Written evidence from Peppy [MEW0044]
1. Introduction to Peppy and our work in menopause
Peppy provides specialist healthcare and wellbeing support, delivered via smartphone by accredited health practitioners. Peppy is a first-of-its-kind employee healthcare and insurance benefit that provides expert health support during major life stages, like the menopause. Companies that sign up with Peppy give their employees access to specialist support and resources, via the secure Peppy app, including:
● Virtual consultations with a specialist
● Confidential 1-2-1 chat with experts
● Group video calls on related/specialist topics
● Access to virtual live events and multimedia resources
Peppy currently provides our menopause service to UK employers across a wide range of sectors - including construction, retail, finance, higher education, NHS trusts, media and legal firms. We are also the sole provider of menopause services to major insurance companies, such as Vitality, where Peppy menopause is available to eligible Vitality Health members, and Aviva, where the service is available to all Aviva employees and their partners.
Kathy Abernethy is the clinical lead for the Peppy Menopause service. Kathy is a founding member, current Trustee and the immediate past Chair of the British Menopause Society (BMS). With a Masters in Community Gynaecology and Reproductive Healthcare, Kathy leads an award-winning NHS London menopause service and is a registered BMS Menopause Specialist. At Peppy, she oversees the team of nurses, counsellors and other healthcare professionals to support our users.
The Peppy menopause service operates in line with NICE Guidance, British and International Menopause Society Guidelines and is consistent with UK NHS practice.
We strongly welcome the Women and Equalities Committee’s recognition of the issue of menopause in the workplace. Our work shows that the problems are at a far larger scale and more severe than most employers recognise. This affects not just individuals, but organisations and the economy as a whole. We are also hugely optimistic that this challenge can be addressed, and see huge momentum in the willingness of employers to provide this support to their staff. In short, government needs to enable them to take action.
2. Views on the themes in the call for evidence
2.1. What is the nature and the extent of discrimination faced by women experiencing the menopause? How does this impact wider society? What is the economic impact of menopause discrimination?
Women struggle to make their voices heard in the workplace and suffer both overt and implicit discrimination as a result. Nearly a third of women surveyed (30%) by the CIPD in 2019 said they had taken sick leave because of their symptoms, but only a quarter of them felt able to tell their manager the real reason for their absence. Privacy (45%) was the number one consideration for women choosing not to disclose. A third (34%) said embarrassment prevented them from saying why they had to take time off.
Uptake rates for Peppy Menopause services are consistently significantly higher than HR teams predict. This corroborates new evidence from Vodafone that 1 in 3 women hide their menopause symptoms at work and half think there is stigma around talking about the menopause.
For individuals as well as their employers, this is a big problem. 45-55-year-old women are the fastest-growing demographic of the UK workforce. A 2019 CIPD study of over 1,400 women found that 59% of women experiencing the menopause say it has a negative impact on them at work. One in ten menopausal women consider leaving their job because of menopause symptoms.
A 2017 report by Joanna Brewis for DfE set out the gaps in our understanding of the menopause. For example, the report found “few studies about women being unable to look for a job, reducing their working hours, identifying negative effects on their careers, or leaving or losing jobs due to transition. There were none examining transition-related effects on finding a job or on women’s wages.” However the report did find evidence that the menopause transition can lead to the following, via a “domino effect” of one symptom (such as hot flushes) leading to another (insomnia) and so on:
• reduced engagement with work
• reduced job satisfaction
• reduced commitment to the organisation
• higher sickness absence
• an increased desire to leave work altogether.
As a result, organisations are losing highly experienced and skilled staff to loss of confidence, loss of productivity and genuine impairment of their health and wellbeing.
As a society, we are bearing a huge cost for this. Inadequate support through the menopause reduces the potential of a whole tranche of the workforce and increases the financial burden on the state. A recent event held jointly by Peppy and the Money and Pensions service highlighted that many people make decisions like reducing hours to accommodate symptoms, take a lower paid/ lower stress job, or even quit work altogether. The impact of these decisions (that are typically made when someone is in their early 50s) is huge for both income and pensions. This compounds the income and wealth gap between the genders in later life.
2.2. How can businesses factor in the needs of employees going through the menopause? How can practices addressing workplace discrimination relating to menopause be implemented? For example, through guidance, advice, adjustments, or enforcement. What are examples of best or most inclusive practices?
There are four pillars to providing menopause support in the workplace:
We find that by creating awareness, employers create permission to say the word ‘menopause’ in the workplace. Awareness-raising can take the form of lunch and learn events, creating a menopause network to enable peer-to-peer support, events led by senior leaders on World Menopause Day etc. This empowers employees to break the taboo and embarrassment about discussing the topic in the workplace, where topics like menopause, fertility and women’s health have historically been huge taboos.
The vast majority of the population, including young women and those in mid-life are woefully ignorant about the menopause. Until 2019, schools did not cover it in the curriculum, public health information was limited to the NHS website and there was a lack of GP training. In a social context, it is still rarely discussed openly. Until a few years ago, there was little discussion of menopause in the media. The entire workforce, regardless of gender or age, needs to have access to basic education about the menopause, as they can be affected if their boss, their colleagues or their direct reports are impacted – or even due to a struggling partner. Line managers, in particular, need to be trained about the legal aspects of supporting someone who is impacted by menopause symptoms within the context of existing legislation, in particular the requirements of the Health and Safety at Work Act 1974, the Management of Health and Safety at Work Regulations 1999 and the Equality Act 2010. Training can take the form of formalised training for line managers, e-learning modules, virtual or live events, or drop-in sessions with a specialist.
As well as creating conversations about the menopause, there needs to be guidance on how to access any resources available to support individuals. Many organisations find a menopause policy helpful for this, but need support in creating this policy. In addition to policy, it may be necessary to review processes around occupational health, health and safety etc. These will depend on the nature of the work involved and the organisation. For example, provisions for toilet breaks for call-centre shift workers, or additional sets of uniforms provided for nurses who are struggling with hot flushes and sweats. Employers need to make it explicit that these provisions are available and reduce the hurdles for staff to access them.
2.2.4 Individual support
Once the conversation has been opened up in the organisation, there may be conversations between the individual struggling with menopause and their line manager/ HR team. This can help bring the issue into the open. However, the situation can continue to be very difficult unless that individual is able to access meaningful and tailored support to them that actually helps to address their underlying issues.
We hear repeatedly that women are struggling to get the support they need from their GPs during the menopause.
● 66% of women are offered antidepressants instead of HRT
● 28% of GPs discuss lifestyle factors related to perimenopause and menopause
● The average score from 2,920 women on GP menopause care was 2.5 out of 5
We see that most people experience a void in the provision of the types of personalised health support that Peppy provides. In some cases, they are able to access it through a particularly helpful GP, but GPs rarely have the time to cover wide-ranging issues and conversations are infrequent (the average GP appointment is just 9 minutes). There are some local not-for-profit initiatives, but very little provision from community or public health services. In the absence of reliable services, many turn to unqualified but enthusiastic mentors, social media or Google searches, which can be convenient and accessible, but highly unreliable/inappropriate.
It is necessary to empower and educate people going through the menopause, so that they can access accurate information and the most appropriate care for them. Peppy’s impact is becoming clearer as our work with employers progresses. Data from our menopause support for Santander’s female employees shows:
● A 46% increase in those stating they are more confident about their menopause journey
● A 56% increase in those stating they are less bothered by menopause symptoms
We have growing evidence that Peppy Menopause complements GP and other statutory services, and drives most appropriate usage of medical services.
2.2.5 The impact of individual support for employees
Having access to personalised, expert support can create huge feelings of relief for employees. They know where they can turn to, they feel empowered, symptoms are reduced, or relieved and there is improvement in mental wellbeing and confidence. One of the clear messages that comes up from the feedback is that employees benefit most when they have early and easy access to support.
“Had I had access 12 months ago it would have probably resulted in me staying well and not having as much time off sick as a result last year.”
"The menopause appointment was exactly what I needed. Expertise, a listening ear and a way forward.”
“I can’t endorse the app more and would encourage anyone experiencing menopausal symptoms to use this brilliant resource. The support I have received has empowered me to take control of my health with a positive conclusion.”
“I spent two years hiding away at work, but I can see now things will be better. I think this should be something every employer purchases for its workforce.”
2.3 How should people who experience the menopause but do not identify as women be supported in relation to menopause and the workplace?
In all of the interventions above, it is important that all initiatives and interactions are as inclusive as possible; for people of all gender identities and ages. It should be acknowledged that menopause symptoms can be experienced at a younger age (1 in 100 under 40 and 1 in 1000 under 30) , due to medical or surgical reasons, or by those who do not identify as women. In addition, people of all ages and genders can be impacted hugely by the menopause if someone in their life is experiencing the symptoms – a spouse or other intimate partner, a sibling, a child, a flatmate, a manager, a colleague, a direct report. In any events or communications, it is important that there is senior male/ diverse leadership representation, and that this is not seen as a ‘female leaders’’ project, but as an issue that is taken seriously by the whole organisation.
In particular, it is extremely important that any personal support provided by the workplace can be accessed fully confidentially. For example, the Peppy solution does not require an individual to inform their line manager or HR in order to be able to access support.
2.4 The importance of employers to women’s health funding and the role of Government
The scale of the challenge facing women’s health and the limitations on public funding for healthcare - especially in light of Covid - puts a priority on accessing other sources of funding. Employers are a potentially huge source of support for women’s health. At Peppy, we have focused intensively on ensuring that our support is not just employer-funded, but provides a hugely compelling employer rationale for substantial investment in their female workforce. This includes:
● The impact of our support is highly evidenced based, showing the value of employers’ funding. Providing specialist support for these areas directly helps the business as well as the individual, in terms of recruitment, retention, engagement, productivity and bottom-line profit.
● Giving employers the ability to promote and share their use of Peppy, as a demonstrable way of delivering on their diversity and inclusion commitments.
● A high level of support is provided by specialist practitioners in a very affordable way for employers.
● Support with Peppy is secure and confidential for users, giving employers and employees confidence that the user will be protected.
● Ensuring that support is available during extended hours, Monday to Friday, and can be accessed by anyone on their mobile wherever they are, and asynchronously – ideal for remote or shift workers, and any employees who also take on carer roles.
The involvement of employers in menopause support also helps to break down the barriers to women feeling comfortable in discussing the issue at work, as discussed above.
In our experience, the desire to fund women’s health support is not just limited to sectors where margins, wages and human resource investment is typically higher, such as professional services. Cost-sensitive employers such as grocery retail and those employing part-time and shift workers also see the value of this investment.
However, our ability to convince employers to fund women’s health is hampered by the tax cost of them doing so, via the benefit in kind regime.This makes investing in healthcare support for employees more than 40% more expensive to employers than the underlying cost, which is particularly acute in more cost- and wage-sensitive sectors. The case for reform is being made in particular by the Working Well campaign led by John Lewis.
Suggestion: To address the current under-funding of menopause support, remove the tax penalty on employer funding.
Peppy has also been supporting the public sector employees. A successful pilot study run by NHS Improvement in 2020 reached 196 users within the first month of launching. Subsequently, six NHS trusts are funding their employees’ menopause support, by giving them access to Peppy Menopause (launched in May 2021), covering 450 women. More NHS trusts plan to launch Peppy Menopause within the next few months.
Overall, Peppy has nine public and/or third sector clients including 6 NHS Trusts, one university, Staffordshire Fire Service and The National Lottery Community Fund. The public sector has the opportunity to show ambitious leadership here, as a major employer of the segment of society that is most affected by the menopause.
Suggestion: Create a clear expectation that all public sector employers provide access to menopause support for their female employees.
 Brewis et al, University of Leicester, The effects of menopause transition on women’s economic participation in the UK, July 2017
 Menopause: All you need to know in one concise manual by Dr. Louise Newson