Women's health in the spotlight

The first Women’s Health Strategy for England is described by Professor Dame Lesley Regan, the country’s first women’s health ambassador, as “the next step on the journey to reset the dial on women’s health”. 

Dame Lesley, professor of obstetrics and gynaecology at Imperial College London and former president of the Royal College of Obstetricians and Gynaecologists (RCOG), says the Strategy “reiterates what I hear repeatedly from women: that our healthcare systems are failing them.”

The Strategy sets out the Government’s ambitions for the next 10 years. Dame Lesley’s foreword notes that the disparities for girls and women identified in the 2014 chief medical officer’s annual report “in some cases have widened and been further exaggerated by the pandemic”. 

She also references the RCOG’s 2019 report Better for Women, which emphasised the importance of preventative health interventions. She notes the system, “all too often forces women to navigate their way around multiple different health professionals and facilities trying to access basic services to maintain their health and wellbeing. The irony is that their care can easily be provided more conveniently and at significantly lower cost during a single visit to a women’s health hub or centre if we adopt a ‘one-stop-shop’ model.”

There’s plenty for community pharmacy to consider in the paper, since access is a running theme. “Most women will menstruate for nearly 40 years, and require reliable contraception (which is also a highly cost-effective intervention) for most of this time to prevent unplanned pregnancies. Contraception is frequently used as a first-line treatment for menstrual problems, but many women meet barriers in accessing the method of their choice due to siloed commissioning,” Dame Lesley says. 

“Although women usually live longer than men, they spend considerably more time in poor health”

“My initial priorities will be to tackle health issues that affect most women for long periods of their lives, which, if left untreated, can limit a woman’s ability to attend school, go to work or undertake their caring responsibilities.”

Dame Lesley’s other priorities include lifting the taboo that surrounds miscarriage, dealing better with menopause symptoms and prioritising quality and longevity of life – “although women usually live longer than men, they spend considerably more time in poor health”.

Medicines in pregnancy gets its own section. The MHRA-led Safer Medicines in Pregnancy and Breastfeeding Consortium brings together 16 organisations, including the Royal Pharmaceutical Society, under a common pledge to meet the information needs of women and healthcare professionals through accessible, clear and consistent advice. “The Government will shortly publish the results of a six-week consultation on original pack dispensing and supply”, which “included a proposal that medicines containing sodium valproate must be dispensed in the original manufacturer’s packaging, which would ensure that women and girls, and particularly those of child-bearing age, always receive patient information about taking the medicine while pregnant.”

In the section on menopause, the Strategy notes that the Government is to introduce an HRT pre-payment certificate by April 2023, while the director general of the vaccine taskforce, Madelaine McTernan, was appointed in April to address HRT shortages. “Actions taken to date have improved the position, and we will take forward her recommendations for ongoing work to engage with the sector to minimise both short-term supply shocks and longer-term supply issues.” 

Reclassifying Gina for the treatment of vaginal atrophy in postmenopausal women is also highlighted as improving access for some women and increasing patient choice.

It’s a long read, but the Strategy encapsulates the significant challenges those providing healthcare services need to address. They are complex (in many cases the position is worsening) and they will not go away, regardless of who finds themselves sitting in the secretary of state’s office next. 

Workforce crisis laid bare

“The NHS and the social care sector are facing the greatest workforce crisis in their history.” So says the Health and Social Care Committee of the House of Commons, which is chaired by former health secretary Jeremy Hunt. 

The picture painted in the Committee’s July report is stark. As of September 2021, the NHS was advertising 99,460 vacant posts; for social care, it was 105,000. New research by the Nuffield Trust suggests that the NHS in England could be short of 12,000 hospital doctors and more than 50,000 nurses and midwives right now. 

The impact of staff shortages is stark. The number of people on a waiting list for hospital treatment rose to a record of nearly 6.5 million in April 2022, and the 18-week target for treatment has not been met since 2016. With demand in the health and social care sector continuing to grow relentlessly, an extra 475,000 jobs will be needed in health and 490,000 in social care by the early part of the next decade. No wonder current health secretary Steve Barclay is reported to be investigating overseas recruitment in a bid to stave off a social care catastrophe this winter. 

“The Government has shown a marked reluctance to act decisively,” the Committee says. “The workforce plan promised in the Spring has not yet been published and will be a ‘framework’ with no numbers. There has been progress towards the 50,000 nurses target, but at the same time the then secretary of state admitted to us he was not on track to deliver the 6,000 additional full-time equivalent GPs promised in the Conservative party manifesto.” 

The Committee accepted the recommendation of the Medical Schools Council and the Academy of Medical Royal Colleges that the number of medical school places in the UK should be increased by 5,000 from around 9,500 a year to 14,500. Pity then that education secretary James Cleverly has gone the other way by reimposing the cap on medical school places, saying “you can’t just flick a switch” to train more doctors. 

“The persistent understaffing of the NHS now poses a serious risk to staff and patient safety, both for routine and emergency care. It also costs more as patients present later with more serious illness. But most depressing for many on the frontline is the absence of any credible strategy to address it. It is time to stop photographing the problem and deal with it,” says the Committee. 

For pharmacists, the report merely codifies what they already know when it says the Government’s aim to tackle the Covid backlog is “totally or mostly unachievable with the existing workforce”, adding that current pressures “have a real human impact on the health and care workforce. In August 2021 alone, the NHS lost two million full-time equivalent days to sickness, including more than 560,000 days to anxiety, stress, depression, or another psychiatric illness. The result is that many in an exhausted workforce are considering leaving – and if they do, pressure will increase still further on their colleagues.” 

The Committee says it heard that almost every healthcare profession is facing shortages, with pharmacy in a list of 25. “The situation is regrettably worse in social care. One in three care workers left their job in 2020-21, a serious setback to the continuity of care which is so essential to those who receive social care. In December 2021, Care England reported that
95 per cent of care providers were struggling to recruit staff, and 75 per cent were struggling
to retain their existing staff.”

Integrated care strategies outlined

A recent NHS Confederation briefing has helpfully summarised how the Department for Health and Social Care (DHSC) intends that the new integrated care partnerships (ICPs) will develop their individual strategies. Here are the acronym-heavy headlines.

The Government expects that integrated care strategies will be informed by health and wellbeing boards’ (HWB) Joint Strategic Needs Assessments (JSNA). ICPs should also carry out further research and draw on other data sources to build a holistic understanding of their local populations’ needs.

Integrated care strategies are encouraged to focus on activity that can be delivered by systems at system (or cross-system) level, while Joint Local Health and Wellbeing Strategies (JLHWSs) – developed by HWBs – should focus on what can be delivered at ‘place’ and in communities. ICPs and HWBs have statutory commitments to deliver both of their strategies separately; however, they should be aligned.

ICPs should engage with local Healthwatch organisations; local people and communities; providers of health and social care services; the voluntary, community, and social enterprise (VCSE) sector; local authority and integrated care board (ICB) leaders; and wider organisations and partnerships to ensure a wide range of people are able to engage and input into the production of the strategy. 

Pharmacy is included in the list of people and organisations to consider engaging, but “there is not an expectation that all stakeholders must necessarily be consulted”. 

The guidance outlines some key areas to consider when producing the strategy, including personalised care; addressing disparities in health and social care; population health and prevention; health protection; babies, children, young people and their families, and healthy ageing; workforce; research and innovation; health-related services, and data and information sharing. 

ICPs will need to consider revising their strategies when they receive a new JSNA, and are encouraged to work with HWBs, local authorities and ICBs to align the timelines of their strategies with the five-year joint forward plan.

The Confed says that while the guidance acknowledges the transitional period ICSs are in, there are concerns about how much detail they will be able to include by a December 2022 deadline. “Leaders recognise that this is an interim strategy on which they can build over the coming months but have asked whether there is value in that if the exercise cannot be completed to a comprehensive degree.

“Our members felt that the ambition ICSs will demonstrate in these strategies must also recognise the reality and the pressures health and care organisations are currently facing. The rising cost of living is continuing and will continue to have a profound impact on people’s physical and mental health, exacerbating health inequalities and increasing demand for services. Measures to address these challenges do not rest solely with the health and care system.”