Woman's Hour - The Equal Pay Act at 50, Rachael Hearson Health Visitor, Public Toilets

Episode Date: May 29, 2020

It’s fifty years since the Equal Pay Act became law, though employers were given a couple of years to prepare for the change to take effect. The legislation followed the strike of a group of women machinists at the Ford factory in Dagenham who wanted to be paid just as a man would for doing skilled work. It set out that an individual can claim equal pay for work of equal value. However, it’s proved tricky over the years for women to find out what their male comparators were earning. It’s also proved tricky for women without financial and legal support to use the law. However, cases have been brought over the years and as the law has been strengthened. Last year, Glasgow City Council agreed to pay out a reported £548 million in compensation to thousands of women who were paid less than men working in jobs on the same grade. Jane is joined by Frances O’Grady, General Secretary of the TUC and by Jane Hannon, Employment partner at the law firm DLA Piper Health visiting is one of those professions that most people think is a bit of a non-job. After 40 years in the NHS and 30 as a health visitor, Rachael Hearson tells us why this is not the case. She’s written about her experiences and explains how the role has changed and why it’s needed more now than ever before. Her book is called Handle With Care.Public toilets have been a well-known victim of council cuts, leaving the UK with 50% fewer toilets than a decade ago. Coronavirus has caused even more closures – albeit temporarily. But where does that leave people who need urgent access to the loo? Jo Umbers from the Bladder and Bowel community explains how this issue is affecting women of all ages. Raymond Martin, from the British Toilet Association, discusses the economic and health importance of public toilets in a post-Covid world.Producer: Louise Corley Editor: Karen Dalziel

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.

BBC Sounds. Music, radio, podcasts. Hi, this is Jane Garvey. It's the Woman's Hour podcast. It's the 29th of May 2020. Hello, good morning to you. Today we're talking about the 50th anniversary of the Equal Pay Act. That's where we're kicking off this morning. Also, later in the programme, public toilets. Not as common as they used to be. And it's actually a pretty serious matter. In fact, in some cases, it stops you going out. If you're one of those people, make sure you're listening around about a quarter past ten. No, a bit later than that, about twenty five past ten when we start talking about that.

But if you've got a point of view you want me to put up across during that conversation, make sure you tweet us at BBC Woman's Hour or you can email the programme via our website. The lack of public toilets and also how are Britain's toilets going to look post-Covid. I'm also going to speak today to a health visitor. We talked about health visitors a couple of weeks ago now on the programme. Not easy for them to do their important work at this particular point in our history. Rachel Hearson is working as a health visitor in Dorset. She's been in the role for over 40 years and she's got plenty to say about what life is like for a health visitor these days.

So 50 years to the day then since the Equal Pay Act became law. The legislation, of course, came after the strike by female machinists at Ford in Dagenham and enshrined in law the right to claim equal pay for work of equal value. So problem solved then. Well, ish. It has been difficult over the years for women, of course, to find out how much their male comparators are earning. And women with no financial or legal support may simply have found it easier to get on with it and not really bother with the issue. We'll talk in a moment to Frances O'Grady, who's the General Secretary of the TUC,

and to an employment lawyer too, Jane Hannan from DLA Piper. First, though, here are a couple of moments from the Woman's Hour archive. This is Barbara Castle, Labour's Employment Secretary. Here she is in 1969 on BBC News. She was at the Labour conference. Oh, I made it quite clear this afternoon we intend to put it to Parliament in the coming session. And I'm going into immediate consultations

with the Confederation of British Industries and the TUC to discuss the detailed content of the legislation within the principles which I outlined to the conference this afternoon. You mentioned that you're going into consultation with the CBI. Now, the CBI have made it pretty clear to you, quite recently, that they're against any start towards equal pay for at least two years, and they want it phased out, I think, over seven years, even when it started. Aren't you going to run in to formidable opposition, therefore,

from the employers right from the very beginning? Well, it is true, as you have said, that they did put this point to me. But I put a counterpoint to them. I said to them, you know, really, equal pay won't stand still, whatever we do legislatively. This is increasingly becoming a factor in pay negotiations. And there's going to be... Women aren't going to wait nine years. It's absurd to pretend they will. And they will force the unions, therefore,

to press this in negotiations. And I put it to the employers, it's far better, therefore, for us to have a planned, phased, advanced towards equal pay over a period which will give the industry's most affected time to repair. And I think the CBI was impressed with this argument. I hope they were. But all this, of course, will be done, as I understand it, by voluntary negotiations, won't it? The government are not going to specify, are they, a timetable of phasing in?

Well, we're not going to lay down an annual progression towards equal pay, so much percentage increase each year. What we are going to say is that at the end of 1975, it will be illegal to discriminate in rates of pay on grounds of sex. One of the things I shall be discussing in the consultations is whether we ought to have a halfway house. There might be some employers who, you know, really pulled their punches and dragged it out too long, unnecessarily long. So we might decide that, say, by 1973, they ought to have got 90% of the way. But this is a matter for consultation. Is this going to satisfy the unions?

After all, they have demanded, the TUC have demanded, equal pay should be implemented in two years. Well, look, seeing that the TUC has been talking about the principle ever since 1880, I think five years ought to seem like a top speed to them. The formidable Barbara Castle back in 1969. Well, she mentioned 1973. Let's go to 1973. And here's a somewhat disgruntled female employee, again, talking to BBC News. We want a fair living wage.

That's all we're asking for. Our wages are absolutely disgusting. We want equal pay for women. The firm are messing about. They just don't want to give it to us. But do you not think the government is trying to introduce equal pay? Oh, the government is, yes. The government's doing everything they can

because it's got to be done, hasn't it? But it's our firm, they just don't want to know. I mean, we're not only fighting for equal pay for us, we're fighting for more money for our men. Do you want to see the government force firms like yours to pay? Yes, definitely. Absolutely, definitely. We've got to have this equal pay and it's

got to be done. That fiery woman, we did try to find out her name. I'm sorry, we couldn't find out who that was, but you never know, you might recognise her, be done. That fiery woman, we did try to find out her name. I'm sorry, we couldn't find out who that was, but you never know, you might recognise her. Somebody might. That was in 1973. So Frances O'Grady, General Secretary of the TUC, is here and so too is employment lawyer Jane Hannan from DLA Piper.

She's in Leeds this morning. Frances O'Grady, Barbara Castle died in 2002. What would she make of where we are in 2020 in terms of equal pay? Well, I hope that she would recognise that we haven't got far enough. I mean, at this rate of improvement of closing that gender pay gap, it's going to take another 50 years. That's far too long for women to wait. And why should we? Well, most of us, many of us would say we are indeed waiting. And of course, we'll get would say we are indeed waiting and of course we'll get on to the fact that the unions haven't always been blinding in this area in terms of

support for women. Can we just go back to the women, the formidable and important women I mentioned right at the start, the machinists at Ford in Dagenham. Just how significant was their struggle? Well you say that about unions Jane but let's remember that it was trade union women who led this fight. It was the strike not just at Dagenham, but Hailwood came out too, that led to the Equal Pay Act. And, you know, without them and without their fighting spirit, then millions of us wouldn't at least have that right to equal pay that we have today. No well we can bicker gently about that in a moment or two Frances and I'm sure we will but can we go back to the women at Ford at Hailwood and indeed in Dagenham just remind some of our younger listeners exactly what their issue was. Well they weren't getting paid the fair rate for the job and they weren't getting equal pay so they wanted an end to sex discrimination in their pay packets and the only way they could get it was to go out on strike. But I think what they did was expose that injustice. And that did lead the then Labour government to agreeing that we needed a law. Because I think if we've learned anything over

the years, it's that there are always decent employers out there who will do the right thing. But there are always some, as the Fari contributor earlier said, who simply won't. And so you need a level playing field, a law that requires all employers to play fair by women. But, you know, there are still millions of women missing out today. So it would be good to talk about what we need to do to make sure that it's a reality. Sure but we have to also be honest and to go back to the point I was making about the traditionally male dominated union hierarchy which in the past made decisions that would have adversely affected female workers and members and done good things for male workers

and members. It wasn't that long ago the GMB union was criticised for not looking out for cleaners on the same pay grade as the men who emptied the bins, but the women were getting £12,000 a year less. Well, there's always been an issue about bargaining power, hasn't there? And I think one of the things that we have to do as a trade union movement is use our bargaining power to benefit everybody that's

what was happening in glasgow biggest pay strike uh in 2018 biggest pay strike ever of 8 000 council workers it what is what happened with julie hayward the gmb member the cook you remember who took the first ever equal value claim and got the support of the shipyard workers who were predominantly men to do that. They clapped her when she won. So, you know, I'm not saying we're perfect, but what I do know is that if you are a member of a union and have the union backing, you're far more likely to win equal pay and all the other policies like family friendly working and job sharing everything else that makes it possible for women to get the wages they deserve now um i am well paid um if i might dispute the fact that i'm equally paid but let's i'm definitely well played paid i'm prepared

to acknowledge that um you are also well paid just to remind people how much you earn? I'm on £112,000 a year. But what I think is important is that the principle, regardless of how much people earn, the principle of equal pay is still really vital. We've seen that in the media industry, the BBC, obviously, Samira Ahmed, with the backing of her union, led by Michelle Stanistreet, the NUJ, together with Bechtu, have won equal pay cases and have pushed for equal pay throughout the media industry. My point is that it's a principle. It shouldn't matter how much you earn. It's not acceptable for women to be discounted, as were simply because they are women no but i wonder how many of us are guilty in our personal lives of behaving in a very different way i had to have a

word with myself the other day when i realized that i was i'm very fortunate i have a cleaning lady and i have a man who cleans my windows actually i pay the man who cleans my windows more per hour than the woman who cleans my house now Now, where does that put me? And why am I doing that? I think there's something very deep in society about the value that we afford different kinds of labour. And we've seen this most graphically probably in the care industry. You know, we've all come out probably for the last time on Thursday night, to clap our key workers, the vast majority of them women, care workers looking after our mums and dads. Seven in ten of them earn less than £10 an hour and they haven't even had proper protective equipment throughout all of this.

What does that say about the value that we put on women's work? Why is it so often described as unskilled when we know that some of the most important jobs in society are highly skilled and yet the worst paid? So how do we go about changing that mindset? Because you're absolutely right that the work traditionally done by women is not paid at the same level as the work traditionally done by men. How do we change it? I think we've got to break down this occupational segregation for a start. I think we have to, you know, why is it that we think car mechanics caring for cars are more skilled

than predominantly a female workforce caring for children? What's going on there? So we need to break that down down I would like to see much more sharing I'd like to see apprenticeships more equal so that we had many more women young engineers and many more men young men learning how to care I think we have to share in our own lives too because that's where it starts doesn't it that if we don't have you know equal shares of housework and child care and caring for our elderly relatives then how is it it's not that

easy for women who are still shouldering the majority of that to do a double shift well let's bring in employment lawyer jane hannon from dla piper jane your job is actually to advise employers isn't it on how they can avoid claims? Yes, that's right. So we do a lot of work in terms of talking to our clients. They don't want to pay people unequally. They want to ensure that all of their staff are paid correctly. But what we do is we do a lot of work with them in terms of looking at, well, are they properly moderating their pay? Are they rolling out job evaluation schemes, for example, to check what people's jobs actually are, working out where jobs are of equal value

to ensure that they're properly paying people so that they're not inadvertently creating a gap in terms of the pay that they're giving to roles which are perhaps predominantly done by women compared to those predominantly done by men. Yeah, but we're about unravelling that mindset, aren't we? And I'm still not sure that we've actually got very close to doing so. What do you tell big companies about how they value their staff? So the main way of going about it is rolling out, as I say, proper job evaluation. But what does that mean? So there are a number of different systems that you can use to evaluate the the actual value of the roles there's a number of different methodology like methodology sorry that you can use to do that so you can do that proper analysis

rather than just saying oh well this this job is more important than that job or you know to this you use these different methodologies to to properly grade the jobs so hay grading for example would be one way of doing it but it's still at the moment the onus is on the woman to find a male comparator and to go from there um surely jane that i mean that is a real problem for the average woman i think that's i think that's right. And previously, there was an ability for women to complete an equal pay questionnaire. So they'd be asking a number of questions of their employer regarding whether they are being paid equally to a particular comparator and asking for that data. But that was removed in 2014. So it's now a case of a woman having a hunch.

So that's a real step backwards. It is. In the 21st century. It is. And that's why the Fawcett Society have proposed a new right to know so that you have the ability to, and there's some draft legislation which has been proposed. Obviously, everything's slightly paused at the moment

with everything else going on in the uk but that this right to know legislation would give employees the ability to ask questions about comparators in terms of their pay and hours about their job descriptions and whether there is any material factor which explains the difference in the pay right so this was this would increase obviously number of people making these requests but it would also mean in my view is that employers would have to take this even more seriously at the moment although you know we have lots of claims each year that the overall number is still relatively no low and this would mean that employers could provide that information at an early stage and address those those any gaps

that there are. Well, we know that the Labour leader, Sir Keir Starmer, has given his backing to that Fawcett Society idea. What do you think about that, Frances? The right to know? I think it's time we ended that kind of 1950s style pay secrecy. Yeah, but the fact that the law changed in 2014 is disturbing, to put it mildly. It is. But I think there are other things we've got to do. Because again, it was our union, Unison, that took the government to court on employment tribunal fees. We saw cases plummet when fees of around £1,000 were introduced.

We got rid of those fees, but we need to know from the government, and they won't tell us currently, that they're not going to reintroduce them. But the other real problem, the bit of the story of the Ford sewing machinists that's often forgotten, is that the company ended up outsourcing those sewing machinists. So they would have never been able to find a male comparator back in the company. And so we want to bring back many of these outsourced contracts that have prevented women being able to compare the value of their jobs with people in the host organisation. That would make a huge difference. And then insecure contracts. Many of those care workers I was telling you about are on zero hours contracts. It's time that we ban those once and for all. Well, OK, you want to ban zero hours contracts, which I know some people often speak up in favour of. Some people, this is pre-COVID, would always argue passionately

that it gave them real flexibility and it suited their way of life, Frances. Women want flexibility. Men want flexibility increasingly too. But it's got to to be it can't just be on the terms of women and their employment prospects, their vulnerability? We know that more women have been furloughed, for example. I suppose, Frances, some people might say, you know what, can you park the equal pay thing for the time being yet again? We're getting all sorts of reports that do give us cause for worry about more discrimination against pregnant women. Again, assumptions that if you've had a baby, you won't need to come back as much as a man who has, you know, so real worries that old fashioned attitudes are going to kick back in, and that women will be seen as more disposable. But I think

it's an opportunity for us too, because I think we have had to all think hard about the jobs that really matter in society I think there is a real push to get fair rewards for key workers and all workers why not you know all working people deserve fairness so maybe we need to rethink our priorities as a society and to get take this as an opportunity to put things right well be interesting to see what happens um thank you very much that's francis o'grady general secretary of the tuc and the employment lawyer jane hannon her company is dla piper in leeds if you are on furlough or perhaps you're on maternity leave and you're concerned about your future you can let us know email the program via our website well talking about maternity reminds me of

Monday's programme, Bank Holiday Monday, wasn't it? Where we talked about pregnancy and labour, birth and life with a newborn during the lockdown. And there were some unforgettable moments during that programme. Do listen back via BBC Sounds if you missed it and you think the programme will be of interest. But I just wanted to replay this segment from Monday's show. This is Lizzie talking about her labour. I called my husband straight after delivery, FaceTimed, you know, the site of his newborn daughter and then things started to go a bit wrong. I didn't quite appreciate at the time, I think, how serious it was. But in short, I had an undiagnosed pulmonary embolism, a blood clot in my lung and it had put pressure on my heart obviously during the pushing stage of delivery such that my heart had gone into distress and what became apparent

afterwards is that I'd had what they call a cardiac event so effectively a sort of mini heart attack during delivery. I think so much of what the women have already said on the programme has been so fantastically understated and calm. I just want to own, and I want you to own the fact, that you've been in labour on your own, in hospital, for any number of hours, and then this happened. And you contacted, I think, your best friend and your mum because you thought you were going to die.

So I had actually said to my husband everything was fine and you should go to bed because by this point it was midnight and he'd been looking after our daughter all day. I just wanted to hear my mother's voice so I sent her a text message asking if she was awake, she knew I was in labour and she went back going yes and I rang her and I just said oh I just wanted a quick chat, just wanted to talk to you and she quickly clocked that I was not in a postnatal ward, that there was something going on and you know at that point I sort of sgwrs cyflym, roeddwn i eisiau siarad gyda chi ac fe wnaeth hi ddod yn gyflym bodwn i ddim yn y gofal hwnnw, roedd rhywbeth yn digwydd. Ac, chi'n gwybod, ar y pwynt hwn, fe wnes i ddweud beth oedd yn digwydd ac roedd hi'n hynod o ddiddordeb. Ac eto,

chi'n gwybod, yn y prynu i'r prynu, fe wnes i alw fy mab a ceisio ddweud i'w ddweud yn dda beth oedd yn digwydd. Ac roedd hi'n hynod o ddiddordeb ond byddwn i'n dweud bod hi'n what was happening. And he was incredibly reassuring. But I would say that I think it was utterly terrifying for him, for my mother, for my best friends. It was probably more scary for them than it necessarily was for me on the whole during the experience. You've been through such a lot, Lizzie. And I want to congratulate you, obviously, for coming through all this. You are all right. I am.

Just stay with us. I just want to bring Kenga in our obstetrician what happened to Lizzie it was unusual wasn't it yes yeah it's very unusual um and you know it's a good thing that they picked it up very quickly and found the underlying cause so they were able to treat it properly but yes um I agree it must be completely terrifying for her. And she sounds very, very brave to go through all that alone. And her poor husband as well, you know, family at home who then can't be there with her. My empathies go to you. Lizzie, how is life now in terms of previous contributors have mentioned that idea of a cocoon? Have you been able to establish that?

Yes, absolutely. And I just want to add as well that whilst my experience was, you know, with hindsight terrifying, the NHS staff were absolutely unbelievable in the way in which they cared for me and were just so nurturing. And I certainly didn't feel alone at any point during the time that I was in hospital without my husband, which is saying quite a lot. Well, our huge congratulations again to Lizzie and indeed to all the other fantastic contributors to Monday's programme. And the very calm voice you also heard in that clip was the obstetrician Kenga Sivarajah. And we should say that Lizzie's daughter, who was making noises brilliantly during that, is Bibi, and she was born at the Chelsea and Westminster

Hospital. So a shout out to them and the fantastic support they offered Lizzie during that experience. On Monday's programme, is your child shielding at home? How are you managing that? And what is it going to be like when some children in England go back to school on Monday? We're discussing this

on Monday's programme and we'd love to hear from you if this is you or your family. bbc.co.uk forward slash Woman's Hour if you want to email us with your experience. bbc.co.uk forward slash Women's Hour if you want to email us with your experience. Now, I mentioned that a couple of weeks ago now we did talk to a health visitor

or somebody from their professional body about how difficult it was actually to be a health visitor at the moment. Today we can talk to Rachel Hearson who spent 40 years in the NHS. She spent 30 as a health visitor and she's written about it in a new book called Handle with Care and she joins us now. Rachel, good morning to you. Good morning, Jane.

Now, I love this book. I thought it was really interesting and it was all about a job I thought I knew about but it turned out I didn't know very much, which I guess is the point of you writing it so really simply what is a health visitor well um we are women usually women who provide a public health service working with individuals families communities attempting to tackle health inequalities through a universal and proactive service mainly for children uh naught to 5 and their families and it's targeted according to need. We know that the first a thousand and one days or two years of a child's life are incredibly significant in terms of shaping our baby's brain and future behaviour so we know that attachment is really key in these early days and weeks and first two years, really. Something you mentioned very early on in the book,

and it did ring true for me, was that that thing that you hear people say, my health visitor was useless. And they say it in a horribly dismissive way. And I've heard people say it. You deal with that head on in this book. Yes, yeah. And I think the present conditions, and especially over the

past five years, really haven't served health visiting very well, really. You know, we're, I think the Institute of Health Visiting says we're ticking the box, but missing the point, especially as we've lost a third of our numbers. Since 2015, I think we reached a high point of 10,500 after the document call to action and now we're below 7,000 whole-time equivalents. Yeah, now this is because you now come from councils rather than from the NHS. Yes, yes, that's right. And so budgets weren't ring-fenced and so, you know, the money that was initially dedicated to us has kind of been lost. And, you know, the service has been eroded quite significantly, really. Yeah, and we need to do something about that.

And the Institute of Health Visiting has written a document called A Vision for the Future. And it's made numerous demands to the government, which means that including a new ring-fenced funding offer for health visiting and statutory protection for the health visitor role to include the healthy child programme and we need a new workforce strategy for health visiting which needs to be launched to get our plans for reversing the cuts to health visitor numbers back up again. Right well let's talk about what you do, the practicalities of what you do. I know that you're currently in a rural area but you've worked in the very heart of London in places like Tower Hamlets in the east of London. When do you first appear in a baby's life?

Well we do an antenatal visit at around the 34 week mark to mums to look at you know how they're progressing through their pregnancy and if there are any kind of red flags that we need to address before the baby's born. But generally after that, we appear at day 10, day 11, usually when the midwives have discharged a mum and a baby into our care. So we usually appear at the time that all the congratulatory cards have been packed away and the flowers are beginning to wilt and the sort of reality of a postnatal situation kind of hits home really. So there's lots of complexities to deal with, you know, issues from breastfeeding to, you know, how you're feeling,

you know, lack of sleep, you know, changes in your body, changes in your perception of who you are, you know, questioning your own identity. And we're looking at trying to identify families that are in need of additional support and children who are at risk of poor outcomes, especially in terms of adverse childhood experiences. Now, I think what's interesting is that some people might have dismissed you as, well, interfering and judgmental. But you're very clear in the book about your own family background.

Yes. You have known poverty. Yes, definitely. Yeah, I grew up with some fairly Dickensian sanitation facilities, shall we say. And yeah, I knew it again much later in the 2008 crash, global crash, when my husband became unemployed and I became the breadwinner, which was thrust on me. And so, yes, times have been quite tough, tough really we lost 70 percent of our household income so um it was kind of pretty much up to me to kind of make everything work glue up everything um so yeah you know help as it is no calamity disappointment failure and I think sometimes

we're kind of perceived as these two-dimensional creatures who kind of turn up and make judgments about other people. And I think, to be fair, we all make judgments about people every day. Oh, yeah. But health visitors have to make sound judgments. Well, I just want to give you some understanding and love from a listener called Claire who says, I'd like to tell my health visitors here in Truro that they deserve great credit. They're patient and they're kind, and they made me feel much better about not having done the dishes. Now, that's such a good

point because I guess that's where a lot of people would be concerned that you come sweeping in and your eyes are everywhere and you're taking notice. Now, you mentioned red flags earlier at an antenatal appointment. What is a red flag? Well, I suppose it can be a whole range of things, really, from somebody's mental health who's deteriorating, a child whose growth is faltering and not, you know, they're failing to thrive. You know, it could be a parent who's taking substances. There could be a sort of calamity in terms of relationship where, you know, parents are divorcing or separating. And, you know, we're often sort of trying to identify things like neglect, which could be emotional or physical. We're trying to identify emotional abuse, physical, sexual abuse, that sort of thing.

And domestic abuse, of course, which has gone through the roof in these COVID times as well. Yes. Well, let me take you up on that. Gone through the roof. You are seeing more or you're hearing about it more what is it? Well we have something called public protection notices which come across our desk via our laptops and when the police are called to a domestic dispute if there's a child under five involved in that household we get details of that incident along with social workers as well and we have to decide you know what what we're going to do and who's going to do it and you know which which discipline is best to deal with that really according to the severity of the incident. But people presumably don't want

you there they don't let you in how often does that happen um i think you know if you're kind of fairly reasonable in approaching somebody to say look i'm here to help um they usually do let you in to be fair um and you know most people are fairly honest about what what's happened and um you know we can signpost them to other kind of, you know, domestic abuse workers and get extra support in terms of family partnership zone workers and things like that. At the moment, do you have PPE? Yes, we do. Yes. And you've never had any problem getting it? No, no. There are a few of us who go out to do visits when there is a crisis.

And there are some health visitors who have underlying health conditions who can't go out for whatever reason. But I am one of those health visitors that has been going out wearing the mask, the gloves and the apron and the Azomax wipes for the scales and everything. And on the whole, how are women coping in those early days and weeks after having their babies um i think it's fair to say it's pretty on occasions it's been disastrous um and lots of parents are quite devastated at not having any support not just from us as a kind of universal service, but, you know, from their families, their extended families, you know, grandparents have been denied, you know, seeing their lovely grandchildren. And, you know, my lovely mums and dads are heroic in how they've

managed to cope without the support that we would ordinarily try to provide. Yeah, it's tough, isn't it? I mean, what is so interesting about what you do is that you're actually the only nurses, I think you say this in the book, who are about prioritising prevention of ill health. So you're proactive, not reactive. Yes, as far as we can be.

And I think that's the beauty of health visiting, really, is that we are there to try and build resilience into families and add resources and identify where families need additional needs and try and make those referrals that are appropriate to that family's needs, really. I think Florence Nightingale actually said, in her wisdom, she wasn't only responsible for healthcare for nurses in hospitals, but also for the first programme for health visiting. And she said there are more people to pick us up when we fall than to enable us to stand on our feet. And I think that that's exactly what we're trying to do, really. Yeah, it's so, so important, that, isn't it? And just really that that's, you know, that's exactly what we're trying to do, really. Yeah, that's it's so, so important that isn't it? And just just really, really briefly that the notion that continuity of care is not as easy as it used to be in your line of work. Are you worried about that?

Yes. Yeah, I am. And I think especially so because our clients are worried about that and often will say to us, you know, I the same health as it did twice you know and and we do try and even though we're working corporately we are assigned to families for the first year of that child's life but you know there are often things that happen that that mean that get in the way of of that continuity and I think that the relationship sometimes is and often is everything really that if you don't form that relationship with with the client they often don't they don't learn the value of the service and they don't come back to you if there is a crisis they learn other kind of pathways and other people to go to other than the health visitor and and this is you know our five contacts which haven't served us

very well, which I say, you know, we're ticking the box, but missing the point. We need to increase those contact points. And the Vision for the Future document is saying that we're going to increase those contact points from five to eight. Well, I'm sure that there'll be quite a reaction to what you said, Rachel. Thank you very much. Rachel Hearson, 30 years as a health visitor. Her book is called Handle With Care. And if maybe you're thinking of a career change or you're in nursing and want to do a different sort of nursing, I'd seek that book out because it's really interesting. Catherine on Twitter, my health visitor was like a second mother to me when my twins were born early.

Whilst they were in special care, she ferried me to and from the hospital. I can't remember her name, but I do remember her support. Catherine, thank you for that. Right, toilets, public toilets, all the lack of them. There are 50% fewer toilets than a decade ago. And post-coronavirus, Britain's public toilets are going to be rather different. Jo Umbers is from the bladder and bowel community.

And Raymond Martin is from the British Toilet Association. Good morning to you both. Good morning. Good morning. I know we've had so many emails on this subject, you won't be surprised to hear. So can I start with you, Jo? On the whole, more women than men need toilets urgently. Who do you actually represent in your community? We have 1.7 million people each year

that actually come onto the bladder and bowel organisation and in terms of the sort of the female male split we have almost 70% to 30% female to male so you know there's a number of reasons for that really sort of females are five times more likely to have a urinary problem. You know, there is childbirth, there is menopause, there's many reasons for that. But we see that through all our stats. I mean, we have three and a half million people each year that actually come on. It gives you some sort of indication

of the amount of issues that probably people don't talk about because it's it's embarrassing well we have an honourable history here of talking about all the things that really do matter well it's so it's so important because this is stopping people going out it absolutely is and that's what we're hearing from the community i mean we specifically asked those obviously, before we came onto the show. We have a closed Facebook community of 11,000 people, and we have a lot of feedback that comes into the site. And that part is important to us because, you know, we have a library, but it is about how people are feeling and what the current thoughts are. And I think the big thing that comes back is it's about confidence people need confidence so

they don't feel a prisoner in their own home sure now we know because of the coronavirus that cafes are obviously shut you can't nip in anywhere to go to the loo absolutely and I guess you're hearing that people are simply too frightened to leave their home that's exactly what's happened yes that's exactly what they're saying they're saying they're feeling housebound and we're not talking about the milk the 1 million that's been shielded we're talking about millions of people yeah that feel that they actually need to have a plan to go out and it's becoming impossible because the you know I mean clearly it's not done purposely sometimes it's the most basic things that actually slip through the cracks, I think.

And that is the issue then, because we can open up society. But, you know, we have 60,000 pubs in the UK. So we have a society where they were all open to us and that's not there anymore. So, no, they don't feel confident and they feel they feel trapped and a lot of them are saying as even as a basic if they could even have the disabled toilets open via the radar key or retailers would accept the just can't wait card so they could open the staff toilets things like that would you know in no cost to society really and would really would really help so many people. Roman what's going to happen to the average British toilet in the future, do you think,

post-COVID? Well, first of all, we've got to get them cleaned and get them open. Then we have to sit with some experts and we need to look at hygiene because this COVID thing is going to be with us for some time. So we need to look at some of the things like surfaces and handrails and flushes and taps and all the equipment that you expect to find in there. And we need to bring the toilets up from the 70s or 80s when they were first produced, these old toilet blocks. We need to refurbish and we need to upgrade them to get them into the 21st century.

And that's where we need some, we need government to step in, put some funding down to the councils give the local authorities that that start yeah i mean quite simply it was council cuts that led to so many public toilets closing in the first place yeah maybe those of us who go out and about we're going to have to start paying again for them aren't we that that's really the only logical answer i'm glad you said again jane because you know when toilets were introduced back in the 1900s we did spend a penny or they did cost a penny at a time and if you relate that to today we should be paying 60, 80 pence for the toilets type of stuff

so yes we're seeing charging being introduced up and down the country but people don't want to pay for toilets they think they should be free and we think we should be free as well we think this is a health issue and government should step in here and put some substantial funding in

it's about health and well-being social inclusion equality for people with disabled and accessible issues that's about public dignity and public decency so we believe they should right i was saying we ought to pay you're saying no we shouldn't well i'm saying with the bta is of the thing that this is a health issue this is about human health and the populace whatever if you have a sick populace you you can your whole economy goes your all your commercial businesses struggle tourism's gone whatever so what we're saying is we need toilets if we have to pay for them we need to pay but they need to be clean hygienically clean attended looked after and well maintained because people will pay if you if you have a good toilet i don't think anybody has a problem going in and spending 20p, 30p, 50p, whatever.

But if they're going to be maintained at the level they have been, Jane, over the last while, then people will kick back almost automatically. Well, here's a quick tweet from Helen who says hand dryers should be turned off before reopening. Hot air circulating asymptomatic coronavirus in enclosed space would be a disaster. I'd never feel desperate enough to use a public loo at the moment, so I'm keeping within 10 minutes of home. Well, briefly, that's the issue, isn't it, Jo? People like Helen shouldn't be staying 10 minutes from home. They should be able to get out.

Yes, that's exactly it. And we're hearing the same sort of things coming through the community where there's a call for you know bring back the toilet attendants you know it's a very interesting debate about whether people would pay because obviously there's a higher cost of bringing things like toilet attendants and the same the same things about the the hand dryers and the blue towels and sanitized surfaces and you know it's it's the big thing about the front door isn't it that you have to touch and you can't see how many people when you come in. So they're all worried about those things. But the main thing is, is a case of, you know, there aren't any toilets, there aren't any public toilets, but the retailers aren't opening their toilets either. So and I think it's a bigger female thing because there's no sensitive way of saying it.

Well, no, we can mention periods. Our anatomy is not set up. It's perfectly all right. That's also the thing. There's periods, but also our anatomy is not set up for a quick release, if you like, or a discreet release, whereas men's is more set up for that. And that's something that comes out as well.

A topic for another day. What was it? You said a quick release. A quick release, yes. I've got time for it in the drama for a quick release Jo thank you very much Jo Umbers

from the bladder and bowel community and Raymond Martin from the British Toilet Association easy to laugh but this stuff is so important

keep your tweets and emails coming on this one well that was me contemplating the prospect of a quick release in the drama

which I can't believe I said that I actually said that on the radio it's dreadful. Oh, I should be sacked, really. As ever, there are a number of people are calling for exactly that this morning anyway.

So that was Joe Umbers and Raymond Martin talking about the genuinely, this is so important, the issue of public toilets. Obviously, so many closed at the moment because of the virus, but there were fewer before all this started because of cuts to council funding. So let's just try to do justice to your emails on this subject. Becky says, I'm so glad you're talking about this. I am a self-employed gardener. I have been able to do some work for the last couple of weeks, but I can't go into people's houses all my coffee shop toilets are shut as well I also cannot wee in their gardens so in lockdown I've given myself two bouts of cystitis and dehydration the other option being not to drink enough oh no don't well don't

do that um I just want public toilets open again please thank you for covering this really important topic um there was also a tweet earlier from another listener who said they'd been visiting a place that I used to go to really regularly when my kids were younger, Chiswick House in West London. And she said the public toilets there are shut. And so people are just going into the bushes, which leads me on to the topic of why is it okay for men to urinate in public, but significantly more difficult or more judged if it's women? I mean, we've all done it. We've all been in a bush,

but it's just harder for us to do it, seemingly, and it tends to be something we try to avoid doing. Maybe we should just go more freely in public. That's going to be my next campaign. Right, Dawn says, I'm lucky enough to spend my days driving a bus around the derbyshire peak district oh how fantastic i can be away from the base for up to 11 hours which means i've got to rely on public toilets well last year derbyshire dale's council

closed the majority of its public loos which meant that some days and this is again it's cropping up i have to restrict my liquid intake because i can't get to the toilet. I get dehydration headaches and a loss of concentration, and that's not good when I'm carrying passengers. I'm so grateful that I can get to a supermarket sometimes, but wanting to go to the toilet gets to the point of distraction. I even filled my bus with petrol the other week because I hadn't been able to get to a loo for nearly five hours and all I could think about was relieving myself. Oh, I guess Dawn means that actually she should be filling it with diesel. Yeah, that must be what she means.

Yeah, well, that's unfortunate, Dawn. Anyway, to top it off, the garage refused to let me use their toilets because of COVID. Thankfully, a friend was in the area and whizzed me off to her house leaving the boss on the forecourt there we go that's i was just i'm so sorry about that dawn so annoying um i can honestly say i've never brought my father greater pleasure in life than on the occasion when i filled my petrol car with diesel and he just was delighted it's one of the happiest days of his life i think anonymous says i'm one of those women who can't go far from a toilet i've got used to restricting my life such as no longer walking with the dogs and very broken nights going to the toilet however

if using public toilets will incur a charge as i need to go at least every hour it will almost be too expensive for me to go out for the whole day anywhere. I guess I'll just have to learn to love my house more. That's just, it's really terrible, isn't it? Claire has an idea. This links into local planning. As many shops have closed in town centres and elsewhere, there is space for more imaginative communities.

Well-serviced and equipped cloakroom shops, as part of an integrated plan, may be cheaper than cafe and pubs, etc., expected to provide for all. Yeah, maybe that is something. Maybe people could set up exactly those. Some of your other thoughts on the programme today. A listener called Jill says,

I led a strike for equal pay for women doing exactly the same job as men at a tomato packers in Guernsey in August 1973. Immediately, I got the sack. Jill, I hope things have improved for you. Obviously, that should not have happened. And on the subject of health visitors,

a lot of people really enjoyed hearing from our health visitor on the programme today. Yes, I'm glad you did, because I thought she was insightful and I thought it gave us an idea of what that role was exactly in 2020. Lindsay says, when I had my first baby back in December of 1983, my health visitor, Jean Lewis, was brilliant. She addressed any concerns I had. She calmed my nerves and she reminded me that housework could wait. Spending time with my baby was to be cherished. I have very fond memories of that wonderful woman. And from Faye, listening to you talk about health visitors, the team in my area supported me to keep breastfeeding,

helped me make friends by running a postnatal group and later they got me referrals for my son's special needs. Such an essential service. They no longer have the funding to run the postnatal group and that for me was a lifeline at a difficult and lonely time. I made friends for life through that and have continued to make it a big part of my life. I wonder if without it, I would have slipped into postnatal depression. Well, Faye, I'm glad that that community did save you in this instance. And I hope things are all right for you and for your child at the moment. Well, he was a young son then. I don't know how old he is now.

But thank you for telling us about that experience. Woman's Hour goes on. We're back with the highlights of our week at just after four o'clock tomorrow afternoon. That's on the radio. The podcast, of course, will be available a little later. And then we're back live on the radio Monday morning. And we're particularly interested then in what it's like if you are shielding a child at home. Monday, of course, is the day that some schools in England will see pupils attending again. Thank you, as ever, for listening. We'll see you either tomorrow or Monday.

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