Photo by Yuri Arcurs/Adobe Stock
Women’s1 sexual and reproductive health needs vary throughout their lives, from the start of puberty to pregnancy and birth, menopause and beyond. Many organisations and professionals are involved, including GP services, gynaecology, maternity and community sexual health services. Women often have to attend more than one service to get the care they need. Services are not always joined up, and it can be difficult to access care. For example - smear tests and coil fitting may happen in different places and are paid for by different organisations. Funding cuts, Covid-19 and shortages of trained staff have also affected women’s health services. For women in disadvantaged groups, it can be even harder to access care and address health needs.
Local teams across the UK have responded by setting up ‘Women’s Health Hubs’.2 Hubs bring the different services together to work more closely in a local area and provide women’s health services in the community. Sometimes this can be in one place (e.g., a health centre) but often it involves clinics and care in a range of locations. Hubs are a new idea, often developed by local doctors, and most women in the UK do not yet have a hub in their local area. There are currently a number of hubs across the UK, and they are all different, with a different mix of services and staff. Services might include coil fitting, menopause care and treatment for heavy menstrual bleeding.
There is a lack of research on Women’s Health Hubs, and we do not know exactly where, why and how they have been set up, or how hubs are working for women and staff. This is what we set out to address in our evaluation.
The aim of this evaluation was to explore the ‘current state of the art’ of WHHs, mapping the landscape, studying experiences of delivering and using hub services, and defining key features and early markers of success to inform policy and practice. This was a mixed-methods evaluation, combining quantitative and qualitative data collection, with data collected at local, regional and national levels.
The evaluation was comprised of three work packages:
This involved building a database and map of all of the known Women’s Health Hubs in the UK. To do this they surveyed people leading the hubs, and interviewed other key people involved in hubs across the country. We developed a working 'typology', sorting different types of hubs into categories.
Four hub sites were chosen to take part in in-depth research. In these four areas, the research team interviewed a range of people including GPs, nurses, sexual and reproductive health consultants, gynaecologists, local senior leaders and women using hub services. The team also held group discussions with women (one in each hub area). The discussion groups were in a local community group in an area or community where uptake of the service is low. In addition, the team also reviewed key documents linked to the hubs, such as business plans and any patient feedback they have collected.
The team brought together the findings from parts one and two of the study to produce evidence and provide recommendations for policy, practice and future research in this area. This included identifying outcomes which are/could be used to understand the impact of Women’s Health Hubs on women’s health.
Most areas of the United Kingdom did not have a Women’s Health Hub. Seventeen active services were identified, established between 2001 and 2022. Women’s Health Hubs were diverse, predominantly GP-led, with different perspectives of the role and definition of a hub. Existing Women’s Health Hub models were providing integrated approaches to meet local needs. Many were at an early stage of development, and evidence of system-level impact and cost was still emerging.
Women using hubs reported positive experiences, finding services caring and convenient. Implementation facilitators included committed, collaborative leaders working across boundaries, sufficient workforce capacity and a supportive policy context. Challenges included access to funding, facilities and equipment, stakeholder engagement and wider system integration, priorities and pressures. Leaders were committed to addressing inequalities, but evidence of impact was still emerging.
There were a number of limitations. It was challenging to locate models; therefore, some may have been missed. Data availability limited assessment of impact, including inequalities. Some population groups were not represented in the data, and the evaluation was more provider-oriented than service user oriented. It was not possible to develop a typology of Women’s Health Hubs as planned due to heterogeneity in models.
A number of recommendations were produced from the findings, covering the following areas: implementing at pace and scale nationally, embedding Women's Health Hubs in local health systems, ensuring a woman-centred approach, and recommendations for further research.
Women’s Health Hubs may widen inequalities if models are more accessible to advantaged groups. The important role of committed leaders in existing 'bottom-up' models may limit scalability and sustainability. Findings suggest that national scale-up will take time and requires funding, and that any scale up efforts need to consider the importance of ensuring a good fit between a hub model and local needs and resources. In 2023, the Department of Health and Social Care announced funding to establish a Women’s Health Hub in every Integrated Care System in England.
Since the Birmingham, RAND and Cambridge Evaluation (BRACE) Centre team conducted their research, some of the recommendations outlined in the report have already been progressed in the national implementation of Women’s Health Hubs. There has been agreement on the definition of what a Women's Health Hub is to ensure clear communication. There is also now a standardised core specification for all Hubs which can be balanced with specific local needs. Progress has also been made in developing national guidance to help overcome commissioning barriers, though this has yet to be published.
1 While we refer to women throughout, we recognise that Women’s Health Hubs may also serve people who are transgender, non-binary, with variations in sex characteristics (VSC) or who are intersex. Our evaluation considered the needs of all people who are in need of services provided by hubs and was not limited to cisgender women.
2 Women’s Health Hubs are understood differently by stakeholders – there is no single, agreed meaning and they are not necessarily a physical location but a ‘concept’. We explored the diversity in language as part of our evaluation.
Jennifer Bousfield
Lucy Hocking, Breast Cancer Now
