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Join us to learn how welfare rights advice services are being integrated with healthcare nationwide to tackle poverty and health inequality. This event will be of interest to people working in Integrated Care Systems and public health policy and practice. Taking action on poverty and health inequality is ever more important for the NHS, as the current cost of living crisis increases hardship among communities. The consequences for health and wellbeing will be felt most keenly among low income and vulnerable patient groups. Health justice partnerships are targeted interventions that support patients with social and economic circumstances that are root causes of health inequality. They are partnerships between health services and organisations specialising in welfare rights. Advice on welfare rights issues is integrated with patient care, helping people resolve problems relating to benefits, debt, housing, employment and immigration, among others. This can support those in the hardest circumstances to maximise their health and wellbeing. This one-day in-person workshop is an opportunity to learn about health justice partnerships and how they are being implemented across the country in a range of NHS settings. We will be joined by speakers who are engaged in service delivery, policy and research, who will provide examples and insights from their work. Speakers will include: Professor Dame Hazel Genn, Director of the Centre for Access to Justice, UCL Cedi Frederick, Chair of the NHS Kent and Medway Integrated Care Board Natalie Davis, Head of Legal Support Policy, Ministry of Justice Catherine McClennan, Director of the Women’s Health and Maternity Programme, Cheshire and Merseyside Health & Care Partnership Paul Sweeting, Insight and Performance Partner, Macmillan Cancer Support Refreshments are provided and there will be opportunities for discussion and networking. Outline of the day (provisional timings) 09.15: Registration and refreshments 10.15: Plenary session 1 - Introducing Health Justice Partnerships 11.45: Plenary session 2 - Health Justice Partnership case studies 13.00: Lunch provided 14.00: Plenary session 3 - Implementing Health Justice Partnerships 15.15: Group discussion session 4 - Where next for you? 16.30: Refreshments and networking Please see our website for further information on Health Justice Partnerships. Register for a place This event is supported by The Legal Education Foundation.

Key findings The gap in Index scores between women in high-income and low-income economies nearly doubled between 2020 and 2021. In 2021, 22 points separated women in high-income economies — whose score remained unchanged at 61 — and women in low-income economies, whose score dropped from 49 to 39. Women’s ability to meet their basic needs — such as affording food — fell, while men’s ability to do so did not change. Women were slightly more likely than men to say there were times in the past year when they did not have enough money to afford needed food (37% of women vs. 33% of men). This gap was wider in 2021 than it was in 2020 — as women lost ground while men largely remained steady. Women in 2021 were more stressed, worried, angry and sad than they were in 2020 — or at any point in the past decade. Stress, worry and anger each increased by three percentage points within the span of a year, while sadness notably rose by six points. More than 4 in 10 women in 2021 said they experienced worry (43%) and stress (41%) during a lot of the day before the survey, nearly one in three experienced sadness (32%), and more than one in four experienced anger (26%) — all at record levels. In nearly 50 countries and territories, less than 10% of women said they had been tested for cancer in the previous year. Worldwide, just 12% of women in 2021 were tested for any type of cancer in the past 12 months, which means more than 2 billion of the world’s women went untested. Belief in the value of going to a healthcare professional declined among women with an elementary education or less. While belief in the value of going to a healthcare professional remained relatively stable among women with four years of education beyond high school or a college degree (92%), it dropped seven points among those with an elementary education or less — from 87% to 80% — leading to a 12-point gap between the two groups. Annual visits to healthcare professionals correspond with two additional years in a woman’s life expectancy. Even after accounting for gross domestic product (GDP) per capita, life expectancy for women who said they had been to a healthcare professional in the past year was 78, compared to 76 for women who said they hadn’t been.

It’s so important that mesh-injured women are able to access redress for their injuries, many of which are life-changing. Often, financial support is not a bonus but is necessary, as women have had to leave their jobs or reduce their hours to cope, move to accessible housing or sell their home to live with family. Many have also experienced marriage breakdown as a result of mesh complications. One in four women in Sling The Mesh need a stick to help them walk, so need to pay for mobility aids or scooters, and there are also the ongoing costs of travel to doctors and hospital appointments. Waiting times are up to four years for mesh removal, so many women cash in savings or pensions to pay for private removal which costs thousands. The psychological impact of mesh injuries also takes a toll and with long NHS mental health waiting lists, many turn to the private sector for counselling for post traumatic stress disorder (PTSD) and trauma. Likewise, many women have difficulty accessing NHS Physiotherapy so turn to the private sector for specialised physio to help mobilise internal pelvic scar tissue which can cause ongoing pain after mesh removal. The concept of redress is about proactively correcting a wrong that has been done to a group or individual. It differs from clinical negligence, which is about identifying and proving that the actions of an individual healthcare professional or service caused specific harm. Redress involves an authority taking responsibility for harm that has been caused under its watch, whereas clinical negligence is an adversarial process with strict legal boundaries. In 2020, the Independent Medicines and Medical Devices Safety (IMMDS) Review’s report, ‘First Do No Harm’ (Cumberlege Review), called for “a new independent Redress Agency for those harmed by medicines and medical devices” to be created, based on models operating effectively in other countries.[1] This Agency was to offer women harmed by mesh a specific, non-adversarial route to compensation. However, in its official response to the report, the Department for Health and Social Care (DHSC) rejected this recommendation, stating that “while the government is sympathetic to the experiences of those patients who gave evidence to the report, our primary focus is on improving future medicines and medical devices safety.”[2] The Government's failure to accept the IMMDS recommendations around setting up a Redress Agency means that the clinical negligence system is the only route left to women to pursue financial compensation, and it is a long, onerous process that is often unsuccessful. Sarah’s story - failures in the clinical negligence route Sarah* has spent the last two years fighting for redress through a clinical negligence case because of injuries following pelvic mesh surgery. Over the past few years, she has gone through two episodes of mesh erosion, two surgeries and an episode of sepsis. Since the mesh device was implanted, she has also experienced fibromyalgia and arthritis of the sacroiliac joints. She recently received a letter from the Head of Clinical Negligence at the law firm she was working with, informing her that they would not take her case forward. It was unlikely to be successful as she had her surgery before complications for mesh surgery were fully understood, and prior to 2013 when National Institute for Health and Care and Excellence (NICE) guidelines for urinary stress incontinence were changed. The letter stated: "The difficulty with your claim is that your TVT/mesh insertion surgery took place quite some time ago in 2007 when this was considered to be the gold standard to treat stress urinary incontinence, because the mesh surgery was quick, relatively simple and did not require a prolonged stay in hospital. It was only later on that the problems with mesh and the risks associated with mesh became fully known.” "A court would assess your claim based on the state of medical knowledge and expertise that existed at the time you had the mesh surgery in April 2007, with the problems and risks associated with mesh only becoming known at a later stage. "Consequently, a court will take the view that the consultant advising you at the time of your surgery in 2007 could only advise you based on the state of medical knowledge that existed at that time and cannot be held legally to blame for the treatment and advice that he gave you, if the risks associated with mesh only became apparent afterwards. "Therefore, unfortunately, further to the above we believe that if your claim proceeded further with the commencement of court proceedings, we would not have a reasonable prospect of success." It is my view that, given the evidence of harm caused by pelvic mesh, a woman who underwent surgery in 2007 should be equally entitled to redress as a woman who had surgery much later. I highlighted the issue with Helen Hughes, Chief Executive of Patient Safety Learning, who responded, “When responding to the IMMDS Review, the Government rejected a recommendation to introduce a separate redress scheme for mesh on the basis that patients could take healthcare providers to court for clinical negligence, or manufacturers for product liability. However, as this case sadly illustrates, the legal complexities involved in this means that for many mesh-injured patients this is simply not an option, leaving them with no alternative route to help meet the cost of any additional care and support they may need.” A national Redress Agency is the only way to offer equitable redress A Redress Agency specifically aimed at women with pelvic mesh injuries would offer a more equitable, compassionate route to secure compensation. As well as women having a higher chance of success going through a Redress Agency, women would not be forced to face the stress of legal action that often lasts for years while dealing with the pain and limitations they live with as a result of their injuries. At the moment, it does not appear that the political will or financial provision exists to make this a reality. *name changed for anonymity Related reading Tokenism in patient engagement is unethical—but it is also dangerous. A blog by Kath Sansom Doctors’ shocking comments reveal institutional misogyny towards women harmed by pelvic mesh - a Patient Safety Learning blog “There’s no problem with the mesh”: A personal account of the struggle to get vaginal mesh removal surgery References 1 First Do No Harm. The report of the Independent Medicines and Medical Devices Safety Review, 8 July 2020 2 Government response to the report of the Independent Medicines and Medical Devices Safety Review, 21 July 2021