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RCOG priorities for the 10-Year Health Plan for England

The RCOG has set out priorities for women’s health for the new 10-Year Health Plan for England. We urge all those working in women’s health in England, and women who use services, to engage directly with the consultation, sharing your professional views and experiences to help shape an NHS fit for the future

The RCOG will engage extensively with the consultation to ensure the voices of women and girls and the women’s health workforce are heard and influence future NHS priorities. However, it is essential that decision-makers hear directly from women and healthcare professionals working in women’s health.

For more details, read about the consultation or participate in the survey until it closes on Monday, 2nd December 2024.

Summary

It is vital women’s health is prioritised in the 10-Year Health Plan. Women make up 51% of the population, yet women’s health has historically been left behind. Investment in services has been inadequate and fragmented, with inequalities evident in access to care and health outcomes and experiences. We have also seen persistently low levels of investment in research into women’s health.

This means that health services can miss the opportunity to ask the right questions, and provide the right information, care and support at the right time, to make the biggest difference in women’s health throughout their lives.

The following priorities for the 10-Year Health Plan will help ensure women are better supported to access healthcare, improve safety, and deliver policies across government departments which support women’s health and wellbeing and a thriving future NHS. Priorities are set out under the three major ‘shifts’ that have been identified by the Government to improve health and care services in England.

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Shift 1: moving more care from hospitals to communities

Implementing Women’s Health Hubs

Recurrent funding and support for Women’s Health Hubs to support every ICB to deliver sustainable, accessible, convenient and joined-up services across women’s life course.

  • The women’s health hub model offers an opportunity to better integrate the services and support women require throughout their life course, with priorities determined based on local need. There are established and pilot services across England,1 but further support is needed to ensure equitable geographic coverage and long-term sustainability.
  • Key aims of the women’s health hub model include an increase in the services women can access in the community and improved prevention of poor health outcomes. They also play an important role in delivering improved efficiency across the system, reducing the number of appointments women need to attend, increasing quality of and reducing variation in secondary care referrals.
  • A government cost benefit analysis in March 2024 found the model to be good value for money because the benefits of hubs impact on a substantial proportion of the population, with opportunities to streamline the health service and limited implementation and ongoing costs.
  • Support for women’s health hubs must include investment in training and development to equip professionals to deliver high-quality women’s healthcare across the system.
  • The RCOG has set out a position on achieving success with the Women's Health Hub model with the Royal College of General Practitioners, Faculty of Sexual and Reproductive Healthcare and the British Menopause Society.

Joined-up commissioning for women’s health

Commissioning for all women’s health services including contraception should sit under the remit of the NHS, or at a minimum there should be mandated co-commissioning of sexual and reproductive health (SRH) services.

  • SRH services are funded and commissioned by local authorities in England in a way which prevents services from providing contraception to manage gynaecological conditions. The RCOG has long recognised this as a barrier for many women accessing care.2
  • Ensuring women can receive the care they need for their gynaecological condition wherever it is available will help deliver efficiency across the system.
  • Listening to women and their families is fundamental to providing person-centred care, and co-production of services with women must be implemented wherever possible. Commissioning of women’s health services must improve access and respond to the needs of women from all ethnic groups.

Staying focused on the significant challenges in gynaecology and maternity care

Effective working in communities can only be delivered through support for maternity and hospital gynaecology care, to ensure women receive timely and effective secondary care when they need it. This includes improving maternity care and tackling the significant backlog in gynaecology waiting lists.

  • Gynaecology waiting lists have consistently outstripped growth compared to other specialties since 2020. Women are now waiting longer than ever for gynaecological care, with nearly 600,000 women on gynaecology waiting lists across England. Huge geographic disparities create a postcode lottery for specialist care.3
  • Longer waits can lead to the progression of disease and the need for more complex treatment, and can have a significant impact on women’s physical and mental health, quality of life, ability to work, and ability to participate in family and social life.4
  • We would like the 10-Year Health Plan to give health services the resources they need to protect gynaecology services against operational pressures, in particular ensuring greater theatre capacity, protect training time in gynaecology, and urgently prioritise improving communication with women waiting for gynaecology care and treatment.
  • Several reviews into the safety and quality of maternity services in England have shone a spotlight on the negative impact of poor maternity staffing on women’s care. Lord Darzi’s report adds to the clear evidence that key factors in maternity staffing such as burnout, unstable working patterns, loss of trained staff and challenges with training are holding maternity services back.
  •  Fully funded policies and programmes must be implemented across the NHS to ensure all women receive high-quality, personalised and safe care, which supports their physical and mental health during and after pregnancy.
  • It is imperative that the 10-Year Health Plan supports the O&G workforce. This includes ensuring safely staffed services which allow professionals the time to train, dedicated plans to retaining the maternity workforce already trained and working in the NHS, building more supportive and learning cultures, encouraging multi-disciplinary training, and increasing flexible working.
Shift 2: making better use of technology in health and care

Support the NHS workforce by fixing the fundamentals of NHS digital systems and estates

The ultimate success of service transformation rests on ensuring that implementation is underpinned by NHS digital systems and estates which are fit for purpose and support, not hinder, the women’s health workforce.

  • The 10-Year Health Plan must commit to the funding needed to modernise estates and facilities and upgrade digital systems and equipment. The NHS estate is currently unable to cope with demand, in a poor state of repair, and unable to cope with the increasing impact of a changing climate. Many maternity units are not fit for purpose, with very small, outdated facilities.
  • Equally vital is the investment and workforce planning needed to deliver the training and development of the O&G workforce to ensure they can lead the transformation to a digital health service. This includes equipping the workforce with the additional time and skills to deliver complex surgical care in the context of clinical care advances such as robotics and artificial intelligence. You can read more about the RCOG’s work on the future of surgical training here.

Investing in research and development in women’s health

Ensure healthcare interventions and policies are underpinned by a robust evidence base through better NHS data collection and reversing the historical underinvestment in women’s health research.5 This will help ensure the transformation in care is equitable and effective, reducing health inequalities and leaving no one behind.

  • NHS services need an accurate understanding of those they serve to best identify inequalities, design appropriate services, and support research on effective interventions. However, better data collection on patient demographics and healthcare outcomes, particularly in gynaecology, is needed. You can read more about data collection and ethnic inequalities here and data and gynaecological cancers here.
  • People who are female, from ethnic minority backgrounds, older or pregnant are often still under-represented in clinical studies, including in major disease areas like cancer and cardiovascular disease. In addition, some women’s health conditions, and effective interventions to address inequalities, are under-researched, as are the barriers to participation in research.
  • Effective interventions across women’s life course must be supported by research into underexplored conditions, ensuring research is inclusive of gender and ethnicity, and supporting research careers in women’s health.
  • Recommendations from the review of equity in the medical devices encountered during pregnancy and the neonatal period must feed in to the 10-Year Health Plan.6

Sustainability and climate change

The 10-Year Health Plan must have NHS England ambitions to become a net zero health service at its centre. This includes providing investment and support for the rapid decarbonisation and climate resilience across the NHS, and ensuring sustainability is embedded in NHS accountability mechanisms.

  • Climate change is negatively impacting women’s health in the UK and globally. Extreme weather, particularly heatwaves and flooding, pose direct and indirect risks to women’s health and access to care in England, particularly during pregnancy.
  • The actions taken over the next decade will be critical in determining whether global warming stays within the 1.5°C threshold set as part of the Paris Agreement. It is vital the 10-Year Health Plan recognises the significant role the NHS has in reducing national emissions.
  • The 10-Year Health Plan must ensure the NHS is well-prepared for the increasing risks to health, health service delivery and wider infrastructure posed by climate change.7
Shift 3: focusing on preventing sickness, not just treating it

A cross-government approach to tackling the causes of ill health and inequalities

Ending inequalities in women’s health requires coordinated and collective efforts from all parts of government. The 10-Year Health Plan must make visible and strong connections with relevant UK Government departments to achieve sustainable and long-term improvements to the wider factors shaping women’s health.

  •  The health system has an important role in tackling health inequalities, but it cannot do this alone. Understanding and responding to how the wider contexts of women’s lives shape their health is crucial to sustainably addressing health inequalities across their life course and supporting reproductive opportunity, choice and outcomes.
  • In England, the disparity in female life expectancy between the most and least deprived areas is eight years, with those from the most deprived areas also living 20 years fewer in good general health. Compared to their least deprived counterparts, women living in the most deprived areas experience twice the risk of dying during or shortly after pregnancy.
  • Across many aspects of women’s health in the UK, Black, Asian and minority ethnic women are found to have worse outcomes and experiences than white women. This includes decades-long disparities in the risk of dying during or shortly after pregnancy, stillbirth and premature birth, and diagnosis and treatment of gynaecological cancers.
  • Improving women’s health and tackling health inequalities requires equitable access to good quality work, childcare and parental leave, a social security system which works for women throughout their lives, and government action on discrimination and violence in society, including racism and gender-based violence. You can read more about tackling health inequalities across government in our policy positions on poverty and deprivation and women’s health and racial and ethnic equality in women’s health.

     

Invest in contraception and pre-conception health

Tackle unmet need in sexual and reproductive healthcare by ensuring SRH services are accessible, resourced and adequately funded.

  • Ensuring women can maintain good health and take decisions about their reproductive, preconception and pregnancy health requires public health services to be adequately funded and accessible. However, there has been a significant real-terms reduction in the public health grant over the last decade, with a particular impact on SRH services, which must be reversed.
  • Contraception is a highly cost-effective public health intervention, with a 2018 analysis finding that publicly funded contraception in England could save £9.00 for every £1.00 invested within 10 years.8
  • Between 2021 and 2022 there was a 17% increase in the number of abortions for residents of England and Wales. This likely reflects unmet need for contraception.
  • In 2022, those living in the most deprived areas of England were almost twice as likely to have an abortion than those living in the least deprived areas,9 reflecting inequalities in access to SRH.

Access to affordable, nutritious food

Ensure access to a healthy diet that supports good health, by expanding and improving the Healthy Start offer to support nutrition in pregnancy and the early years, and taking bold action to address diet-related ill health across the population through regulation and population level actions.

  • Access to healthy food is important for a healthy pregnancy. Having a balanced diet before and during pregnancy supports maternal health and helps ensure the fetus gets the nutrients needed to grow properly, while overweight or obese can increase the risk of pregnancy complications.
  • The Healthy Start scheme provides pregnant women and families with pre-school aged children from low-income households with a weekly payment to spend on healthy food and milk, and to access vitamins. However, the scheme has failed to keep up with inflation, and a third of those eligible are missing out on vouchers, particularly in more deprived areas.
  • The NHS must make greater efforts to increase awareness and uptake of the scheme. The Government should also widen eligibility criteria to more families, including more people on low incomes and those with no recourse to public funds.
  • Some risk factors for gynaecological cancers could be reduced with support for affordable, nutritious diets. For example, it is estimated that around a third of endometrial cancer diagnoses are caused by overweight and obesity.10
  • Population-level actions to support people to maintain good general health and a healthy weight, such as those recommended by the Obesity Health Alliance, should be adopted. This includes restrictions on promotional tactics, measures to encourage reformulation of unhealthy food and drink products, and encouraging healthier communities through planning policy.

Support and funding of abortion care

NHS-funded abortion care must be supported by adequate funding and resourcing to deliver timely and accessible services, including the training of essential healthcare professionals and ensuring that services are commissioned and provided in every part of the country.

  • Abortion is a safe and common procedure. Over 250,000 women access abortion care each year in the UK, and a third of women in the UK will have an abortion at some point in their lives.
  • To deliver women’s health care which is fit for the future the NHS must take steps to ensure that specialty training opportunities and commissioning supports the long-term sustainability of the abortion care workforce.

References