First Report - Menopause and the Workplace

Menopause still carries significant social and cultural stigma, particularly for certain groups, including LGBT+ people and young and ethnic minority women. We are encouraged by the recent shift towards talking about menopause more openly, by the inclusion of menopause in the Relationships, Sex and Health Education curriculum and the recognition of persistent stigmas and taboos in the Women’s Health Strategy. However, this is no time for complacency, and we must build on the growing momentum. The Government should lead on disseminating good quality and accurate information about menopause. Firstly, we recommend that the Government launches a visible public health campaign around menopause; its symptoms, impact and how to seek treatment and other help, including support at work. A diverse range of expert stakeholders should be consulted to ensure the campaign is inclusive, accurate and impactful and reaches communities and groups typically underrepresented in discussions around menopause. Second, the Government should work with schools and menopause experts to develop high quality, accurate and inclusive resources and ensure that teachers have the knowledge, confidence and ability to teach this important aspect of the RSHE curriculum to all pupils.

GPs will be the first port of call for many women who are experiencing perimenopause or menopause. It is vital that women can trust their GPs and that GPs feel confident and well-equipped in diagnosing a condition that affects half the population. Menopause must be given more priority in both the initial training and continuing professional development for GPs. We recommend that the Royal College of General Practitioners makes training on menopause a mandatory aspect of continuing professional development requirements for GPs. In the meantime, all GP surgeries should ensure that at least one member of their clinical staff has received specific training around menopause. We further recommend that the Care Quality Commission considers whether surgeries are providing effective, evidence-led menopause care, during their inspections.

It is unacceptable that there are parts of the country where women cannot access the specialist menopause services they need. By 2024, there should be a menopause specialist or specialist service in every Clinical Commissioning Group area. The Menopause Taskforce, working with the NHS, should prioritise this as part of the ongoing work into the menopause pathway. The response to this report should set out a plan of how this recommendation will be achieved over the next 18 months.

We are extremely disappointed that despite a clear Government commitment on a single-cost, annual pre-payment certificate for HRT, almost nine months later that commitment has not been realised. Progress has been further derailed by supply issues. We welcome the Health Secretary’s announcement of an ‘HRT tsar’ to consider the challenges with supply. The Government must act urgently to ensure that lower cost HRT prescriptions are being issued and dispensed. Over the next three months the Government should communicate widely to ensure GPs and patients Menopause and the workplace 47 know about both the current NICE guidelines permitting a 12-month prescription, and the forthcoming single-cost pre-payment certificate. This should include but not be limited to: (Paragraph 35) • writing to all GPs and community pharmacists to ensure they know about the new scheme • communications (for example, posters) in GP surgeries, pharmacies and walk-in centres • through the Gov.uk website and DHSC social media accounts

We recommend that the Government commits to removing dual prescription charges for oestrogen and progesterone, replacing it with a single charge for all women. We also recommend that the Government works with the NHS and the ‘HRT tsar’ to develop a national formulary for HRT. Both of these recommendations should be completed within six months of publication of this report. The Government should provide the Committee with updates on the HRT supply situation on a six-monthly basis. (Paragraph 36) Menopause in the workplace

Menopause is a workplace issue. There is a legal, economic, and social imperative to address the needs of menopausal employees. We are not persuaded that a legal requirement for every workplace to have a menopause policy would embed meaningful change. But there is much that employers can and should do to help their employees. Many of the solutions involve practical adjustments and, in allowing additional flexibility and understanding, alongside fostering a greater respect and understanding of menopause. Employers who fail to support their menopausal employees, or act punitively towards them, leave themselves vulnerable to discrimination claims. They also risk their reputation, their ability to attract and retain female talent, and their profitability

The Government has a key strategic role in helping businesses and should lead the way in developing and disseminating good practice. The Government should appoint a Menopause Ambassador to work with stakeholders from business (including small to medium enterprises), unions, and advisory groups to encourage and disseminate awareness, good practice and guidance to employers. The Menopause Ambassador should publish a six-monthly report on the progress made by businesses, and such report should include examples of good practice as well as noting particularly poor practice.

We recommend that the Government, in consultation with the Menopause Ambassador, produces model menopause policies to assist employers. The model policies should cover, as a minimum: how to request reasonable adjustments and other support; advice on flexible working; sick leave for menopause symptoms; and provisions for education, training and building a supportive culture.

Menopause symptoms can have a significant and sometimes debilitating impact on women at work. The Government should work with a large public sector employer 48 Menopause and the workplace with a strong public profile to develop and pilot a specific ‘menopause leave’ policy and provide an evaluation of the scheme and proposals for further roll out, within 12 months of commencing the scheme.

We are disappointed that the long-promised Employment Bill has still not materialised. The Government should bring forward legislation before the end of the current Parliament to make the right to request flexible working a day-one right for all employees. It should issue employers with guidance encouraging them to grant any reasonable requests for flexible working, rather than placing the burden on the employee to justify their request. (Paragraph 67) Legal reform

Neither the Health and Safety Executive (HSE) nor the Equality and Human Rights Commission (EHRC) provides any advice on menopause on its website. This should be rectified. The HSE and EHRC should publish guidance on the legal considerations when supporting employees experiencing menopause, within the next six months.

The current law does not serve or protect menopausal women. Whilst the law rightly protects women from pregnancy and maternity discrimination, it does not specifically protect menopause. This is anomalous, given all women will experience menopause, whilst not all women experience pregnancy. It is unsatisfactory that menopausal women must instead frequently present themselves as suffering from a disability in order to make an effective claim. We consider any burdens on employers due to legal change are outweighed by the existing and considerable costs to society, the economy and individual women, of menopausal women leaving the workplace prematurely. Section 14 of the Equality Act 2010 provides a partial solution and is ‘shelf-ready’. The Government should immediately commence section 14 of the Equality Act 2010.

We are also persuaded that a new protected characteristic of menopause should be created, although we acknowledge this will need careful drafting and consultation. The Government should launch a consultation on how to amend the Equality Act to introduce a new protected characteristic of menopause, including a duty to provide reasonable adjustments for menopausal employees. This consultation should commence within six months of publication of this report. The Government’s consultation response should include a review of whether the newly commenced s14 (above) has mitigated concerns about the current law. (Paragraph 98) Menopause and the workplace 49