Clare Wade

Exactly 2 years ago, Clare hit rock bottom and took an extended break from work—not for a serious disease or major surgery, but because of something that all women experience but are often unable to access proper care or support for. In this blog for the hub, Clare shares her experience of trying to access menopause support and treatment in the NHS. Dismissed and unsupported In October 2021, I hadn't been in my new job for long when I started to experience memory issues and didn’t feel quite myself. I was 46, and as the symptoms worsened I started to wonder if I had early on-set dementia. After a few weeks, I requested a GP appointment. On the call the male GP listened to my concerns. I asked him if it could be perimenopause, but he said given my symptoms and the fact I didn’t have night sweats it wasn’t. I’ll never forget his final words: “it’s not menopause, you’re too young and don’t have the right symptoms. Try to forget about it, don’t dwell on it and you’ll be fine”. He was perfectly pleasant but left me wondering what on earth was wrong with me? It was around this time that Davina McCall’s first documentary (Sex, Myths and the Menopause 2021) was released and my husband suggested we watch it. As those featured on it discussed menopause and the wide variety of symptoms, I thought: that’s me, that’s how I feel! It gave me renewed confidence to return to the GP. I requested a female GP—I felt strongly that I shouldn’t need to, but my symptoms were worsening and I needed help. Over the next 2 years I had several telephone appointments with the female GP, who again was very amenable but didn’t seem to know much about menopause or treating the symptoms. Every call was the same: she’d ask how I was and if whatever hormone replacement therapy (HRT) medication I tried since our last conversation had helped. I would answer ‘no’ or sometimes I'd tell her that whatever I’d tried had made things worse, and she would ask what I wanted to try next. She never offered any insight or other support; it always felt like the onus was on me to turn up to our calls with suggestions. Through mine and my husband’s research we had discovered bio-identical HRT so in my final GP call I suggested this, only to be told I would never be able to access it on the NHS. The mental and physical impact it had on me After 2 years of trying everything the NHS had to offer I was on my knees, mentally and emotionally. I literally could not function. It’s difficult to really explain the impact of 2 years of deterioration, but at work I couldn’t remember questions that I wanted to ask in meetings and I couldn’t absorb actions allocated to me—they left my head as soon as people spoke the instructions, so I started to write them down but then constantly forgot that I’d written notes. I wasn’t myself and struggled to function as an assistant director. It erodes your confidence to the point where you’re continually on edge. If anything unexpected happens it becomes impossible not to panic; you feel your heart racing and heat flushing your face. Your brain scrambles and you just can’t form reasonable thoughts to deal with whatever’s happening. Conversations become really challenging, you’re unable to find the right words to articulate yourself—it became quite an amusing thing at home, but at work in meetings, when everyone is looking at you and you just can’t form the sentence, it’s hugely embarrassing. Weight gain and skin and hair problems are often an issue and that also impacts your confidence; you look in the mirror and don’t really recognise yourself. Relationships are harmed, you forget birthdays, can be sharp and snappy with those closest to you and don’t feel up to the usual get togethers. My husband says it was like living with someone with permanent premenstrual syndrome. I now understood why so many women disappear from their careers during their 40s and 50s; it becomes incredibly difficult to continue. Colleagues were starting to notice, raising concerns for my wellbeing with my manager who was completely supportive and understanding. He said to me one day: “I can see you’re not ok and people are starting to notice. I’m not telling you to take some time off, but are you ok to be at work?” At first I was a bit taken aback. I thought I was hiding it well enough, but over the coming days realisation dawned that I needed to take a different course of action. Finally finding help through a private clinic My husband was so supportive and for some time had been suggesting a private clinic that he’d found online. I had resisted, after many years working in and around the NHS. After working all my adult life and paying into the system, I felt I should be able to access appropriate care via the NHS. But I’d reached a crisis point so reluctantly I made the call. Within 2 days I had an appointment for an assessment and blood tests, another 2 days and my blood results were back and 2 days later my first bio-identical HRT cream was in my hands for my treatment to start. Six days was all it took after 2 years trying but failing through the NHS. I should explain that there are two types of HRT: body-identical and bio-identical. Body identical HRT is widely available on the NHS but formulations are standard, so if you’re lucky enough that they replace the hormones your body is missing great, but, if not, they don’t help and sometimes can make things worse. Bio-identical is specifically formulated for each individual patient following a blood test to replace what your body is missing. However, bio-identical HRT is pretty much never available via the NHS as it does not follow the same Medicines and Healthcare products Regulatory Agency (MHRA) regulatory pathway as conventional body-identical HRT. (You can find out more about body-identical and bio-identical HRT from the British Menopause Society.) The wider patient safety issues Why is this ok? Why are around 4.5 million women in the UK at any one time largely left to navigate this alone without the proper support from the NHS?[1] Had I not accessed private care, I honestly don’t know where I’d be now. From a patient safety viewpoint, suicide rates among women aged 45–55 (the age when perimenopause and menopause typically happens) are notably higher. Despite this, little qualitative research has been carried out on the relationship between perimenopause, menopause and mental health challenges, including suicidality. In 2021, a survey of 2000 women between the ages of 46–60 was carried out on behalf of ‘Health and Her’ and showed that 9% of perimenopausal women had contemplated suicide and 86% had suffered mental health issues, yet 80% didn’t even share this with their partner, and 25% admitted to making mistakes at work.[2] The economy also suffers, with menopause symptoms resulting in around 14 million lost workdays per year in the UK.[3] The estimated financial cost to the economy is £10.5 billion,[1] alongside other less visible impacts, such as talent retention and productivity. Closer to home, relationships suffer with peak divorce rates seen for couples aged 45–49 (Office for National Statistics). Sixty-five per cent of women reported menopause symptoms impacted their marriage,[4] but only a fifth of women experiencing relationship issues due to menopause seek support.[5] Light at the end of the tunnel? In recent times, more is being done to recognise the impacts of perimenopause and menopause and to provide guidance and support. The upcoming Employment Rights Bill is expected to introduce more comprehensive requirements for employers, and mandatory legislation, including requirements for menopause support, is expected to be implemented by 2027. Help is also out there to access, including Menopause Support and The Menopause Charity. For healthcare professionals, the British Menopause Society is the specialist authority for menopause and post reproductive health in the UK. Two years on I’m doing great. My symptoms started to slowly decline within weeks of starting my treatment, but the cost of private care is out of reach for many. I was also lucky to have great support at home and work. Given the severe impact of perimenopause and menopause to many women, their families, friends, workplaces and the economy, surely it would be a more mature and long-term approach for appropriate care and treatment to be offered to women when they need it? If symptoms were recognised and dealt with in a timely, efficient manner, many women would remain well and able to function properly in society. The on-going cost to the NHS and the economy would reduce overall, relationships would be less likely to suffer and more women would have the choice to stay in their chosen careers. References Chiren L. Navigating the menopause maze: why employers must act. British Safety Council, 3January 2024. Newson L. New research on women’s mental health and suicidal thoughts and behaviours during menopause Department for Work and Pensions. Shattering the Silence about Menopause: 12-Month Progress Report. TStowe Family Law. The impact of the menopause on relationships. 18 October 2021. Navigating Legal & Medical Landscapes: The Family Law Menopause Project and Newson Health Research & Education. Menopause Mastery, 12 September 2025. Further reading on the hub Raising awareness of surgical menopause Menopause Support - Getting the most out of your doctor’s appointment Pausitivity - Know your menopause poster British Menopause Society: Tools for clinicians Share your experiences What support have you been offered for your menopause symptoms? Did you have to go private to get the support you needed? Have you had a positive experience with your GP you could share? Have you had difficulties getting HRT that works for you? To help us understand how these issues impact the lives of patients and families, please share your experience and insights in our community forum thread on menopause or you can email us at [email protected].

In this blog, Clare Wade, Patient Safety Learning's Director, draws attention to the impact toxic cultures have on staff and how, sadly, most often nothing is done about it. Clare shares her own personal reflections from past experiences in her career. There is a clear link between toxic cultures and patient safety, and while there are no easy answers these behaviours must be acknowledged, challenged and cured if the NHS is to survive. I’ve personally experienced toxic culture and behaviour on many occasions, but I found two examples particularly tough to navigate. The first was more than 20 years ago when I worked clinically in a trust largely staffed by the local population where most colleagues were either related or friends; I lived some distance away and commuted in. I’d witnessed troubling behaviour from one senior time-served nurse several times, but one day I heard a blatant, serious breach of patient confidentiality between her and another patient. I was shocked and initially didn’t know what to do. I raised it with the nurse involved who laughed at me, and then the sister in charge who told me to just forget it. After much deliberation, I went to the matron in charge of the department. Conversations took place behind closed doors and eventually I was hauled into trust HQ for a formal meeting, alone—the nurse was nowhere in sight. I was accused of causing upset and the nurse had denied any wrongdoing. In no uncertain terms it was made clear that I should keep my head down and mouth closed if I wanted to remain in post. From that day on my time was made miserable, colleagues closed ranks, stopped talking to me and I was ostracised until the day I left the trust. Later in my career, at a different trust, a new director was recruited to lead my department. From the start something felt off as several senior leaders quickly left their roles. It became obvious that the director was a bully; we largely worked in open plan offices, and the director thought nothing of shouting at and belittling people in front of everyone, even other directors and the CEO. It was impossible for senior colleagues not to know what was happening, but no action was taken. The situation worsened with many people taking sick leave or leaving the trust completely. I came under fire as the director didn’t agree with how I led my team or how we worked, even though our performance was excellent. An external consultant was brought in to identify issues with my practice and help build a case against me. The consultant admitted this to me and said they couldn’t find anything wrong to report back. At the time I had a mentor relationship with a senior board member, and I chose to confide in them with the hope of gaining some insight into how I might be able to better deal with the situation. I didn’t know until sometime later, but my mentor was informing the director about our conversations. As time passed, the behaviour worsened and, although many colleagues were experiencing it too, it was obvious I was on my own in wanting to speak up. I was encouraged to go to a senior HR colleague who would be empathetic, so I did and eventually the director agreed to mediation. I was so nervous ahead of the meeting, but it went ahead and to my surprise the director admitted to some of the allegations and agreed some actions. If I thought my treatment had been bad to this point, I had no idea what was to come. It felt like open season with the director’s full toxicity focussed on me. Derogatory rude emails would be sent daily, raising my anxiety as they landed in my inbox. Meetings where we were both present made me feel sick; they would think nothing of singling me out in front of everyone for their derision and nastiness. The barrage was constant and debilitating, affecting every part of my life and breaking my confidence. One day I couldn’t take any more so left work early and crawled into bed at home where I felt safe. I decided to call the senior HR colleague who had facilitated the previous mediation to ask for an update about the agreed actions. I was absolutely shocked to my core at their reaction, they shouted down the phone that I’d had my opportunity to air my grievances, nothing more was going to happen, the director wasn’t going to be held accountable for the agreed actions and I just needed to forget it and get on with my job. Was I naive to expect a different response? I hit rock bottom, felt scared to go into work and knew I had to get out of there for my health and sanity. Even when I left, the impact followed me to my next role; my confidence and resilience were shot and took a long time to rebuild. The director stayed in post for another couple of years until there were so many grievances that the CEO had to act. The sickening part is that after a period of ‘gardening leave’ the director secured another senior role in another trust in the area so will be perpetrating the same toxic behaviour onto others. I know there are thousands of experiences throughout the NHS just like mine and, unfortunately, in many organisations culture and behaviours aren’t improving. This problem is endemic and has decades of history behind it. There is a clear and acknowledged link between toxic cultures and patient safety. Within the NHS Patient Safety Strategy, NHS England states that: "positive patient safety and healthy organisational culture are two sides of the same coin. A culture in which staff are valued, well supported and engaged in their work leads to safe, high-quality care." In order to improve the care delivered to our loved ones, friends and ourselves, the NHS must take action to improve its culture. Forget the financial situation and the waiting lists, this is the most pressing and wicked problem facing our health service today; it permeates throughout everything and unless it is acknowledged, challenged and cured no other interventions will work. Money doesn’t solve toxic cultures, neither does restructuring the NHS for the umpteenth time. Sadly, some colleagues have taken their own lives because of the toxicity they have endured, this needs to stop now. There are no easy answers here but if we don’t put this right the NHS won’t survive. Share your story Have you worked in a toxic culture? Have you tried to speak up? Have you examples of a good team culture? Add your comment below (you will need to be a hub member and signed in) or contact us at [email protected] and we can share your story anonymously. Related reading on the hub Speaking up for patient safety: A new interview series about raising concerns and whistleblowing Speaking up as an agency nurse cost me my career My experience of speaking up as a healthcare assistant in a care home