The professor of obstetrics and gynaecology at Imperial College’s St Mary’s Hospital Campus and women’s health ambassador for England explains how to improve women’s healthcare.
Dame Lesley Regan’s honours are legion. She is professor of obstetrics and gynaecology at Imperial College’s St Mary’s Hospital Campus, women’s health ambassador for England and was awarded a DBE for services to women’s health in the 2020 New Year’s Honours List to name only a few.
Here, she talks to Healthcare Today about how the conversation around women’s health has evolved, why the creation of community-based hubs to treat women is such an effective tool and how they would save the NHS a “significant amount” of money.
How has the conversation around women’s health changed in recent years?
Women’s healthcare is being taken more seriously now than it was in the past, but I still don’t think it is taken seriously enough. It’s important to remember that the majority of occasions when girls and women seek healthcare professionals, they are not actually ill. Instead, they are often taking steps to maintain their health or prevent illness. Take pregnancy! For the vast majority of the 800,000 maternities expected in the UK this year, that does not mean the women are sick, but they still require the input of healthcare professionals.
Another critical point is the shift in how women’s health is perceived. When I left medical school, women effectively disappeared from the health service’s radar at the age of 50, once they were no longer considered reproductive. Thankfully, this has changed.
This is a point I have emphasised repeatedly, particularly in my role as Women’s Health Ambassador over the last two and a half years. For the first time in history, women like me will live longer post-reproductive lives than we did reproductive ones. This shift brings with it very different healthcare needs.
We must focus on postponing the conditions that will become the major killers of women. The leading causes of death among women are heart disease, complications from osteoporosis, frailty and dementia. While we may not be able to eradicate these conditions entirely, we can delay their onset by encouraging women to be proactive about their health.
“I envision women being seen in community-based health hubs where they can access a range of services in a single visit.”
Are greater preventative health measures the answer?
Prevention is always more cost-effective. Take, for example, a broken bone or a fractured hip. Treating such an injury is incredibly expensive and the reality is that once a hip fracture occurs, the individual is often set on a downward trajectory. No matter how dedicated they might be to physiotherapy even if they were to recover, it is unlikely that they would regain the same level of mobility they had before the injury. This leads to frailty which often leads to a more reclusive lifestyle, which in turn can result in depression.
When I talk about prevention and healthcare efficiencies, I envision women being seen in community-based health hubs where they can access a range of services in a single visit. For instance, they could have their cervical smear, mammogram and bone density scan (DEXA), while also addressing issues related to periods, contraception or menopause.
This approach would save the NHS a significant amount of money.
There is also something invaluable that we rarely put a price on: the power of education. When you help mothers, wives or daughters understand what they need to do to maintain their health, they are not only more likely to take action themselves but also to share this knowledge with others. This ripple effect is immeasurable in its impact.
Do GPs and healthcare professionals have enough training in how to support women’s reproductive health in midlife and beyond?
I’m struck by how different things are now compared to my own clinical experience as a junior doctor. It would never have occurred to me to start an obstetric ward round with my consultant without first visiting the postnatal ward. Today, that kind of basic, essential care is often overlooked.
Back in 2011, I contributed to a report called High Quality Women’s Healthcare published by the Royal College of Obstetricians and Gynaecologists. It emphasised that despite the rise of highly technical interventions, the basics of women’s healthcare should not be forgotten. Yet, over the next 14-15 years, we completely ignored those recommendations.
This neglect is evident in my own experience. On Monday morning, I had an ST4 trainee with me – someone who is more than halfway through their specialist training in obstetrics and gynaecology. I was fitting a progesterone-coated coil into a woman’s uterus, not for contraception but as a mechanical barrier to address a specific condition.
I asked the trainee if she would like to load the coil for me, but to my surprise, she had never seen one before and didn’t know how to do it.
This is a stark example of how the basics are being overlooked in modern training and practice.
“I don’t believe we need more money – we just need to reallocate the resources we already have.”
You’ve spoken about the need for women’s health hubs to deliver wraparound care. What is stopping them being set up?
The problem is that everyone expects a lump sum of money to be dropped on the table to make it happen. But I don’t believe we need more money – we just need to reallocate the resources we already have.
The NHS budget currently exceeds £200 billion annually, and a significant portion of that is wasted on unnecessary secondary care appointments which is far more expensive to maintain than community-based services.
We need integrated care board leaders and healthcare leadership to think differently. Many consultations could be done virtually, saving time and resources.
Last autumn, I conducted a detailed analysis for ministers on the 600,000 women on the English waiting list for gynaecology services. Of those women, 85-87% do not require hospital admission or invasive procedures. They are waiting to be seen in secondary care because they can’t access guidance, advice or minor procedures. GPs and practice nurses often say they can’t or won’t provide these services because they’re not properly reimbursed, lack training, or find it difficult to access certification. I’m working on alternative solutions, but the system keeps saying “no”.
General practice poses a particular challenge because GPs are not NHS employees – they’re contracted to provide services. If a GP needs to attend training to learn how to insert coils, they must backfill their role with a locum, which is costly and creates disincentives. This is where the hub model comes in. By creating community-based hubs, we can see women closer to home, triage them effectively, and provide training opportunities.
How can we ensure that women from disadvantaged or minority backgrounds have equal access to the healthcare they need?
Because these hubs are community-based, grassroots organisations, they act as advocates and help encourage women to access care. For example, if you have a group of women who wear hijabs, they are unlikely to feel comfortable having a cervical smear performed by a male clinician. Understanding these cultural and social nuances is crucial to providing effective care.
There are also language and cultural barriers to consider. In some South Asian dialects, there is no word for “menopause”, making it nearly impossible to ask women about menopausal symptoms. Additionally, we’ve observed significant variations in the age of menopause onset across different ethnic groups, as well as stark disparities in health outcomes.
To address these challenges, we need to communicate with women in ways they understand and provide access to healthcare professionals they can trust.
We’ve also piloted mobile hubs, which have shown great promise. In Manchester, for instance, we’ve organised a couple of buses that travel around and provide services to sex workers, the homeless, and drug addicts. This model ensures that even the most marginalised groups can receive the care they need in a way that respects their dignity and circumstances.
What policy changes are needed to make this happen?
The NHS is undergoing significant changes, and one clear indicator of this is the Department of Health’s public consultation in 2021, which asked women what was wrong with the health service from their perspective. The fact that it took 18 months to compile the resulting report was because the response was overwhelming. This engagement underscored the urgent need for action and ultimately led to the creation of the Women’s Health Strategy.
The agreement I made with my co-authors was simple: for every problem we identified, we had to propose an alternative that was not only effective but also cost-efficient. I argued that improving women’s healthcare would benefit everyone – economically, socially, and educationally – and that it could be done for less money. In short, it’s a win-win for all.
Lead image of Dame Lesley Regan, courtesy of One Welbeck.
