Recommendation 6

HM Government Accepted

Cutting waiting lists, including for gynaecology, is a critical part of our health mission to build an NHS fit for the future and a top priority for this government. NHS England’s plan on reforming elective care for patients (linked in ‘Introduction’ above) sets out how the NHS will reform elective care services and meet the 18-week referral-to-treatment standard by March 2029, meaning earlier diagnoses and treatment. The plan sets out how, in gynaecology, NHS England will support the delivery of innovative models, offering patients care closer to home and piloting gynaecology pathways in community diagnostic centres ( CDCs ) - for example, for patients with post-menopausal bleeding. We are working with NHS England and the Women’s Health Ambassador on how we take forward the Women’s Health Strategy for England (linked in ‘Introduction’ above) by aligning it to the government’s missions and forthcoming 10 Year Health Plan. As part of this, we will consider the committee’s recommendations on key performance indicators and metrics. Measuring diagnoses times for reproductive health conditions such as endometriosis would be a useful indicator for measuring progress. However, this is currently challenging to operationalise. For example, women may not always receive a definitive diagnosis because milder forms of the disease can be managed with a presumed diagnosis and therefore avoid the need for an invasive procedure (so, in line with National Institute for Health and Care Excellence ( NICE ) guideline [NG73] Endometriosis: diagnosis and management , women are often treated initially in primary care for suspected endometriosis). Only some women with endometriosis need to be referred to secondary care for further investigations and treatment. Furthermore, primary and secondary care administrative data sets are not currently linked in a way that allows us to follow individual patient pathways and measure diagnosis times. An ongoing Office for National Statistics study on endometriosis is working to link primary and secondary care data to: better understand diagnosis times estimate how many women are living with undiagnosed endometriosis This study will help inform future work. NHS England is also looking into metrics that best reflect timely access to care and outcomes for women. This work will: explore whether time to diagnosis is the optimum measure identify any gaps in data or limitations in data capture that could affect the ability to adequately measure and report on performance For example, patient experience measures, such as those gathered through the government’s Reproductive Health Survey for England 2023, are also important for measuring progress.