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Health

Women hold up half the sky

Katherine Church

28 November 2023

“ Women hold up half the sky “
Mao Zedong, Emphasising the critical role of women in the cultural revolution.

The case for all Integrated Care Systems to prioritise Women’s Health and the implementation of Women’s Health Hubs

In the UK’s health and social care sectors, our reliance on women to hold up the sky is closer to 80%.

Our workforce is highly feminised:

78% of the NHS workforce are women
82% of the care workforce are women
A third of the care workforce are nurses, a profession that is approximately 90% female. Many nurses not only have professional caring responsibilities in their healthcare roles but also carry unpaid caring responsibilities in their personal lives.
59% of today’s unpaid carers are women contributing an estimated £77bn of care to the UK economy (c 50% of the total annual budget of the NHS)

Our sector is facing some of the most difficult times in its history. Waiting lists are at their highest, with unprecedented workforce issues in both recruitment and retention.

Disproportionate impact of women’s health issues on our sector

The impact of women’s health issues on the economy is generally not well understood; however a recent AXA Health report shows that this is taking a hefty economic toll on the UK, costing around £20.2 billion each year in sickness absence alone. In addition, when facing health issues that affect women, 83% report a financial impact, while nine in ten also experience emotional job-related struggles.

There is a general lack of data around the health issues which particularly affect women, however, we do know that:

1:10 women are considering leaving the workforce due to the impact of the menopause (50% of the health and care workforce are of menopausal age around 45- 60)
1 in 10 women suffer from endometriosis with over 50% of women visiting their GP up to 10 times and A&E at least once pre diagnosis (a lengthy process taking an average of 8 years). 20% of women with endometriosis have visited hospitals more than 10 times in their diagnosis journey.
Presenteeism (where women come into work but are unable to work at full productivity levels) cost an additional 9 days per annum according to a 2023 BMJ article.

Not only does this have a negative effect on women’s lives and well-being but the impact of these issues on a predominantly female NHS and social care workforce hampers efforts to deliver health and care to the rest of the population.

There are over 500,000 women on waiting lists for secondary care, in the main for gynaecological conditions; with an average of 16 weeks wait from referral to treatment. These are some of the longest waiting times nationally; how many of these women are also health and care workers?

Focusing on women’s health issues could get doctors, nurses, carers, social workers, care assistants back to work, greatly assisting the NHS and social care in addressing its workforce issues.

As well as the human cost; there is a sound economic argument for early recognition, diagnosis and treatment of these debilitating health issues and enabling women to work as productively as possible. Retaining skilled and experienced staff in the workforce will improve service delivery and decrease pressure on the sector.

Supporting the 80% who are holding up the sky will offer benefits to all service users.

Women’s Health Strategy and Women’s Health Hubs: the opportunity to innovate through digital:

One year on from the publication of the Women’s Health Strategy, most ICSs are focusing on the design and delivery of their Women’s Health Hubs (WHH).

Designed to bring a range of women’s services together under one (physical or digital) roof; there is a huge opportunity to think boldly, to collaboratively redesign clinical pathways and journeys for women which leverage innovation and digital technologies to scale and extend access to health and care services for many women.

There are a wide range of models being designed across the country with hubs being developed out of primary and secondary or community care settings.

Investments in digitising primary care, implementing Electronic Patient Records (EPR) alongside developing shared care and personal health records accessed via patient portals integrated with the NHS App create a digital ecosystem which can be leveraged in the development of WHHs.

Designing for digital can enable WHHs to scale and reach wider groups, creating communities of support, connecting women with similar health concerns, providing encouragement and sharing experiences and management strategies. There are exceptionally good examples deployed today which can be replicated and scaled. However, any move to digital needs to be designed within the context of digital exclusion; an in-depth understanding not only of user needs but barriers to access will inform intelligent, multichannel design of services which work for everyone. Designing women’s health hubs informed by ICS digital inclusion strategies at an ICS level is critical to ensure that no woman gets left behind.

We have a thriving Femtech ecosystem in the UK with up to 56% of women between 18-14 and 40% of women 40-54 regularly using women’s digital health platforms. FemTech is revolutionising women’s health by helping de-stigmatise many aspects of women’s health—from menstruation to pelvic floor health to sexual wellness; by empowering women to connect with and have more control over their bodies and by extending the reach of health and care professionals through digital.

By integrating remote monitoring and femtech applications into Women’s Health Hubs, we have the opportunity to ensure that these apps are clinically and digitally safe; “prescribing” them as part of a joined up set of services across channels.

As part of Women’s Health Hubs, we can intelligently integrate apps, remote monitoring platforms and wearables into the service proposition designed to meet the needs of women and practitioners.
Conditions which disproportionately impact on post menopausal women such as Cardio Vascular Diseases (CVD) can be remotely monitored and data integrated into women’s health services enabling identification of symptoms, prevention and more timely interventions.

Engaging women in the design of women’s health services

As well as having the most to gain from focusing on addressing women’s health issues, the health and care sector also has the most opportunity to do so.

We have a huge and engaged clinical and practitioner community who could be invited to help to

Design
Test
Pilot
Pathways, new models of care and digital solutions

This community is both user and practitioner with the dual perspective of assessing whether new services work for women as:

Clinicians
Practitioners
Care givers
…an unprecedented opportunity to innovate from a multiplicity of perspectives.

For many of these clinicians, the work which they do in Women’s Health is amongst the most enjoyable and rewarding part of their working lives, enabling them to specialise in and focus in these areas may act as powerful and motivating retention factors.

Fit your own oxygen mask before fitting others’

In a final thought, there is a strong argument to prioritise the treatment of our female workforce as a deliberate policy initiative. In the same way as we vaccinated essential workers as a priority during Covid, we could prioritise our female workforce as part of Women’s Health strategies. This will bring capacity and capability back into services and address some of the clinical areas with the longest outpatient waiting times.

Focusing Women’s Health Hubs on delivering services to those sections of the population will provide significant benefit to the wider health and economic outcomes for Integrated Care Systems.

We have a huge opportunity to shape a new form of healthcare delivery, combining the power of digital technologies with traditional clinical models to benefit women, both as patients and as service providers, genuinely turning the dial for women’s health.