Our latest panel discussion focused on women and health tech, generating conversation around the gender health gap and the potential role of digital in this space.
For the purposes of the discussion we were joined by Kim Ashall, head of virtual wards for North West Anglia Foundation Trust and programme lead for virtual wards for Cambridge and Peterborough ICB; Natalie Duffield, director of Inhealthcare; Sally Robinson, head of strategy and best practice at United Lincolnshire Hospitals NHS Trust; and Dr Victoria Betton, director at PeopleDotCom.
Kim shared that she has worked in the NHS for around 30 years and is a physio by background before she moved into management. She has been working in virtual wards for approximately 16 months now and shared her passion for this topic.
Natalie has also been in the industry for 30 years around “many different tech innovations”. She explained that Inhealthcare is one of the “leading remote patient monitoring platforms with national platforms in Scotland and Northern Ireland as well as regionally across the UK.”
Victoria is the director of her own consultancy, PeopleDotCom, which she has been running for almost four years. Before that, she trained as a social worker and worked in the NHS for 25 years in various strategy and innovation roles. “I’ve been working in digital for around 10 years now and I’ve always been very interested in inequality, digital exclusion and design thinking, bringing a user-centred approach to digital transformation.”
Sally shared that she was approaching the discussion from two standpoints; as head of strategy and best practice at her trust, which sees her look after clinical strategy and development, and as chair of the trust’s women staff network. “We’ve got a really active network, with nearly 2,000 members at the moment,” she said. “We’re really active within the trust and the system.”
The gender health gap, and the women’s health strategy
To set some context for the discussion, Victoria provided some insight into the gender health gap as it exists today, as well as the 10-year women’s health strategy for England, published in 2022.
“We know that women make up 51 percent of the population, and statistically we live longer than men – but we live a greater proportion of our lives with ill health or disability,” she said.
Additionally, when considering diseases that affect both men and women, Victoria noted that women are not always equally taken into account. She cited coronary heart disease as an example, which is believed to kill twice as many women as breast cancer; however, heart disease is often seen as a ‘men’s disease’.
When it comes to women-specific health issues such as miscarriage and menopause, Victoria said: “There is just not enough focus and huge amounts of stigma. Women are underrepresented in clinical trials, in education and training and in policy development.”
She also commented on the disparities between women with regards to intersectionality, when it comes to affecting factors such as ethnicity and poverty.
Kim raised a point about the NHS workforce, noting that it is “still a very male-dominated organisation”. Despite women making up nearly 70 percent of the workforce, she said, only 44 percent of CEOs are women.
Looking at the gender gap for health on the widest possible scale, Natalie shared that when she researched the topic, she found that the UK is reported to have the 12th largest gender gap on a global scale.
Moving onto the women’s health strategy, Victoria explained that it considers women’s health across the life course and centres around six key points: women’s voices and contributions at policy level; improving services; addressing disparities; information and education; women’s health in the workplace; and research and data.
“Digital doesn’t feature that strongly within the strategy in a really obvious way, but of course digital and data underpin so much,” she said.
The role of digital in driving change: how can technology play a role in closing the gender health gap?
With regards to the role tech can play, Natalie commented: “We can do a lot – we lead busy lives, and it can be hard to find the time to get an appointment, let alone attend an appointment. There can be a significant mental impact from some of these conditions on women too, and the topics are often quite personal. We’ve run a lot of technologies which allow us to make healthcare more accessible remotely to help with these things, but it’s also about utilising tech to catch things early – for example, we run an extensive hypertension blood pressure service up in Scotland that has 25,000 patients and 49 percent of those are women. The more we catch things early, the more we can enable women to talk about these health issues and raise awareness and knowledge.”
Sally agreed, saying that her experience through her staff network and through conversations with patients highlights the need to make healthcare more accessible, rather than expecting women to fit into existing structures which might not suit. “How can we change our structure, change our delivery methods and alter our accessibility to make it easier for women? For example, we have a high percentage of part-time workers at the trust to support women who are working different hours because they’re also involved in things like school runs or caring for a parent. For patients, we try to set up services so that they are there for women within the times that they are available. If they’re not available, is there a digital alternative that we can use? Can we use apps, tech that women can take home with them, wearables that can report data back to us on a regular basis, to help in bridging that accessibility gap?”
Kim pointed to the example of a smartphone. “You can do anything with that thing that you hold in your hand,” she said, “and we shouldn’t underestimate that. Digital can help women to identify issues and problems, whatever they may be; you can search just about anything online and get an answer, and whilst this does have a negative side as it can cause worry and it isn’t always entirely accurate, it can also provide a lot of reassurance. Digital opens us up to a huge amount of information, and that can empower women to make informed choices and have more control.”
Coming back to the points around accessibility, Kim added: “For me accessibility is also around language – we use such a lot of jargon in the health service, and I think tech and the options for communicating with patients digitally offers us an opportunity to make some informed decision about the language we use.”
Victoria agreed with the points around digital supporting better access to information and education, raising the NHS website as one such source; however, she said, in order to make the most of this you need to both digital literacy and health literacy. It can be a real minefield when you are looking for consistent, well-presented, relatable information.”
She added that she is always interested in unintended consequences. “I don’t think we should assume that digital will cross the gender health gap, or enable women to access better healthcare sooner, unless we design with women, for women, by women.”
Challenges around digital healthcare for women
“So much about the current situation we find ourselves in impacts everybody’s health,” said Kim, “and can impact women as part of that – the cost of living crisis, for example, is having a massive impact on families. Women often put themselves last in a family and will make sure that everybody else is OK, but it’s their health that suffers. I don’t think we should underestimate that. There’s so much bad news about, and the pressures of social media can play a role too; there’s a lot of anxiety and depression linked to these factors.”
Kim highlighted the disparities that can be found in research with regards to women’s health. She described a piece of research that focused on a ligament issue that led to knee problems for footballers. Following intensive research, it is now known how to treat and care for this issue in male footballers; but it does not work for women footballers, because women’s bodies are different and there were a lack of women included in the research. “That’s just an example of how wider health issues, whilst they can affect everyone, are quite often dominated by men’s research and therefore we don’t always know what we need to do in terms of supporting women.”
Sally said: “Another challenge in this space is that we need to ensure that digital isn’t the only option. It needs to be a choice, part of a suite of options, and it needs to come with support to access it in the first place. When developing the strategic direction for my trust I have to ensure that I’m not making assumption about what people have access to, because it’s all well and easy to say that we’ll do everything virtually because it’s quicker, but that can cause a real issue. Digital by default is a lovely sentiment, but it’s just that at present – a sentiment. I attended a meeting yesterday where we were looking at our areas of deprivation, and our east coast doesn’t really have access to the internet yet as standard. There will be similar places across the UK. So for me the challenge isn’t just about what we face; it’s about challenging ourselves to not just accept a default.”
Victoria brought up femtech, and how femtech founders can find it particularly difficult to get investment for their work. “There’s a lot of work to be done in the software space, with regards to women having a greater voice – coming back to Kim’s point around the NHS being female dominated until you get to senior positions, when I worked in the digital space I was actually quite taken aback at just how male dominated that world was, as a comparison.”
Natalie agreed: “The gender gap in tech has been vast for many years. We need to make sure that whatever we build technology-wise is a foundation that can grow and develop as a service matures, as patients mature, and as conditions mature.”
She also highlighted the need to ensure that digital services are flexible, using the example of automated phone calls for elderly patients who might struggle with technology, whereby information is read out over the phone and users can press a button for yes or a button for no.
On how different groups of women can face different challenges, Victoria said: “We’re not homogeneous as women, and there are all sorts of factors that can have a disproportionate impact on health issues. We absolutely need to take those into account, and it comes back to co-design – building things with and for the people who will use it.”
On this note, Victoria explained that she undertook a project for an acute NHS trust in the north west around the trust’s introduction of an EPR and associated patient app. “We had a researcher sit in on clinics for the day – she sat with women attending the clinic and let them use the app, observing how they found it. We realised that if the trust was going to be successful at implementing the patient app and not creating unintended consequences of increasing inequality, they needed to have midwives onboarding women to the app. It was particularly affecting women who didn’t speak English as their first language, for example.
“When you are thinking about implementing an application, you need to think about it in the context in which it will sit and understand the current workflow; and think about how women use technology in their everyday lives, particularly excluded women. Then you need to think about the support required in this area.”
How digital is helping to meet women’s health needs
Looking to current projects on digital in women’s health, Sally talked about how her team are keen not to “run before they can walk”, spending extra time to make sure they understand the tech before thinking about implementing.
“One of the things we’ve implemented is a digital menopause service for our staff, which has helped us overcome some of the issues around access with us being such a rural region. We’re about to expand it, and I’m having discussions with people in the femtech arena, to find out how we can maximise the use of these clinics to help a wider group of women. Things like endometriosis, menstrual concerns, pregnancy loss, fertility; these are things that my female staff are wanting to look at, and so we’re being led by them, and we’re in discussions with some tech providers about how we can bring that in.”
Sally added that “for those femtech companies and innovators, to have a cohort of people that will come along the journey and test things with you; the NHS are a great option for that; we have access to lots of people who will give feedback and help you on the way”.
Kim also shared some insight into her recent work on digital in women’s health, including on the virtual wards that her team set up about eighteen months ago.
“About 56 percent identify themselves as women, and actually over 60 percent are aged 75 and over, which already says something about digital skills. One of the issues we have identified is that there are some situations whereby women might be being controlled at home. So we’re sending women home with kit to connect to their smartphone, and telling them how to use it, but if they’re not the primary controller of that data, or of that phone, then there’s an issue. We don’t know how to deal with that yet, but we are mindful of it.”
The question is also, according to Kim, whether women will be able to rest and recuperate when they get home, like they would on a ward, or whether expectations about house keeping and other duties within the home will interfere with this. With this in mind, she said that her team is “looking at commissioning some evaluations to see what the outcomes are for the people that go home on virtual wards”.
Victoria discussed how proud she was of having built a very diverse team, saying, “I think there is something about our role, and men as allies, in thinking about diversity in terms of recruitment, and there’s those social value things you can look at when you’re working on procurement”.
Natalie agreed with the need to work on ensuring diversity, saying, “we try to be as diverse as we can, and we’ve developed a gestational diabetes solution for women, which has been developed by women, and that’s been a great success”.
Identifying areas with potential for digital in women’s health
Natalie noted how getting the governance in place is important when it comes to the potential for digital in women’s health, and how “we need to look at getting services which are doing well, going further”.
“It’s not just about one piece of tech, it’s about the ecosystem around that technology; I don’t think one partner can do everything, it’s about seeing what different technologies are out there that can come together to resolve an issue around the disease, pathway or patient.”
Going back to the women’s health strategy, Victoria talked about the role that digital could play in women’s health hubs, joining up services and making them easier for women to access and use.
“I think something that thinks about that life course, and thinks about the conditions and experiences that women have, helping them to navigate health services, would be a great way for health hubs to really make a difference. I’d like to see them given more resources and capacity, because those two things are such an issue.”
Kim discussed how she would love to see more work being done in prevention on women’s health, starting from a young age, with “lots of work to be done around exercise, smoking, nutrition”. She also talked about how from a personal standpoint, she had recently begun to look into ways of preventing dementia, but how that sort of thing should begin a lot earlier.
Getting the information being sent out right, and achieving consistent and clinically-led messaging across platforms, would be a great use of digital in the women’s health space, Sally shared.
“For me, there’s a real opportunity to use digital to share information to protect women from having to do things that may be damaging both physically and mentally, like retelling their story over and over again.”
Our panel then moved on to take questions from our live webinar audience.
We’d like to thank all of our panellists for joining us for this session. You can watch the webinar here:
In another of our recent panels, we were joined by Liz Leggott (project manager, greener NHS champion and NHS England clinical entrepreneur at the South Yorkshire Primary Care Workforce & Training Hub) and Emma Stratful (chief operating officer at OX.DH) for a discussion on digital primary care. Liz and Emma discussed a range of topics, from the projects they have been involved with to challenges in this space and the role of innovation in primary care.
