Cast your mind back to last summer. When the unseasonal conditions concerning you were the temperatures causing pavements to melt, rather than freeze, and the source of the lingering croak in your throat wasn’t the office bug doing the rounds, but screaming at the telly as the Lionesses stormed to Euros victory.
You’d be forgiven for missing the document that landed on a Government website on the penultimate day of August. But while you were tending to your immediate needs by bulk-buying fans and Strepsils, it was laying out plans for the next decade of female healthcare in England.
The Women’s Health Strategy had been a long time coming. Conceived in the wake of a series of headline-making health scandals from PIP breast implants containing industrial-grade silicone to defective vaginal mesh used to treat urinary incontinence and pelvic organ prolapse, the 124-page document declared its ambition to ‘right the wrongs’ of decades of health inequality.
No mean feat in an era in which gynaecology waiting lists remain at record-length, multiple NHS trusts are facing reviews into historic failures in maternity care and getting a diagnosis for a chronic female health condition like endometriosis takes an average of seven years.
Built off the back off a call for evidence to which more than 100,000 patients, campaigners and healthcare professionals contributed, the strategy indicated its intention to correct the ‘male by default’ approach to healthcare that’s inherent in everything from the historic lack of female representation in clinical trials to the training of healthcare professionals.
That sub-sections spoke to issues at the heart of failings in female healthcare, from fragmented sexual and reproductive health services to dismal ‘disparities in health outcomes’ – a phrase which encompasses the haunting statistic that Black women are four times more likely to die in childbirth than white women – was well-received by commentators.
But perhaps the surest sign that the Government finally understood just how much was at stake was the appointment of the then-president of the Royal College of Obstetricians and Gynaecologists, Professor Dame Lesley Regan, to oversee the strategy’s implementation in a newly created role of Women’s Health Ambassador.
Seven months on, that document is on my lap as I perch on the edge of a sofa in a yellow-hued room on the second floor of number 10 Downing Street. It’s the eve of International Women’s Day, and I’m the lone journalist among a group of formidable women on the frontline of female health, who’ve been invited here to give the strategy something of a health check.
Rory Arnold / No10 Downing Stree
Rory Arnold / No10 Downing Stree
Among them is menopause champion and broadcaster Davina McCall, gynaecology doctor and author of The Gynae Geek Dr Anita Mitra, GP and health influencer Dr Aziza Sesay and GP and regular on BBC Breakfast and ITV’s This Morning Dr Nighat Arif. Together, there are 25 women sitting around the conference table this afternoon, with Professor Regan and Maria Caulfield MP, Minister for Mental Health and Women’s Health Strategy, at the head.
The conversation is free-flowing, scaffolded by two questions: what do they make of the strategy’s content? And what should the priorities be for its second year? From the ambition to introduce ‘women’s health hubs’ to an NHS website struggling to compete with TikTok, these are some of the topics they touched upon. And, crucially, what it means for you.
Women’s Health Hubs are on the horizon
There are eight priorities for the first year of the strategy, which runs from July 2022 to July 2023. But the one which dominated the discussion was women’s health hubs – ‘one-stop shops’ where women will be able to access everyday healthcare like having a coil fitted, getting a prescription for HRT or seeing a specialist about pelvic pain, all under one roof.
The concept exists already – there are currently hubs in Liverpool, Manchester, Sheffield, Hampshire and London. But the goal is for there to be at least one women’s health hub in every Integrated Care System (the technical term for the carving up of England into 42 distinct regions in which organisations come together to deliver health care).
‘The vast majority of times when women consult healthcare professionals, they’re not ill, they’re simply trying to maintain their health,’ said Professor Regan, explaining the thinking behind the inclusion of women’s health hubs within the first phase of the strategy. ‘We need to be wrapping services around women, rather than making them run all over the place.’
Rory Arnold / No10 Downing Stree
On the question of how the strategy would reflect the cost-of-living crisis that’s taken hold since its publication – a crisis we now know to be affecting women’s health disproportionately – Minster Caulfield said she hoped the hubs would help here, too. ‘I think that by bringing health to women rather than expecting women to traipse round GPs, hospitals, clinics, it will help the most disadvantaged to access healthcare.’
The idea was well-received in the room, with almost everyone who spoke voicing their approval, from their potential to improve access to contraception to reducing dire diagnosis times for female health conditions. Among them was Caroline Andrews, a trustee for the Polycystic Ovary Syndrome charity Verity.
‘It’s heartening to see and hear where there are good practices such as women’s health hubs, and we know of some success with PCOS such as the [specialist Polycystic Ovary Syndrome service] running in Coventry university hospital and the success that has had,’ she told me via email after the event, with the caveat that more effective treatment needs to be supplemented by research ‘directed at dealing with the whole person’, rather than a ‘range of symptoms’.
The Government have since announced an investment of £25 million over the next two years to ‘accelerate development’, with hubs being ‘tailored to meet local women’s needs’. But at the time of writing, no concrete plans for new hubs had been shared, so we can’t tell you yet when you can expect to have one on your doorstep.
The 8 priorities for year one of the Women’s Health Strategy
- Encouraging the expansion of women’s health hubs
- Improving information provision on women’s health, including improvements to the NHS website
- Supporting women’s health in the workplace
- Pregnancy loss, including the development of a pregnancy loss certificate
- Fertility, including improving access to NHS fertility treatment for female same-sex couples
- Improving access to HRT via the HRT prescription prepayment certificate in April and boosting HRT supply
- Healthy ageing and long-term conditions
- Boosting research and evidence into women’s health, and improving women’s participation in all research
Menopause education needs an upgrade
Beyond improving access to healthcare, the hubs could also be ‘a gamechanger’ for women in the first throes of the perimenopause, pointed out Davina. ‘Wouldn’t it be nice to have some continuity of care so that by the time you speak to a GP, they might recognise that the symptoms you’re experiencing are actually signs of the perimenopause?’ she asked the group.
Her question nods to the knowledge gap that persists among GPs – an issue fellow attendee Katie Taylor, founder of The Latte Lounge, an online platform for midlife women, has been campaigning on for years. ‘I founded The Latte Lounge seven years ago and we continue to support thousands of women because so many of us have been misdiagnosed by our healthcare professionals through no fault of their own, but due to a lack of menopause training at medical school and/or catchup training.’
Rory Arnold / No10 Downing Stree
Indeed, a freedom of information request put to 33 medical schools by Diane Danzebrink, founder of the #MakeMenopauseMatter campaign, in May 2021, found that almost half of the 32 who responded had no mandatory menopause education on the curriculum.
As a result, menopausal women all too often have their symptoms dismissed or misinterpreted; research published in 2019 found that more than a third of women going to their GP with menopausal symptoms were given antidepressants – a prescription that the majority felt was ‘inappropriate’ for their symptoms.
At the heart of the misinformation surrounding menopause is a lingering unease around HRT on the part of both patient and prescriber – a reticence that has roots in a flawed study from 2002 which overstated the link between HRT and breast cancer.
And while the evidence now shows that, for the majority of patients, the benefits of taking HRT outweigh the risks – with only those with a history of oestrogen-sensitive cancer not recommended to take it – anecdotal evidence suggests that some GPs are still reluctant to prescribe it to their patients.
In a letter to attendees after the event, Minster Caulfield said that ‘lifelong learning opportunities’ and ‘training for healthcare professionals from undergraduate through to specialist level’ would be integrated into their planning. In the meantime, if you’re seeking support with menopausal symptoms, it’s worth asking if there’s a GP or practise nurse at your surgery with specialist training in the menopause to ensure you’re getting the best advice.
The NHS website needs to be more usable
As a health journalist, the NHS website is a useful resource and a bookmarked URL I visit almost daily. But as a patient, it can be overly clinical and hard to navigate, with some conditions absent entirely; among them is Adenomyosis, a condition in which tissue that normally lines the uterus grows into the muscular wall, as Tanya Hall, founder of the community and education platform The Adeno Gang, pointed out.
That’s if you end up on the NHS website at all, of course. A survey published last May found that women were just as likely to look to social media and influencers for health advice as they were to the NHS. And while there are some exceptional health communicators on platforms like Instagram, TikTok and Twitter, they’re operating in a space in which celebrities are paid to promote appetite-suppressant lollipops.
Both Professor Regan and Minister Caulfield are all too aware of the website’s failings; making improvements to the NHS website is among the eight priorities for the first year and they’ve since announced that a dedicated area for women’s health will be going live on the website this summer. But as multiple women in the room pointed out, it doesn’t matter how good the information is if some groups of women are never going to see it.
‘Young people are going straight to TikTok and Instagram, so the NHS needs to be making content that’s as snappy and engaging as that if has a chance of reaching people in a meaningful way,’ said Dr Philippa Kaye, GP and author of the soon-to-be-published Breasts: an owner’s guide and The M Word.
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Dr Sesay, who has 24,000 followers on Instagram, agreed. ‘Snappy health videos such as those I share on my Instagram page should be available on TV, billboards, newspaper websites and reputable health websites like the NHS to capture audiences who aren’t on social media while continuing to spread awareness through these mediums as well.’
This becomes even more vital for topics that are inherently hard-to-communicate or stigmatised, she added, giving the example of a reel she made on how to check your vulva for signs of cancer. ‘I truly believe we can both save and change lives, as well as empowering more people to advocate for themselves through [this kind of] education,’ she adds. ‘I hope to see this underestimated tool being utilised more readily.’
For now, the usual rules of social media engagement apply: follow qualified health professionals and never DM for health advice, instead booking in with your GP if you’re experiencing persistent health symptoms.
New HRT legislation is welcome…but shortages persist
One of the first legislative changes linked with the strategy is the introduction of the HRT prescription prepayment certificate (PPC) coming into effect on April 1st. The new rules will mean that rather than paying out for a new prescription for HRT every two to three months, women will be able to access a year’s worth of menopause prescription items for the cost of two single prescription charges (currently £18.70).
While the legislation is one the priorities for the strategy’s first year, it’s been a long time coming; it’s the result of a campaign and forms part of a Private Members Bill by Carolyn Harris, a Labour MP and co-chair of the Government’s UK Menopause Taskforce, and has already been delayed by a year.
Nevertheless, its imminent arrival was greeted with enthusiasm by those in the room, including Lesley Salem, founder of the menopause charity Over The Bloody Moon. ‘It’s a very welcome move that means cost shouldn’t be a barrier for those who want to manage menopause with HRT– our research with Kantar last year revealed that HRT was the most effective and popular intervention used by women, with 84% claiming they noticed some or a great improvement.’
Rory Arnold / No10 Downing Stree
Taylor agrees. ‘In my opinion we shouldn’t need to be paying for HRT at all – it replaces the hormones we naturally produce and has been shown to have a protective factor on our long-term health, including preventing osteoporosis, reducing heart disease and potentially many other diseases,’ she told me, speaking after the event. ‘But for those who need it, and have struggled to afford it, any reduction in price, especially during the cost-of-living crisis, is extremely welcome.’
And yet, as both Taylor and Davina pointed out, capping the cost of HRT means little if the women who need it can’t access it. While the broadcaster joked that she’s often blamed for the HRT shortages which first took hold in the spring of last year in response to surging demand (demand that has, indeed, been dubbed The Davina Effect) at the heart of her comments was a serious point. ‘The shortages that continue to affect HRT supply are the five most popular types,’ she told the group. ‘And if you stop taking medication that’s working for you, you can go mad in 24 hours.’
Women’s Health has reported before on the mental health fallout of the HRT shortages. One woman – 44-year-old Nicola Merchant – told us that after finally happening on a medical solution to managing her perimenopausal symptoms, watching her supply dwindle felt like ‘a ticking time bomb’ and that she was actively reducing her dosage in order to ‘eke out’ her remaining supply.
In a letter to attendees after the event, Minister Caulfield said that she while she understood the challenges presented by shortages and was working hard to manage supply issues, ‘it will take time for suppliers of those products to build their capacity in order to fully meet that demand,’ adding that Serious Shortage Protocols (SSPs, where a substitute medication is agreed with the patient) would continue to be used to manage supply in the short to medium term.
But as Davina pointed out in the meeting, while the work being done to resolve this issue as quickly as possible is welcome, it’s not enough for manufacturers to be meeting existing demand; they need to be anticipating demand. ‘I totally agree with Davina’s comments – the demand is going to keep increasing as awareness keeps increasing,’ Taylor tells me. ‘For the thousands of women, like me, who have tried everything else already, HRT is not a “nice to have” but a necessity.’
What will happen next?
There’ll be more announcements in the coming weeks and months before the strategy moves into its second year – and everyone I spoke to for this piece was in agreement that the progress made so far had been positive. But I can’t help feeling conflicted.
While writing this piece, it occurred to me that many of the conclusions I’m coming to are fundamentally inconclusive; the strategy’s success hinging on work that hasn’t happened yet. And while the ambition for wholesale change is commendable, I wonder how much of it will be possible in a climate of intense social unrest, not to mention political instability, like the one we’re living through.
Then there’s the fact that some issues are more easily fixed than others. Modernising the NHS website is one thing, dismantling biases both unconscious and otherwise that – as the strategy acknowledges – are contributing to racial disparities in health outcomes, another thing entirely.
It feels inadequate to say that all we can do is put our faith in the process, but I’m heartened that those in the trenches of women’s healthcare are holding the Government’s feet to the fire; even more so that they’ve been invited into the corridors of power to do so – and will, I expect, be invited back.
After the meeting, we file downstairs and gather on the steps, taking it in turns to have our picture taken in front of the most famous door in the land. ‘It was a surreal experience,’ Dr Sesay tells me, when I ask her how she thinks the meeting went. ‘It was heartwarming seeing an inclusive room filled with a diverse group of powerful changemakers who all echoed the same goal,’ she says, before adding: ‘It’s long overdue.’
