A new report from the Royal College of Obstetricians and Gynaecologists (RCOG) High Quality Women’s Health Care: A proposal for change, published today, is proposing a significant change to the way NHS women’s health services are structured.
The report concludes that the combined force of the NHS reforms, workforce and financial pressures against a backdrop of rising demand, increasing complexity and changes in demographics means that the delivery of women’s health care in the current configuration cannot be sustained.
The recommendations include the following:
• Services should be provided in managed clinical networks which link primary, community, secondary and tertiary services
• A life-course approach to women’s health care should be adopted utilising every interaction a woman has with the health service, irrespective of age, to promote health and lifestyle rather than the constant firefight against disease and ill health
• The variation in health service provision needs resolving by universally adopting clinical standards, guidelines and mandating the reporting of outcomes
• Pressures on the workforce due to the Working Time Regulation and trainee numbers will need different service configuration and will lead to a reduction in the number of medically staffed units to ensure a safe service
• A national clinical director in women’s health should be appointed to lead on the quality agenda and ensure that service configuration, workforce and commissioning issues are championed in women’s health care
Hospitals should be configured so that safe and timely care can be provided by multiprofessional teams. Currently, too much care is provided within secondary and tertiary settings.
For maternity services, the managed network model will mean more midwifery-led care. Networks and hospitals will need to be configured to accommodate these changes, and provide 24/7 medical obstetric services for women on fewer sites than at present. For isolated or remote units different solutions will need to be found.
For gynaecological services, the women’s network will facilitate choice and encourage more care closer to home, in the community or in a primary care setting.
With an ageing female population, more specialist attention is also needed for women in later life. The RCOG’s Expert Advisory Group, which undertook the review, says that focus should be on health promotion and preventive medicine rather than disease intervention.
Chair of the Expert Advisory Group, Dame Joan Higgins, said:
“Women’s health services need to be planned in a way that enables integration across different levels of care, delivered in partnership between local health and social care services and the voluntary sector. This network of providers should ensure that women experience co-ordinated and appropriate care which meets their needs.
“Women will still have ready access to hospital-based care but this will be when clinical need dictates or the woman chooses to have her care delivered in this setting.”
Dr Tony Falconer, President of the RCOG added:
“There is much to celebrate about the current quality and delivery of women’s health care services in the UK. The UK has declining infant, neonatal and maternal mortality rates. However, there is scope for significant improvement and an urgent need to elevate the standards of care in all parts of the UK.
“The life-course approach will ensure that at every opportunity, the health service can be there to give advice and improve a woman’s health irrespective of her situation or her social background. Adopting such an approach to delivering health care will provide women with consistent information from a young age, enabling them to make better decisions about their own health. This is an empowering document – both for women and the NHS.”
To view the full report please click here.
The Expert Advisory Group of the RCOG was chaired by Dame Joan Higgins and range of professional organisations were involved as members on the panel or provided oral/written evidence including:
• Royal College of Anaesthetists
• Royal College of General Practitioners
• Royal College of Midwives
• Royal College of Nursing
• Royal College of Paediatrics and Child Health
• College of Emergency Medicine
• Faculty of Sexual and Reproductive Healthcare
• Association of Early Pregnancy Units
• British Association of Perinatal Medicine
• British Fertility Society
• British Gynaecological Cancer Society
• British Maternal & Fetal Medicine Society
• British Society of Gynaecological Endoscopy
• British Society of Urogynaecology