c. Local Women’s Health Champions and the Women’s Health Ambassador/National Clinical Director for Women’s Health should maintain national oversight of commissioning decisions to ensure the needs of women are met throughout the life course. d. Merging NHSE and DHSC also brings an opportunity to bring together and merge the expertise of the women’s health and reproductive health policy teams which currently sit separately. This will help to enable joined-up policy around the holistic needs of women across the life course. e. Moving NHSE into the DHSC also brings an opportunity to bring together and merge the expertise of the women’s health and reproductive health teams which currently sit separately. This will help to enable joined-up policy around the holistic needs of women across the life course. At a minimum, providers of PPC are desperate for the Government to make clear the responsibility for PPC in the maternity pathway to avoid PPC continuing to be seen as a luxury by too many and causing the entrenchment of health inequalities. The Impact of Commissioning Arrangements on Funding Contributors were also in strong consensus that PPC commissioning structures across England resulted in highly unsustainable funding arrangements, and this presents an immense obstacle to delivering the service for women in their local area. With no detail or clear accountability as to who is responsible for the commissioning of maternity contraception, funding, sustainability and staff training cost remain unclear and variable by area: “[PPC] doesn’t actually sit anywhere in terms of commissioning responsibility, so you’re often working with willing leads in areas, forging your own local direction and clarity around who should pay for what. This undoubtedly leads to variable offers at local Vast amounts of time and resource is spent by healthcare professionals organising, negotiating and securing funds for this service across multiple funding pots – an avoidable waste of clinical time in a pressurised health system. For example, in Portsmouth the PPC service is funded by various existing services: • Maternity covers the cost of POP and injectable training and provision level. Consistency is key.” James Woolgar, Chair of the EHSHCG • Obstetrics fit IUCDs at C-section within their provision of care • Public health covers the cost of the IUCDs and condoms in maternity settings • Public health fund the integrated sexual health service who provide the follow up of IUCDs at elective c-section following 4 weeks post fit
For example, in Hertfordshire: “This lack of clarity and the absence of collaborative commissioning creates inconsistencies in delivery and inequities in provision between Trusts in different areas of the country.” Local authorities responding to the English HIV and Sexual Health Commissioners’ Group survey on PPC echoed this challenge when asked about the obstacles for providing PPC: “Lack of clarity over whose responsibility it is in a very difficult funding climate.” “Lack of national guidance about commissioning responsibilities.” “The commissioning responsibilities for maternity and contraception being separate doesn’t help.” The Government’s 10 Year Health Plan rightly acknowledges the particular challenges women face in navigating the health system and the ongoing fragmentation of women’s health services. Indeed, the current system does little to support the reality of women’s lives, leaving them to try to manage their reproductive and post-reproductive health across siloed, disjointed services. The Government’s stated intention to increase integration, collaboration, and clarity across the NHS presents an opportunity to fix the fragmented commissioning structures surrounding women’s health and contraception, while empowering ICBs to plan and deliver the services women need across the life course, including PPC. What is Needed to Deliver Better PPC? The View of Local Authorities “More clearly defined commissioning responsibility with clear funding and accountability to support.” “First, national policy and commissioning structures must evolve to reflect the reality that contraception is a core component of postnatal care.” “Promote consistent commissioning guidance nationally: standardise expectations across Integrated Care Boards to avoid regional variation.” With the merging of NHSE and the DHSC and the Government’s welcome stated focus on integration, accountability and clarity in the health system, comes an ideal opportunity to fix the fragmented commissioning structure around women’s health and contraception: a. The DHSC should ensure that each ICB has a named individual who is formally accountable for the joined-up commissioning of contraception and women’s health services, including post-pregnancy contraception, always in collaboration with local authority partners. This role should carry clear responsibility and authority to coordinate service delivery. This accountability is essential to empower ICBs to plan and deliver the services women need. b. The DHSC should support and promote best practice of co-commissioning of PPC services, for example, creating a national forum to share examples amongst ICBs.
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