What is Women’s Health?
Women’s Health is a broad term in healthcare. It is relevant to more than 50% of the global population and addresses the gender-related health issues which can arise over a lifetime. From puberty to the menopause and beyond, Women’s Health issues are addressed by key priorities in the NHS Long Term Plan, from centralising safety collaboratives for maternity services to personalising therapeutic options for breast cancers.
The range of specialties within Women’s Health is vast, as is the number of women utilising specialist services. The NHS looks after around 600,000 women in maternity services each year, and 200,000 women annually for menopause symptoms. Women’s Health is treated and managed in many NHS services, either directly or indirectly, such as Primary Care, Physiotherapy and Specialist Nursing.
What can digital achieve?
Digital transformation is a key objective of the NHS Long Term Plan, with the specific intention of making digitally-enabled services mainstream. Digital innovation has grown exponentially in the healthcare space. In response to this, a new NHS unit, called NHSX, was created to drive digital transformation. An analysis by the Healthy London Partnership, a group specialising in complex public health issues, predicted digital adoption could increase capacity by 25% in Primary Care, release 20% of GP workforce and in turn unlock huge recurring annual savings. Successful digital transformation has delivered the standardisation of a gold standard of care and made this available to patients directly. In turn, removing barriers to care such as physical access difficulties and variations in Health Care Professional (HCP) management.
Standardising quality of care is a challenge in Women’s Health. As highlighted by the World Health Organisation, 222 million women internationally are still not getting the contraceptive services they need. Variations in the standard of Women’s Health is also seen within the NHS. National audits have consistently found that significantly fewer older people are screened for urinary symptoms when compared to younger people, despite the greater prevalence of urinary dysfunction in the older population.
Digitally-enabled services are less restricted by capacity, and able to implement the gold standard of care at scale. As such, digital transformation in Women’s Health presents an opportunity to deliver a consistent quality of care at the required scale. Importantly for NHS commissioning, it would also achieve same-year cost-savings through the relative cost of alternative support.
Where has innovation made an impact?
Digital transformation is already making an impact in some areas of Women’s Health. In quarter 1 of 2020, Women’s Health global venture funding increased by 150% from the close of 2019. Telehealth and diagnostics emerged as popular segments, likely in response to the disruption caused by Covid-19, with the expectation that their use will continue to increase.
A notable example of this impact is work stream 7 of the NHS Maternity Transformation Programme, in which digital technology is being harnessed to make digital care records available to 100,000 women. The Women’s Digital Care Records project moved maternity records online, to a fully remote / digital process. Maternity teams are benefitting from the advantages of a digital-first approach, such as reduced administrative burden and easily personalised support. Women under the care of the services can access care and support conveniently outside of the hospital setting, with greater autonomy over care decisions.
Digitally-enabled treatment approaches in Women’s Health became mainstream in 2018, when award-winning pelvic floor trainer, Elvie, announced the availability of its product on the NHS supply chain. Research published at the 2017 International Continence Society Conference, reported a reduced surgery rate by 50% and £424 in-year cost-saving when using the Elvie compared with standard care for pelvic floor dysfunction. Elvie uses a Bluetooth system, to make biofeedback therapy available to all women. The same treatment had previously been subject to long waiting lists and limited availability nationally.
To date, there has been a preference to adopt innovation in younger patient groups with specific symptoms or clinical pathways to be followed. Perhaps this reflects the well-known complexity within elderly care, and the challenging intersection between health and social care. Solution-focused innovation within this area of Women’s Health would be a welcome aid to community Bladder and Bowel and Community Nursing Services, who report rising referrals from patients with Urogynaecological dysfunction and decreasing budgets.
Why does innovation matter?
The NHS has heavily invested in digital innovation, by launching NHSX in 2019 it showed commitment to supporting the development and implementation of digital services. Importantly, positioning NHSX as the centre, setting the standard for the real innovators from Start-ups, NHS Trusts, and Charities to step forward to deliver the solutions to the NHS’s problems.
The innovations of independent organisations have successfully pushed forward standards of care in the NHS for many years. NHS England’s National Diabetes Prevention Programme (NDPP) is demonstrating the improvements to patient care achievable with digital adoption. Treatment pathways for this demographic are typically poorly attended, with less than 50% of eligible people receiving the available support. The NDPP opened its programme to telehealth providers, and as a result have seen dramatically higher engagement rates and outcomes across the target demographic.
Engagement in Women’s Health services is a historic challenge. 30% of women in England fail to attend their cervical smear screening appointment, with this number close to 50% in England’s most deprived areas. Breast screening uptake also sees a 30% drop off in engagement, with BAME groups and women from lower socioeconomic classes having especially low attendance rates. Transforming engagement in breast screening alone could potentially detect almost 8,000 more cancers each year.
The digital wave is gaining momentum across all sectors. High quality evidence is now emerging, showing real-world NHS settings benefitting from the digital rethinking of what “good care” looks like. The first wave of digital adoption has favoured the management of less complex issues in Women’s Health, such as Maternity Services and stand-alone treatment aids. The challenge now is for innovators to address key challenges such as health inequalities, chronic under-reporting of Women’s Health issues, and increasingly complex patients for whom continuing care is needed.