SCRUTINY is, as Deputy Louise Doublet puts it, “where the magic happens”.
“It’s often called the critical friend of government,” she explained.
“Our democracy functions best when you have ministers who are working hard and doing the best they can, and then scrutiny also working hard to see – within that work – where there are any gaps or anything the minister might have missed, and anything that can be tweaked slightly.
“We’re all human. Nobody’s perfect, and there will always be areas to improve – and that’s where the magic of scrutiny happens.”
As chair of the Health and Social Security Scrutiny Panel, Deputy Doublet is this month aiming to create a bit of that “magic” herself.
Alongside her fellow panel members, she is preparing to publicly question Jersey’s Health Minister and his team at a hearing focused solely on the Island’s women and girls – and the healthcare systems meant to support them.
The decision to dedicate an entire scrutiny hearing to women’s health was, says Deputy Doublet, long overdue.
“I noticed all of the social commentary around women’s health and I felt that, as a panel, we had a duty to investigate further,” she said.
“In our quarterly hearings, we have two hours to cover everything to do with health, and I just felt that we weren’t getting enough time to actually give the minister and his assistant ministers the opportunity to talk about all the things that are happening and for us to try to get to some of scrutiny magic, as I like to call it.”
The special Scrutiny hearing follows the publication of a detailed needs assessment from the Public Health Department, which set out – in stark detail – the “systemic gender inequalities” that persist in Jersey’s healthcare system.
These include significantly higher rates of poor health among older women, gaps in services for conditions primarily affecting women, and a growing sense among many women that their voices simply aren’t being heard.
But what truly sparked the panel’s decision to act was the government’s shelving of the dedicated women’s health strategy last year – a move that left many, including Deputy Doublet, frustrated.
“It was really disappointing, because it felt like going backwards after having that commitment,” she said.
“I can understand some of the reasons why [the strategy was scrapped], but what the public is telling me is that they’re not happy with that decision.
“Lots of women especially don’t agree with course of action, and are making representations to me and to the scrutiny panel about different areas of women’s health and telling us that they want to see it prioritised more. They want to see a cohesive strategy.”
Deputy Doublet acknowledged that a women’s health “action plan” is due to be published, but added: “I think what we do actually need is a proper strategy.”
She explained: “The problems are so endemic and they’re so deeply rooted in medical culture and in our culture more broadly that I don’t think an action plan is quite enough.
“I think we need a longer-term strategy as well.”
One of the strongest themes to emerge from Deputy Doublet’s conversations with constituents is the feeling of not being taken seriously – a sentiment that will be familiar to many women navigating Jersey’s healthcare system.
“I struggle to find a woman who hasn’t felt that she’s been treated differently in a medical setting,” she said.
“I think part of the reason why we need a woman’s health strategy is because, of course, women’s bodies are different.
“Women experience menstruation, some women experience pregnancy and childbirth, women will go through menopause – it’s those kind of additional needs that are often the areas where women feel that they’re dismissed.”
Conditions like endometriosis, polycystic ovarian syndrome, and premenstrual dysphoric disorder are frequently misdiagnosed or ignored, she explained.
“I’ve become aware that there are hundreds of women on the Island suffering with these conditions – and a lot of them are suffering silently because, when they’ve tried to ask for help, they’ve been told ‘it’s just a period’ or ‘it’s just part of being a woman’.”
One reason for this, she believes, lies in unconscious bias.
“I know that some GPs are fantastic in this area,” she said. “But with any issues around inequality, the first thing that we need to do – myself included – is reflect on unconscious bias.
“We all have unconscious bias, and I would ask any medical practitioner – whatever gender they are – to integrate that into their practice and reflect on the characteristics of the patient in front of them.
“Many of them do this already, but I think there’s room for more of this to happen.
“Medical professionals need to really reflect on the personal characteristics of the patient that they’re treating and how their own unconscious biases might be impacting on the way they’re interacting with that patient.”
She added: “Those thought processes can be really challenging and difficult to go through, because it it involves admitting that you could do better and reflecting on how you can do better. Ultimately, that’s what scrutiny is about.
“That reflection is something that I think anyone who’s delivering a service to the public that should have as a regular part of their practice.”
Among the questions Deputy Doublet hopes to explore at the hearing is access to services, funding priorities, and how women’s health is integrated into Jersey’s broader health strategy. But she’s also clear that this isn’t just about challenge – it’s about collaboration.
“I think it’s an opportunity for the ministers to share information with the public about what they’re doing and to show the public that women’s health is important to them,” she said.
“It is also an opportunity to celebrate some of the good practice that’s going on, because I think there might be some services and help available in Jersey that women don’t know about.
“One of the aims of scrutiny and of the hearing is to celebrate what’s happening already and to get that information out there.
“And then, as with any scrutiny work, we will be challenging the ministers in some areas where we’ve had representations, or where we’ve become aware that the services aren’t optimal, to try to get to the get to the specifics of what might not be working.
“We want to draw out the reasons why from the ministers, and give them an opportunity to tell us what they’re planning on doing about it, or what they’re currently doing about it.”
When the women’s health strategy was abandoned last year, the government instead pledged to focus on three key areas: IVF, contraception, and the Island’s abortion law.
Progress on these three issues will be discussed at the hearing.
While an amended proposition from backbencher Deputy Lucy Stephenson improved fertility funding on the Island, Deputy Doublet noted that that are still “gaps”.
She explained: “I’m a member of the LGBTQ+ community myself, and I know from fellow members of that community who have approached me about the services they are receiving that there’s a higher cost.”
The new access criteria for IVF funding that came into force on 1 January 2025 includes the requirement for couples to “be infertile”.
For heterosexual couples, this can be proved by being “unsuccessful in getting pregnant through regular unprotected sex for two years”.
But homosexual couples must prove their infertility by using artificial insemination, and not becoming pregnant after 12 cycles.
Six of these cycles must have used intrauterine insemination – a type of artificial insemination where sperm is placed directly into the uterus during ovulation, rather than through intercourse.
Each cycle of IUI costs upwards of £1,000 – meaning that same-sex couples have to spend over £6,000 before they can access government-funded IVF treatment.
This cost disparity has been dubbed the “gay tax” by campaigners.
“I think that is a really quite worrying inequality that I believe should be changed,” said Deputy Doublet.
“I’s a discriminatory policy because it is placing a far higher cost burden on same-sex couples who want to conceive.
“I think that any couple who wants to start a family in Jersey should be supported to do so – not least because our birth rate is plummeting and young people are leaving the Island.”
Another area which has seen some progress recently is Jersey’s abortion law – which Deputy Doublet has long campaigned to update.
In 2021, she successfully pushed to remove the seven-day ‘cooling-off’ period women had to observe before seeking an abortion.
And she’s cautiously optimistic about the proposed changes to Jersey’s termination of pregnancy law which were set out last month.
“I am really pleased that it’s got to this stage because I’ve been working on this area for a number of years,” she said. “It’s essential healthcare for women.”
She voiced her support for plans to remove the law’s requirement that women demonstrate “distress” in order to qualify for an abortion.
“I don’t think women should have to present as being in distress if they’re seeking a termination,” she explained.
“I think if a woman has made a rational decision – and sometimes it’s an economic decision, or sometimes it’s a decision related to domestic abuse or rape – she should be able to just go and request that medical service without having to satisfy any particular kind of emotional state.”
But there’s still work to do. Under the proposed changes, abortion will remain a paid-for service – costing £185, or over £500 for those without a health card.
“I think, if a woman is in a situation where she is pregnant and doesn’t want to be, adding a charge onto that situation is not really appropriate,” she said.
“And it is really concerning that the charge is so much higher for people who don’t have a health card.”
Deputy Doublet added: “I think the charges need to be looked at, because I know that there will be some women who just won’t be able to access a termination if it’s a paid-for service.
“One thing I would hope we have learned from the Violence Against Women and Girls report is that economic abuse is hugely prevalent in Jersey.
“It’s present in the majority of cases of any other type of domestic abuse, so if a woman is being subject to sexual abuse by a partner then she is also likely to have limited access to funds.
“It’s really critical that abortion charges are considered and, on balance, I don’t understand why it would be a paid-for service.”
Other issues on the Scrutiny panel’s radar include contraception, postnatal physio, incontinence, the maternity unit – including the recent discourse around the suspension of Jersey’s home birth service, and support for women who have had miscarriages.
“I just think that we could be doing a lot more, and our services could be improved on all fronts for women,” said Deputy Doublet.
The Scrutiny panel chair is also concerned about older women, and why – statistically – they spend more years in poor health than men.
The Island’s first-ever Women’s Health and Wellbeing Assessment showed that females in Jersey can expect to spend around 24 years of their life in poor health, compared to only 18 years for males.
“I’d like to understand and have a conversation about why that might be the case, because that’s the ultimate indicator,” explained Deputy Doublet.
“I’m also aware that there are some conditions, such as chronic fatigue and fibromyalgia, that are more common in women, so the panel will be asking questions around some of those things as well.”
So what does Deputy Doublet hope will come from this special scrutiny hearing?
“I would like to see ministers coming along, ready to speak openly and ready to work together with the panel to find some areas where that scrutiny magic can happen, where improvements can be made that would make a big difference to the lives of women.”
She also wants to amplify voices – particularly those Islanders who may not usually engage with politics.
“This hearing is for every woman in Jersey,” she said. “And for everyone who has a mother, a sister, or a daughter.
“I think it’s particularly important that we get women’s health right, because women are often the ones who are caring for more vulnerable or unwell or younger members of our society.”
While some may question the focus on women’s health – and ask, what about men? – Deputy Doublet is clear: “We can do both.
“I’m aware that there are some areas of men’s health that need particular attention. I recently asked a question about drugs for treating prostate cancer because somebody approached me about that, so if there are specific areas that men feel they are being treated unfairly, or that their services aren’t being delivered satisfactorily, I am really happy to hear from from them as well.
“But this hearing is partly a response to the data that we’ve been presented from Public Health, and the strategic needs assessment that showed in black and white all those different women’s health issues.”
When is the hearing taking place?
The hearing will take place on Wednesday 30 April from 12pm to 2pm at St Paul’s Centre.
Members of the public are encouraged to attend, with the panel available from 11.30am to speak with Islanders before the session begins.
The panel has also called on Islanders to submit their own questions by emailing scrutiny@gov.je by Wednesday 23 April.
Although the hearing will not be live-streamed, a recording will be uploaded to the States Assembly website and YouTube after the event.
