Women's Health Services in Wales Facing Jeopardy Amidst Resource Shortages

Specialist centres in Wales that handle complex endometriosis cases are facing jeopardy, prompting warnings from gynaecologists that women's health services are "broken." These concerns have led to calls for a nationally commissioned service and a fundamental overhaul of the funding model to better reflect the true cost of specialized care.

Kelly O'Shea, a 32-year-old woman living with chronic pain, shared her experience of waking from multiple operations only to be told that the necessary procedures could not be performed due to a lack of adequate resources. Frustrated and desperate, she ultimately paid £20,000 for her endometriosis treatment. O'Shea reported that on one occasion, her surgery was halted because a bowel surgeon was unavailable, leaving her endometriosis untreated. On another instance, her operation was cut short because the operating theatre was needed for an urgent case.

"I was promised we'd have the whole team there and they'd get me out of pain," O'Shea stated. "But it's always the same excuse - they weren't available, or they ran out of surgery time. You just think 'why are you putting me through an operation if you haven't got the surgery time?'"

These challenges are exacerbated by funding differences between England and Wales, according to clinical staff. Changes introduced by the British Society for Gynaecological Endoscopy (BSGE), a national accreditation body, highlight the resource constraints hospitals in Wales are experiencing. If more resources are not allocated to increase capacity and dedicate teams to endometriosis care, the BSGE accreditation requirements may not be met. This could lead to a downgrading of services, a potential exodus of skilled staff, and a significant number of patients being sent to England for treatment.

At a recent cross-party Senedd group on women's health, gynaecologists emphasized the need for either a nationally commissioned service or a revised funding model. The Royal College of Obstetricians and Gynaecologists echoed these sentiments, urging the Welsh government to "commit to sustainable resourcing of gynaecology services - including adequate workforce numbers, staff training and appropriate facilities across the country."

One of the endometriosis surgeons at the Cardiff and Vale health board's specialist centre, Lutfi Shamsuddin, explained that the issues stem from allocating dedicated time for multi-disciplinary teams in complex cases and ensuring surgeons perform a minimum number of operations annually. He noted that his centre relies on the "goodwill" of other specialists rather than having their roles integrated into the endometriosis service rota. BSGE-accredited centres require named gynaecologists, specialist nurses, colorectal surgeons, urologists, and radiologists with time dedicated to endometriosis care at least six times a year.

Cardiff and Vale health board added its specialist endometriosis centre to its risk register earlier this year, citing that BSGE changes could lead to its closure without adjustments to meet accreditation criteria. About one in 10 women are estimated to have endometriosis, with approximately 40% referred to hospital gynaecology teams. For cases involving deep infiltrating endometriosis affecting organs like the bladder and bowel, women in south Wales are referred to BSGE-accredited centres, while those in north Wales are sent to hospitals in Liverpool or Chester.

Abigail Holmes, clinical board director for women and children at the health board, stated that the only way for the service to survive is for it to be nationally commissioned by NHS Wales' joint commissioning committee (JCC). While endometriosis services were discussed as a potential JCC commission in June 2024, no new investment was made available for national services to be established.

A petition has been launched in response to the concerns about the Cardiff and Vale health board's centre, gathering over 11,000 signatures. David Fluck, executive medical director at the health board, assured patients that the endometriosis service is a core-funded health board service and that efforts are underway for longer-term sustainability and improvement.

Delyth Jewell MS, deputy minister for women's health, acknowledged that the current setup is "not sustainable" and expressed a commitment to exploring regional or national solutions to ensure continuous availability of these vital services. "Because women already wait too long to have endometriosis symptoms spotted. It's non-negotiable for me - we have to make sure these services continue to be made available."