Women’s health DOES matter!
Date: 18 Aug 2022
Author: Dr Anne Connolly
Following the Launch of the First Women’s Health Strategy for England, in this month's eFeature Dr Anne Connolly explores how much Women’s Health Matters and some of the changes needed for implementation.
There has never been a better time for women’s health in the UK. The ‘strategies’, ‘plans’, and ambitions of the devolved nations’ politicians promise to reduce the inequalities women experience because they have a womb. For too long women have been compromised because of pregnancy, periods, or menopause. For too long research has focused on men and not been inclusive of women. And for too long have women of colour been compromised more than others, creating an inequality within the inequality. Now is the time to ensure these commitments to change happen - and we all have a role to play.
There must also be recognition that the phrase 'women's health ' is not exclusive, but is inclusive of the trans population, recognising that not all those born with a womb identify as a woman and that not all women have wombs.
England Women’s Health Strategy
Last month the Women’s Health Strategy for England1 was finally published. A few months late, not great timing before the political summer recess and in the middle of political chaos - but the commitment to change for 51% of the UK population has been made.
The wide-ranging ambitions of the strategy were informed by results of a public survey undertaken at the end of 2021. Nearly 110,000 women responded to the survey, which is deemed to be representative of women’s needs, however with only 0.5% of respondents from the Midlands and the North and 7% from Black and Asian women, the challenge continues to make sure those who are seldom heard are not ignored2.
The recently published Strategy for England includes many well-received ambitions to improve the care provided for women recognising the life-course approach required.
- Improved education for clinicians
- Better patient information
- Support in the workplace
- Improvements in research
- Development of one-stop clinical services providing holistic care.
However, there remain many challenges to achieving the ambitions at a time when the health and care system is on its knees with post-Covid catch up, following years of austerity:
- No extra funding planned for Women’s Health
- No reduction in other workload
- No clear recommendation to developing the multi- disciplinary workforce required
- No changes to the siloed commissioning arrangements of women’s health and reproductive health
- Minimal recognition that poverty, unemployment, and wider social determinants significantly reduce health and well-being.
Women’s Health Ambassador
It is excellent to see the appointment of Professor Dame Lesley Regan as the Women’s Health Ambassador working to drive the strategy. Lesley is well respected and during her tenure as the RCOG president published the ‘Better for Women’ Report. The England Women’s Health Strategy follows many of the recommendations made in the RCOG report including the provision of one-stop care in local ‘women’s health hubs’.
One stop shop (aka women’s health hubs)
With the recent restructuring of the health and social care system into Integrated Care Systems (ICSs) and local primary care networks (PCNs) there is an opportunity to use public health and referral data to gain an understanding of the local population needs to deliver appropriate, accessible care on a bigger footprint.
In the last sponsored feature, James Woolgar wrote about the excellent work they are doing in Liverpool where they are using local primary care networks to deliver LARC services. The significant improvements in LARC provision in Liverpool is testament to the work that can and is being done.
James is not prepared to stop there, he is currently working to jointly commission one-stop holistic health providers that women are wanting, to include managing menstrual problems, providing menopause care, ring pessary provision etc that can be provided in intermediate care services.
Care Closer to Home
In 2000, I spent many hours travelling around the country sharing the work we were doing in Bradford developing GP with Special Interest (GPSI) services. These services used the skills of local GPs who had undergone enhanced training, working with the local specialist teams to develop pathways of care with the ambition of providing holistic care, closer to home, reducing the lengthy hospital waiting lists and allowing the hospital teams to provide the specialist work they were trained to do. The services were evaluated well by patients, were financially advantageous to the system and reduced the pressure on the hospital waiting times. They also maintained a workforce in primary care where we could spend part of our time as general practitioners and part delivering the care we had additional passion for.
Unfortunately, following the 2012 Health and Social Care Act many of these enhanced primary care/community services were discontinued or subsumed by larger providers. The ambitions of the Strategy to deliver one-stop shops should learn the lessons of these previous initiatives.
The PCWHF’s Women’s Health Hub Toolkit3
Since publication of the Better for Women4 report the Primary Care Women’s Health Forum (PCWHF) has been developing resources to support clinicians and commissioners to consider the local opportunities to improve access to intermediate holistic, one-stop care. These resources, published on the PCWHF women’s health hub toolkit, include tips and tricks to develop a hub, including developing a needs assessment, writing a business case, sharing examples
We recognise that one model is not appropriate for all but can be developed similarly to those enhanced services for long-term conditions i.e., diabetes care, traditionally delivered in secondary care but with training and locally agreed pathways are now provided in and out of hospital settings.5
The model for future women’s health care is also very similar to other health conditions requiring a left-shift, improving prevention and early intervention to optimise health and wellbeing and reduce demand and costs of surgical intervention.
Making this work
There are many opportunities to support the recommendations of the Strategy, but this needs commitment at ICS level to deliver.
- Prioritisation – hopefully this box is ticked by the publication of these strategies and plans.
- Funding - considering the efficiencies of new models of care and moving money around the system to deliver the care that women want and need.
- Ensuring optimisation of the multi-disciplinary workforce by developing affordable, achievable, modular training appropriate for the local needs.
- Reducing inequalities by engaging the voluntary sector and using co-production to ensure care delivered is fit for purpose for local communities
As Professor Dame Lesley Regan rightly states: “When we get it right for women, everyone in our society benefits.”
Women won’t let this drop now they have a voice - and neither will we.
Declaration - This article is funded by Bayer and the author has received an honorarium.
2 Call for Evidence, Let’s Talk About It, March 2021.
3 Primary Care Women’s Health Forum - www.pcwhf.co.uk
4 Better for Women Report, RCOG, December2019
5 Unadkat N et al. Taking diabetes services out of hospital into the community. London J Prim Care (Abingdon). 2013; 5(2): 65–69.