Women's Health Base

A look at women, the world and the web

Posts Tagged ‘nhs’

Nuvaring availability a ‘postcode lottery’

Posted by hannahflynn on February 12, 2010

Where you live can affect your access to a form of contraception, results from my survey of Primary Care Trusts (PCT) in England has shown.

The NuvaRing, which was approved by the National Institute for Health and Clinical Excellence (NICE) for use in January 2009, could be unavailable in nearly one third of PCTs in England.

These results were obtained by a survey of PCTs in England using Freedom of Information requests. The results shown in the Google map below are preliminary, as more responses are needed for a comprehensive overview of the situation.

The NuvaRing is a form of combined hormonal contraception which comes in the form of a vaginal ring. This is left in for three weeks, and then removed for a week to allow a withdrawal bleed (similar to the pill) before another ring is inserted.

It has become clear during this investigation that the NuvaRing is still being considered for inclusion on formularies in many areas. Some PCTs can give no time frame for when a decision will be made and many do not expect a decision to be made for many months.

The reasons given for this are varied. They include a lack of information regarding where funding will come from and very frequently, a lack of demand for the product. In the case of Trafford PCT, the drug has been clinically approved but ‘financial concerns have not been resolved’.

Cost concerns arise again, even where the NuvaRing is available. Nearby Manchester’s PCT warned, ‘We advocate principles of cost effectiveness and where applicable this may mean using the drug of the lowest acquisition cost.’

The NuvaRing costs, on average, £9 a month. This figure is ‘comparatively expensive’  compared to combined contraceptive pills, which vary in cost but average a couple of pounds a month. However, it is by no means the most expensive form of contraception a couple can opt for. The new ‘morning after pill’ or ‘Plan B’, Ellaone which was launched in the UK in October 2009 costs £16.95 per dose and costs three times as much as Levonorgestrel . Implanon, one of the LARCs being recommended costs the NHS £79.46 (correct April 2009) , which is cost effective if used for 3 years, but if removed sooner than a year can prove far less cost effective than the contraceptive pill. Though of course, these figures do not take into account the cost of a pregnancy, unintended or otherwise.

All contraception is available free of charge to patients in the UK on the NHS.

Since 2005 NICE has recommended that all women requiring contraception should be offered a choice of all methods of contraception by their GP, including long-acting reversible forms of contraception (LARCs). Last year in 2009, the NHS introduced three new sexual health indicators into their Quality and Outcome Framework (QOF), which is a voluntary annual reward and incentive programme for all GP surgeries in England. These included:

  • The percentage of women prescribed an oral or patch contraceptive method in the last year who have received information from the practice LARCs in the previous fifteen months and,
  • The percentage of women prescribed emergency hormonal contraception at least once in the year by the practice who have received information from the practice LARCs at the time of, or within one month of, the prescription.

Currently, the NuvaRing does not count as a LARC under NHS guidelines, but one of the benefits of use is that user error is lower; you only have to remember to change it once a month rather than take a pill every day.

In order to fulfill the NICE guidelines laid out in 2005, the NHS launched the ‘Contraception – Worth talking about’ campaign in November 2009. It was revealed in written answers to questions submitted to the Health Secretary Gillian Merron in January 2010  that estimated advertising expenditure ‘to date’ was £1,218,000 and estimated advertising costs for further activity planned for February 2010 is approximately £1,513,000. Budgets for 2010-11 and 2011-12 are currently under review.

Although some PCTs cite a lack of demand for the NuvaRing (for example in Redbridge and South Staffordshire PCTs no application had been made for the NuvaRing), South and Eastern Kent PCT reports 60 being prescribed in the last financial year.

One further problem associated with the NuvaRing is that it requires storage in a fridge. Some PCTs claim they do not have storage available for the product.

While some PCTs have banned the prescription of the NuvaRing by coding it RED or RED RED on their formularies, other PCTs have made it available to women who are unsuitable candidates for other available forms of contraception. Surrey PCT resported, in response to the FOI request submitted that, ‘The Medicine Management sub–committee (May 2009) agreed that Nuvaring® may be of benefit in a small number of patients and therefore should be available to patients in family planning clinics where other treatments are not suitable.’

I await further information to add to this investigation.

* You can become part of this investigation here.


Posted in Women's Health | Tagged: , , , , , | 1 Comment »

Stonewall poster campaign highlights lesbian health issues

Posted by hannahflynn on September 16, 2009

Gay rights group Stonewall has launched a new poster campaign with the Department of Health encouraging lesbian and bisexual women to take better care of themselves.

The move follows the results of ‘Prescription for Change’, the first major survey ever conducted into lesbian and bisexual women’s health in Britain, which has revealed half of the UK’s 1.8 million lesbians report a recent negative NHS experience. The Stonewall research used over 6,000 lesbian and bisexual women in the study.

Stonewall has developed the slogan ‘Love your inner lesbian’ which is going to accompany the campaign. The research, released last year, found deeply disturbing levels of self-harm, substance abuse and exclusion from routine testing for cervical cancer.

The survey also found lesbian and bisexual women are reluctant to be honest about their sexual orientation when talking to doctors. The poster campaign which will hit healthcare centres and clinics soon, aims to encourage women to talk frankly to their doctors about their healthcare needs.A series of posters is now been available depicting the slogan, as well as key statistics from the report – including smear testing, lesbian parenting, mental health issues and drink and drug habits.

The lack of attendance to cervical screening by lesbian and bisexual women is worrying considering the increasing trend for sexually transmitted diseases which can lead to the development of abnormalities on the cervix which can lead to cancer. However, 30% of cervical cancers  occur without pre-exposure to HPV; a cancer causing virus, meaning groups which are not in a high risk group for HPV, Chlamydia and gonorrohea i.e lesbian women, are still at risk of developing the disease. The report suggested their is an increased cost in treating lesbian and bisexual women who usually present with a disease later than their heterosexual peers.

One of the recommendations of the report is to make lesbian health issues more visible so women are more comfortable discussing them with a doctor.

Source: Utalkmarketing.com

Posted in Women's Health | Tagged: , , , , | Leave a Comment »

Breast cancer screening hit by recession

Posted by hannahflynn on April 29, 2009

Women in Ireland are missing out on their breast screening, as a recruitment freeze in the public sector has affected the appointment of radiographers.

Following the Irish budget, the appointment of any new radiographers has been suspended. Plans for the national breast cancer screening service , BreastCheck in Clare, Donegal and Leitrim have been affected.

Last year, it was claimed, money was withdrawn from Donegal’s screening programme because BreastCheck was due to be rolled out this year. A similar situation is occurring in Belfast.

A spokesperson has said interviews and checks for prospective radiographers has been carried out but they are unable to employ them.

Pressure groups are claiming to lose the service will be political suicide for any government.

It will be interesting to see if the £2 billion cut in secondary health care over the next 5 years in the NHS will affect screening here. It expects to make £500 million of those cuts by getting patients out of hospital more quickly, or not inviting them for screening at all perhaps?

Posted in Women's Health | Tagged: , , , , | Leave a Comment »

‘Cervical cancer vaccine side-effects’ in Daily Mail

Posted by hannahflynn on March 9, 2009

The Daily Mail reported 1,300 girls had experienced adverse side-effects after receiving the cervical cancer vaccine “with 2,891 different adverse effects noted”.

The Mail does mention these figures have been obtained from the Medicines and Healthcare products Regulatory Agency (MHRA), from reports by doctors and has noted the responses from three separate parties: Government ‘health experts’, Jab (a vaccine support group) and Jo Trust (a cervical cancer awareness and support charity). All have stated the risks are minimal and are to be expected when 700,000 women have been vaccinated.

While some of the adverse affects noted are to be expected from a vaccination programme, pain and swelling at injection site and in some cases anaphalyxis, The Mail’s reporting elsewhere in the article is a classic example of the issues raised when correlation is used to imply causation.

It would be hard to find a link between a long-term mental illness, anorexia, and a vaccine but that is what is implied by The Mail.

Similarly, Bell’s Palsey, Guillain-Barré syndrome and an epileptic fit are all serious conditions, but when one person out of 700,000 has reported this occurring after receiving the jab, the levels of significance are pretty much incalculable.

No variables in the individual’s concerned are noted, and nor is the recent change in the way adverse reactions to drugs are recorded.

The NHS recently reported a high uptake in its Yellow Card scheme, which improved to make it easier for patients to report any concerns they have with their medications, over the past couple of years. It is recommended: “Even if you are not sure whether a medicine that you are taking is causing other symptoms, it is best to report it”. These are recorded by the MHRA.

The effects of reporting claims of this seriousness without providing context are evident in the comments section. Not available during the last vaccine scare (MMR) caused by bad reporting in the media, the general public’s response to these stories is now indisputable.

Stephanie, UK states:

“”Ministers say it will ultimately save 700 lives a year.”

That would be 0.1% of the 700,000 girls vaccinated so far, in percentage terms lives saved will decrease as more are vaccinated.

“But Government health experts insisted the Cervarix vaccine was safe and that the total of 1,340 reports was to be expected, given that more than 700,000 girls were vaccinated last year.”

0.19% of the 700,000 girls vaccinated experienced adverse side effects, almost twice the percentage of the ‘obvious benefit’.”

She then asks, “Why is it necessary to vaccinate all young girls to save 700 lives per year?”

When will the media bother to answer this question?

Posted in Women's Health | Tagged: , , | 2 Comments »

Tories say mixed-sex wards must go

Posted by hannahflynn on January 9, 2009

Mixed-sex wards have failed to be phased out following the Government’s election promise to remove them, claim the Conservative party.

The Tories have promised to introduce individual rooms for expectant mothers in NHS hospitals.

They claim hospitals are failing to provide single-sex washing and toilet facilities on their wards, though this is a requirement. They also suggest that not providing separate toilet facilities nullifies any single-sex wards.

This is following an FOI request showing 15 percent of hospitals still used at least one single-sex open plan ward.

Posted in Women's Health | Tagged: , | Leave a Comment »

Cervical Cancer NHS Website Up

Posted by hannahflynn on November 20, 2008

A website put up by the NHS to promote cervical screening to young women has received strong criticism from feminist groups.

Feminist community blog The F Word has criticised the use of men on the site in its post entitled ‘Apparently men have to be Cervix Savvy’.

In a four point list the blogger suggests the NHS are patronising women by getting men to tell them about the benefits of getting screened.  

The comments left also criticise the website, on one count for suggesting that cervical smears should be part of a woman’s beauty regime.  

Just over two weeks ago the NHS announced it was to inject £250,000 in to a campaign to increase the number of women turning up for their cervical smears after numbers dropped to an all-time low this year.

The numbers were never good and since the minimum age was raised in England it has got worse.

A row broke out over the minimum age earlier this year with some consultants stating that if all women turned up at 25 there would be no cause for worry, but as they didn’t the minimum age for smears should be reviewed.

Posted in Women's Health | Tagged: , , | Leave a Comment »

Cash For Cervical Screening

Posted by hannahflynn on October 28, 2008

Recently I was interviewing people for an article on what the minimum age should be for cervical smears in England, as it is higher than it is in the rest of the UK. The overwhelming consensus was that it wasn’t very clear, but what was certain was that women not turning up for their smears when they are first called was a major cause for concern.

The NHS announced today that they are injecting £250,000 into a campaign to tackle the falling numbers of women who turn up to their screening appointments in England, and it isn’t a moment too soon.

Its epidemiology 101 that you need to have 80% of the population covered in a screening programme for it to be most effective. Current figures for 25-29 year-olds are at 66.2%. I won’t bore you with the view that raising the minimum age is hardly going to encourage people to go; the figure stands alone.

However, maybe it isn’t all doom and gloom. Speaking to Robert Music at Jo’s Trust (a cervical cancer support charity) recently he claimed that a London hospital had told him the number of requests for smears had shot up from around 250 per week to around 750 since Jade Goody’s diagnosis. Every cloud…

Posted in Women's Health | Tagged: , , | 1 Comment »