With the NHS struggling to clear huge surgical and screening backlogs and facing continued pressure from Covid-related staff absences, it’s a tough time for it to take on another major challenge. But ministers have promised to “reset the dial” on gender inequalities in healthcare, with the publication of the first ever government-led women’s health strategy.
The pressures of the pandemic have only exacerbated health inequalities. Figures published by the Royal College of Obstetricians and Gynaecologists (RCOG) earlier this year revealed that gynaecology waiting lists across the UK saw a 60% increase on pre-pandemic levels – the biggest percentage increase of all elective specialties. So with a women’s health strategy being needed more now than ever, this programme of reform is welcome.
The strategy appears to map only loosely on to the six priority areas outlined in December, based on a consultation with 100,000 women. Menstrual health and gynaecological conditions feature prominently.
Endometriosis, a painful condition in which womb-lining tissue grows elsewhere in the pelvis, is mentioned six times in the release and this is an obvious area for improvement. It affects roughly one in 10 women of childbearing age, but diagnosis takes an average of eight years, despite the condition being progressive and potentially affecting fertility.
The introduction of certificates for baby loss will be welcomed as an important way that the healthcare system can acknowledge and validate patients’ experience of miscarriage. It won’t change the most important outcome – the loss of a baby – but it can help change how patients feel about their care and may make them feel more able to talk to employers and others about the impact this has had on them.
The strategy is the latest in a series of agile moves from the government on women’s health in the past year – changes that have not required huge investment but needed someone to take the time to think about them, and that can make a meaningful difference.
Other changes include extending the provision of abortion pills at home, widening access to HRT, including making vaginal oestrogen tablets available over the counter, and banning harmful “virginity repair” operations.
However, other supposed priorities seem to have dropped from view. Mental health, surprisingly, is not mentioned at all in Wednesday’s release, and there is little on the life-course approach to women’s health that the government’s new women’s health ambassador, Prof Dame Lesley Regan, has long advocated.
Some elements have appeared out of the blue without much clarity on how they fit with the government’s broader goals. There is £10m for mobile breast cancer screening units, for instance, which clearly is not a bad thing, but is this investment really linked to the existence of a women’s health strategy or was it happening anyway as part of the planned catch-up programme? It would be a shame if the strategy just became an umbrella for publicising disparate initiatives related to female health.
The strategy states an ambition to tackle more deep-seated cultural issues, with plans for an expansion of training on women’s health for incoming doctors. However, the culture in healthcare is not set simply by knowledge, but also by values.
The current focus on women’s health was prompted by a string of scandals, ranging from maternity deaths, rogue surgeons and vaginal mesh implants. These apparently unconnected events all arose and were facilitated in a system that does not place enough inherent value on female health.
The government has a powerful role in shaping which areas of health are prioritised, but some of the biggest, most promising ideas in its strategy – including women’s health hubs across the country – are yet to be given any targets or committed funding.
Such concrete commitments will be essential if it is to achieve the ambitious goal of closing the gender health gap and supporting women to live well.
