Tackling inequalities: how can the NHS prioritise women’s health?

Women make up 51 per cent of the population – but their health needs certainly don’t get 51 per cent of the attention. That’s the view of Professor Dame Lesley Regan, chair of the charity Wellbeing of Women, and a former president of the Royal College of Obstetricians and Gynaecologists (RCOG).

She was speaking at an HSJ webinar, held in association with Hologic, to discuss tackling inequalities and how the NHS can prioritise women’s health. Around the table were leading figures with healthcare backgrounds, as well as Caroline Nokes MP, who chairs the Women and Equalities Select Committee.

All agreed that more needed to be done to increase the focus on women’s health – but also pointed to practical measures that are already making a difference, including better use of data to inform new policy.

According to Sarah-Jane Marsh, however, part of the problem is that women’s health simply isn’t seen as “a thing”. “I really think for a lot of people it’s not in their vocabulary,” she said.

As chief executive of Birmingham Women’s and Children’s Foundation Trust and chair of maternity transformation with NHS England, Ms Marsh has a national and local perspective – and with both hats on, she sees a need for action.

She would love to see every integrated care system having an approach to women’s health. “It wouldn’t have to be uniform, it wouldn’t have to be perfect. But it would have to be something to demonstrate that we understand.”

This needs a life-course approach, she added. “It’s not just picking out one thing here or there – we’ve got to look at the holistic journey for women.”

The UK government consulted last year on a women’s health strategy – which Ms Nokes MP welcomes. But she said it was decades too late. “I’m very conscious that for years I’ve been going to ministers, raising on the floor of the House of Commons in oral questions, going into Westminster Hall and speaking in debates about medical services that are or are not accessed by women,” she said. “But it’s taken until 2021 for the government to wake up to the fact that you need to have a holistic women’s health strategy.”

The government had yet to respond to the strategy consultation, she said, adding that it was not enough to ask about the challenges for women accessing healthcare services and what the priorities should be. “You have to crack on and produce the strategy and bring about change,” she added.

Accurate information is critical to improving women’s health, but very few countries have dedicated women’s health policies, and very few have access to reliable data, said Tanja Brycker, VP international strategic development, breast & skeletal health and gynaecological surgical solutions at Hologic. “You can’t have a conversation about something which you can’t define [as a] current measure.”

Hologic has developed the Global Women’s Health Index in partnership with the Gallup World Poll, to create a database by country, over time, tracking multiple issues essential not only to improving health, but also the quality of life and life expectancy of women around the globe, said Ms Brycker.

The first results, reported in 2021, showed that every country had room to improve, with no country scoring higher than 69 out of 100. The UK came in 12^th place – testament, Ms Brycker said, to strong leadership in women’s health within the universal healthcare system. “The NHS, for all the areas where we would want to see improvement, is a phenomenal basis of care for the women in this country,” she said.

The index does identify gaps, however – such as in preventative care, where the UK only ranks at number 70. The majority of British women hadn’t been tested for cardiovascular disease, blood pressure, cancer, diabetes or sexually transmitted infections in the previous 12 months, she said, adding that this simply wasn’t good enough.

Karen Joash, a consultant obstetrician and gynaecologist at Imperial College Healthcare Trust, and a member of RCOG’s taskforce on racial inequality, questioned whether we wanted a national disease service or a national health service.

“We’ve got a service which is fantastic and which in many ways ranks in the top 10 of health institutions across the world. But it was designed by men at the time without the needs of women at the forefront – without the needs of users central to the care delivery. Therefore the system cannot meet the requirements it needs to meet.”

Prof Regan said that the health service had been designed to focus on disease intervention, rather than prevention and “maintenance”. While women’s needs across their lifespan from teenage years onwards were very predictable, she added services were too focused on pregnancy.

“Although this is an incredibly important part of life for 80 per cent of women, it’s not the defining thing in their lives. As a result, many of the other things, that I would call the maintenance issues, have been neglected.”

An on demand version of this webinar is available. If you had already registered for the event, click here to access the recording.

For those who have yet to register, click here and scroll to the foot of the page to complete the form. Details of how to access the on demand recording will then be sent to you via email.