Women's Health Hubs

Introduction

Women’s sexual and reproductive health needs are complex and vary across the life course. These health needs are currently met by a range of providers, professionals and venues, including primary care (general practice), gynaecology, maternity, community sexual health services, and genitourinary medicine. Often, provision is not well-integrated, and there are inequalities in accessing services and in sexual and reproductive health outcomes.

Funding cuts, workforce issues and gaps in training provision, Covid-19 and fragmented commissioning between the NHS and local authorities are contributing to increasing challenges.

Local teams across the UK have responded by establishing Women’s Health Hubs to improve provision, experience and outcomes for their population, and to address inequalities, at the same time as seeking to use healthcare resources more efficiently.

Women’s Health Hubs are understood differently by stakeholders – there is no single, agreed definition and they are not necessarily a place, but a concept. Hubs function to meet the integrated needs of women’s reproductive healthcare by enabling women to be seen in the community by a practitioner with appropriate skills, usually within primary care although not necessarily within their own practice.

Though Women’s Health Hub models are new and emerging, they have been highlighted as good practice, with wider roll-out of hubs recommended. Women’s Health Hub models may also feature in the upcoming Women’s Health Strategy, expected in Early insights, e.g. from the Primary Care Women’s Health Forum suggest there are a range of service models and local contexts into which the approach has been introduced with a variety of services available e.g., the provision of long-acting reversible contraception and menopause management.

However, there is a paucity of research to date on these different hub models. Initial scoping work has identified gaps in knowledge including where, why and how Women’s Health Hubs have been set up and implemented, aims, and experiences of implementation and delivery, including those of service users. An evaluation of the current Women’s Health Hub landscape would bring together and generate evidence around what the models currently look like, insights from commissioning, implementation, delivery, successes and challenges, and potential improvements.

It is expected that this evaluation will be followed by a separately commissioned longer-term impact evaluation. Research design and methodology

To inform our study design, the research team undertook scoping work to better understand the current context and landscape of Women’s Health Hubs. This consisted of a rapid scan of relevant policy and evidence, interviews with 10 key informants, and establishing a Stakeholder Advisory Group with whom we held a workshop to share scoping findings and refine our study focus.

The scoping work included a brief exploration of which geographical areas are currently implementing Women’s Health Hubs, what the evaluation should prioritise, and how best to collect data. Aims

The overall aim of the early evaluation of Women’s Health Hubs is to explore the current ‘state of the art’, 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. Specifically, the study will evaluate why, where and how hubs have been implemented, why different approaches have been taken, if and how inequalities have been considered, and experiences of implementation, delivery and receiving services.

The evaluation will provide feedback about the successes and challenges of hubs and potential improvements, including different stakeholder group perspectives regarding what hubs are intended to achieve, and whether hubs are making progress towards this.

It will also gather preliminary evidence about what is known about performance, outcomes and costs and how they are/can be measured. Evaluation questions In order to address these aims, the study seeks to answer the following questions: 1. What are Women’s Health Hubs, and is there variation in how stakeholders name and define them?

2. How many Women’s Health Hubs have been established/are in development across the UK, where are they, and what are their characteristics, including models of structure, commissioning and delivery? 3. Why have Women’s Health Hubs been implemented, and how are they intended to address health inequalities?

4. What have Women’s Health Hubs achieved to date? How do Women’s Health Hubs achieve this?

5. What are the experiences and perspectives of staff regarding Women’s Health Hub setup, commissioning, funding, implementation and delivery? 6. What are the experiences and perspectives of women who have used hub services? 7. How are Women’s Health Hub performance, outcomes and costs measured, and how might they be measured in future?

Our evaluation comprises of three work packages:

Work package 1: Mapping the current landscape and context for Women’s Health Hubs. Work will include: consolidating evidence from the evaluation scoping phase (key informant interviews and published evidence), and gathering additional information to inform a database of UK Women’s Health Hubs, which will be refined throughout the evaluation; undertaking an online survey of leads from each UK Women’s Health Hub (e.g. lead commissioners, hub providers); conducting interviews with regional stakeholders (aiming to speak to one per NHS England and Improvement region), which may include, for example, ICS leads and Regional Directors for Public Health; and if possible, developing a working typology of hub models, to inform sampling of four exemplar hub sites to be included in in-depth research (Work Package 2).

Work package 2: In-depth work with four exemplar hub sites in England. The work will involve: selection of exemplar hub sites; set up and familiarisation with sites; qualitative interviews with staff working in or with hubs; qualitative interviews with service users; analysis of key documentation and refinement of the working typology of hub models.

Work package 3: Consolidating evidence and developing recommendations. One of the purposes of this rapid evaluation is to generate and share learning across the system to support local adaptation and equitable rollout of Women’s Health Hubs. Work Package 3 will bring together the findings from Work Packages 1 and 2 to generate evidence and provide recommendations for policy, practice and research.

The work to support this will include: interviews with 4-5 national stakeholders; production of a rich description and map of UK Women’s Health Hubs, including achievements, impact on inequalities, stakeholder experiences, and barriers/facilitators to implementation; identification of outcomes which are/could be used to assess impact; development of a theory of change (if possible) and development of recommendations for policy, practice and research.

We recognise that Women’s Health Hubs may also serve people who are transgender, non-binary, with variations in sex characteristics or who are intersex, and we will work to ensure that our evaluation is inclusive. Involving women

The scoping work undertaken to inform the study design included rapid consultation with three women with lived experience of NHS women’s health services (note not Women’s Health Hubs) who shared their views about the concept of Women’s Health Hubs and where the evaluation should focus.

We will also establish a Women’s Advisory Group to provide input throughout our evaluation and draw on their experiences to shape the evaluation and influence the wider women’s health sector. For example, the group will be asked to review relevant research tools and outputs, advise on effective ways to reach women to take part, including ethnic minorities, those who are disadvantaged and the seldom heard, and comment on emerging findings.

Outputs and dissemination We anticipate disseminating the findings in a number of ways, including: • A final report submitted to NIHR to be published in the NIHR Journals Library. • An interim output to share preliminary evaluation findings.

• A short summary report in digital format, supported by infographics, highlighting the overall findings of the rapid evaluation.

• A slide-pack summarising high-level findings for each of the four hub sites involved in the in-depth research. We will also offer each of our four sites the opportunity to attend a local workshop event to share and reflect on their findings. • Papers published in academic journals. • Presentations at conferences, , workshops and meetings.

• Sharing findings on social media platforms.

• Disseminating findings through BRACE networks, including to key bodies and stakeholders, e.g. the Royal College of Obstetricians and Gynaecologists, the Faculty of Sexual and Reproductive Healthcare, National Voices and the Primary Care Women’s Health Forum.

Throughout our dissemination activities, we will draw on the expertise and assistance of our partners, Stakeholder and Women’s Advisory Groups, the BRACE Health and Care panel and steering group members who are involved with the project and the BRACE Centre. Timescale The study will take place over 12 months from April 2022 - March 2023.