NHS menopause funding statistics do not show the full picture, say experts

Women of different backgrounds and ethnicities face barriers accessing menopause treatment

Research that suggests menopause funding is a ‘postcode lottery’ has been criticised for being misleading.

Analysis by the BBC Shared Data Unit of NHS prescription data shows some local health areas spend three times the amount per woman on Hormonal Replacement Therapy (HRT).

In Bedford, which ranks 98th out of 107 CCGs, just £8.42 is spent per woman aged 45 – 60, 67% less than the highest ranking, West Sussex CCG at £14.09.

However, menopause activists, specialists and the NHS BLMK Integrated Care Board (ICB) have told the Bedford Independent that these figures could lead to drawing the wrong conclusions and that while Bedford does fare better than most, there are still areas for improvement.

“False conclusions”

Experts spoken to by the BBC Shared Data Unit said the decision-making of local health boards meant that some women were not being offered the full range of options because their local health board did not fund them.

In response, an NHS BLMK Integrated Care Board spokesperson said: “Making comparisons in this way, although well intended, can lead people to draw false conclusions.

“The reality here in Bedfordshire is that no restrictions have been placed on HRT prescribing, which means that doctors will always ensure that the women in their care get the most cost-effective medications that meet their clinical needs.

“We continue to encourage all women who are experiencing menopausal symptoms, whether they have yet to seek medical advice or feel that their treatment needs reviewing, to speak with their GP.”

At the forefront

BBC analysis of British Menopause Society data shows 59% of health authorities in England have no NHS clinics, including all of Devon and Cornwall and large areas in the North.

The data also showed almost a third of existing NHS clinics are either in London or Surrey.

In many ways, Bedford is at the forefront of menopause provision. BEDOC is a social enterprise that runs one of the few NHS specialist menopause clinics in the country.

Run by Lesley Quinn, the clinic is accessed by many of Bedford’s GP surgeries.

Lesley Quinn, clinical services and governance manager, Bedford on Call (BEDOC)
Lesley Quinn, Bedford on Call (BEDOC)

Women can ask to be referred to the Menopause Clinic by their GP, provided their practice is signed up to the BEDOC Enhanced Access Service.

“The formulary – the list of medication that has been approved by the local Integrated Care
Board – in Bedford has a wide range of options,” said Lesley.

“BLMK is one of the few ICBs that offers testosterone, which allows us to prescribe a
complete package of individualised menopause care within this locality.”

“The problem isn’t postcodes”

Menopause activist, Anita Powell, said that the problem went far deeper than a mere postcode lottery.

She said that women from lower social economic groups and ethnic minority groups were not being listened to.

“Sometimes language is a barrier, but I have spoken to English-born women who speak perfect, and their voices are being ignored,” she told the Bedford Independent.

“Also, some communities have a historical mistrust of doctors and medicine. Black women are four times more likely to die in childbirth than white women.”

Anita Powell of the Menopause Alliance group

Anita established the Menopause Alliance, a peer menopause group and is also co-founder of Black women in menopause, a national online peer support group for Black women and allies to explore the topic of menopause.

“I have noticed that among Black women there is a more significant lack of trust in medicine and doctors,” said Anita.

“The comments expressed are about bad past health experiences, passing on historical community negative mistrust/concerns, plus there is little trust in the medicine as they fear it has not been tested thoroughly on women of colour.

“Some fear that women of colour are more likely to react negatively to HRT.”

Earlier in the year, Anita worked with key menopause Bedford experts Leslie Quinn of BEDOC, Dr Thanga Katimada from the Medic Centre and Dr Emily Davy, who works within the NHS.

They gave menopause education and advice to women in Queens Park. “Some Asian women said they don’t know what menopause is or what good ‘menopause healthcare’ looks like and never talk to peers about menopause,” said Anita.

Menopause support

Socioeconomic factors also impact access to menopause information and medication.

“White women from lower social economic groups may not have the confidence to question their doctors and demand HRT,” said Anita.

“In addition, they may not have the funds to afford the medication fees or private medical or non-medical services. The Menopause private sector has grown fast over the past few years, as they benefit from the limited services offered on the NHS.”

She says the cost of living crisis has meant that some women are having to choose between paying their bills and struggling with their health or going without and paying for private menopause services and medication because they feel that their GP is not a menopause option.

Even if you are prescribed HRT, from April 2023, a flat rate of £18.70 for all HRT prescriptions is charged across England.

Anita believes the problem is more than a postcode lottery, but, an actual menopause health inequality.

“You might live in a wealthy postcode but be part of a disadvantaged community experiencing additional barriers affecting your ability to optimise their menopause health.”

Anita believes women from low social economic and women from Ethnic minority groups need to have more tailored menopause support conversations to help empower their knowledge, making them more informed on their health options.

While the NHS says that more specialist menopause training is being given, Anita says that the government should add menopause to the NHS QOF list.

The QOF is a payment performance scheme offered to doctors, where doctors receive additional payment for treating/testing/prescribing for specific health concerns.

“If menopause were on the Qof list, it would give doctors more incentive to develop their knowledge and explore menopause with the patients,” she said.

“Many menopausal women are offered antidepressants and not HRT. Antidepressants and depression are on the QOF list.”

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