Agenda item

Briefing Note

The Board considered a Briefing Note and verbal update of the Deputy Chief Medical Officer, Coventry & Warwickshire ICB, regarding the Coventry and Warwickshire Integrated Care systems progress on the Women’s Health Strategy.

Public health concerns for Coventry residents included health inequalities faced by those living in the 10% most deprived areas in Coventry which impacted on the wider determinants of health such as education, housing, and employment. Studies had found that women were among those had reporting loneliness and social isolation and those with a disability had often faced discrimination in the workplace. There were 173,300 women and girls living in Coventry (just over 50% of the population). About 45% of the local population identified as being of an ethnic group, up from 33% in 2011. Coventry had a young population with the largest group of residents being in the 25 – 39-year age group. However, the health and wellbeing of Coventry’s population was below the national average being in the 46th most deprived borough in England. Life expectancy in Coventry as lower than the national average for women, and women could expect to live on average for 82 years (vs men 78, Eng 82.8). However, the number of years a woman could expect to live in good health in Coventry was to age 64 years above the national and regional average (vs Eng 62.6, Regional 63.9, Warks 83.

The National Women’s Health Strategy was published in 2022 to address the inequalities women faced in accessing services of good quality and having a good experience of care. The strategy aimed to improve support for women and girls from age 15 years and over. This also included people who did not identify as women but may require women’s health services.

In response to the strategy, ICBs were tasked with developing Women’s Health Hubs by December 2024 to focus on eight key priority areas i.e. Menstrual health issues, menopause, cervical screening, prolapse, STI and HIV screening and treatment, preconception support, breast pain management.

Coventry and Warwickshire ICB had delivered a Women’s Hub model that included the joint working of multiple existing services including, but not limited to, the Primary Care Gynaecology Service, Integrated Sexual Health services, Domestic Abuse services and public health universal services.

A Women’s Health Steering group was set up with key stakeholders to deliver the Hub model and foster partnership working. There was also a Health Inequality subgroup, a Women’s health community forum and a preconception task and finish group with representation from Coventry public health and community representatives. A women’s health webpage was in development to improve awareness of women’s health services in Coventry and Warwickshire.

The Primary Care Gynaecology Service, which covered 5 of the 8 Women’s Hub priority areas, delivered 6 clinics across the system, with 2 clinics in Coventry at Longford Primary Care Centre and Forrest Medical centre. The services offered both face to face and virtual support to women in Coventry.

There were over 1200 women (as of Nov 2024) seen in the Coventry clinics with Coventry GP practices referring to the Primary Care Gynaecology service. Overall, 80% of cases seen by the service had been resolved with no onward referral to secondary care.

The top three issues women presented across all clinics was for menopause, menstrual issues and prolapse.

Secondary care gynaecology waiting times remained a challenge nationally and locally. The transformation team was working with UHCW as well as other acute trusts to improve women’s access to alternative support.

A new gynaecology clinical network was launched in Dec 2024 with representation from all sectors including all Hospital trusts and primary care to address this issue.

The infant mortality rate in Coventry was higher than national and regional average. For the Coventry and Warwickshire system, still births were within 5% of national average and higher than 5% of the national average for neonatal deaths.

A preconception task and finish group had been set up to identify ways to support women before pregnancy, to improve pregnancy and maternal outcomes across Coventry and Warwickshire.

Coventry Public Health, the Local Maternity Neonatal System (LMNS) and Warwickshire Public health had run a Preconception Workshop to identify with stakeholders the key issues around preconception health.  As a result, a Preconception task and finish group had been set up with key stakeholders to support raising awareness of preconception information among other actions.

The Preconception Task and Finish group was collaborating with Tommy’s, the national childbirth charity, on a local awareness raising campaign with targeted support for women who were Black, Asian or from other ethnic groups, as well as those living in deprived areas.

Cancer leads at the ICB were in discussions with UHCW on a proposed model for managing breast pain in the community.  Women suffering breast pain who were not suspected of cancer currently had no other option but to be placed on the cancer 2 week wait list.

Cervical screening was being delivered by primary care as well as opportunistically via the Integrated sexual health and the primary care Gynae services.

A Primary Care Women’s Health Workforce and skills survey had been sent out to all practices in the system. Of the practices that responded, 30% were from Coventry. This survey was being evaluated to determine the potential training needs of primary care clinicians on women’s health issues.

As a response to the Women’s Health Strategy, Coventry and Warwickshire Women’s Health hub model had been delivered according to the NHS England criteria by working together with multiple services and stakeholders of the Women’s Health Steering Group including community representatives.

Additional funding for the Women’s Health Programme had not been identified post March 2025 and the formal women’s health programme would come to an end. This posed a risk to the significant women’s health work developed over the past 12 months.

To mitigate this risk, system leads had been identified to continue this work as part of Business as Usual, such as but not limited to Gynaecology, Clinical network to advise on gynaecological elements of women’s health strategy, Preconception, and infant mortality to be led by the LMNS and Cancer transformation team to oversee the response to breast pain.

Post March 2025 there was a need for system partners to ensure that the foundations set over the past 12 months were built on to support the needs of Women’s health.

Members of the Scrutiny Board, having considered the verbal report and presentation, asked questions and received information from officers on the following matters:

• Women’s hubs were in place and sexual health services were working in partnership with them. A new web page was being hosted on the website signposting women to specific services. Work on breast pain had started as well as developing GP skills. These works would continue and outcomes would be measured.
• Primary care gynaecological services had been measured over the past 12 months and it was found that women who used these services had a better, swifter service, being treated by a mixture of clinicians, led by GPs with skills in gynaecology. This service was being evaluated and as it was a pilot, it would go out to tender and would continue to develop alongside secondary care gynaecological services.
• Primary care gynaecological services was a referral service from a patients’ GP and work undertaken over the past 12 months enabled an understanding of what that could bring. There had been a good uptake in Coventry.  Wait times for primary care gynaecological services were approximately 6 weeks.
• Analysis of trans and non-binary patients had not yet been undertaken.  The national strategy had been designed to make it easier for anyone to access services however, additional health promotion had not been undertaken nationally or locally as yet for non-binary or transitioning people.
• A specific stream of work had not been undertaken on women’s mental health.

The Board requested clarification on healthy life expectancy age for women in Coventry.

RESOLVED that the Health and Social Care Scrutiny Board (5):

1)  Continue to collaborate on women and girl’s health issues and ensure that all services are working together to improve the support for women and girls aligned to the Women’s Health Strategy.