In July 2022, Eluned Morgan MS, the Health and Social Services Minister, addressed the Senedd, shedding light on the need for a transformative approach to women's healthcare in Wales. The Minister stated, "This isn't right and it's not fair," pointing to entrenched gender biases within the healthcare system that can often overlook the distinct needs of women and girls. The fundamental issue, she noted, is that women's health services are often based on men’s experiences of illness, resulting in poorer outcomes for women.
Despite the urgency of the matter, Wales is still without a dedicated women and girls' health plan.
A vision for enhancing women’s healthcare
The Royal College of Obstetricians and Gynaecologists (RCOG) presented a comprehensive vision for enhancing women's healthcare in its 2019 'Better for Women' report. This vision underscored the importance of person-centred care and empowering women in decision-making processes. The Scottish Government published its women's health plan in August 2021, while the Welsh Government issued a Women and Girls' Health Quality Statement in July 2022.
The Quality Statement, a precursor to a forthcoming 10-year plan, outlines the anticipated healthcare standards that NHS Wales should provide for women and girls throughout their lifetime. The Minister said the quality statement is a crucial "first step" in the transformation of women's healthcare in Wales. She also said she expects the comprehensive 10-year plan, led by NHS Wales, to have substantial input from women's health organisations.
The UK Government published its women's health strategy for England in August 2022. However, progress in Wales seems to be slower than anticipated. In September 2022, the Minister provided an update on the women's health plan, announcing the establishment of the Women's Health Network by the NHS Executive. The Network is tasked with drafting the plan. Yet, in December 2022, NHS Wales published only the initial phase, termed the "discovery phase”.
The timeline halts at this point, leaving questions about the plan's current status and future trajectory. The Women's Health Network was supposed to be operational by May 2023. It should now be implementing and monitoring the 2024-2034 Women and Girls’ Health Plan.
Reasons for the delay
The Chair of the Senedd's Health and Social Care Committee, Russell George MS, sought an update on the plan in November 2023. The Minister acknowledged the plan's slow progress:
This is now an NHS health plan, so this is not going quite as quickly as I’d hoped.
I can't determine what they're going to do, because it's their plan—it's the NHS plan. I do the quality statement, they do the delivery.
Despite the delays, the establishment of a Women's Health Network (responsible for drafting the plan, and overseeing and assessing progress against the Women’s Health Quality Statement) has progressed, with key posts, including a clinical lead and network manager, due to have been filled in December 2023.
The lack of a published plan however, raises questions about the reasons behind the delay. The Minister suggests that developing a comprehensive clinical plan for women's health involves addressing a wide range of issues, conducting consultations with women across Wales, and ensuring the plan aligns with stakeholders' feedback. Resource constraints and challenges in collaboration may also be contributing factors.
Role of the Women’s Health Network
The intended role of the Women's Health Network is to advance women's health through a clinical strategic approach. Led by clinicians, the network aims to enhance the quality, safety, and outcomes of patient care at national, regional, and local levels.
The NHS Wales Discovery Report has already outlined the Network's tasks, including developing actions, key deliverables, and measurable outcomes in six priority areas, including:
- improving women's voices in healthcare interactions
- providing better access to information
- prompt access to support
- enhancing workplace well-being
- improving mental health support and
- conducting research on key women's health topics.
Other tasks include reviewing and analysing health conditions affecting women and girls (outside of reproductive and gynaecological issues) through audits and demand/capacity modelling, implementing recommendations from the All-Wales Task and Finish Group on Menopause, and taking forward the recommendations of the planned care programme on gynaecology services.
Stakeholders’ vision for the women and girls’ health plan
Annex A to the Quality Statement lists specific health conditions that relate to women and girls that are often overlooked, such as menstrual problems, endometriosis, and menopause. The statement also includes a list of general health issues related to ischaemic heart disease, cardiovascular disease, and cancer screening that may require different care for women.
It is anticipated, that the NHS women and girls' health plan will address the various issues outlined in the NHS Wales Discovery report and the Quality Statement. Together, these include closing gender gaps, removing gender inequalities, and transforming the way the NHS supports and cares for women and girls.
In March 2022, the Health and Social Care Committee held an evidence session with the Women's Health Wales Coalition (WHWC), a coalition of over sixty charities and health organisations including Royal Colleges and patient representatives. The WHWC outlined its priorities for a women and girls' health plan (and later published its own plan for Wales).
The WHWC called for a cross-governmental approach to women and girls' health, recognising that women's health issues extend beyond health and social care, involving education, housing, social justice, and other areas. While the Quality Statement does not explicitly mention cross-government working, there is evidence of collaboration, such as the period dignity strategy led by the Social Justice Minister and the inclusion of menstrual well-being education in the new curriculum in Wales.
Other priorities identified by the WHWC include:
- listening to real-life stories and experiences of women and girls, recognising intersectionality and normalising discussions around women's health;
- increasing access to specialist services;
- addressing concerns about GPs' referral practices;
- Tackling the backlog in the healthcare system;
- improving data quality, particularly in instances where women are underrepresented in clinical trials, or where research findings lack disaggregation by sex and gender; and
- enhanced training for all healthcare professionals in managing women's health issues and conditions.
The WHWC say that addressing unmet needs in women's health in Wales requires a comprehensive, gender-specific approach to healthcare services for women and girls, and call for the plan to be reported annually to assess progress. The WHWC also believe equality in health outcomes between men and women must be the fundamental goal.
Article by Sarah Hatherley, Senedd Research, Welsh Parliament