Introduction
The Ladies’s Well being Technique for England units out our 10-year ambitions for enhancing the well being and wellbeing of girls and ladies, and for enhancing how the well being and care system listens to ladies. The technique encourages the growth of girls’s well being hubs throughout the nation to enhance entry to companies and well being outcomes.
This doc is meant to assist commissioners, suppliers and different companions to ascertain ladies’s well being hubs, specifically built-in care boards ( ICBs ) as they implement the £25 million funding in ladies’s well being hubs. Recognising that the event of current ladies’s well being hubs has been led by many particular person clinicians and commissioners, this doc can be meant to assist additional domestically led initiatives.
This doc has been developed collaboratively with stakeholders and builds on a draft introduced on the Division of Well being and Social Care ( DHSC ) ladies’s well being hubs ‘Shaping the long run’ workshop on 6 April 2023. Additionally it is knowledgeable by different proof gathering and engagement exercise undertaken by DHSC and companions, together with the findings of the interim report, Early analysis of girls’s well being hubs, commissioned by the Nationwide Institute for Well being and Care Analysis ( NIHR ).
Defining and describing ladies’s well being hubs
Definition
Ladies’s well being hubs carry collectively healthcare professionals and current companies to offer built-in ladies’s well being companies locally, centred on assembly ladies’s wants throughout the life course. Hub fashions intention to enhance entry to and experiences of care, enhance well being outcomes for ladies, and scale back well being inequalities.
Description of girls’s well being hubs
Ladies’s well being hubs (‘hubs’) are understood as a mannequin of care working throughout a inhabitants footprint and usually are not essentially a single bodily place.
Hub fashions tackle fragmentation in service supply with the intention of enhancing entry, experiences and outcomes. Hubs replicate the life course method to ladies’s well being, the place care is just not restricted to interventions for a single situation, however as an alternative is wrapped across the wants of a person girl, which in some circumstances could also be a number of wants. For instance, hubs can present administration of contraception and heavy menstrual bleeding in a single go to or combine cervical screening with different facets of girls’s healthcare akin to long-acting reversible contraception ( LARC ) becoming or elimination.
Hubs contain partnership working throughout the NHS, native authorities and the voluntary and neighborhood sector. Additionally they require collaborative commissioning of contraception companies by NHS and native authority commissioners[footnote 1].
Hubs are locally, usually working on the interface between major and secondary care. They supply intermediate care, the place companies are extra superior than sometimes seen in major care, however are for well being points which don’t essentially want a referral to secondary care. Hubs shouldn’t have to be a constructing or particular place; they could make use of digital sources to offer digital triage or consultations, or alternatively they could make use of current services, for instance GP surgical procedures or neighborhood centres.
A lot of hub fashions are already in existence and are mapped within the NIHR -commissioned analysis of girls’s well being hubs[footnote 2]. Examples embrace Liverpool, the place the ladies’s well being hub mannequin operates throughout the town’s major care networks. The Liverpool hub mannequin is delivering a major improve in appointments and prescribing charges for long-acting reversible contraception – each for prevention of being pregnant and managing menstrual issues. In Manchester, the hub has advanced from a neighborhood gynaecology service working carefully with major care and is properly obtained by the ladies it serves.
Some hubs have integrated a digital supply. For instance, Metropolis and Hackney hub has pioneered using digital menopause engagement occasions and digital group consultations, with comply with up in bodily places the place wanted, to enhance entry to and effectivity of menopause care. Extra broadly, improved interoperability between IT programs – for instance for appointment reserving, and shared affected person information throughout suppliers – may even be necessary for delivering streamlined entry to care. The NHS’s work to make it simpler for sufferers to entry GP-held information by way of the NHS App may even be necessary for supporting ladies to handle their very own care.
Via these early adopter websites and preliminary findings from the analysis, we have now seen that hubs are serving to to satisfy system priorities:
delivering care nearer to house
enhancing affected person expertise
tackling well being inequalities
lowering strain on secondary care and ready lists
The rising proof suggests probably important effectivity advantages over time.
Place-based partnerships are well-equipped to ascertain new fashions of care akin to ladies’s well being hubs[footnote 2]. ‘Place’ tends to cowl a inhabitants of across the dimension of a former medical commissioning group ( CCG ) or native authority footprint (200,000 to 250,000), though this varies throughout the nation.
The supply of companies will usually happen at major care community ( PCN ) degree, led by built-in neighbourhood groups to make sure companies are accessible to and meet the wants of the populations they serve[footnote 3]. For instance, the place hubs are delivered inside PCNs , a number of GP practices might function because the hub serving their PCN . Hub fashions have began small, for instance serving one or two PCNs , after which expanded to a wider footprint. This will contain governance on a bigger footprint for efficiencies and scale, with companies nonetheless delivered domestically inside every PCN .
The dimensions of the inhabitants lined by a hub and technique of delivering companies will doubtless differ throughout the nation relying on native geography and demographics. In accordance with the precept of subsidiarity, choices ought to proceed to be made as shut as doable to native communities.
There are additionally alternatives for working at system degree the place there are advantages of scale, for instance, agreeing strategic priorities, minimal requirements and constant care pathways throughout a system, metrics and analysis, digital transformation and workforce improvement.
When establishing hubs, commissioners and suppliers ought to contemplate how the situation and companies supplied by hub fashions can greatest meet inhabitants wants and scale back inequalities, and assist meet the priorities recognized by native wants evaluation and built-in care methods. Affected person voice must also be central to the event of hubs, together with engagement with native populations all through design, implementation and analysis to make sure hub fashions meet native wants and enhance affected person expertise.
Whereas on this doc we check with ladies, we recognise that some individuals who don’t establish as ladies additionally require entry to the companies listed and will profit from care in ladies’s well being hubs. These teams may even have particular wants and experiences which must be thought-about.
What hubs usually are not
In addition to describing ladies’s well being hubs, it is very important be clear what hubs usually are not. They aren’t:
a substitute for major care, which ought to stay the primary level of contact for most girls looking for non-emergency healthcare, together with for points akin to menstrual well being or menopause
a substitute for secondary care or specialist companies the place that’s required. Equally, hubs usually are not hospital outpatient companies, as this could not align with the precept of bringing care nearer to house for most girls
a further barrier within the affected person journey – hubs mustn’t delay referral for specialist and/or pressing care the place required, for instance referral into most cancers pathways
a duplication of current companies – ladies’s well being hubs mustn’t duplicate different native companies, and moderately might enhance pathways into different companies, for instance psychological well being companies
one dimension suits all – hubs must be tailor-made to satisfy native inhabitants wants and system goals
Goals of girls’s well being hubs
When creating hub fashions domestically, the particular targets and targets will should be tailor-made to native inhabitants wants. Equally, there may be profit in having shared goals to assist be sure that hub fashions assist to ship the ambitions set out within the Ladies’s Well being Technique.
The ten goals of girls’s well being hubs
Goals for ladies and ladies:
higher entry to companies, together with preventative healthcare and early intervention, and lowered unmet want for healthcare
improved affected person expertise, with care being delivered in a single appointment the place doable
improved well being outcomes and lowered well being inequalities
improved entry to well being info, in a variety of codecs, and supported affected person self-management the place acceptable
Goals for the workforce:
optimising the talents of multidisciplinary groups by joint working and coaching alternatives
improved workforce expertise and retention
improved communication and partnership working between major, neighborhood and secondary care
Goals for the well being and care system:
better effectivity, by care delivered on the proper time, in the fitting place, and by the fitting particular person; fewer pointless secondary care referrals; and collaborative commissioning to make greatest use of sources
extra integration and partnership working between well being system companions – NHS, native authorities, the voluntary and neighborhood sector, and sufferers – in order that companies higher meet the wants of girls and ladies
higher assortment and use of information by commissioners and suppliers to know ladies’s well being wants and enhance service provision and outcomes
Companies and care pathways
There isn’t a ‘one dimension suits all’ method as hub fashions should be tailor-made to native inhabitants wants. They need to be wrapped round ladies and ladies’ well being wants throughout the life course. Proof from current hubs present that hub fashions might begin with an preliminary service supply which is then expanded over time – with a long-acting reversible contraception ( LARC ) service usually the primary constructing block.
Core companies to carry right into a hub mannequin are[footnote 4]:
menstrual issues evaluation and therapy, together with however not restricted to take care of heavy, painful or irregular menstrual bleeding, and take care of situations akin to endometriosis and polycystic ovary syndrome
menopause evaluation and therapy
contraceptive counselling and provision of the complete vary of contraceptive strategies together with LARC becoming for each contraceptive and gynaecological functions (for instance, LARC for heavy menstrual bleeding and menopause), and LARC elimination, and emergency hormonal contraception
preconception care [footnote 5]
breast ache evaluation and care
pessary becoming and elimination
cervical screening
screening and therapy for sexually transmitted infections ( STIs ), and HIV screening
In lots of circumstances, major care will already be offering these companies, or some parts of those companies, for instance routine cervical screening and opportunistic STI testing. Hubs mustn’t disrupt major care the place it’s already working successfully for ladies. Nonetheless, by reflecting the life course method and the necessity to wrap companies across the wants of girls, hubs can combine pathways which are sometimes not joined up. For instance, when having LARC fitted or eliminated, a lady ought to be capable of even have her cervical screening if due or STI testing if acceptable inside the identical appointment, minimising the necessity for a number of appointments and invasive procedures.
Hubs have the potential to carry many companies nearer to house, and to streamline pathways of care. There are quite a few different areas of girls’s well being the place some or all parts of the care pathway may very well be constructed right into a ladies’s well being hub mannequin. The precise companies will differ relying on inhabitants well being wants, the present arrange of companies and workforce expertise. Some areas for consideration are:
HPV vaccination, together with catch up provision
incontinence care – together with provision of or signposting to continence evaluation and/or companies akin to urodynamics and ultrasound, conservative administration akin to pelvic flooring physiotherapy, and if wanted referral into specialist companies
pelvic organ prolapse care – together with evaluation, conservative administration akin to pelvic flooring physiotherapy, and if wanted referral into specialist companies
pelvic ache evaluation and therapy, and if wanted referral into specialist companies
recurrent urinary tract infections evaluation and therapy
outpatient diagnostic and/or therapy procedures, together with however not restricted to ultrasound, hysteroscopy, biopsy and colposcopy
vulval dermatology and/or vulva clinics
sexual well being companies, together with provision of or signposting to prevention and outreach companies, HIV therapy companies and psychosexual companies
fertility evaluation and recommendation, diagnostic testing and referral into infertility therapy companies
different companies for expectant, new or bereaved moms, for instance perinatal psychological well being companies and maternal psychological well being companies, pelvic well being clinics and breastfeeding assist
provision of or signposting to abortion companies
provision of or referral to breast ache clinics
breast screening and referral into breast most cancers pathways
osteoporosis evaluation and care, for instance DEXA (bone density) scanning or fracture liaison companies
Ladies’s well being hubs must also keep clear pathways into secondary and specialist care, which might comply with current major care pathways and never create an additional step within the affected person journey. Examples embrace:
gynaecological most cancers pathways
specialist gynaecology companies, for instance specialist menopause clinics, specialist companies for extreme endometriosis, and specialist centres for ladies with mesh issues
maternity companies and/or antenatal care
early being pregnant items, and companies for recurrent miscarriage
Reflecting the necessity to meet ladies’s well being wants holistically, hubs might additionally develop care pathways into different well being and public companies, together with however not restricted to:
psychological well being companies
home violence and abuse companies
sexual assault referral centres (SARCs)
specialist feminine genital mutilation (FGM) companies
ladies’s centres, which offer holistic neighborhood assist for ladies with complicated wants
household hubs, which offer companies for households with infants, kids and younger folks
public well being programmes, for instance for smoking, weight problems, drug and alcohol assist
grownup social care
social prescribing
Ladies’s well being hubs supply logic mannequin
Following a assessment of literature, this logic mannequin has been drafted to map the meant supply of girls’s well being hubs. It reveals how the coverage can result in its meant impacts and outcomes.
DHSC thanks the Birmingham, RAND and Cambridge Analysis Centre (BRACE) staff for sharing early findings and their concept of change as a way to developthis logic mannequin.
Description of supply logic mannequin
The picture reveals a diagrammatic move chart, which represents a ladies’s well being hub supply logic mannequin. The highest 5 rectangular textual content packing containers are shaded gray and browse:
inputs (sources)
actions (companies, actions, processes)
outputs (results of actions)
outcomes (results of outputs)
impacts (long run imaginative and prescient for change)
These are the important thing parts that characterize every stage of the logic mannequin.
Below inputs, there may be one other textual content field, which incorporates:
funding
infrastructure (services or on-line)
medical house and gear (relying on service)
integration (IT programs and pathways)
skilled healthcare professionals
admin workers
undertaking supervisor
From this field, there are 3 arrows. One which connects, and factors to, a field beneath the actions textual content field which incorporates the actions:
heavy menstrual bleeding session and therapy
long-acting reversible contraception ( LARC ) becoming for gynaecological and contraceptive causes
) becoming for gynaecological and contraceptive causes LARC elimination
elimination menopause session and therapy
pessary becoming and elimination
cervical screening
different contraception recommendation and provision
evaluation of incontinence and/or prolapse
emergency contraception
breast ache evaluation and care
screening and therapy for sexually transmitted infections ( STIs ), and HIV screening
One other arrow factors to a textual content field beneath actions that claims academic/info and occasions for ladies together with group consultations, and one other to a different textual content field that claims additional coaching for healthcare professionals/upskilling.
These actions packing containers then level to the 4 packing containers beneath outputs. These packing containers embrace an inventory of the actions a hub can be enterprise, together with the primary which has X quantity consultations, X quantity LARCs fitted or eliminated, X quantity pessary fitted or eliminated, X cervical screenings, X quantity STI screenings and coverings, X quantity clinics delivered, X contraception administered, and X incontinence therapies. One other which has X variety of lowered appointments and X quantity lowered secondary care referrals. One other that has X quantity occasions and group consultations run, and one other that features X quantity healthcare professionals skilled.
These output textual content packing containers have arrows that time to 4 end result packing containers. The primary one consists of:
elevated entry to companies
elevated affected person expertise
lowered ache
lowered development of sicknesses
discount in size of pathway
The second consists of:
discount in secondary care ready lists and backlogs
lowered undesirable pregnancies
The third consists of:
elevated labour pressure and/or academic participation
elevated healthcare professionals ladies’s well being skillset
The fourth reads: elevated healthcare professionals’ expertise.
These end result packing containers are adopted by 5 connector arrows, pointing to the ultimate column of textual content packing containers on the chart, that represents impacts.
The primary field, in giant textual content, reads: ladies expertise improved entry to ladies’s well being companies and a discount in inequalities. The second field reads: system degree effectivity, and the third and last field reads: healthcare professionals’ retention. The logic mannequin reveals a simplified technique of how the inputs related to a ladies’s well being hub result in their related outcomes and impacts.
Discover additional info on the Ladies’s Well being Technique for England.
For ongoing NIHR -funded analysis of girls’s well being hubs, see Ladies’s Well being Hubs from the College of Birmingham.
For extra sources for commissioners and suppliers, see Major Care Ladies’s Well being Discussion board ladies’s well being hub toolkit.