Women at its centre: the steps for reimagining the UK’s healthcare system

Healthy women are the cornerstone of families, communities, and economies. However, too often our healthcare services are designed without the needs of women in mind. As gender remains a key determinant of health outcomes, it is crucial we address the inequities in health which face half the world’s population.

A year on from the Women’s Health Strategy, there remains an opportunity to put the needs of women back at the centre of healthcare delivery, and there are three clear things we need to provide women with if we are to seize that opportunity: Knowledge, Technology and Access.

Knowledge: Helping women understand their health

From having a better understanding of her personal risk of developing cancer, to being clear about what constitutes a ‘normal’ period, how can we expect a woman to properly engage with the health system, if we don’t provider her with the information she needs to understand her own health and risks?

We welcomed the Women’s Health Strategy focus on this area, but much more needs to be done.

As a society we ask women to attend regular breast cancer screening appointments; an emotional, often stressful experience. But then we fail to provide these women with crucial, personalised information about their risk of developing cancer that would help them engage with the process.

Imagine the difference to women’s experiences of breast cancer screening if the Government provided each woman with a comprehensive cancer risk assessment at the start of their screening journey. This would allow women with higher risk factors – for example, dense breasts – to be accurately identified and prioritised for more frequent screening, with the reassurance that would bring.

With regards to menstrual health, education should start early. The Government should introduce a specific module on healthy menstruation in the relationships, sex and health education (RSHE) curriculum, which should be explored as part of its current review of the curriculum.¹

This would provide all girls with an understanding of what could signify abnormal periods or heavy menstrual bleeding and leave them in a far better position to seek help if they struggle with their periods.

Technology: Providing reassurance and certainty

The second important step that needs to be taken is ensuring that women have access to the best technology possible as part of their healthcare.

Too often women are left waiting for diagnostic or other test results around serious conditions, leaving them anxious and afraid. Access to better, innovative technologies – for example, AI driven diagnostics – would mean that more accurate results could be returned to women sooner, providing a sense of certainty and reassurance.

In breast cancer screening, the most obvious example is providing wider access to 3D MammographyTM. The technology identifies up to 65% more invasive breast cancers than traditional 2D Mammography alone, which is the technology we predominantly currently use.^2*

Or take digital cytology in cervical cancer screening. This uses AI and advance imaging to improve early diagnosis of pre-cancerous cells and cancerous cells and was piloted for the first time in the UK last year, in Scotland.³

During the pilot, the cytology team were able to increase capacity by about 25%, meaning that women received their results quicker.

These are just two examples, and it’s important that we have a framework that will drive adoption of these sorts of advancements in technologies more generally. We welcomed the MedTech Strategy, and the recognition of the need to accelerate access to innovative technologies.

The Government should now establish an adoption pipeline for MedTech and identify the innovative technologies that can support early cancer detection.

Access: Matching healthcare delivery to a woman’s needs

We need to make sure that every woman can access healthcare and advice in a way that is right for her, based on her needs and her lifestyle. To be frank, great care is only great if a woman can access it.

For example, we still find ourselves in a position in which if a woman is seeking help for contraception, wants to discuss a heavy period, and needs to have a cervical smear, she will need to book three separate appointments with three clinicians. That’s three occasions off work or times she’ll need to rearrange family life – who could blame her for deciding not to bother!

Or take treatment for heavy menstrual bleeding (HMB). As Hologic’s recent report on HMB noted, providing women with all of their treatment options at the point of diagnosis, will help her to make an informed decision about the treatment which is right for her.⁴

Too often, a hysterectomy is presented as the only option for treatment, when in reality a less invasive treatment pathway, such as the outpatient hysteroscopy service, could better suit a woman’s needs. The Government should ensure every hospital in the UK has the facilities to offer the range of treatments in a variety of healthcare settings, which are available to women who have heavy menstrual bleeding.

Putting women’s needs at the heart of healthcare services

No one is under any illusions that it will be a simple task to reimagine the healthcare system so that it truly puts women’s needs at its heart. But if we wish to build a society that truly values women, and which benefits from their wider contribution across the economy and culture, we have no choice.

We hope that these three steps provide a framework

1. Gov.uk (2023) Review of relationships, sex and health education to protect children to conclude by end of year. Available at: https://www.gov.uk/government/news/review-of-relationships-sex-and-health-education-to-protect-children-to-conclude-by-end-of-year (Last accessed: 27th June 2023).

2. Friedewald SM, Rafferty EA, Rose SL, Durand MA, Plecha DM, Greenberg JS, et al. Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA, 2014 Jun 25;311(24):2499-507. *Breast cancer screening using tomosynthesis in combination with digital mammography." JAMA 311.24 (2014): 2499-2507; a multi-site (13), non-randomized, historical control study of 454,000 screening mammograms investigating the initial impact the introduction of the Hologic Selenia® Dimensions ® on screening outcomes. Individual results may vary. The study found an average 41% (95% CI: 20-65%) increase and that 1.2 (95% CI: 0.8-1.6) additional invasive breast cancers per 1000 screening exams were found in women receiving combined 2D FFDM and 3D™ mammograms acquired with the Hologic 3D Mammography™ System versus women receiving 2D FFDM mammograms only

3. BBC News (2022) New tech improves cervical cancer screening. Available at: https://www.bbc.co.uk/news/uk-scotland-glasgow-west-60648553 (Last accessed: 27th June 2023).

4. Hologic (2022) The right patients, the right setting, the right clinicians: Improving patient pathways for heavy menstrual bleeding. Available at https://www.hologic.co.uk/app/uploads/2022/11/WP-00242-GBR-EN_002_01.pdf (Last accessed 27th June 2023).

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