, but it's also used for some mental health conditions as well. And for some women, it is the only medicine that controls their symptoms. And it's absolutely key that nobody stops taking their medicine without talking to their doctor. But what I would say is

that we want to see a reduction in the numbers of women who are being started on this medicine and also men as well, because it's also been shown that there are some potential risks to children from men taking this medicine as well. So what stands in the way of that happening? It's the complexity of the system. It's the fact that people will be started this in a specialist clinic and then maybe the prescriptions are continued by their GP. It's about access to highly effective contraception and it's also about women being told about the problems that they could have from this medicine. In the past doctors were told about it but it was actually restricted from women and from patients because there was a fear that they would stop taking the medicine as a result and I think what I've seen from the amazing campaigners not only with sodium valproate but also with pelvic mesh is that women are absolutely able to make the right decisions when they're given the information that matters to them it's about making really personal decisions but also

having the access to all the care to to all the services that you need, like, for example, highly effective contraception. Your brief is so to really listen to and respond to patients' views, promote patient safety, specifically as we were talking about medical devices and medicine. Will your brief overlap with Dame Lesley Regan, who was appointed in June as the government's first ever Women's Health Ambassador for England? Yeah, absolutely.

So Dame Lesley and I met just before Christmas, and there's a huge amount of overlap in the work that we'll be doing. And I think that's one of the things I'd say is working in partnership with Dame Lesley, but also others across the whole of the health system is the only way forward in this. It's about taking the views and the experiences of patients, amplifying those and making sure that we change policy and we change processes and we change the practices of delivering health care. And for people listening, how would they contact you? Well, I have a very small team, although I've got a meeting later on with the Department of Health officials, because I think we can see

that there's a huge amount more rather than just sodium valproate, primidos and pelvic mesh. So I have an email address, which can go on to our Twitter or your Twitter account. But also, people are, this year, I'm looking forward to going out and meeting people in different parts of the country so that I can continually hear from patients from their experiences and use that information to make things better in the future. You mentioned mesh and also sodium palpation. How much time is that taking up? It's taking up almost all the time that I have at the moment. But people are contacting me about a wide range of other problems. For example, problems after taking antibiotics, after the COVID vaccine, problems with the timing of medicine, the way that medicine is being administrated, but also gaps in the information about different types of devices which are being fitted.

There are a whole host of different areas that I'd love to have the time to be able to deal with. And that's why it's really keen. I'm really keen to expand my team to be able to offer more help. Well, let's hope that happens for you with that meeting. But you're going to stay with us because I want to bring in health journalist Sarah Graham, who has a new book out called Rebel Bodies, a guide to the gender health gap revolution. Good to have you with us, Sarah. Welcome. Hi, thanks for having me. And, you know, you've heard a little of Dr. Henrietta Hughes there speaking about some of the challenges that she faces. I'm just wondering what goes through your mind.

I think she's going to be a very busy woman. She's got a big job on her hands, both she and Dame Lesley. You know, I think it's great to see both Henrietta and Dame Lesley appointed to these new roles. I think, you know, we are really seeing the right conversations happening when it comes to women's health and, you know, government trying to listen more to women's experiences and, you know, government trying to listen more to women's experiences and to really improve things. So I think it's a really good first start.

I think we've seen some promising steps in the right direction. And yeah, I'm excited to see what comes of it. Well, we've heard also from Dr Henrietta about women not being listened to. That came up quite quickly. And the government has acknowledged that women's health

is the poor relation when it comes to medical understanding, funding and research, which brings me to your book. What was the thing that surprised you most as you delved into, and I should say it's quite exhaustive,

it goes from heart disease to autoimmune, it could be long COVID, also gynecological issues. What did you take away from it? I mean, I think one of the things that I really wanted to explore with the book, and it's kind of a culmination of stuff that I've been writing about for a long time. And one of the things that I had really noticed was that actually a lot of the issues that come up are really across the board not just in kind of the the areas that we traditionally think of as women's health so you know as you say it

comes up in cardiovascular disease autoimmune diseases and and with all of these different conditions I was seeing similar patterns similar themes of women not feeling heard, not feeling listened to, you know, of being made to feel like they were being hysterical or making a fuss about something that wasn't really an issue or that wasn't a medical concern when actually it was. Where do you think those issues come from, that issue of not being believed or not being listened to? I mean, I think the short answer is sexism. You know, I think the medical system, like the rest of society, is still very patriarchal. We have a lot of very kind of deeply ingrained attitudes that will take time to shift. But I think the longer answer, which obviously I explore a lot in a lot more depth in the book, is that there are some really complex issues going on here. So on the one hand, we have a lack of knowledge about some of the

conditions that kind of primarily or disproportionately affect women. You know, there are gaps in research, gaps in our understanding, which puts doctors at a disadvantage as well, you know. There's also a lack of kind of time and empathy, you know, which we're seeing particularly in a system under pressure. And as I say, these kind of really outdated attitudes about women that we're emotional, we're irrational, that we can't be trusted to kind of accurately represent our own experiences. With that, you know, it's really a toolkit as well, just to describe it to people. It's like a guidebook and you have all these various organisations to get in touch with, but also advice on how to advocate for yourself.

And one of them, Sarah, was, you know, to bring somebody with you and that it could even be more effective if it's a man that is brought with you. That stopped me in my tracks. Explain. Well, it's a really tricky one. And I'm always a little bit reluctant to say this, but actually, you know, so the woman who gave that tip was a chronic illness advocate called Hannah Hoskins. And she said that she'd experimented with this. She'd experimented with going on her own versus taking her partner. And she said, often her partner didn't have to say anything at all. He would sit there, he would look at his shoes the entire appointment. But the dynamic with the doctor was just different from having somebody else there um you know and I and I don't think that women should have to take someone with them in order

to be listened to or taken seriously I think you know we need to be really clear that women should be listened to regardless um but it's an interesting one that does seem to come up that having a man there seems to make a difference sometimes with some patients and some doctors um you know and I think having somebody there whether it's a man or not can give you a bit more of a confidence boost you know they can be there for moral support. They might be able to advocate for you if you don't feel able to speak up. So, you know, there are lots of reasons why you might want to take somebody to your appointment

if that's an option for you. That's one of the issues you talk about. We did have Nadine Doris, when she was a health minister, she came on the programme talking about women needing to become more confident and not take no for an answer. How do you feel about that particular line? Yeah, I mean, I wrote about it at the time. It was astonishing, but not surprising, I think, was how I would sum up my feelings.

I think, you know, it was a very good way of kind of dodging the government's responsibility on this, you know, to say, oh, well, we need to empower women to be more confident and to speak up more. And I absolutely agree that, you know, there are things that we can do as patients to get the best out of those appointments to navigate the system. But I'm very clear in the book that no matter what you do or don't do to advocate for yourself it is never your fault if the care you receive is not up to scratch. Which is something you underline. I just want to go back to some of the specifics of the book. You did spend quite a bit of time, as I mentioned, there's a wide ranging list

but a lot on endometriosis, fibroids, PMDD and polycystic ovary syndrome. Why those in particular? I mean, those are four of the conditions that come up a lot in my work. You know, they're four very common gynecological and hormonal issues that, you know, I think people don't necessarily realise how common they are. But also they seem to be the ones that very commonly women find themselves not feeling heard not feeling listened to being told oh it's just a bad period it's just pms you just have to you know you just have to kind of suck it up and get on with it

um and another aspect kind of coming back to the toolkit part of it before i go back to dr henrietta um you talk about language that people could use. I mean, it's very specific, like while giving birth saying stop, I do not consent, for example, if it was a procedure taking place. But I was thinking you need to, I don't know, to be able to be thinking of those words while you're in the middle of something and very distressed must be so difficult. Yeah, absolutely. And I mean, that's another thing where, you know, I say having an advocate there, you know, in the case of childbirth, having had a conversation with your birth partner beforehand about what you do or don't consent to can be really important so that your birth partner knows to step in and say, hang on, we've talked about this, what you're doing is not okay. But yeah,

like you say, it is really difficult. And that's another reason why I think it's so important that we don't allow ministers to get away with saying that it's our fault for being fobbed off, because actually, it is really hard, you're in a really vulnerable position when you're seeking healthcare. And not everyone will feel able to speak up. And I want to turn back to you, Dr. Henrietta Hughes, who's also with us. You know, Sarah outlines the concerns there and their money. And I know you've also looked at her book, Rebel Bodies and the stories. You know, they're heartbreaking, really, what people have gone through. But I began this segment talking about those waiting times in A&E.

And that is for, you know, emergency life or death situations. And, you know, one might wonder, how would issues like the ones that Sarah raises be dealt with if in fact, it's on its knees at the very first point of contact with the healthcare system? Well, it's absolutely concerning to me. And as a GP, I know that people are working day in day out to try and offer the best care that they can to patients in this most difficult time and what I would say is that if we can start moving away from what's the matter with you to what matters to you I think we can unlock a very different conversation a much more personalized and a much more important topic of conversation to that person at that time. And I have to say, having read Sarah's book, I thought it was absolutely fantastic. I thought there were so

many aspects in it about the same types of problems that people are raising to me about not being listened to. And I think the onus has got to be on the healthcare system to create the environment where people do feel safe to say things, rather than putting the burden onto patients, particularly women, to say, you know, you need to be speaking up more. And how does that happen then? I mean, where should that training be happening for people to be more open or understanding or believing? I think this starts right from day one. It starts in terms of professional practice, but it also is a societal problem. And I've seen this experience myself as a doctor, when I've had a man sitting in the clinic

with me, who's not medically qualified in any way, immediately patients start looking at him and telling him their story. Somebody brought a prescription for the man to sign, even though he wasn't a doctor. So I think we see it in both directions. We see sexism in terms of the experience of patients, experience of families, but also experience of the healthcare staff as well. And I think this is something we need to look at really carefully because it has an impact on people's health and also on their feeling of being listened to and being heard. Here's one that came in. I've just seen it actually for you, which says, dear Woman's Hour,

I'm a male fan of your programme. That's great. And a practising medic. Listening to the delightful and effective Dr Hughes, it strikes me that this is all the wrong way round. Wonderful advocates such as Dr Hughes

and Dame Leslie are surely not the answer. It comes down to medical education and every doctor playing their part. Staying up to date, medical training has been shortened and so focused that the wide view and extensive knowledge has been lost. I think this is about leadership. Leadership is such an important aspect of this because when you see the people who are training you, who are the experienced people doing the right thing and acting as the role models then that was what people pick up on and it's that's what people follow so I think that we do have a lot of allies out there in the system

and I really welcome your listener getting in touch because it's absolutely not a question that every single person is not interested in the views of women but we do need to make it much more part of the training and the experience that people have going through their, you know, their careers, that they're alert to the fact that it's not just women who might not get listened to, but it's also a much broader inclusion. And I think that Sarah's book really comments on that as well. It sounded, Sarah, reading your book, that you feel things are going in the right direction, even though people have gone through terrible, terrible experiences. You talk also about long COVID perhaps being a moment of reckoning, thinking about those chronic diseases.

I mean, what do you think the first step could be, bearing in mind the pressures that the NHS is under? Something that is actually doable yeah no absolutely and and i share a lot of baroness cumberledge's uh frustrations about the slow progress so far but i do feel that the conversation has gone in the right direction um in in the last few years i think you know going back to your point about the the crisis in a&Es, the fundamental point is that we need a functioning NHS. We need a workforce that is, you know, happy, healthy, fairly, fairly treated in order to make any of this happen. You know, it's great. We've got the women's health strategy, but none of it will be possible without the staff, without without an NHS that works. You know, I think there are lots of promising things in the Women's Health Strategy.

I think at the end of the day, it's funding. Funding is the big thing that we really need. You know, the Women's Health Strategy talks about education for doctors, which is fantastic. You know, it talks about reducing diagnosis times for things like endometriosis I think which is currently eight years according to your data yes yeah absolutely um which is far too long you know and we need a specific target to try and bring that down which currently isn't

in the strategy um I think so I think you know there are lots of things that we can do there are lots of things I know that Dame Leslie Regan is very keen to to put into. So I think there are lots of things that we can do. There are lots of things I know that Dame Leslie Regan is very keen to put into practice, but I think we have to also look at the basics of having a well-funded, well-resourced NHS to make any of that possible. Yes, which of course is one of the really big questions. Thank you so much, Sarah Graham.

I will also say that Sarah does get into patients sometimes dehumanising doctors so that it's really a two-way street as well where change has to happen. Also to Dr Henrietta Hughes, thanks so much for coming in to join us. Thank you so much. And thanks for all your messages coming in as well. I'll just give the text again,

84844 if you want to respond to anything that you've heard on the programme so far, both with these guests and my previous guests, I'd love to hear from you. But you want to respond to anything that you've heard on the programme so far, both with these guests and my previous guests, I'd love to hear from you. But I want to move on because we've been talking about women finding their voice there, right? To be able to speak out and advocate for themselves. And our next interview is part of our Finding My Voice series. We talk to women about the moment they realised they had something to say or stand up for. Elika Ashuri, she was an actor and a baker

who rarely kept up with politics, whether that was the politics of her birth country, which is Iran, or the UK, where she had lived since she was 16. But it all changed in 2017, when her father, Anousheh, was detained by Iranian authorities while he was in the country visiting his mother. What followed for Elika was, as she describes it, a crash course in human rights campaigning in the most unimaginable circumstances as she fought for her father's release.

He flew home on the same plane that brought Nazanin Ezzeghari Radcliffe back to her family in March 2022. But even after his release, Elika has continued to campaign for the rights of women and also political prisoners in Iran. She joins us now on the programme. Welcome. Thank you very much for having me. So you were an actor and a baker turned political activist. Talk us through that particular transition and finding your voice

uh yeah i think here those aren't normally things that you would think of going hand in hand when you talk about someone's career but i did um study and train to be an actress and i was uh kind of in the height of finding my feet in the acting industry when my dad's incident happened. And because I also ran my own business as a patiss bills. So I had to keep going with my own business and start campaigning kind of as a second job, really. And that's how I put a part of my life on hold and picked up a completely new path for myself, which has kind of lead us to where I am today. So talk me through that because I can't imagine from being pretty much apolitical if I've understood correctly to then being in the centre of this firestorm. Perhaps tell our listeners a little bit about what happened to your father and how what were the first steps you did Who did you get in touch with when you started trying to campaign for his release? When it first happened, I mean, we were so shocked when we found out what happened for about two months when we had no contact with him at the beginning because he was detained literally from the streets.

He was taken into a van with a bag over his head and detained. We didn't even know where he was. We thought there was a case of mistaken identity where they'd taken my dad and thought he was someone else because we were so non-political as a family, you know, going back and forth to Iran. We had really tried to make a point of not being political so that we have freedom of movement. And when my dad was charged with spying for Mossad, I remember in those first couple of months, I actually didn't know what Mossad was. That's how naive I was about politics and where all of this was headed. And it was only in hindsight that we found out that this was just a political

game between two governments and taking hostages was a kind of diplomatic game that Iran plays for financial gain and for political gain and that's how we were thrown into it and what we did at first was nothing because we were hoping that by doing nothing and because the Iranian authorities were saying that if my dad cooperated they would release him we cooperated with them and kept quiet but when we realized that the situation was grave and after four months nothing had happened my dad was the one who suggested we would inform the Foreign Office because he was scared that his British passport was going to be misused because it was confiscated. And that's how we contacted the Foreign Office, whom after finding

out what happened also advised us to stay quiet because they thought that these things would be solved easier if we didn't make too much noise and that's why we were quiet for almost two years we were trying to let the foreign office do what they were doing and that was a very intense time for us as a family because it's a very heavy burden to carry with you and not tell anyone you know how do you explain the lack of a family member suddenly and how do you go about your normal day-to-day life with something like that weighing on you so it was a very dark time for me because I had to survive I was on survival mode not telling people what was wrong but inside uh just really being resentful and bitter about everything and everyone and i remember it was um the iranian regime that actually

publicized my dad's case um after two years i think what's the point of a hostage if you know you can't bargain with them so they released an info about my dad and then that kind of snowballed into the western media catching up and in order for us to control the narrative we decided to be vocal and first with caution and then we just threw caution to the wind and we went full-blown with our. And to this day, the only regret I have is that we didn't go louder sooner. Yeah, that you didn't go sooner, but you did find your voice. And what was that like then to be able to speak about your father, to talk about his plight? Actually, very liberating, although we did then face a new set of challenges because in my mind,

having seen how global the news of Nazanin it really didn't happen for us that way and from the moment we went public to this day it's been a challenge for us to stay relevant in the media and I remember to the day that my dad came back there were still British politicians who didn't know who my dad was and to this day there are people who would not know who he was or whether he was on the same plane as Nazanin and that that was a in a way that was a blessing for me because having seen what's happening in Iran now and having seen how difficult it's been for the Iranians to amplify their voices globally for this issue I see resemblances of what happened to me and my case and the tactics that I've learned along the way to be heard I'm applying them to this now.

Can I jump in and we've just about a minute or so left but what would your advice be to those Iranian women right now who are trying to find their voice? I would say be loud I know it's dangerous I know that speaking up against this regime carries its own risks. But I do believe this is an instance where sharing these voices, sharing the news of Iran is literally saving lives in Iran, because putting international pressure on Iranians and putting them on the spotlight stops them from carrying out the atrocities. And as we've seen yesterday, Britain is now going to formally acknowledge IRGC, Iranian Revolutionary Guards, as a terrorist group. So our voices have been heard and it's working. So I really think we should continue and not let this momentum die. Thank you so much for joining us, Alika Ashuri.

A great voice. I noticed you took specifically the amount of time that I gave you as well. So wonderful to have you on our series, Finding My Voice. Great to have spent some time with you today. I'll be back with you again tomorrow. Last comment on brows, which we started with.

I burnt my brow in the 70s. I haven't worn one since. I'm 67. Talk to you tomorrow. Thanks for listening. That's all for today's Woman's Hour. Join us again next time. Hi, I'm Helen Lewis,

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