The first priority of Menopause UK is better quality treatment and better access to care. We know services need to be better. Measuring the care that is currently provided is an essential first step towards improving it.
When we set out to make a map in a month, we knew we were being optimistic. It seemed incredible that there is currently no comprehensive picture of menopause services nationally. And guess what? There still isn’t.
Still, we’ve taken the first step towards creating one. We started with the clinics listed by Menopause Matters, and supplemented that through calls for information throughout July and August. It’s not an encouraging picture. The ratio across the UK as a whole is approximately one specialist NHS clinic to every third of a million women of menopausal or post menopausal age. There seem to be huge variations in provision: Scotland looks relatively well served with each of its nine specialist clinics serving less than 100,000 women. At the other end of the scale, we could only find two specialist NHS clinics in the North of England, a ratio of 1: 1,250,000.
So we now have a picture, of sorts. But there’s still a lot we don’t know. The map doesn’t include menopause clinics in primary care, which remains uncharted territory. It doesn’t say anything about the quality of care, or women’s satisfaction with services. And it doesn’t measure service volume.
The map also doesn’t include the service provided by practitioners who are known locally by their colleagues to have a special interest in menopause. One of the reasons why local menopause clinics in primary and community care have proved hard to track down is that the majority aren’t formally commissioned. One even asked us not to put their service on the map, because if their bosses found out they’d ‘probably be told to stop’. We salute anyone who is using their initiative to provide women with the care they need, but surely no-one’s interests are being served in the long run by a situation where dedicated practitioners feel they have to engage in guerrilla health care?
Given all these acknowledged shortcomings, we wanted to improve our map. It seemed only right to give the NHS the chance to check over the information before we published it. And here we hit a brick wall. Menopause isn’t covered by NHS England’s specialist commissioning remit. As a new network with no paid staff, we found ourselves faced with 211 CCGs and 151 health and wellbeing boards in England alone – a difficulty highlighted by Regional Voices in their recent paper on Voluntary and Community Sector and Localised Health Commissioning.
Still keen to engage with the NHS, we looked around for some national leads on menopause care. Or some regional ones. We’re still looking, and if you think it might be you, we’d love to hear from you.
Making this map has got us thinking about why it’s so easy for menopause to get missed when local services are being planned.
- Firstly, menopause is still not understood to be a significant health issue, affecting women’s quality of life, employment, and long term health. Hopefully the NICE guidelines on menopause, expected in 2015, will go a long way towards making the case for properly planned menopause care.
- There is no real consensus about what appropriate, value for money menopause services look like. There are no nationally defined care pathways, and no model service specification for local services to refer to. Individual staff have a mountain to climb if they want to set up a local service. And women wanting specialist help currently have to find out for themselves where that help is provided and by whom.
- Care might be given in a number of different settings, by professionals from a variety of specialities (gynaecology, endocrinology, sexual and reproductive health), or not at all. Nobody is keeping track.
- Menopause care doesn’t fall under specialised commissioning arrangements. Where it is recognised locally, there is no consistency about where it sits. Does it belong with women and children? Sexual and reproductive health? This contributes to a lack of transparency. Instead of being part of the conversation when services are being planned, practitioners and service users are left out of the picture.
The number of women receiving care from the 29 specialist clinics on our map are a fraction of the women currently looking for help.
We’re not giving up. We’ve just started creating an online forum for people involved in providing and planning menopause services. The first focus of discussion is about commissioning. If you’d like to know more, do get in touch.