All-Wales Menopause Task and Finish Group, Final Report, January 2023

Through collaborative working between healthcare professionals, service-user representatives and Welsh Government officials, the All-Wales Menopause Task and Finish Group has sought to address issues surrounding inequitable access to menopause services for women seeking advice on menopause related symptoms, across Wales.

At the UK Menopause Taskforce’s inaugural meeting on 3 February 2022, Eluned Morgan, Minister for Health and Social Services, stated that Wales is committed to ensuring that the same high standards of menopause care are available to everyone. The aim of the All-Wales Menopause Task and Finish Group has therefore been to put forward advice and recommendations to the Welsh Government, which will generate improved menopause care and support for women across Wales.

For women who go through the menopause, it is critically important for them personally and in terms of family, societal and economic reasons, that any symptoms can be identified and managed in a timely manner to avoid negative impacts on their everyday lives and wellbeing.

All-Wales Menopause Task and Finish Group Establishment

To help achieve improvements in the way in which NHS Wales supports women experiencing the menopause, the Welsh Government, with support from the multidisciplinary Welsh National Specialist Advisory Group for women’s health and the Royal College of Obstetricians and Gynaecologists’ Welsh Executive Committee, established the All-Wales Menopause Task and Finish Group. 

The Task and Finish Group was formed during July 2022 and its membership includes representation and expertise from all relevant professional groups, all NHS Wales health boards, patient and public voices as well as Welsh Government policy leads and professional advisers. 

All-Wales Menopause Task and Finish Group Objectives

The objectives of the task and finish group are to brings together clinicians, policymakers and service users in Wales to advise the Welsh Government on:

• appropriate access to and standards for menopause service provision in Wales
• objectives for raising awareness of the menopause across the life-course and settings
• demand-capacity modelling for multiprofessional menopause service provision in Wales
• measures to identify variations in service provision and delivery of care across Wales
• implementation and evaluation of the National Institute for Health and Care Excellence (NICE) and other best evidence-based practice recommendations for menopause service provision across Wales
• distribution of menopause specialists and service providers in Wales aligned with British Menopause Society standards
• research priorities to increase knowledge and understanding of effective management for menopause

The task and finish group puts forward the following recommendations:

1. The Welsh Government should take forward the recommendations from the All-Wales Menopause Task and Finish Group to the UK Menopause Taskforce.
2. NHS Wales should incorporate the recommendations from the All-Wales Menopause Task and Finish Group into the development and implementation of the 10-Year Women’s Health Plan.
3. The Welsh Government should require the adoption of the British Menopause Society (BMS) Menopause Practice Standards [¹] and the NICE Menopause Quality Standards ^[2] by all health boards across Wales. These standards of care should be available to all women seeking advice, support and treatment for symptoms related to the menopause in Wales, irrespective of their ethnicity, background or other circumstances. 
4. The Welsh Government should commission a research project to identify the most effective ways to disseminate knowledge to school age young people, those in higher and further education settings and workplaces, about the physiological changes and wellbeing factors associated with the perimenopause and the menopause.
5. The Welsh Government should require the NHS Wales Executive to monitor the performance of all health boards in respect of the following provision: 

1. timely access to and availability of menopause services in primary, secondary and community care
2. culturally sensitive and inclusive menopause services
3. timely access to a healthcare professional with expertise in the menopause in each general practice cluster
4. access to national guidance to support referrals to menopause specialists
5. access to timely availability of multiprofessional menopause services
6. access to a range of HRT preparations
7. service capacity modelling and provision based on active monitoring of numbers of referrals and waiting times
8. reporting of key metrics and data regarding service quality, safety and user satisfaction to inform oversight and monitoring

6. The Welsh Government should work collaboratively with NHS Wales to determine and agree quality and safety measures for menopause service timeliness and provision. This should include the following maximum acceptable waiting times for women seeking help for menopausal symptoms: 

1. face-to-face or virtual consultation with a health care professional in primary care: within four weeks of request
2. e-guidance/e-advice as and where appropriate within four weeks of referral to a menopause specialist
3. face-to-face or virtual consultation with a menopause specialist within twelve weeks of referral

7. The Welsh Government should require that health boards meet BMS Menopause Practice Standards around training in women’s health and the menopause. 
8. The Welsh Government should require health boards to consider the skill-mix required to deliver high quality menopause services within their local contexts in line with BMS Menopause Practice Standards. This should include consideration of primary and secondary care service delivery, in addition to nursing, pharmacy, allied health professionals and medical staff as well as social prescribing. 
9. The Welsh Government should commission the development of an audit tool as a means for health boards to assess quality improvement and compliance against national standards, inclusive of service user satisfaction through patient reported outcome measures (PROMs) and patient reported experience measures (PREMs). 
10. The Welsh Government should work with other national stakeholders to enhance public awareness of the menopause through expanding the information and resources available on the NHS Wales website.
11. The Welsh Government should work collaboratively with the UK Government and Health and Care Research Wales to develop an ongoing research programme on the menopause, particularly within the following priority areas: 

1. hormonal treatment options for people with known breast cancer
2. HRT and risk of breast cancer
3. HRT and risk of venous thromboembolism 
4. HRT and dementia
5. premature ovarian insufficiency and its risks^[3] 
6. effects of the menopause on ethnic minority groups and people with underlying disabilities 
7. impact of social prescribing
8. effect of psychosocial and cultural interventions on the menopause

All-Wales Menopause Task and Finish Group Terms of Reference

1. Purpose: 
   Multiprofessional All-Wales Forum to advise the Welsh Government on standards of care, improve service quality and safety, reduce unwarranted variation, improve knowledge, awareness, care and support available for people experiencing any stage of the menopause.
2. Objectives: To bring together clinicians, policymakers and service users in Wales to advise the Welsh Government on:
   • appropriate access to and standards for menopause service provision in Wales
   • objectives for raising awareness of the menopause across life-course and settings
   • demand-capacity modelling for multi-professional menopause service provision in Wales
   • measures to identify variations in service provision and delivery of care across Wales
   • implementation and evaluation of NICE and other best evidence-based practice recommendations for menopause service provision across Wales
   • requirements for menopause specialists/service providers in Wales aligned with BMS standards
   • research priorities to increase knowledge and understanding of effective management for menopause
3. Membership and Quorum:
   1. The membership will include representation of all relevant professional groups, all NHS Wales health boards and patient and public voices. Membership will aim to reflect equality and diversity principles in all aspects of membership. Additional members may be co-opted for individual meetings as required to provide balance or appropriate representation. The group’s full membership can be found at Appendix A.
   2. Meeting will be considered quorate with at least eight of the members/representatives attending including the Chair and/or nominated Chair. Individual members are asked to prioritise the meetings but may nominate a named alternate in the event of their unavoidable absence.
4. Meetings:
   1. The task and finish group is anticipated to require three meetings to complete the work. At the Chair’s discretion, additional meetings may be requested to ensure the completion of objectives in a timely manner.
   2. Meetings will be arranged via Microsoft Teams and minutes noted by administrative support.
5. Reporting Arrangements:
   The task and finish group will report to the Chief Nursing Officer, Welsh Government.

The Association of the British Pharmaceutical Industry Cymru

• Richard Greville, Director, Pharmaceutical Industry

Aneurin Bevan University Health Board

• David Bailey, General Practitioner, Primary Care and General Practitioners Committee Wales
• Janet Badger, General Practitioner, Primary Care
• Nikki Noble, Advanced Nurse Practitioner, Sexual and Reproductive Health
• Rhiannon Griffiths, Woman's Health Clinical Specialist Physiotherapist, Physiotherapy

Betsi Cadwaladr University Health Board

• Bidyut Kumar, Consultant and Menopause Specialist, Secondary Care
• Eleri Phillips, Formulary Pharmacist, Pharmacy
• Geeta Kumar, Consultant and Menopause Specialist and Task and Finish Group Chair, representing Chair of Welsh National Specialist Advisory Group and Welsh Executive Committee
• Gillian Breese, General Practitioner, Primary Care
• Kalpana Upadhyay, Consultant and Menopause Specialist, Secondary Care

Cwm Taf Morgannwg University Health Board

• Helen Bayliss, Consultant and Menopause Specialist, Gynaecology and Sexual Health
• Nadia Z Hikary-Bhal, Consultant and Menopause Specialist, Secondary Care
• Tehmina Riaz, Speciality and Associate Specialist Representative

Cardiff and Vale University Health Board

• Anna Denereaz, Consultant, Secondary Care
• Elizabeth Arnold, General Practitioner, Primary Care
• Jayne Forrester-Paton, General Practitioner and Menopause Specialist, Primary Care
• Mari McDonald, General Practitioner, Primary Care
• Nigel Davies, Consultant, Secondary Care

Fair Treatment for the Women of Wales

• Dawn Owen, Patient Representative, Service User
• Lisa Nicholls, Patient Representative, Service User

Hywel Dda University Health Board

• Harinakshi Salian, Consultant, Secondary Care
• Helen Munro, Consultant, Sexual and Rep Health
• Sarah Rees, Senior Nurse Manager, Women’s Health

Powys Teaching Health Board

• Amanda Price, Clinical Nurse Specialist, Women’s Health

Swansea Bay University Health Board

• Amanda Davies, Consultant, Secondary Care
• Manju Nair, Consultant, Secondary Care
• Sandar Hlaing, General Practitioner, Primary Care and General Practitioners Committee Wales

Welsh Government

• Heather Payne, Senior Medical Officer, Welsh Government
• Richard Chivers, Policy Officer, Welsh Government
• Rowan Carbury, Policy Officer, Welsh Government

Welsh Medical Committee Chair

• Barbara Compitus, Welsh Medical Committee

[1] British Menopause Society (2022). Menopause Practice Standards. Available at: BMS-Menopause-Practice-Standards-JULY2022-01D.pdf (thebms.org.uk) (accessed 01 November 2022). 

[2] National Institute for Health and Care Excellence (2017). NICE [QS143]: Menopause: Quality Standards. Available at: Overview | Menopause | Quality standards | NICE (accessed 29 November 2022). 

[3] National Institute for Health and Care Excellence (2019). NICE Guideline [NG23]: Menopause: diagnosis and management. Available at: Recommendations for research | Menopause: diagnosis and management | Guidance | NICE (accessed 01 November 2022).