In 2021, the government called for input on the Women’s Health Strategy with the following key themes:
We fed into this consultation with experts by experience, front line workers, the service user engagement team as well as the systems change team.
In January 2022, the new Vision for the Women’s Health Strategy has been published and we are pleased to see a local Member of Parliament- MP Maria Caulfield, leading this initiative.
We now are keen to share our reflections on the recent Vision for the Women’s Health Strategy for England by publishing the letter we have sent to MP Maria Caulfield in response to the publication on the 7th March 2022. And we hope to get an opportunity to discuss this further.
Open letter from Fulfilling Lives South East to the ‘Women’s Health Strategy: Our Vision’ publication
Subject: Women’s Health Strategy: Our Vision
Kate Jones, Engagement and Co-production Worker
MichaelaRossmann, Systems Change Officer firstname.lastname@example.org
Rebecca Rieley, Systems Change Lead- email@example.com
Sue Westwood, Expert by Experience
Victoria Hensley, Engagement and Co-production Worker
Contact details: Rebecca Rieley & Michaela Rossmann, Fulfilling Lives South East – BHT Sussex,144 London Road, Brighton, Sussex, BN1 4PH
Dear Maria Caulfield,
We are a local charitable project who are keen to share our reflections on the recent Women’s Health Strategy and are pleased to see a local Member of Parliament leading this initiative.
- OVERVIEW OF FULFILLING LIVES SOUTH EAST PARTNERSHIP
The Fulfilling Lives South East (FLSE) Project started in 2014 and is funded until July 2022 by the National Lottery Community Fund, and operates in Brighton and Hove and East Sussex, as one of 12 projects across England.
We are funded to:
(a) provide intensive support for people experiencing multiple disadvantage,
(b) involve people with lived experience of multiple disadvantage at all levels and,
(c) challenge and change systems that negatively affect people facing multiple disadvantage.
We have highlighted six themes that have arisen from our work to date and within each theme we have further identified several Commitments for Change – changes that we believe will help improve support systems and services for people with multiple and complex needs.
One of our core themes of our Manifesto for Change is addressing Health Inequalities.
- MULTIPLE AND COMPLEX NEEDS (‘MCN’)
Multiple and complex needs (MCN) are persistent, problematic and interrelated health and social care needs which impact an individual’s life and their ability to function in society. They are likely to include; repeat street homelessness, mental, psychological and physical health problems, drug and/or alcohol dependency, and offending behaviour. People with MCN are more likely to experience violence and abuse, including domestic violence, live in poverty and have experienced trauma in childhood and throughout their lives.
- OUR RECOMMENDATIONS
How we are feeding into the Women’s Health Strategy- Consultation:
FLSE has fed into the open call for evidence for the Women’s Health Strategy as a collaboration between the Systems Change Team and the Service User Involvement team. Together, we have used case studies, experts by experience and data from our project to inform the below recommendations:
A) Women’s Voices:
FLSE would like to see the healthcare system change to a more inclusive, trauma informed and collaborative system, where women don’t feel stigmatised when seeing professionals. Ideally, specific women’s only spaces are created so that taboos (such as sex work) and re-traumatising experiences are minimised. We would also like to be given a choice of being seen by female professionals instead of male professionals.
Our experts by experience feel that being listened to by a professional is crucial, but there’s a difference between being listened to and actually being heard.
Women experiencing MCN feel underrepresented and sometimes ignored or belittled. There are currently lots of gaps and barriers when trying to provide a person-centred health service.
In contrast to the 96.9% of women who shared their own experience via the online consultation, our client group also faces digital exclusion and we feel that their voice has been left out.
We are happy to see the acknowledgement of stigma and taboo in the new Vision document but we strongly feel that trauma informed training needs to be rolled out across the healthcare system, not only in connection with Violence Against Women and Girls specific services/aspects of the healthcare system.
B) Healthcare Policies and Services:
Our clients and experts by experience would like to see a more flexible appointment system and walk-in clinics for women experiencing MCN. One of our experts points out that ‘GP surgeries should ditch using Covid as an excuse for failing of health services. We need a new approach and start again.’ The real issue for our clients is accessibility. This can’t be overlooked. If you can’t get through the GP’s door, then health outcomes won’t be improved.
We appreciate that ‘Ensuring equitable access to services and reducing disparities in health outcomes’ between women is now on the government’s radar and geographic disparity and women with disabilities are mentioned.
We are, however, concerned that women experiencing MCN, or multiple disadvantages, have not been named as a population category itself. It is often difficult for our clients to make appointments with GP surgeries by a certain time and day, which is exacerbated by feelings of not deserving help. In our experience, especially in Eastbourne since the closure of the walk-in clinic, it is extremely difficult to get through to GP surgeries, and if so, many of our experts by experience report difficulties ‘getting past’ receptionists who can appear to act as gatekeepers.
We welcome the life course approach of the vision document but feel that links between services are missing, especially when it comes to some of the potential links between the Mental Health Act, Mental Capacity Act, the VAWG Strategy and the Women’s Health strategy. We would like to see resource being directed to link us these strategies at a national level.
Our recently published mortality report shows that our clients experience on average at least 7 long-term health conditions which can lead to early deaths. We need policies that are fit for purpose and interconnected. We also call for a joined-up approach between support services within primary and secondary healthcare but also the third sector.
C) Information and Education
In our experience, women experiencing MCN are linked in with a variety of systems and services: the prison system, alcohol and substance misuse services, adult social care, domestic abuse and the physical and mental health services. The one commonality though is women are left feeling that these systems operate in isolation and information is not being shared.
This is two-fold:
- Information about the clients is not being shared across services effectively and our clients need to consistently repeat their stories which can be re-traumatising;
- Health information is not being shared between services and systems. Trusted relationships, such as key workers, might be outside of the clinical healthcare system but are crucial to provide support, information and education to clients.
We appreciate that there is an acknowledgement of education and training for healthcare professionals on specific physical and mental health issues being needed in the Vision, but we would also like to see training on trauma informed approached and a less siloed approach between physical and mental health as well as the wider NHS services, adult social care and the third sector.
D) Health in the workplace
FLSE has employed a total of 41 individuals with lived experience of MCN, through its employment programme. You can read our findings from the employees’ perspective here and the employers’ point of view here.
We would encourage greater attention on supporting the health and wellbeing of those with experiences of multiple and complex needs in the workplace and see this support as an enabling factor, helping people with lived experiences re-enter the workplace as well as supporting their health and wellbeing.
E) Research, evidence and data
Due to the high complexity of clients, we call for an open-ended, tailored and individualised approach. We believe that the healthcare system unfortunately is not always prepared to support women who experience multiple and complex needs or reach out and include them in research studies. FLSE would welcome a new, more collaborative and inclusive way of working to enhance the reach of research because historically women experiencing MCN have been under-represented in data and research.
Our project’s Research and Evaluation Officer has produced a toolkit to support researchers with practical advice and tips on applying the principles of trauma-informed practice to their research activities, specifically running focus groups, one-to-one interviews, and service observations. It is suitable for evaluators, researchers, service leads, commissioners, or anyone who would like to find out more about the experiences of people who may have been affected by trauma. This can be found here.
- OUR CONCLUSION AND BEST HOPES
In our experience, the key to providing better healthcare to women experiencing MCN is accessibility and flexibility. This is also supported by the King’s Fund ‘Interventions to tackle health inequalities need to reflect the complexity of how health inequalities are created and perpetuated, otherwise they could be ineffective or even counterproductive.’
FLSE is based in Brighton and East Sussex which means that our clients have worse health outcomes due to coastal inequalities, than in other areas as explained by Chief Medical Officer Prof.Chris Whitty’s annual report 2021.
Nonetheless, we hope that our contribution to the call for evidence for the Women’s Health Strategy will contribute to a better system for women experiencing multiple and complex needs.
That is why our best hopes for the Women’s Health Strategy are that:
- Multiple and complex needs is recognised as a population category in itself, alongside disabilities and minorities.
- There is recognition that some of the listed priorities (such as gynaecological health) can be traumatising or re-traumatising for women who have experienced certain forms of abuse and women experiencing/who have experienced MCN. As a result, high quality trauma informed training needs to be provided to all healthcare staff (incl.GP receptionists) and that the training includes the voices of lived experience.
- The different strategies (such as VAWG, Mental Health Act, Mental Capacity Act) are linked together and find a systemic way to collaborate more efficiently.
- The life course approach to include social determinants of health, as well as more joined up working, so that we move away from a focus on singular health issues, towards more joined up approaches to complex health conditions such as coexisting conditions mental ill health and substance use.
With kind regards,
The Fulfilling Lives South East team
Michaela Rossmann, Systems Change Officer
Rebecca Rieley, Systems Change Lead
For further information about Fulfilling Lives work in this area, please contact:
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[…] full Strategy will be published in spring 2022 but in the meantime, we have written a letter to Maria Caulfield MP to share our reflections and recommendations to improve the health of women with MCN for, […]
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