Clare Higgins
Head of Sales Marketing, VUIT.OnlinePopulation health data platform VUIT has conducted a study of the key challenges in women’s healthcare pathways.
The COVID-19 pandemic has had a significant impact on women’s health in England and, like many of the measures taken during lockdown, this is an impact we will be feeling for some years to come.
VUIT has conducted our own study of the data and, in this article, has set out some of the key challenges that exist in women specific pathways.
Early diagnosis and screening
We will start with early diagnosis and screening:
Fig. 1: 25-49-year-old women receiving cervical screening in the last 3.5 years
As you can see in Fig.1, the national picture through the pandemic to 2022 shows a very concerning picture for 25-49-year-old women, where the current level of screening is 70.4% compared to 72.5% at the start of the pandemic. Whilst this is only 2.1%, it is 2.1% of a very large population group, 10.3-10.5 million dependent on data source, meaning that approximately 216,000 women are late receiving or have not received a test.
Due to delayed cancer screenings, or worse, the risk that many women have missed out on critical cancer screenings altogether, means delayed diagnosis and treatment. This will directly affect their longer-term outcomes and, in some circumstances, life expectancy.
‘Missing’ referrals
Next up is the number of ‘missing’ referrals:
This next issue, in part driven by the first, is the “ghost” waiting list.
These are the people who were not referred to acute pathways during the pandemic and, therefore, are not showing on the current waiting list. Vuit analysis shows that, compared to the average referral rates pre-COVID19 there was a huge, but expected, drop off in referrals. However, with referral rates still stubbornly under historic levels, this deficit has never been recovered. It is reasonable to assume that a number of these patients presented as an emergency and so did not flow through the elective process. Nevertheless, this is a concerning picture.
This calculated figure of missing referrals is 165,360 women across England.
Fig. 2: Gynaecology Admissions pre– and post-COVID– 19
Acute waiting lists
Now we move on to the actual waiting list in acute Hospitals.
Whilst all specialities have, to some extent, suffered from increased waiting lists, the change in the size of the elective waiting list for gynaecology far outstrips all the others, standing at nearly double the pre-pandemic level.
Fig. 3: % Change in the size of the elective waiting list in England from December 2019 to December 2022 by gynaecology.
However, this is not the only story here, as we can now look at the number of women on the waiting list for gynaecology that have not yet had a ‘decision to admit’. This effectively means they are waiting for an appointment to find out if they can be safely discharged or if they require a procedure in the hospital. Whilst this is not an appointment, anybody would realise it is far better than living with uncertainty, and potentially deteriorating health, whilst you wait in turn.
Fig. 4: NHS Trust Scatter Plot of current proportion of the waiting list without a decision to admit vs. median weeks taken for decision to admit being made for gynaecology service. Newcastle Upon Tyne Hospitals NHS Foundation Trust highlighted.
As seen in Fig.4, Vuit analysis shows that, on average, 85% of patients referred to gynaecology in England wait 8.5 weeks for this decision to be made. In the most challenged Trusts, this number goes up to approximately 90% waiting over 35 weeks (and up to 42 weeks) for a decision.
Cancer services
Lastly is the picture relating to cancer services:
Again, we can see here that women’s pathways have been impacted more adversely than other non-gender-specific pathways. The orange lines on the graphs in Figs 5, 6 and 7 highlights the difference between both the 2-week wait and 31-days to wait for a decision to treat. If there is some positive message here, it is that this ground is made up at the treatment stage, with 74% of women on the breast cancer pathway being treated within 62 days. Unfortunately, all of these differences sit in the context of a continuing decline in overall performance over time.
Fig 5. Percentage of patients meeting two-week wait target for first breast cancer assessment.
Fig. 6 Percentage of patients meeting 31 days first treatment standard for breast cancer.
Fig 7. Percentage of patients meeting 62-day referral to treatment for breast cancer.
Final thought
The COVID-19 pandemic has had a significant impact on women’s health in England. It has led to disruptions in access to essential healthcare services and delayed cancer screenings. Whilst there is pressure on services everywhere, there are questions to ask around equity of service for women in some of the most life-limiting pathways.
It is crucial to address these issues and ensure that women have access to the care they need to maintain their health and well-being. We need to listen to the data.
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