Local CCG spent 40% less on menopause Hormone Replacement Therapy per woman than CCG which spent most

New analysis of NHS prescription data has shown some local health areas spend three times the amount per woman on Hormonal Replacement Therapy (HRT).

Data from the BBC's Shared Data Unit has revealed West Suffolk Care Commissioning Group (CCG) spent an average of £14.09 per woman aged 45 to 60 on Hormone Replacement Therapy (HRT) between April 2021 and June 2022 – the most spent anywhere in the country.

Meanwhile, 79 of the 106 CCGs in the country were spending at least 20 per cent less than the West Suffolk figure – with the Heywood, Middleton and Rochdale CCG spending 40% less at £10.03 on patients’ HRT.

Conversely, Leicester City spent the least on HRT for their patients, averaging at just £5.56 per patient.

Clinical Commissioning Groups have now been replaced by Integrated Care Partnerships.

HRT replaces hormones that are at a lower level as you approach the menopause. Not every patient will need or want HRT, and clinicians advise against it in some circumstances - including for patients with a history of certain types of cancer or blood clots.

The drugs looked at in the data, collated by Oxford University, included estradiol and estriol with progestogen, oestrogens conjugated with progestogen, oestrogel, norethisterone, dydrogesterone and medroxyprogesterone acetate.

Experts said the treatment options offered by some local health boards were "very limited", adding that the decision-making of local health boards had contributed to a ‘postcode lottery’ and that some women were not being offered the full range of options because their local health board did not fund them.

Diane Danzebrink, of the Menopause Support charity, said GPs “hands were tied”.

“Often we will hear from women who are being prescribed oral tablets as a first line, and they're not being offered options,” said Ms Danzebrink.

“Sometimes that is because those options are purely not available on their local CCG formulary. So that sort of ties the hands of their doctors to be able to offer them choices. But we do definitely see that it seems to be in some parts of the country rather than others.”

Other reasons cited for the disparity include cultural differences. Menopause expert and GP specialising in women’s health Dr Anne Connolly said different ethnic groups could “experience symptoms differently or manage them differently”, while Ms Danzebrink added that cultural barriers such as language could cause problems for some groups of women.

She said: “In some communities, it is not accepted to talk about women's health. Women aren't encouraged to talk about their health, they're not encouraged to seek help and support.

“You could also talk about not just the cultural barriers, but perhaps the language barrier. Not everybody has English as their first language. And I think this is sort of part of the wider issue that we have around sharing factual evidence-based information and for people to know that there are options for support.

“What we need to see is a government led public health campaign. We need to see something that is sharing education with all parts of society. And that might mean being in different languages, it might mean being in Braille.”

The NHS says it has increased training for clinicians.

An NHS spokesperson said: “The NHS has a Menopause Pathway Improvement Programme, which includes increased learning for clinicians in how they can best support menopausal women, and working with clinical colleges and menopause organisations to improve awareness and understanding.

“A new Menopause Optimal Pathway will also guide clinicians and help women in the workplace during peri-menopause, menopause and post-menopause.”

 

Read more: 3 in 10 North West employers do not feel well equipped to support women going through the menopause at workPublished: 18 October 2022

 

Patients who seek out treatment for menopause symptoms can be referred to specialist NHS clinics for further care.

But BBC analysis of British Menopause Society data shows 59% of Clinical Commissioning Group areas (CCGs) in England have no NHS clinics, including all of Devon and Cornwall and large areas in the North – including the Rochdale borough.

The Department of Health and Social Care said it will consider a recent Women and Equalities Committee target to provide at least one NHS menopause clinic or specialist in every CCG by 2024.

Of the 199 clinics in England, 75 are run by the NHS, with 124 operating on a private basis.

Concerns had been growing over HRT supplies following reports of shortages of transdermal treatments, including popular gels, after an increase in demand following work by campaigning charities and celebrities to raise awareness.

In July this year, Parliamentary Under-Secretary of State for Health and Social Care Maria Caufield told a Westminster Hall debate there had been a 30% increase in demand for HRT products but said only a few products were now affected by shortages.

From April 2023, a flat rate of £18.70 for all HRT prescriptions will be charged across England. Currently HRT is treated as any other prescription, costing £9.35 or £18.70 for two types.

"We have met trade suppliers, manufacturers and pharmacists to discuss the challenges they face and to try to overcome them," said Ms Caufield.

"Of the more than 70 products that are available, we are now down to pressures on three or four, and even with those we are seeing significant progress."

 

Read more: World Menopause Day: Menopause can impact all aspects of a woman's lifePublished: 18 October 2022

 

The Department of Health and Social Care said it would consider a recent Women and Equalities Committee target to provide at least one NHS menopause clinic or specialist in every CCG by 2024.

A Department of Health and Social Care spokesperson said: “We have put women’s health at the top of the agenda by publishing a Women’s Health Strategy for England, appointing the first-ever Women’s Health Ambassador, and taking action to increase supply and reduce the cost of Hormone Replacement Therapy.

“We have accepted the recommendations of the HRT taskforce, including the continued use of Serious Shortage Protocols when appropriate to manage shortages, and NHS England continues to work on gathering data on maintaining and updating local formularies in England.

“The UK-wide menopause taskforce is seeking to end the taboos surrounding the menopause and considering the role workplace policies can play in supporting menopausal women, and the government’s Health and Wellbeing Fund is helping expand and develop projects which support women experiencing the menopause to remain in the workplace.”