Women's health plan 2021 to 2024: final report

Cross-Cutting Actions

Short Term Actions

Action: Establish a central platform for information on women’s health on NHS Inform.

The NHS Inform Women’s Health Platform was launched in May 2022.

The Platform brings together women’s health information from across NHS Inform into one place, responding to women’s ask for a ‘trustworthy, comprehensive health website for women and girls and healthcare professionals’.

Connections have been made throughout the content to help women access the information they need, when they need it. For example, information on pregnancy includes links to information on the pelvic floor. Content on menstrual health symptoms like heavy menstrual bleeding links to more information on possible causes such as fibroids and endometriosis as well as information on possible treatment options like the combined contraceptive pill.

As of October 2024 there have been:

• Over 58,000 users on the life sections
• Over 838,000 views on the Periods pages and
• Over 2.95 million views on the Menopause pages.

New and refreshed information has also been developed for NHS Inform on:

• Menopause
• Periods and Menstrual Health
• Planning for Pregnancy
• Pelvic Floor
• Pelvic Organ Prolapse
• Urinary Incontinence
• Lipoedema
• Women’s Heart Health
• Hysterectomy
• Women’s Health – How your Pharmacist can help
• Self-help tool: Periods and mental wellbeing
• Self-help tool: Menopause and mental wellbeing

Within these new information resources, new films and animations have been developed to provide easy to digest information on key aspects of women’s health.

To highlight this important information to women, a number of campaigns have been developed by NHS24 via social media, including on women’s health support in community pharmacy.

Getting to know your pelvic floor

All bladder and bowel functions need good pelvic floor muscles. Strong pelvic floor muscles boost core strength and stability and can improve sexual function too. We understand that women and girls might find it embarrassing to talk about, making it difficult to get the information they need on this important aspect of women’s health. So, we created two brand new resources to help them better understand what the pelvic floor muscles are and why they are so important over the lifecourse.

A new animation explains the pelvic floor muscles, where they are in the body and their function – as too often we assume that women and girls know and understand their anatomy.

A short film describes how to exercise your pelvic floor muscles, providing women with a straightforward way to access information, direct from health professionals expert in this area.

Action: Seek women’s lived experience through the continuation of a lived experience group, to inform heath policy and improve healthcare services and to ensure women are meaningfully involved in decision making and priority setting going forward.

Running alongside the Women’s Health Plan, the Health and Social Care Alliance Scotland (the ALLIANCE) has been delivering a women’s health programme aimed at highlighting and involving lived experience.

With this programme, the ALLIANCE have promoted opportunities for women to share their experiences to influence progress and innovation, whilst also ensuring that supportive and comprehensive information on women’s health is readily available and accessible. This programme followed previous ALLIANCE engagement work in 2020 and 2021 to hear from women about their experiences of accessing services in Scotland to inform the Plan’s development^[3].

The ALLIANCE’s women’s health programme over the period 2021-2024 was divided into three main priority areas:

1. Creating opportunities for women and people with lived experience to share their experience and feed into the progress and implementation of the Women’s Health Plan and innovation in the field of women’s health.

This included the hosting of the Women’s Health Lived Experience Stakeholder Group. The Group brings together lived experience and third sector representatives from across Scotland. Meetings to date have provided opportunity to share experiences, to influence change, stay updated on the Women’s Health Plan, and learn about current priorities and innovation in women’s health in Scotland.

2. Signposting people to accessible resources and sharing trusted and engaging information on women’s health.

From 2021-2024 the ALLIANCE have held 28 webinars, learning sessions, workshops and community events, reaching over 1100 individuals and covering various subject matter from menopause and the workplace, to women’s heart health, to polycystic ovary syndrome. A number of video and print resources have been published to signpost people to further information, such as NHS Inform, and to showcase lived experience of specific conditions.

3. Promoting a positive culture of learning, support and confidence around women’s health experiences and conditions that challenges stigma and misinformation.

To support this objective the ALLIANCE produced a Conversation Café toolkit, recognising the value that peer support networks can bring to self-management, and helping people feel that they are not alone in their experience and/or condition.

Since its publication, the toolkit has been requested and used by a number of organisations, libraries and community groups to explore the topic of women’s health with their lived experience participants.

Detailed information about the ALLIANCE programme can be found separately in their own Women’s Health Programme Highlights Report. This includes quotes and testimonials from partners, lived experience stakeholders and women who have participated in the programme over the years.

Webinar – Prioritising Pelvic Health

On 2 September 2024 The ALLIANCE hosted a free online event to discuss female pelvic health, providing information and tips for managing pelvic health across the life course. The webinar featured Jenny Munro, Advanced Practice Physiotherapist (Continence), who explained the function of pelvic floor muscles, as well as outlining how to prevent, self manage or seek support for symptoms of bladder and bowel incontinence, and prolapse.

133 people attended the session on the day from various locations across Scotland including Glasgow, Edinburgh, Dumfries, Forth Valley, Ayrshire, Orkney, Inverness and the Black Isle. Participants were actively engaged in the session throughout using the chat and Q&A functions to ask questions, share experiences and offer peer support to those who may be experiencing symptoms.

‘Very warm and engaging presenter, I really enjoyed listening to her. She explained everything so clearly whilst also managing to make the issues feel less daunting.’

‘I liked the positive approach - it gave a sense that help/advice is there and any pelvic health issues can be improved.’

‘I gained a better understanding of what conditions the advanced physio would see. I would be more confident referring patients. I learned more about the anatomy of the pelvic floor.’

‘This was a brilliant webinar and I found it really informative.’

Action: Share examples of good practice to encourage primary care to consider different and more flexible options for provision of women’s health services to best meet the needs of their communities.

• A Women’s Health Plan Knowledge Hub (‘KHub’) has been created for stakeholders involved in the delivery and implementation of the Women’s Health Plan to share examples of best practice and facilitate discussions on improvements in women’s health, across all sectors.
• Examples of good practice and partnership working are regularly shared across the networks, including the National Menopause and Menstrual Health Networks where examples of innovative practice across primary and secondary care are regularly exchanged.

Group Consultation and Menopause – NHS Lanarkshire

A GP in NHS Lanarkshire noticed that women in her practice were repeatedly being seen through multiple GP appointments before their symptoms were being diagnosed as being related to the menopause. In response, over the last 18 months, this GP has facilitated 10 face-to-face menopause group consultation sessions at their practice for patients presenting with menopausal symptoms.

To invite women to take part in the group consultation, the practice sent a text message to all women registered to their practice aged 45 – 55 years old, which was 994 women on their practice list. Those interested in taking part could sign-up through an Eventbrite link, and a YouTube video was available that explained what to expect during the group consultation.

The face-to-face group consultations took place with a group of 12 – 15 women at the surgery in the evening. The consultation session, facilitated by the practice manager and the GP, provided women with information about the menopause, a discussion of individual symptoms and treatment options, along with a wider discussion on other aspects of women’s health. Following the session, patient notes were written up by the GP and any prescriptions or additional GP appointments were arranged as required.

Feedback from patients has been very positive with women reporting greater confidence in managing menopause and increased patient satisfaction on access to a healthcare professional following the group consultation. The GP running the sessions has also described greater job satisfaction from implementing and delivering these menopause group consultations for her patients.

Action: Promote the use of video or telephone consultation where appropriate to support access to services for women, particularly those who may otherwise be required to travel long distances or who may have difficulty travelling to appointments.

An engagement exercise was completed by the Near Me team to understand the value of video consultations in the diagnosis, treatment and management of endometriosis. Findings from the engagement highlighted a range of benefits of video consultations for endometriosis, including for:

• patients experiencing pain given that they do not need to leave their home;
• patients living in rural and island areas;
• patients who work, reducing the time they need to take off work;
• post-op and follow-up appointments, where physical examinations are not required;
• pre-op appointments, where physical examinations are not required;
• helping to make a holistic assessment of the patient, which cannot be done as easily over telephone;
• seeing a patient with their local clinician; and
• enabling women to avoid triggers which could exacerbate their symptoms, for example, sharing waiting areas with those accessing ante-natal care when they may be experiencing fertility challenges.

Near Me and Endometriosis: An Engagement Exercise*

*Key points from women with lived experience of stage IV Endometriosis and Clinicians from Specialist Endometriosis Centres. More detail is available in the first WHP report published here.

Findings from the engagement activities have informed the direction of the Near Me programme, including how services are supported to implement Near Me for their patients. Activity around this action has now been incorporated into ‘business as usual’ promotion and comms plans.

Medium Term Actions

Action: Establish a Women’s Health Champion and a Women’s Health Lead in every NHS Board to drive change and share best practice and innovation.

• The Women’s Health Champion, Professor Anna Glasier, was appointed in January 2023.
• There is a Women’s Health Lead in every NHS Board. The Leads meet on a quarterly basis through the ‘Women’s Health Leads Network’, chaired by Professor Glasier.

Women’s Health Champion Lunchtime Seminars

Scotland’s Women’s Health Champion Professor Anna Glasier has created a space for learning and professional development for those working in women’s health across Scotland through the creation of her series of ‘Lunchtime Seminars’.

Researchers, clinicians and world-renowned experts are invited to present on a range of women’s health topics with the intention of sharing knowledge, supporting learning and inspiring change. Sessions have covered;

A public approach to women, contraception and abortion with Dr Rosie McNee, Empowering Women to Manage Menopause with Professor Martha Hickey and the SACHA (Shaping Abortion for Change) Study with Professor Kaye Wellings.

There will be a fourth seminar towards the end of the year on the subject of cervical screening.

Action: Promote use of Relationships, Sexual Health and Parenthood (RSHP) resources to teachers and parents as part of the school curriculum and to support workers to ensure young people who are non-attenders or not in mainstream education have access to resources.

All children and young people have a right to learn about their growing bodies, relationships, sexuality, sexual health and parenthood in ways that are appropriate to their age and stage of development.

Evidence^[4] has consistently shown that children and young people who are taught about these issues are more likely to delay the onset of sexual activity and experience positive outcomes when they do enter into sexual relationships. That is why RSHP education is an integral part of the health and wellbeing area of the Scottish curriculum. In addition to existing mechanisms to promote the use of RSHP resources as widely as possible, specific areas of work have contributed to heightened knowledge of existing RSHP resources.

Specific work to promote RSHP resources has been undertaken, including:

Public consultation on revised statutory RSHP teaching guidance published, which includes links to RSHP teaching resources. Over 4,000 responses have been analysed ahead of the drafting of a report on the outcome of the consultation.

Finalisation of the revised teaching guidance following the public consultation ahead of publication in 2025.

A partnership of health boards has managed a project comprising a series of conversations with parents and carers about where, what, when, why and how children and young people learn about RSHP education and to find out how they support learning at home. This included a survey to parents and carers. A report on the outcomes of this project will be published soon.

Maintenance and promotion of the summary of RSHP resources on the Education Scotland website^[5].

Action: Improve collection and use of data, including qualitative evidence of women’s lived experiences, ensuring disaggregation by protected characteristics. Robust intersectional analysis of this data should be used to inform service design and improve healthcare services and women’s care and experience.

The Women’s Health Plan acknowledges the lack of data on the health of women, and how this is exacerbating the health inequalities that women and girls face, “simply put, we know less about how best to treat diseases in women [and girls]^[6]”.

Data Development: Routine Data

Over the course of the last three years, work has been ongoing to map the data on women’s health we have – and what is missing.

We have published a ‘Review of the Data Landscape’ that sets out some of the routinely published data on women’s health currently available in Scotland and highlights key gaps. That review has been published alongside this report.

The Care and Wellbeing Dashboard, which provides access to the latest data on population health outcomes and the wider determinants of health in Scotland, will also include breakdowns by sex where this data is available.

Questions on menopause have been added to the Scottish Health Survey.

Policy in Practice: NHS Grampian - Using data to understand provision of LARC

In this case study, colleagues from NHS Grampian set out how they have been making use of local data to increase access to LARC.

“Primary care colleagues in NHS Grampian have always been engaged in providing a high standard of contraceptive care, however the pandemic brought lots of challenges in delivery of contraception, particularly LARC. NHS Grampian Sexual Health Service has remobilised post covid-19 to accommodate additional LARC delivery however demand continues to outweigh capacity. As a result, NHS Grampian has taken a proactive approach to try to understand our LARC provision across the region, using available data.

LARC Data and Survey: NHS Grampian Pharmacy colleagues are working with a Public Health Researcher to look at all methods of prescribing, to have a full picture and trends overtime, with LARC prescribing prioritised. The LARC data for each GP practice will be benchmarked against NHS Grampian’s average and shared alongside a training needs survey. This survey aims to identify training and education gaps regarding LARC provision to increase accessibility. The individual practice data will also be available in a dashboard tableau, in due course.

We will be providing each GP practice with their data to encourage increased uptake - this will also include data regarding increased abortion rates in Grampian and subsequent demand on sexual health services.

A further survey for GP colleagues is being developed by Sexual Health which will also explore more generalised barriers to uptake and LARC provision. Through the survey, we will have a clearer idea about how we can support GPs to deliver more LARC in line with the HIS Standards of Care.

Post-natal contraception: NHS Grampian is also currently reviewing local data on the proportion of women having conversations with midwives throughout their pregnancy on their postnatal intentions for contraception. In addition, the method of LARC each woman takes up when discharged home/to health visitor is also being captured.

Holistic Care: All individuals of a reproductive age within NHS Grampian presenting for treatment/investigation under gynaecology services in both the inpatient and outpatient setting are offered a selection of LARC provision during their consultation.”

Data Development: Women’s Lived Experience

• Evidence and input of women’s lived experience is an ongoing part of the delivery of the Women’s Health Plan, with the ALLIANCE leading the lived experience programme.
• Women’s Lived Experience of their health and use of healthcare services was also articulated through the report on ‘experiences of discrimination and the impact on health’. You can find more information on that report here.

Young Women’s Lived Experience

The Status of Young Women in Scotland: Experiences of Accessing Healthcare.

“Being listened to, heard, believed and validated, were by far the most important features of a positive healthcare experience. Young women appreciated practitioners who showed empathy and genuine care”.

The Young Women’s Movement is Scotland’s national organisation for young women’s feminist leadership and collective action against gender inequality. Since 2016, the Status of Young Women in Scotland (SYWS) has investigated critical issues affecting young women in Scotland. SYWS 22-23 focused on young women’s experiences of accessing healthcare in Scotland. The research was conducted in collaboration with a working group which comprised of young people, healthcare professionals, and experts from across the third-sector.

This research collected a wide range of findings on issues across the access to healthcare journey, including;

• The highest proportion of young women (40%) rated their experiences as “okay”. Under a third (30%) of young women said their experience of healthcare was mostly good. Just under a fifth (17%) rated their experiences as mostly bad and a further 8% rated it as mostly awful.
• Young women struggled to access the healthcare they needed and deserved.
• Young women are not taken seriously in healthcare settings, they are often dismissed, and their experiences are minimised. Young women were then often left with no further offer of support or follow-up.
• They want to be heard, seen, listened to and validated. They want healthcare professionals to take them seriously.
• Improving training for medical professionals is essential, especially relating to sexual and menstrual health, also surrounding how conditions present differently in young women.

Long Term Actions

Action: Adopt a life course approach in all services to improve women’s health holistically.

Studies have shown that women do not always receive equal healthcare to men and that outcomes for women are poorer. The conditions in which women and girls live significantly impacts overall health and women’s ability to access healthcare services.

Services are not often developed with the needs of women in mind, and in particular those women who – for numerous reasons – may not have confidence in health practitioners where a relationship of trust has not been established.

The delivery of the actions throughout this and subsequent phases of the Women’s Health Plan will work toward achieving this long-term outcome.

Action: Provide and promote a Women’s Health Pharmacy Service.

NHS Pharmacy First Scotland provides advice, treatment and referral, if necessary, for a number of women’s health issues, for example cystitis, period pain and thrush as well as providing antibiotics for specific common clinical conditions such as uncomplicated UTIs in women.

In addition, women can access free emergency hormonal contraception (EHC) from the pharmacist. A three-month supply of progesterone only contraception (POP) is also available free of charge from community pharmacies. Known as ‘bridging contraception’ this supply is available for any women who might need it until they can access a longer-term supply of the contraception they would like. This is usually walk-in without the need for an appointment or blood pressure check.

A Women’s Health Pharmacy Awareness Campaign on NHS Inform was launched in August 2024 to highlight the healthcare advice and support that community pharmacy teams can offer to women and girls and raise awareness of the services in place.

We are working with stakeholders to further promote Community Pharmacy women’s health services with women and girls, including the University of Edinburgh who have highlighted the service through their ‘Advice Place’.

Policy in Practice: NHS Greater Glasgow and Clyde Pilot of Oral Contraception though Community Pharmacy

Scottish Government funding has been provided to NHS Greater Glasgow and Clyde to develop a pilot project that will deliver oral contraception (OC) through the community pharmacy network. Once up and running, the service will be open to all female patients aged 13 to 50 whose chosen contraceptive is OC. The service will offer a wide range of OC that can be prescribed and will provide both the progesterone only pill or combined oral contraception. Existing patients will be able to obtain a 12-month supply and new patients will have access once an assessment is made.

Currently four GP practices and five pharmacies have signed up to the pilot in Bishopbriggs, with supplies starting in September 2024.

Action: Establish a Women’s Health Research Fund with the aim of closing gaps in scientific and medical knowledge in women’s health for both sex-specific and non sex-specific conditions.

Due to current financial constraints, it is has not been possible to establish a Women’s Health Research Fund during this phase of the Woman’s Health Plan. As a long term action, this work will continue into subsequent phases.

However, the Scottish Government continues to recognise the importance of funding in this area, and has funded the following women’s health research;

• The Scottish Government collaborated with Wellbeing of Women on a £250,000 research call in 2022, to commission Scottish research on endometriosis.

In addition to this, the Scottish Government, through the Chief Scientist Office, has invested in a wide range of women’s health related research, providing funding for grants and fellowships. For example:

• In January 2023 the Chief Scientist Office announced funding of £299,509 for the 30 month ENDOCAN project, led by researchers at The University of Edinburgh.
• £299,970 was awarded to researchers at the University of Aberdeen for their ‘FEEL GOOD’ feasibility and pilot study, a comparison of vaginal mechanical devices and pelvic floor muscle training (PFMT) versus PFMT only for female stress urinary incontinence.
• £299,786 was awarded to researchers at the University of Edinburgh to conduct an exploratory study looking into protection of vulnerable women against HPV infection and cervical cancer. This study aims to understand how health services can be best designed to reduce the risk of cervical cancer among vulnerable women in Scotland. Women experiencing homelessness, transactional sex, substance misuse and in custody/prison are at greater risk of developing cervical cancer, but are less likely to engage in and therefore benefit from the HPV immunisation and cervical cancer screening programmes, both of which substantially reduce risk.
• £296,114 was awarded to researchers at the University of Aberdeen to research prevention and early detection of breast cancer in high-risk premenopausal population, including working to develop a prospective clinical trial to inform the development of better breast cancer screening for young women at high risk of breast cancer.
• A full list of CSO funded women’s health research projects is available in Appendix A.

Research collaborations to improve cardiovascular health in women

On 2^nd September 2024 Professor Anna Glasier, Women’s Health Champion and Professor Andrew Horne hosted the first in a workshop series looking at how to stimulate research collaborations and improve cardiovascular health in women.

A range of speakers highlighted the numerous areas where more research and cross specialty collaboration on women’s risks of CVD could lead to life saving interventions. A follow-up meeting will take place in November.

Action: Develop a programme to ensure that cultural competence, gender competence, trauma informed practice and human rights is embedded as a core component within all clinical education, training and Continuing Professional Development (CPD).

Activity on this action has not yet formally commenced. As a long-term action, it will continue beyond the lifetime of this phase of the Women’s Health Plan.