Maree Todd: 'I worked in the NHS for 20 years, I know it’s not easy for everyone to access'

Last year, as most of us were slowly reclaiming our lives from the pandemic, Maree Todd’s changed in an instant. 

Her husband John, a previously fit and healthy 48-year-old, had a heart attack and was given clot-busting drugs in the back of an ambulance en route to Raigmore hospital in Inverness.

In the months that followed, his recovery was complicated by the continued pressures the NHS faced because of Covid. As a minister for public health, it has given Todd, someone who worked in the health service for more than 20 years as a pharmacist, an insight into the struggles many people have had accessing care and support since the pandemic arrived and overwhelmed everything in its path.

“His recovery has been very complicated,” she says. “He hasn’t fully recovered – we’re nearly a year on and he hasn’t managed to get back to work. It has been extremely tough on our family, and we’ve been tipped into a whole new world. 

“We were young, fit, healthy people with no health conditions and we were tipped into a whole new world where life, particularly for my husband, has revolved around accessing help and healthcare, and that’s not easy for a young man.”

I ask her if his recovery has been directly affected by the pandemic.

“There’s no doubt things have been delivered differently; there’s been lots of phone calls where there would’ve been face-to-face appointments…things have been different, but he has been able to access healthcare.

“What wasn’t different was the emergency situation. I called an ambulance, they did an ECG in our kitchen, transmitted that ECG to Raigmore where a nurse read it and recognised my husband was having a heart attack and he was administered clot-busting drugs in the ambulance on the way in.

“The emergency situation was phenomenal, but none of my family could go and visit him other than me, his sisters still haven’t been able to come and see him. Life is very different for people who are experiencing illness.” 

Todd, who caught Covid in June last year, forcing her to become one of the many MSPs who have had to self-isolate, says that even before her husband’s heart attack, she knew the stresses and strains the NHS was under.

“I worked in the NHS for 20 years, I know it’s not easy for everyone to access. All government ministers are human, we all have our own lives, our own health concerns…we all have our insights. One of the things that John’s experience has done for me is make me very passionate about preventable ill health…”

Before entering politics as an MSP for the Highlands and Islands in 2016, Todd worked for NHS Highland, mainly as a pharmacist at a psychiatric hospital. After serving as a minister for children and young people, she moved to become a minister for public health, women’s health and sport following last year’s election. 

Within months of taking up her new post, she was forced to issue an apology in the Scottish Parliament for errors made in cervical screening going back more than 20 years. Todd told MSPs that 430 women who had partial hysterectomies had been wrongly excluded from the screening programme. A small number of the women later developed cervical cancer and one of them died. 

“That was very hard,” she says. “My mind was very full of the women who were affected by it – I was very concerned about how anxious they would feel, and I wanted to be absolutely sure that they knew what to do with that information as soon as it hit the public sphere and that there was a system in place to reassure them. It was hard – the pressure was on me to make sure I got that right for the women listening.”

Is she confident that the full extent of those failings is now understood?

“We are still looking at the much wider numbers,” she says. “I’m sure we caught the women who were wrongly excluded because of having had partial hysterectomies but there is enough concern for us to look at the whole population. We are reasonably confident that we are looking effectively in the right places first, but it is possible we might find more wrongful exclusions which is devastating.” 

An important part of Todd’s ministerial remit is delivering the Scottish Government’s Women’s Health Plan, which includes improving treatment for endometriosis and raising awareness of conditions which many wrongly think to be a bigger risk for men, such as heart disease. The plan also includes the development of a menopause and menstrual health policy for the workplace.

Todd updates Holyrood on the cervical screening failures | Credit: Scottish Parliament TV

Earlier this year, First Minister Nicola Sturgeon said she felt a responsibility to talk about her own experience of the menopause. Appearing on The Shift podcast, Sturgeon said: “We talk about the menopause much more, and I’m very conscious of being a woman with a profile and a platform, a fair degree of influence, so I feel a responsibility – given that I’m at that age – to talk about it myself.

“And yet even talking about it like this, I am so far out of my comfort zone in terms of the intensely personal nature of it.”

Todd laughs when I suggest that Sturgeon raising the issue makes her own job more difficult as someone who is charged with delivering in this area.

“Do you think it’s a bad thing to have the first minister on your side? It’s a brilliant way of using her profile to highlight an issue which is so significant for so many women. One of the challenges I have as women’s health minister is that these things are just not talked about, so to have someone in her position, with her job…one of the symptoms people struggle with during the menopause is brain fog and Nicola Sturgeon is someone who uses her brain all day, every day. Talking about the menopause is a brilliant thing.”

Todd, who grew up in the Highlands and went to school in Ullapool, says she remembers people referring to periods as “getting the curse”.

“That was a phrase that was used to talk about starting your period and it’s shocking when I think back to that. On the menopause, we talked about people going through ‘the change’ in hushed tones…”

As a young, newly qualified pharmacist, Todd says there was a lot of debate over the use of hormone replacement therapy (HRT) to treat the symptoms of the menopause amid a number of studies which suggested associated risks, including an increased risk of breast cancer. The official advice from the NHS now is that the risks of HRT are small and are usually outweighed by the benefits.

“I remember thinking at the time, well at least when I’m older and facing the menopause, the picture will be clearer, the evidence will be solid, and it is. The evidence is clear, and people can go have a look, and make a decision for themselves.”

Have women been treated as second-class citizens by the NHS in the past?

“Yes, that’s absolutely why we have a women’s health minister – women do face health inequalities. Part of that is the mystique around our bodies, the myths and all of that. But some of that is because it’s a man’s world.

“If you look at women’s heart health, there’s a solid body of evidence that indicates when women have a heart attack, firstly it’s not recognised and secondly, the usual battery of treatments are not routinely offered. So, women suffer poorer outcomes. Heart attacks kill more women than breast cancer does – that’s a clear indication that health looks at women as abnormal men. We can’t keep doing that.” 

On the question of sex, it’s hard to avoid the controversial reform of the Gender Recognition Act. Earlier this month, the Scottish Government introduced the Gender Recognition Reform (Scotland) Bill, which will make it easier for trans people to obtain a Gender Recognition Certificate.

Those campaigning against the legislation have argued it will put women at risk by allowing those who are biologically male access to female-only spaces. Supporters of the bill say protections for women will remain under the Equality Act, while the first minister has dismissed concerns as “not valid”.

The atmosphere in the room becomes noticeably more tense when I ask Todd if she agrees with some of her ministerial colleagues that there are no legitimate concerns for women surrounding the reform of gender recognition legislation.

“Absolutely. I don’t have concerns about the bill, I think it’s a pretty straightforward change in a bureaucratic process,” she says. “It’s about changing your paperwork and making that easier for a community that have been excluded, who have suffered health inequalities and have told us loud and clear just how degrading and difficult the current process makes it for them. Changing that bureaucratic process for that population seems like a very good idea to me.”

But what about concerns raised by those including the author JK Rowling, who say the legislation will put vulnerable women at risk? Todd says those concerns don’t relate to the gender reform legislation, but instead to the Equality Act, which is not currently being reformed. 

“It’s not that I’m unaware of the toxic debate that’s raging out there,” she says. “I struggle to understand the concerns at times – it’s perfectly possible to have women-only spaces now and it will be perfectly possible to have women-only spaces in future.”

As Scotland continues its tentative lifting of the remaining Covid restrictions, life is slowly returning to a version of what we left behind in March 2020, even if case numbers continue to be worryingly high. But Todd reckons we’re still only “halfway through” the pandemic.

“We know from the very beginning, that this is a global pandemic. We’re not through it until everyone is through it.”

Despite that rather depressing thought, Todd believes one positive to come from Covid has been a growing public awareness of health messaging. She says there are early indications that uptake for both bowel and breast cancer screening have increased during the pandemic. 

“People are taking more care to prevent ill health. It’s not every single individual. As a whole population, people are taking steps but there are some people, for example, who were drinking heavily before the pandemic who drank even more heavily during it.  

“There’s very little positive to have come out of the pandemic…but one positive is that people are more able to navigate information and make risk assessments – we’ve all been doing that multiple times on a daily basis. I think that will stand us in good stead.”