A new report from the Royal College of Obstetricians and Gynaecologists (RCOG) High Quality Women’s Health Care: A proposal for change proposes 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 report recommends that services should be provided in managed clinical networks which link primary, community, secondary and tertiary services. It also says that a life-course approach to women’s healthcare should be adopted, utilising every interaction a woman has with the health service, irrespective of age, to promote health and lifestyle rather than to constantly firefight against disease and ill health. It also says that the variation in health service provision needs to be resolved 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 require a different service configuration and will lead to a reduction in the number of medically staffed units to ensure a safe service. The report recommends that 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. Further, it says that 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 midwiferyled 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.
