Dr Helen Daniels from our team talks to Dr Helen Munro about the development of Women’s Health Hubs in Wales, the lessons emerging from their implementation, and how they could support the wider ambition to improve women’s health across Wales.
Earlier this year, I was incredibly fortunate to receive a personal award from Health and Care Research Wales through their Advancing Researcher Scheme, which is currently open for 2026. Winning a fellowship had been a goal since I graduated with my PhD ten years ago, but chronic health issues always got in the way—all my energy went into making sure I stayed in employment, rather than into pursuing those ambitions. I also wasn’t very sure about what kind of researcher I actually wanted to be. I started with a qualitative bent; one of my earlier projects with Population Data Science involved exploring the views of the public on the use of their genetic data for research. But after seeing the analysts around me day after day with their heads buried in code and numbers, I was completely seduced and made the leap to becoming a data scientist soon after. A very steep but unregretted learning curve ensued (many thanks to Prof Ashley Akbari for believing in me!).
Several years later, post-Covid and post-long-term sick leave, I started working with the HCRW Evidence Centre. For the first time, I was working much closer to policy and seeing how research evidence could be used to answer questions that mattered to decision-makers in real time. I remember presenting to a roomful of clinicians about a project I was involved with on chronic pain, and I was completely moved by how engaged and invested they were in what I had to say. After that, I started working on a project looking at inequalities in hormone replacement therapy prescribing in Wales. This was with Dr Helen Munro, consultant in sexual and reproductive health, Wales’ first Clinical Lead for Women’s Health, and lead on the recently published NHS Wales Women’s Health Plan. Given my own history and the work I was increasingly drawn to, women’s health inequalities suddenly felt like an obvious fit. I saw the call for the Advancing Researcher Scheme, got together with Helen to figure out an idea, and we landed on the evaluation of the Women’s Health Hubs. Helen now mentors me on this project, alongside Professor Jacky Boivin and Dr Sofia Gameiro from the Women’s Health Research Centre.
The Women’s Health Hubs have been in place in Wales since March this year. These hubs ‘bring together doctors, nurses, and other health specialists to support women’s health at every stage of life’. There are a lot of moving parts involved in the hubs, so to get a better handle on the job I’d taken on, I sat down with Dr Helen Munro to ask her some questions and find out more about them.
Can you tell me a little bit about your background and how you came to be involved in women’s health at a national level?
I’m a consultant in sexual and reproductive health, and I’ve been with Hywel Dda Health Board since 2017. I joined NHS Performance and Improvement in April 2024 as the Clinical Lead for the Strategic Network for Women’s Health and to lead on the development of the Women’s Health Plan. I’ve always been interested in how we can change population health. I trained as a GP and did a year abroad in Africa. I came back to do a master’s degree in public health, focusing on developing countries. It really sparked my interest in how you impact population health, and in the people who make decisions around key drivers that can change thousands of lives, not just one or two. I find that a great privilege. I knew that a role like this was going to come up in Wales, so when it was advertised, I applied.
How did the Women’s Health Plan come about, and what shaped its development?
In 2022, the Welsh Government commissioned a team to look at developing a strategy for women’s health in Wales. Around 4,000 women contributed their experiences to help build a picture of what was happening on the ground. Where did women feel that their health was being ignored; where services weren’t supporting them? That work identified several key priorities. These findings were published in the Discovery Report in 2022 and helped inform the design of the Women’s Health Plan.
Welsh Government asked that the Women’s Health Plan be developed through an NHS-led process rather than produced as a policy paper, as in England and Scotland. I met with ministers and colleagues, and we started to put together an outline for what a Women’s Health Plan could look like. We were guided by the Welsh Government and collaborated with subject matter experts from across Wales. We were clear we wanted it to take a life course approach and not be focused solely on gynaecological issues. The plan was published and presented to the Senedd on 10th December 2024.
How did the Women’s Health Hubs become part of the Women’s Health Plan, and how did the rollout develop from there?
I already knew about Women’s Health Hubs through colleagues in England and some of the challenges they had experienced setting them up.
To consider how women’s health hubs could work in Wales, we brought together a stakeholder group of about 80 people from across health to talk about what Women’s Health Hubs could look like here. I wanted to think strategically about the model rather than simply copy what had been done elsewhere. I was also quite keen initially not to call them ‘hubs’ because, particularly for the public, that gives the impression of a physical building. I didn’t feel that would necessarily work in Wales, especially in geographically large Health Boards such as Powys, Hywel Dda and Betsi Cadwaladr, where people may have to travel considerable distances. We did a lot of blue-sky thinking about what could work, what the barriers might be and what the gold standard would look like, and we also drew on the experience and evaluation of Women’s Health Hubs in England. Once the decision was made to proceed with hubs in Wales, we had to move at pace, and implementation timelines were necessarily ambitious, which created opportunity but also challenges for embedding some elements of best practice from the outset.
It’s given women’s health a big focus. Women’s health received significant focus through ring-fenced investment from Welsh Government for the development of Women’s Health Hubs. Each Health Board was asked to identify a Senior Responsible Officer (SRO) to oversee delivery of the Women’s Health Plan, appoint a clinical lead, and establish a local working group. The pace of implementation meant that some Health Boards had less time than ideal to undertake detailed needs assessments before services commenced.
When you were developing the hubs in Wales, what did you learn from the experience of Women’s Health Hubs in England?
Because I’d worked in England for 10 years, I already knew some of the people running hubs in places like Manchester, Liverpool and London, so I had a sense of what was happening there. One of the key things that came out of the evaluation in England was that women often didn’t know what the hubs were, what they provided or how they could access them. So, one of the things we asked for in Wales was for each Health Board to have a communications plan in place from the outset. We were also able to reference the English service specification when thinking about the Welsh model, including some of the cost-effectiveness and cost-benefit evidence, but the England specification itself was very broad. In Wales, we decided to take a more focused approach in developing a ‘Clinical Implementation Guide’ (CIG) that aligned with the Women’s Health Plan and in the first year would focus on Menstrual Health, Menopause and Contraception.
What did you want the Welsh model of Women’s Health Hubs to look like?
Having worked and lived in one of the most geographically spread areas of Wales, for me it was about working with and supporting primary care to deliver more women’s health services locally, alongside investing in training and upskilling primary care colleagues. Within the clinical implementation guide, we described the hub as an ‘interface’ service between primary and secondary care… That shift towards community care was important, particularly for rural communities, rather than trying to bring everybody into a hospital environment that may be far away from where they live.
Has that model worked well so far?
I think it’s worked well in some areas, particularly where hospitals have been able to engage with primary care practitioners, support them and upskill them. Cwm Taf, for example, already had a gynaecology hub and they’ve been able to use a similar model to support primary care in developing the Women’s Health Hub, with support from hospital gynaecologists. Similarly, Hywel Dda, set up a pilot Women’s Health Hub in Aberystwyth, and a GP with a special interest in women’s health was running the clinic, with a consultant gynaecologist to provide support and training.
And what hasn’t worked so well?
I think the short-term nature of the ask has been difficult. If we’d said, “We’re going to develop hubs, you’ve got five years, we’re going to invest in the Health Boards, do a full needs assessment, support recruitment, develop the digital side and strengthen the connection with primary care,” I think that would have been very different. Instead, the short-term nature of the programme and funding created additional challenges, particularly around recruitment and workforce planning. Establishing new services is always easier when organisations have longer-term certainty around funding and staffing. There was also an expectation that Health Boards would develop business cases to sustain services beyond the initial funding period, at a time when many organisations were already managing significant financial pressures.
How would you define success for the hubs?
One of the things I felt was coming through from the England reports was that benefits were being seen where GPs had been upskilled, particularly around the delivery of long-acting reversible contraception and menopause care. Within Wales, we have focused a lot on training in the first year, and I think that’s where we’ll hopefully see the biggest return on investment. My hope is that the GPs who have been trained will go on to use those skills in their practices, and that over time we’ll see things like a reduction in unplanned pregnancies, more management of heavy menstrual bleeding, and more menopause care in the community. Those are the kinds of areas where I’d hope to see the impact of that initial investment.
How were women and communities involved in developing the hubs?
We had a planning framework, with patient engagement built into the early stages. We linked the Health Boards with organisations including Fair Treatment for the Women of Wales and Llais, and we also worked with the Women’s Health Research Centre on developing a co-production framework. We had a very clear ask that every Health Board involve patients and the public in developing their hubs. I think where hubs have been more successful, it’s probably where they’ve had patients involved from the get-go and good engagement with communities.
Given that the hubs look different across Wales, what were the key components you wanted every hub to have?
Clinically, we had the priority areas set out in the Clinical Implementation Guide: menopause, menstrual health, contraception and abortion care. From a service-development perspective, we also wanted a multi-disciplinary team approach; we wanted people to think more broadly about psychology, bladder and bowel care, nursing, pain, pharmacy and what could be offered in one ‘space’ for women. My vision was that the Health Boards wouldn’t run the same and probably wouldn’t necessarily offer the same things, but there would be elements that were standardised around waiting times, the holistic model, data collection and expectations for what women should be able to access. The seven Health Boards all work quite differently but they need to have standardised ways of approaching the hub. What the finished model looked like had to be in line with each Health Board’s health needs assessment and what its population needed, which would be different.
What other questions do you think need to be answered as part of the evaluation?
I think it’s about where Women’s Health Hubs fit into the bigger strategy for Community by Design. The left shift is being discussed in all aspects of care, and what we don’t want is siloed working where we develop a family hub, a respiratory hub and then another hub for another condition. That’s exactly the opposite of what we’re trying to do. For me, it’s about how we use the wider health team and how Women’s Health Hubs integrate with other hubs and community spaces. No physical condition stands alone. No condition is isolated from someone’s psychological, physical, spiritual or environmental space. We have to try to bring these services together rather than think of them as standalone entities.
What decisions need to be made over the next year or two about the future of the hubs?
We want to continue to work with Health Boards to ensure women’s health is prioritised in their plans. Women’s Health Hubs are only one part of this, and it is more about how we are improving women’s health in Wales and delivering the Women’s Health Plan. It is about continuing to upskill and collaborate with primary care. It is about bringing more community services together. It is about using digital innovation and maximising the potential of the NHS App.
We have a ten-year Women’s Health Plan, so it is about working with each Health Board to map those 64 actions against its current services across primary, community and secondary care and work together to make women’s health better for its population.
What have been the most positive learning experiences for you personally?
I think the great thing about Wales is that it is quite small. I’ve loved working with the clinical leads, SROs and local Health Boards who have really caught the vision and wanted to make a difference. People were looking at ways to engage different communities and groups, and for me, that has been one of the positive things—having those conversations. I’ve also really enjoyed being able to do projects like Chronic Women, working with Literature Wales and the Poet Laureate for Wales, and thinking about different ways that we can start conversations around women’s health. I think that’s one of the things I’ve enjoyed most in the role: you find pockets of people who are enthusiastic and really want to do something and bring about change. They understand and share your vision, and that gives you energy to carry on.
Many thanks to Dr Helen Munro for taking the time to talk to me.
For more information on the hubs, see https://womenshealth.nhs.wales/.
For further information on the HCRW Advancing Researcher Scheme, go to https://healthandcareresearchwales.org/researchers/funding-schemes/advancing-researcher-scheme.