FemTech in the NHS - the silver bullet?
Today the government’s Women and Equalities Committee’s report found that ‘Medical misogyny’ is leaving women with reproductive conditions in needless pain and undiagnosed for years. Could digital and technology help to improve women’s health conditions and experience within the NHS?
The answer is yes. Over the past year I’ve worked with many healthtech and digital health companies focusing on women's health supporting with UK market access including the NHS. Improvements in women’s health are long overdue and there is a notable and intensified focus on the inequalities in women’s health. This has triggered a significant increase in the technologies being developed to meet this gap, often labelled FemTech (I have mixed feelings on whether healthtech for 51% of the population should have a cutesy name).
Often I find that FemTech Founders have personally experienced these inequalities and disparities in their healthcare and consequently built technology solutions to improve women’s health. But adoption within the NHS for FemTech solutions is more challenging than others, and I’ll summarise in this article some pointers if you plan to sell your solution to the NHS.
This subject is close to my heart, I've always been passionate about women's rights, setting up a local Fawcett Society group back in 2011. Our aim was to improve women's access to public services (btw it didn't work). This was all linked to my NHS role at that time as an Equality and Diversity lead in a London community NHS Trust. During my 7-year role, we achieved some success addressing health and workforce inequalities for ethnic minority and LGBTQ+ staff and patients. But strangely women’s health wasn’t raised as an issue. This could have been that our data analysis showed that access wasn’t an issue and patient experience didn’t show any differences, however the inequalities are more subtle and hidden. As shown in today’s report.
For those FemTech companies who are targeting the NHS as a market, I’ve compiled my suggestions from my experience working both with FemTech clients and within the NHS.
Gathering insights about the NHS market
Talking to key stakeholders within the NHS at the earliest stage will help to determine if the NHS is a priority focus rather than other B2B (e.g. pharma or employers) or B2C markets. Health Innovation Networks should be able to help identify if your solution meets the needs of their local healthcare systems and give advice on routes to markets, evidence generation etc.
As the NHS is notoriously challenging market that is complex, and slow, so work out your commercial reason for targeting the NHS and if all the resources required will meet your revenue targets. If you are seeking credibility by gaining the ‘NHS endorsement badge’ to attract other UK and international markets and / or attract consumers to buy your solution from a trusted NHS supplier, then the effort is probably justified.
But if your commercial target is to secure 10+ NHS contracts in one year, then you may need to review the likelihood of this happening within women’s health and I’ll explain why.
Challenges with women’s health pathways
Most clinical pathways and services for addressing specific women’s health conditions are underfunded with long waiting lists for treatment usually resulting in surgery being required (e.g. gynaecological). So you’ll need to show the value of your solution to the NHS particularly if it can achieve the following:
a - Help women to self-manage whilst on waiting lists and thereby improve their symptoms or decrease likelihood of costly treatment required in the future.
b - Improve their condition so they don’t need a secondary care referral or takes them off a waiting list. This could be either through direct care provision or better self-management (note this depends upon the clinical condition).
c - Enable earlier diagnosis of conditions (e.g. endometriosis), particularly if this reduces cost of expensive diagnosis procedures and surgery required.
d - Risk stratification tools using clinical data to assess and categorise a patient’s risk to determine the right time and place for treatment.
I believe that due to women’s health inequalities there are rarely standalone ‘womenc’ services but rather care is embedded into general healthcare provision. For example, with peri-menopause and menopause the structure of care at the moment relies upon GPs to provide this specialist advice and treatment. Even though every women will experience the menopause at some points there are some patient groups that argue that GPs need better training on the menopause. As well as the need for wider access to specialist menopause clinics in the NHS.
If this is the case, the evidence required to demonstrate the savings (or neutral cost) with your FemTech solution might be difficult to estimate. Particularly when NHS commissioners are not paying for a specific service in primary or secondary care that your solution will enhance or replace.
Often women’s health conditions are undiagnosed and under-treated. For example, pelvic floor health and there are only a handful of NHS pelvic floor clinics, which appear to mostly focus upon post-natal care. For preventative FemTech solutions, NHS stakeholders often tell me they create a risk of increasing demand and cost by identifying more women requiring treatment. But in reality I doubt this is the case and only a short term risk but in the long term savings could potentially be generated by avoiding expensive treatments and surgery (and don’t forget improving the woman’s quality of life).
Research is key with your NHS adoption strategy
For your solution there maybe gaps (and therefore opportunities) for specific health conditions that affect women more than men (backed up by research studies rather than anecdotally). This might be part of your value proposition when approaching NHS payers, for example Irritable Bowel Sydrome (IBS) is twice more common in women than men but there are not tailored pathways for treating women particularly as research highlights the link with hormonal fluctuations. Analyse how your solution could address these gaps and provide more personalised and / or risk stratified care for women.
Learn about the funding flows in the NHS
As part of your market research, analyse who is likely to benefit from the savings generated by your solution (eg. the commissioner or the NHS provider). These are the end buyers you need to be engaging with and understand their funding flows (e.g. block contract. blended payments etc). Be aware of perverse financial incentives that are embedded into NHS funding flows. If your solution will decrease income from unit prices for specific procedures / services that NHS providers get, then they are unlikely to be interested. One of my previous articles explains NHS savings and return on investment calculations in more detail.
Health inequalities – CORE20+5
As COVID-19 magnified the inequalities facing certain populations including women, the policy and funding focus on health inequalities provides another opportunity for promoting the value of your solution to NHS stakeholders.
Learn about NHS England’s CORE20PLUS5 strategy and its priorities. I have seen that people who are economically better off will usually prioritise paying for their healthcare particularly self-care such as health app subscriptions and buying wearables to monitor their health. But those populations living in more deprived areas are unlikely to buy an app over core living expenses like buying food. As CORE20 is targeting the 20% most deprived areas, your solution could add value by meeting these priorities by addressing women’s health conditions and variations in care for these deprived geographical areas. The PLUS5 part of the strategy includes maternity as one of the five priorities, again another route if you have a maternity focused solution.
If you are talking to Integrated Care Board (ICBs) commissioners or Primary Care Network leads ask how they are using their health inequalities allocated funding. They may have small pots of funding for piloting your solution if they are struggling to find the budget.
It is tricky to find out what the 42 ICBs are doing with the £25 million investment to establish ‘women’s health hubs’ and when split by 42 ICBs can’t achieve much. I haven’t been overwhelmed by the activities within these hubs that I’ve come across, there doesn’t seem to be much focus on innovative approaches and using digital and technology solutions to improve care. But you could do a deep dive into ICB Board and committee papers to find out if any of these hubs’s priorities are aligned with your solution and approaching the hub lead (try searching up the leads on LinkedIn).
NHS Wales have launched their Women's Health Plan this week, with a small amount for research funding (£750,00) for women’s health conditions and setting up women’s health hubs to support menstrual health diagnosis and understanding. This could be another opportunity for FemTech solutions target and targeting tthe Welsh Health Boards who I often find adopt digital and technology solutions more than in England.
Future Opportunities
It is a hugely exciting time for FemTech and the opportunities to ensure that women don’t have to face the medical misogyny highlighted in today’s report. Personally, I think hormonal health needs greater focus. For example, the link between lower oestrogen levels in women during peri-menopause and other health conditions (eg. blepharitis) needs greater focus and training for clinicians (including the ophthalmologists who didn’t pick this up for me).
My predictions are that hormonal health and monitoring from wearables will start to improve the diagnosis and treatment for women’s health and will start to revolutionise our healthcare in the UK.