Agenda item

The meeting received a presentation from Joanne Copping and Alexandra Humphrey who made the following points:

Reproductive Outcomes

·       Women in the BNSSG area spent longer in poor health than in other areas. In addition, unplanned pregnancies were high and abortions were rising in the area

·       Whilst emergency contraception was free for over 25s, there had been a decrease in uptake

·       Rates of certain STD’s such as gonorrhea had been increasing and condom use had been declining

·       Maternity outcomes were variable. Outcomes were worse with certain types of screenings reduced, such as breast cancer

·       Whilst rates or cervical cancer had been reduced following HPY vaccination, rates of vaccination and cervical screening were not sufficiently high

·       The demand for support for problems caused by menopause was huge. These included heavy menstrual bleeding, endometriosis and incontinence but data was poor since the problem was stigmatised and frequently hidden

System Wide Approach

·       There was a focus on sexual reproductive health but currently lots of gaps in the date

·       There was a fragmented landscape of commissioning and budgets with public health being responsible for sexual health and NHS England were responsible for screening. Many patients needed help navigating the system

·       Consultation concerning sexual health focused on key areas such as access to gynaecology

·       Work from public health in preventing unplanned pregnancies led to benefits elsewhere (ie the health service) and therefore close working was required to achieve effective interventions

·       The escalation of costs for care had resulted in variable quality and inequities in access and outcomes

·       Women’s health strategy needed to embrace diversity and innovation to deal with a shortfall in funding

National Guidance and Women’s Health Hub

·       The National Health Strategy had been drawn up in 2022 – a definition was provided

·       Core Services included issues such as tackling menstrual problems and assessments

·       The Health Hub would provide wrap around care so that, when a woman had a coil fitted, she could have a cervical cancer screening at the same time

·       These would also provide primary care options rather than requiring an automatic transfer to hospital

·       Phase 1 was currently taking place from August to November 2023, Phase 2 – High-level planning from November 2023 to January 2024, Phase 3 provided detailed planning via a working group, Phase 4 in April 2024 was the implementation phase

·       A workshop had taken place on 7^th December 2023 and had involved a wide range of organisations

·       Emerging themes were a follows – long-acting e=reversible contraception, support access to good quality information and education, education training and support for healthcare professionals, involving women in planning and making changes, reducing the service delivery problems of silos of funding and commissioning and the need to harness the collective power of people and organisations for delivery

In response to Board Members’ questions, Joanne Copping and Alexandra Humphrey made the following points:

·       Whilst there was some additional funding which would recur within gynaecology and maternity services, there were gaps within this provision. It was noted that changing the system to make it work better would help to meet probable unmet need and was likely to require more funding. There were a lot of voluntary sector partners who could help with this provision

·       Bristol was piloting two sites delivering LARCs (Long-Acting Reversible Contraceptives) in a different way. Whilst some of these practices were working well, others had none at all. Provision of a separate hub, clinic and/or service would help since it would provide women’s health care through a clinic in a non-GP setting

·       The integration of different services through wider community support was important through a wide range of different hubs

·       Whilst there were opportunities for embedded relationships to provide support for certain issues such as HIV, there was also a need to manage expectations given the limited resources available

·       The future wider development of hubs would help to provide an approach that was more focused on prevention and was more societal than medical