The delivery of women’s healthcare in the current configuration cannot be sustained, claims a report.

The study by the Royal College of Obstetricians and Gynaecologists recommends that services should be provided in managed clinical networks which link primary, community, secondary and tertiary services.

Workforce pressures created by the Working Time Regulations and trainee numbers demand different service configurations and the number of medically staffed units must be cut to ensure a safe service.

High Quality Women’s Healthcare: A proposal for change concludes that the combined force of the NHS reforms, workforce and financial pressures against a backdrop of rising demand, increasing complexity and changes in demographics means that women’s health services have to change.

The report also highlights the variation in health service provision nationally and calls for the universal adoption of clinical standards and guidelines, and making the reporting of outcomes mandatory.

Hospitals should be configured so that safe and timely care can be provided by multi-professional teams. Currently, too much care is provided within secondary and tertiary settings, it says.

For maternity services, the managed network model will mean more midwifery-led care. Networks and hospitals will need to be configured to accommodate these changes, and provide 24/7 medical obstetric services for women on fewer sites than at present. For isolated or remote units different solutions will need to be found, it concludes.

For gynaecological services, the women’s network will facilitate choice and encourage more care closer to home, in the community or in a primary care setting.

In the bigger picture, the report calls for a life-course approach to women’s healthcare. Every interaction a woman has with the health service, irrespective of age, should be used to promote health and lifestyle rather than the constant ‘fire fight’ against disease and ill health.

Furthermore, a national clinical director in women’s health should be appointed to lead on the quality agenda and ensure that service configuration, workforce and commissioning issues are championed in women’s health care

Chair of the RCOG’s expert advisory group, which undertook the review, Dame Joan Higgins, said: “Women’s health services need to be planned in a way that enables integration across different levels of care, delivered in partnership between local health and social care services and the voluntary sector. This network of providers should ensure that women experience co-ordinated and appropriate care which meets their needs.

“Women will still have ready access to hospital-based care but this will be when clinical need dictates or the woman chooses to have her care delivered in this setting.”

With an ageing female population, more specialist attention is also needed for women in later life. The group says that focus should be on health promotion and preventive medicine rather than disease intervention.

Dr Tony Falconer, President of the RCOG added: “The life-course approach will ensure that at every opportunity, the health service can be there to give advice and improve a woman’s health irrespective of her situation or her social background. Adopting such an approach to delivering healthcare will provide women with consistent information from a young age, enabling them to make better decisions about their own health.”

Read the full report.