Women and Girls Health – What we already know


The article below sets out a snapshot of the current position in Scotland on the topic of Women and Girls, and Health, and also includes a ‘state of the nation’ prepared by the government’s analytical department.

 

National Screening Programmes

Within the National Screening Programmes there are a number of screening programmes which are aimed exclusively at women including Breast, Cervical and Pregnancy Screening.

Under our £100 million Cancer strategy we are investing up to £5m in our national screening programmes to reduce inequalities in access to screening.

This includes supporting the work of charities like Jo’s Cervical Cancer Trust to increase awareness and address some of the barriers to participation and funding their innovative new outreach service targeting women less likely to attend, as well as their first ever Scottish roadshow.

We are also supporting an innovative breast cancer risk reduction trial which aims to reduce women’s risk of developing breast cancer by working with them to help them make lasting changes focused around physical activity, diet and weight.

We are continuing to raise awareness via our hard-hitting cervical screening awareness ‘flower’ campaign across digital platforms.

In addition, the Detect Cancer Early programme has supported activity across breast, lung and bowel cancers, as well as the recently launched Survivor campaign that aims to highlight that more people are surviving cancer and early detection plays a big part.

In terms of pregnancy screening, we are committed to ensuring that pregnant women in Scotland have access to high quality, safe and effective screening services and accept the recommendations made by the UK National Screening Committee and the Scottish Screening Committee to introduce an evaluative rollout of Non-invasive Prenatal Testing (NIPT).

NIPT is more accurate than the current primary tests. A negative NIPT result will offer pregnant women the information they need, without the need for a further invasive diagnostic test – reducing the unnecessary harm from miscarriage that can be caused through these tests.

We also acknowledge the need to work closely with organisations like Downs Syndrome Scotland, who support people with Downs Syndrome to live full, active and rewarding lives and to ensure that pregnant women and their partners have full and balanced information.

 

Endometriosis

Specialist Endometriosis Centres

A working group set up by the Chief Medical Officer concluded that Scotland would benefit from three specialist endometriosis centres, to fully meet the needs of patients across Scotland.  Two of these specialist endometriosis centres are in operation in Aberdeen and Edinburgh, providing multidisciplinary, high quality and person centred treatment for the management of all grades of endometriosis. They also have an important role in raising awareness.

Edinburgh

The Specialist centre in Edinburgh is based at the Centre for Reproductive Health (MRC) at the University of Edinburgh and the Royal Infirmary of Edinburgh (NHS Lothian).

The Centre in Edinburgh has an excellent working relationship with Endometriosis UK. Together, they’ve sign-posted links to a wide variety of organisations that offer additional support.

Aberdeen

Aberdeen Royal Infirmary hosts a British Society for Gynaecological Endoscopy (BSGE) accredited centre for north of Scotland patients.

Development of the West of Scotland (WoS) Centre

Planning continues for implementation from April 2019. An agreed clinical pathway has been agreed. Patients will undergo pre-operative investigations and post-operative follow up with their home Health Board.

The specialist centres treat all endometriosis patients.  For accreditation purposes, a specialist centre must undertake at least 12 pararectal dissection surgical cases each year. The West of Scotland centre has clarified it will be able to accommodate 24.

This complex specialist surgery is in addition to the surgery for endometriosis performed on a daily basis by general gynaecologists.

Scottish Access Collaborative (SAC)

Gynaecology is a specialty that is involved in the SAC. This brings together stakeholders to consider how to sustainably improve waiting times for non-emergency procedures in a range of specialty areas.

The gynaecology specialty group discussed the common gynaecological symptoms that women and girls present with, including pelvic pain, and then identified a number of improvement opportunities, while mapping key areas within the current gynaecology services.

A specialty report was published in December 2018. The Modern Outpatient Programme will take forward the outcomes. The gynaecology clinical community met on 27 February 2019 to consider the recommendations. These include:

    • improving access to information for patients to self-manage,
    • GPs to have easy access to nationally recommended guidelines and pathways
    • support for development of primary care cluster groups so that some primary care clinicians within regions can become specialised in aspects of Women’s Health.

 

Endometriosis UK

  • Endometriosis UK is the leading UK charity dedicated to providing information on endometriosis and support for those affected by this condition.
  • The Scottish Government has a positive relationship with the charity and they were actively involved in the CMO’ s short life working group in 2015.
  • As part of the work of the CMO’ s group in 2015, Endometriosis UK conducted a patient survey that found most women in the UK living with severe endometriosis want care to be provided by a BSGE accredited centre.
  • The Scottish Government has invited Endometriosis UK to apply for funding in 2019-20 to support a project that will raise the profile of the condition and/or improve the awareness of the condition amongst healthcare professionals.

Post-Partum Contraception

It is widely recognised that short inter-pregnancy intervals of less than 12 months are associated with an increased risk of obstetric and neonatal complications including preterm birth, stillbirth and neonatal death. The provision of post-partum contraception (PPC) has therefore been a policy priority for some time. It is set out in the Refreshed Maternity Framework (2011), the Sexual Health and Blood Borne Virus Framework Update (2015) and the Pregnancy and Parenthood in Young People Strategy (2016).

The provision of long acting reversible contraception (LARC) methods as part of PPC is particularly key, as these provide a high level of efficacy and do not require regular effort from the user. However, it is essential that women are always offered LARC as a choice within a range of methods (if any is desired) so that they remain in control of their own reproductive health.

The APPLES (Accessing Post-Partum LARC in Edinburgh South East) project looked at improving access to contraception for postpartum women, with particular emphasis on LARC methods. This is now being rolled out across NHS Lothian and the Scottish Government has provided funding for projects to improve access to PPC in NHS Greater Glasgow and Clyde, and NHS Ayshire and Arran.

The PPIUC (Post-Partum Intrauterine Contraception) Study is looking at implementing and evaluating PPIUC within Lothian maternity services (provision of intrauterine methods, the ‘copper’ coil and the mirena coil, immediately post caesarean section and vaginal delivery).

In response to your request below please find below some information regarding the National Screening Programmes that are specific to women.

The Scottish Government will continue to play its part in addressing the Health gender challenge, working with partners to effect change.

Further reading: Scottish Government Analytical Services – State the Nation