Gender inequality occurs in different ways. On International Women’s Day last year, we put a spotlight on women’s rights to health, asking ‘Is it really the case that women's health is taken less seriously than men’s?’
Since then, the Health Minister, Eluned Morgan MS has committed to transforming healthcare for women and girls. This includes gynaecological conditions (i.e. menstrual problems, endometriosis, and menopause) and services for health conditions where gender-related disparities occur (i.e. cardiovascular disease, asthma, incontinence and mental health).
In this article, we look at the progress the Welsh Government has made in developing a women and girls’ health plan.
Progress towards a women and girls’ health plan
The Royal College of Obstetricians and Gynaecologists (RCOG) published the ‘Better for Women’ report in December 2019. It recommended that each of the four UK nations publish a plan to address areas of unmet need for women’s health. Delivery plans have been published in Scotland and England but not yet in Wales.
The Health Minister’s quality statement on women and girls’ health, which outlines physical and mental health issues that affect women and girls across the life course (i.e. optimising women and girls’ health and wellbeing at all ages) was issued last July. It describes what health boards are expected to deliver to ensure good quality health services to support women and girls.
The responsibility for developing the women and girls’ health plan (which must set out how NHS Wales will deliver the ambitions of the quality statement) sits with the NHS Wales Collaborative. It published its initial report in December 2022. The report is the first phase of the development of a 10-year women and girls’ health plan (2024-34). It combines an evidence review of women’s health with the voices of women and girls, with NHS Wales having consulted over 3,800 women between June and November 2022.
The Minister describes this stage as the ‘discovery phase’, saying it’s “the start of a conversation and covenant with women over the next 10 years”. The Minister also says “the NHS now needs to respond to women’s stated priorities”.
Women’s wishes and improvement opportunities
The quality statement on women and girls’ health includes a list of 29 conditions where the Health Minister says there is gender inequality. These range from asthma to dementia, heart disease and stroke to gynaecological disorders, and osteoporosis to mental wellbeing, anxiety and depression.
The Minister outlined that she wants to see Health boards and Trusts (who are responsible for planning and delivery of women and girls’ health services) improve their gynaecological services. She commits them to providing timely care for women and girls who need menstrual and fertility care, endometriosis and menopause support. Health boards and Trusts are also expected to provide better support for reproductive choices, such as abortion, IVF and miscarriage/ pregnancy loss. Addressing gender-related health disparities in heart disease and incontinence is also a priority.
The survey data from NHS Wales has been analysed to rank areas of priority, with gynaecological and pelvic health conditions (i.e. endometriosis, menstrual health, menopause etc) the area of highest concern to women and girls. Closely followed by mental health and wellbeing (i.e. anxiety and depression, eating disorders etc).
The NHS Wales report says that Health boards and Trusts should focus on specific priority areas where a need for NHS Wales improvement has been identified. But it also emphasises that:
…the plan should help reduce health inequalities, improve equity of service, improve health outcomes for women in Wales, and ensure that NHS services reflect women’s needs across their life course.
The plan is one part of a wider picture when it comes to women and girls’ health. Health boards and Trusts will need to focus on these greater challenges and inequalities if the Minister’s ambitions are to be achieved.
Next steps and recommendations
There are six key themes set out in the NHS Wales Collaborative’s report, where it identifies opportunities to improve NHS Services:
- The voices of women and girls (gender inequality and culture) – improving the way healthcare professionals listen to women and girls about their health concerns and take them seriously.
- Access to healthcare and health outcomes – tackling the barriers many women and girls experience to accessing healthcare, particularly non-urgent care.
- Wellbeing – rethinking the factors that affect wellbeing and quality of life, including better workplace and mental health support. Better support for parents and carers.
- Information, education and communication – improving the information and education that is provided so that women and girls can make informed choices based on their own circumstances and the best evidence available.
- Health in the workplace – greater empathy, understanding and flexibility in the workplace to address inequalities and support a positive work/life balance. NHS Wales should aim to become an exemplar employer.
- Research – building a reliable evidence base and set of data to improve understanding of health issues specific to women, and gender differences in health.
The report points to 5 short term actions to be taken forward in the next 6-12 months:
- Establish a Women’s Health Network (which will be tasked with monitoring progress and outcomes against the quality statement).
- Develop actions from the six priority improvement opportunity areas (set out above).
- Audit and undertake demand and capacity modelling of the top major health conditions affecting women and girls, outside of reproductive and gynaecological.
- Implement the recommendations made by the All-Wales Task and Finish Group on Menopause.
- Consider actions from the planned care programme on gynaecology services.
How has the plan been received by stakeholders?
The Women’s Health Wales Coalition (which is made up of over 80 third sector organisations, Royal Colleges and Faculties, patient representatives and clinicians) initially welcomed the quality statement.
The Health Minister confirmed NHS Wales will be drawing on the Coalition’s version of a women and girls’ health plan (published in May 2022). More recently, one of the co-chairs of the Coalition (Fair Treatment for Women in Wales) said:
…we remain concerned that co-production with patients and public is properly embedded in all work related to the Women’s Health Plan and that Coalition members’ expertise is utilised throughout.
The quality statement recognises that co-production is key to redesigning healthcare services for women and girls. The Coalition will undoubtedly hold the Minister to her word - that Health boards and Trusts will ensure women’s health services are co-produced. Women’s voices are central to the success of the plan and to delivering better outcomes for women and girls.
The Minister has promised to transform healthcare for women and girls. Whether it’ll be another year before we start to see tangible outcomes, remains to be seen.
Article by Sarah Hatherley, Senedd Research, Welsh Parliament
* This article uses the term ‘women and girls’ but recognises that it is not only those who identify as women who require access to women’s health and reproductive services (i.e. some transgender men may also experience menstrual cycles, pregnancy, endometriosis and the menopause).