FemHealth Focus: From strategy to action - building better women's health

Intro: Hello, and welcome to Talking digital health, a podcast by law firm Mills & Reeve, hosted by health and tech lawyers Sophie Burton Jones and Charlotte Lewis. Our aim is to discuss key topics of interest to people procuring tech and digital products and services in the UK health and care market. And also to people selling tech and digital products and services to the UK health and care market.

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Charlotte Lewis: Hello and welcome to Talking digital health, the podcast from law firm Mills & Reeve, where we explore the people, ideas and innovations shaping the future of health and care. I'm Charlotte Lewis.

Sophie Burton-Jones: And I'm Sophie Burton-Jones. And we're your hosts for this episode.

Charlotte Lewis: We've taken a short break last month after HLTH Europe. We're all a bit exhausted. So we're coming back and about to kick off our femtech series. In this episode, we're delighted to be joined by Dr MaryAnn Ferreux, Chief Medical Officer at Health Innovation Kent, Surrey and Sussex, and an experienced leader in digital innovation, clinical transformation and population health.

And Dr Aamena Salar, a GP with specialist interest in women's health, who has been at the forefront of developing innovative community-based women's health services. Thank you very much for joining us today. Lovely to be here. Fantastic. Nice to be here.

Sophie Burton-Jones: So, as Charlotte said, this episode is building on our Femhealth Focus series, which explores the barriers and opportunities shaping the future of women's health.

And across the series, we are focusing on three interconnected themes. Firstly, investment and support. Secondly, research and data. And thirdly, policy and strategy. Now, this particular episode of the podcast is going to focus on policy, strategy, and innovation, and we're exploring how technology, digital health, and femtech can help address the long-standing gender health gap and improve outcomes for women across the UK.

We think at the moment it looks like women's health has never received more attention from policymakers, healthcare leaders, investors, innovators. But many women continue to experience fragmented care, unequal access to services and significant variations in outcomes. So we want to get a bunch of people along to talk about how we can stop that and improve things.

Charlotte Lewis: Definitely. Because I guess the core question that we're really exploring in this episode is: how do we move beyond recognising the gender health gap and starting to scale the innovations and pathways and systems change that will close it? And that's why we've invited these two fantastic women along to talk about these, just these topics, because I know that they're really important to them too.

So we're going to kick off with our first question. And the theme really is around where technology can have the greatest impact. So we've spent years building evidence base around the gender health gap and increasing awareness of the challenges women experience when accessing healthcare. But looking ahead, where do you believe technology, innovation, and digital healthcare can have the greatest impact over the next five years?

Not just in improving services, although that's very important, but fundamentally improving outcomes for women. Yeah, any thoughts on that really just to kick off the conversation?

Dr MaryAnn Ferreux: Yeah, I mean, I'm happy to start. So I think that although it's fantastic to see us talking about this more now, I think we also need to really understand that although there feels like there's a lot happening in this space, there really hasn't been for many, many years.

And so before we kind of move into that innovation space, I think we do need to be really cognisant of the knowledge base or the lack of knowledge and evidence that sits within women's health. If we look at the global research spend, less than 1% of research funding actually goes into women's health despite women making up 51 to 52% of the population.

So that's a tiny proportion of all research funding that's spent on women's health issues, and that becomes really problematic when we start to look at the areas that really need attention. So when we think about endometriosis as an example that has a seven to eight-year wait for diagnosis, we can see that the lack of research in that space has become problematic. When we think about menopause and the treatment around HRT or women managing symptoms, it's something that will happen to 100% of females, yet from a research perspective, we know relatively little about it, and it's only really just in the last few years that it's become part of a sort of everyday conversation.

So I think that there's a huge amount of potential and opportunity. There've been a number of different papers published by the likes of McKinsey that are talking about the size of the prize in women's health potentially being more than a trillion dollar sort of industry by 2040.

And I think there's this growing recognition that women are actively looking for solutions in this space, so it becomes a really exciting place to be. But what I'm seeing all the time is that, there aren't enough innovations coming through, and then those that are coming through women founders in particular, are really struggling to get the investment that they need to scale and spread those innovations so they can have the greatest level of impact across the population.

So I think some of the really positive things that I'm starting to see are when I hear from women founders who are designing things by women for women around critical issues that are important to them and really designing those with women's voices at the centre of what that needs to look like.

So I think we, we need to be really cognisant that we've had a very patriarchal system. It has been very male b- biology and physiologically led, and so trying to change that will take some time. But I think there's a huge amount of engagement and energy in this space, and a lot of excitement as to what that potential could look like.

And I guess I would put it into two categories. There's general health for women, and then there's sex-specific health for females. And so I think that every facet of health kind of needs to be looked at. But perhaps for us to make those biggest gains, we really need to start to prioritise and think about, well, what are the one or two things that we could sort of dramatically impact quickly as a really strong collective and collaborative group?

Because I think that, we can't boil the ocean. We've only got so many resources. You know, there's only so many of us working in this space. So what is it that we think we could all sort of come together and look at in that space? And I think, you know, Aamena and I have talked about this before, that mentioned endometriosis.

Perhaps the other one we might want to look at is something like cardiovascular disease, where we know that women have much poorer health outcomes than men, and it's sort of like the number one cause of mortality for women. Those are two kind of areas where I think lots of innovation could be happening in that space, and we're starting to see that come through.

Charlotte Lewis: Yeah, I think on the cardiovascular front, I think Forbes published something, it might be in the McKinsey report as well, but something like in the low millions of pounds worth of investment in cardiovascular disease for women, considering it's the number one cause of mortality.

And then autoimmune disease - very little funding for research, and obviously disproportionately affect women more than men. Yeah. So I think it's quite interesting that there are these conditions that span both sexes, but hugely, um, destructive for women, and we're not prioritising that.

I just completely agree.

Dr MaryAnn Ferreux: But I mean, I think if you see, the sort of history of medicine and how it's been developed, it makes perfect sense that everything was kind of on the default human was a man. And so when we're looking at, you know, even some of those medtech solutions that sit in cardiovascular, they are built with a male body in mind.

They're not built thinking about breasts and women wearing a bra and perhaps having, you know, the electrodes around your heart might not be conducive to your anatomy. You know, they're not thinking about the bias that's kind of reflected in some of the, dosaging for pharmaceuticals and things like that, where women tend to be, disproportionately smaller and lighter than men.

But a lot of that is built again on that kind of male physiology. And not thinking about women's hormones in general and how that might affect how we experience complications from treatment or want to be treated. And perhaps some of the holistic aspects to disease management that are not always sort of thought about as part of the care plan.

So, you know, I think recognising those biases that are inherently baked into the system is something that, I do a lot of work on in just talking about them, people realising, "Oh my gosh, I didn't even think about that." When we all practice CPR and resuscitation, actually, the, the training dummy is a male torso. Or how do you think that might affect you if you see somebody collapse in the street who's a woman?

You know, what we've research is showing is that people are less likely to go and do CPR on women- Yeah ... because of some of the biases that exist. So I think it's understanding, having that awareness that those are the biases that are there, that there's a historical context to it, but then thinking about what are we going to do differently moving forward and really having more energy around some of those key priority areas.

Sophie Burton-Jones: We've now got a female health secretary. Do you think that helps? Doesn't really make a difference because there's so much machinery around it. Any immediate thoughts on that?

Dr Aamena Salar: I think it's helpful to have women who understand other women. And also for us to see women in leadership roles driving forward.

So the whole thing, you know, obviously makes sense and adds momentum to it. But I think, as MaryAnn said, we need to be more focused. You know, what is it that we're going to try and achieve in the next five years, and really underpin that with a strategy. So for me, outcomes means better quality of life for women.

So I think what we do is we look at conditions as a health system, we are point solutions at best in people's journeys. We're not supporting people through their life courses, and we need to shift that so that we are truly offering women information, earlier diagnosis, data-backed evidence-based pathways and care that enables them to manage these conditions for whatever duration they're suffering for, which is not usually one or two appointments.

So that's for me, what will shift the dial in terms of impact and outcomes over the next few years.

Dr MaryAnn Ferreux: And I think there's like a really unique opportunity to really shift the conversation. So, I think that there are still people who are not convinced, if I'm going to be honest. You know, the people I talk to that are not really convinced about the kind of health inequalities or, "Oh, God, women's issues again."

Mm-hmm.

But I think there's a massive opportunity to look at family health through the eyes of women. So understanding their societal role and the role within families, and the impact they can have on everybody's health within the household. If women are well and are healthy, then it's much more likely that their families will be as well.

And so when we think about, you know, children and young people, when we think about men's health, I think there's a massive opportunity to look at that through a renewed light through women and the role that they play. And think about health in its broadest concepts, not just from a disease specific perspective, but from a range of kind of social determinants that all impact on the health of women and their families.

And what are the behaviours that, and the prevention strategies, that we need to think about to really look at those upstream drivers that are affecting women's health outcomes in the long term.

Sophie Burton-Jones: Talking about the life cycle of care rather than it being point at various points.

How close are we do you think to being able to deliver that properly integrated, personalised women's healthcare pathway? And what things are still standing in the way?

Dr Aamena Salar: I mean, I think we've got plenty of reports, lots of examples, loads of pilots, lots of different variations of it, a lot of postcode lottery.

I think what we really need is now a unified approach to how we're going to roll this out, so we need to move from pilot to scale. We need the infrastructure. What are the key ingredients to get those services off the ground? What will enable primary and secondary care to work together to move away from postcode lottery to equal access?

Is that a national standard with KPIs that are wrapped around it, the national dashboard with some local variation, yes. But at least that we have an agreement on what is a women's health service hub, whatever you like to call it, neighbourhood team. It's all the same thing. It's pulling care out from the hospital into the community and working in an integrated way.

What does that look like? Can we have the funding to follow? Can it be long-term? Can it drive research data and evidence that we need to improve and reiterate? And can we look at how to address the backlogs that we can't get there at, you know, we don't keep repeating history. We're not just shifting and creating more work, and we're not addressing that half a million plus and growing waiting list.

So how do we work at both angles and join this up? So I think we've got the vision, we've got the focus, we've got lots of best practice examples out there. But I think we need a real implementation plan that's more sort of future-proofed.

Dr MaryAnn Ferreux: Yeah, I totally agree. I think the Women's Health Strategy for England is a great start.

It's the first time we've got something on a page, on... well, many, many pages- ... that's that talks about the size of the problem and some models and approaches of how to address it. I think that what I see is the biggest issue is it's just so big. There is so much to do. I mean, there are 60 actions or something within that strategy, and there's no money that goes with it.

I think there are always ways around it. I think one of the things that I think is fascinating about women in general is we're quite savvy, and we're great at problem-solving and multitasking. You know, and I know that that is a really gendered, a generalism of things to say, but I do think those are things that we are inherently good at, and, you know, making something out of nothing.

And so I think the strategy puts a range of options and opportunities on the page. I think from a policy perspective, it's incredibly important that the leadership now have sight of the problem and the size of the problem. We can't be ignored anymore. But I do think we're going to have to get our amazing brains together to be really clever around what we do, to be really targeted about that approach, and collaborative across spaces.

So I think one of the things I've been incredibly encouraged about is the conversations I'm having about women's health are no longer just sat in the healthcare space. I'm talking to people across multiple sectors about women's health. You know, I've had interest from lots of different areas that have nothing to do with health, and they're asking, what can we do?

Even from a workforce perspective, you know, we've got a large female workforce. How can we help support them? Understanding that women are a core element of people's businesses and from an economic growth perspective. So I think the conversations that we can have can be much bigger than we're currently having.

I think they're very in our kind of typical NHS standard of like this is the clinical pathway, and this is... But actually, when you talk to women, and we've done a lot of insights work, how women on the ground talk about their health and talk about healthy behaviours and prevention is a lot more holistic, and I think that perhaps isn't captured.

And I think there's a massive opportunity to really empower women to look after their own health at home and prevent that kind of progression of disease that requires a GP or requires a secondary care referral. And I'm not quite sure we've got the things in place to enable that. You know, I think there's lots of opportunity in the digital space when we talk about innovation with various different companies who are doing apps, who are looking at AI, who are looking at medtech, to start to feed back some of the insights that we're getting from women, both from a research perspective.

I know, Aamena, you speak to patients all the time. We've done some kind of focus groups and feed that back to innovators and commissioners around the types of solutions that need to be designed and funded moving forward.

Dr Aamena Salar: I think MaryAnn's hit the nail on the head. I think it's just so interesting to hear you say that because it's exactly what we see on the ground.

We actually had a focus group of women who'd used the service. You know, bearing in mind this is a service that's been established for 10 years and we are able to see people once they come through the service in a timely fashion, you know, within a month they can get key diagnostics and be on their way in terms of understanding their conditions.

But what we got resoundingly from the women that were using the service were saying, "Look, it's great that you tell us that we don't have anything to worry about," or, "This is the condition that we're dealing with. But actually, my day-to-day, managing my weight, my mental health, my lifestyle choices because I don't really want medication."

But that, we're not commissioned to provide that service. We don't have the wraparound to personalise it, as MaryAnn's saying. And that's, you know, a woman is not a symptom. Mm-hmm. We are reactive as a service provider to a symptom. They come to us for bleeding or pain or, you know, urinary issues. And what they're trying to say is, "I'm more than that.

I'm a woman. I'm a carer. I'm a mom. But also, these are the different facets of, of who I am, and I want to be able to manage my health. Give me the information-" Yeah ... "and the tools to do that." And we need to design services with that in mind. Because I think, that joined-up approach that MaryAnn was talking about is exactly where we need to be.

They are holding roles, so where's the employer in that? We need to be working within schools, for example, because we need to be helping them as parents with their children as they raise them, who face similar issues. We need to be truly holistic and joined up and collaborative in how we design services.

And I think, again, that's the only way in which we're going to future-proof any of this. Yeah. Oh, oh-

Dr MaryAnn Ferreux: And I, and I mean, I s- I see what's happened just with menopause in the last five years. Mm-hmm. I don't think we even talked about it 10 years ago. Mm. Yeah. I certainly, as a clinician, didn't even know there were 30 different symptoms of menopause.

I remember at medical school- But if we pick that- ... I think we had a half an hour lecture at medical school.

Dr Aamena Salar: Absolutely, but MaryAnn, if we pick that apart, so menopause is a brilliant example how we've really shifted in terms of awareness and people coming forward. But yet even that, there are gaps, right?

Dr MaryAnn Ferreux: Absolutely.

Dr Aamena Salar: There are gaps in terms of we're not holistic. It's largely HRT prescribing. Sure. Let's be fair. Um, so the non-HRT stuff, the holistic stuff, you know, lifestyle measures is not really bread and butter to what services provide, and that's what women are looking for more and more. You know, how do I manage my mood, my sleep?

Sophie Burton-Jones: Yeah.

Dr Aamena Salar: What exercise should I do? What diet changes should I make? Where is that in menopause care? And then, and I'm sure we'll talk about this, it's still the same people coming forward. Okay? And why is that? Is that an awareness education thing, or is it because we're not quite providing culturally sensitive and informed interventions, if you like, when we are talking menopause?

And that's just one example, right? And I'm sure that there's a lot in every single other domain of women's health. So even though we've come a long way, we've still got a long way to go, but we need to be very strategic on how we address that. And I think one of the concerns is that if we don't address it, the gap is going to continue to widen for lots of reasons because femtech is accelerating everything.

It's great, but we need to keep that joined up.

Dr MaryAnn Ferreux: And I think menopause is a really good example where you could come at the problem really ham-fisted and go, "Well, the solution is HRT."

Dr Aamena Salar: Mm-hmm.

Dr MaryAnn Ferreux: But if you don't listen to women's voices, and particularly what you've mentioned there, Aamena, which is around across ethnically diverse communities that all view aging within the women's life course quite differently from a cultural perspective-

Dr Aamena Salar: Absolutely.

Dr MaryAnn Ferreux: -you can just hammer away at what, well, it must be HRT and measuring women's hormones that the solution for femtech innovators. But actually, you know, there will be many, many women that have no interest in taking HRT and want to manage it in a much more holistic way. And understanding their bodies for the first time sometimes, understanding what the some of the symptoms might be, some simple solutions to how to manage that in a better way, may well be enough for them.

But I think that the more ... That's why I sort of go back to that beginning part around the research, the more we can understand both the qualitative and quantitative data that kind of sits around women's health, both sex specific and general health, I think the better our solutions will be for the future.

And The Health Innovation Network, you know, we're very, very strong on that kind of PCIE function, the patient community involvement function, and ideally looking at that co-design pathways so that we're not, developing something and then going back and asking clinicians and patients, "What do you think about this?"

We actually have them in the room at the design stage and going, "What is it that you want? What are the needs that you have, and how do you think we could problem solve this together?" I think it's a completely different conversation. I think it's really exciting to see what comes through.

I know that a lot of the femtech kind of people that I speak to, there's a lot of investment going into hormone health. Mm. But I don't know, maybe that, maybe that will, it isn't or is the solution. I don't know. I think it's interesting. I think the jury is out on whether that's where kind of the future is,

but ultimately, we don't even have the data to say, around women's hormones that, you know, is this something that we should be tracking, and is this something that, people can do with that information? So for me, all information is good information, but I'm always really consciously aware in that research space.

I mean, we go back to biomedical research, they don't even use female mice.

Charlotte Lewis: Yeah.

Dr MaryAnn Ferreux: So before we even got to human research, we've eliminated female hormones from the start of pharmaceutical development. So it's just a huge amount that we've got to do to kind of alter that trajectory and really understand how our bodies might function differently from kind of the male default.

Charlotte Lewis: There's an awful lot in what you've said for me themes that are coming out around e- education and research and the holistic approach. It's not necessarily a pure healthcare issue. This is about women more broadly. You've talked about patriarchy, and we can see, you know, the threads of that all the way through.

So I was going to... whilst you're sort of talking really about inequalities, I wanted to move on to our next question, which was about ensuring innovation reduces inequalities rather than widening them. You've sort of hinted at this. It's something that technology has huge capacity to seek massive improvements in healthcare.

We know that, but it also creates an opportunity that could potentially widen those inequalities and that gap. So from your perspective, how can we ensure that technology helps reduce health inequalities rather than creating potentially a two-tier system of women's healthcare?

Dr Aamena Salar: This is where me and MaryAnn are probably going to clamber over each other, you know?

But I hope ... We probably won't, because we're both very passionate about this. But I know that, I can certainly talk for absolutely ages on this. I think we need to be conscious and mindful about how we approach this. You know, I think digital exclusion and deprivation, they are real issues and then when you combine that with the fact that certain ethnic groups are harder hit in terms of health outcomes for example, black women antenatally have more risk during the antenatal perinatal stage.

Same with cancer. If you don't join up both of these things, which is digital exclusion, deprivation, and access to, to care, and the fact that certain ethnic groups are higher risk, and then approach this in a strategic way, and what I mean by that is say, "Okay, data sets and research, male, white, those are the predominant data sets that we've got that are driving a lot of our AI capabilities and our research, how do you actually now switch that and shift that so that we're actually serving all the people, all the population, and try and be inclusive?" So I think MaryAnn talked about, absolutely right, co-designing and hearing the voices from the outset. I think making sure that you have research and data set that is inclusive.

I think always providing choice, femtech, technology, digital applications, brilliant. They're not the solution for absolutely everybody, and they may not be. People are earlier and late adopters. We have to personalise it. We have to offer a catalogue. I think one of the things that I also struggle with really is that once you get something in one area that works, okay, we don't share practice, and we don't roll it out.

You look in the UK and you look globally, and there's lots of ways in which people have tried to bridge these gaps, and they've got solutions that have potentially worked, but we then go back to reinventing it somewhere else. And we're so, sort of, bound by our geographical area that sometimes even in the UK we just don't look outside often.

I'm sure MaryAnn can speak a lot about this, that there are so many global examples that we could bring back into the UK that would improve our healthcare systems.

Dr MaryAnn Ferreux: Yeah, I think this is where the money is important. Unfortunately, the money available for women's health in itself is just widening that inequity, all of the inequities that you've just talked about.

So that, you know, I think that health equity piece across the board is so important. We do a lot of work around the digital inclusion, but that's only kind of one part, one piece of the puzzle, really. So because there is a lack of investment into women's health, what I'm seeing is that there aren't enough femtech solutions coming through.

There certainly aren't enough that are ready to scale, both nationally and internationally. What I'm seeing is that those that are willing to invest in femtech end up having to invest in models that are kind of B2C, because that's where the money is, that's where the growth is. Women buying their own because things are not being made available.

But what that does is it inadvertently widen health inequalities, because those women that can afford to purchase tend to be white, educated, financially stable. So we've got whole communities, like the community where Amena practices, which is around Birmingham, massively ethnically diverse, who are going to miss out on so many amazing new products that could really help them.

So I think without clear government and policy intervention in this space, I do worry a lot about the types of priorities that come through for women's health that I'm not sure will have impact, if I'm going to be honest. Yes, they might, on the surface improve the outcomes for individuals, but what I'm talking about is real impact on the ground.

I'm talking about healthy life expectancy as an example. I don't think you'll see that with really many of the products that are in the market currently. But that doesn't mean that we shouldn't do more, you know, I think that there is something about using a podcast like this to actually promote what that opportunity could look like, to help to draw awareness to where some of the problems are, and to get people thinking about collaborating in new and different ways around key areas for their region.

And I think thinking about, from a national perspective, what is the impact we want to see? So Aamena talked about priorities for five years, but what would good look like? What do we want to actually see in five years? I mean, my version is, you know, completely erase any gender inequities.

That's probably not realistic. That's probably, a 20 to 30 year programme of work to see that level of impact on healthy life expectancy. But we certainly should be looking at the gynae waiting list, people not having to wait seven to eight years to get an endometriosis diagnosis. So I think there are some simpler things in there that we could be bringing together both our academic partners, our clinicians industry and commercial partners to go, "Let's solve this problem together.

Let's all put a share and a stake into this and see what we can achieve in three years." And at the moment, what I'm seeing is a very fragmented system where everyone's kind of doing their own thing. So I think that that's something that we could certainly work towards and change moving forward.

Dr Aamena Salar: There's a couple of points I just wanted to pick up that MaryAnn made really well just to consolidate what we see on the ground. You know, we love embracing tech and innovation. You know, MaryAnn's got a fantastic programme, FemTech Accelerator. It's been going on for quite a while, has led the way, and we support the innovators that come through.

In recognition that service innovation will only get you so far, you know, you need to embrace the newer innovations that are coming forward. But what we find is that often we can help implement into a clinical pathway, we might be able to get proof of concept, in terms of research.

But what then happens to a lot of these innovations is we're, as MaryAnn said, priced out because we can't scale to adopt because of the price point, and hence they end up on a shelf somewhere, or on Amazon or whatever for people to purchase and self-pay. Then the other thing that it's sad to see is a lot of innovation goes abroad.

So from an economic perspective, there's a lot of value add for us to retain that innovation. Other trade commissions are doing it in reverse. They're understanding that, you know, there's a tech boom, there's an economic benefit. How do we support people? So I think, again, the point that MaryAnn made earlier about joining up and collaborating, it's not, you shouldn't just sit under one header, like, this is women's health or this is femtech, it's kind of thinking about the whole thing really, and seeing how we can embrace these innovations to improve people's quality of life, but also to drive the economy. That's a real reason we should try and kind of push this forward too.

Charlotte Lewis: And so many reasons why, I mean, Sophie mentioned our new health secretary.

We've got a, a new prime minister who is very pro prevention and, you know, Live Well is the sort of scheme in Great Manchester that he advocates very strongly for. His female health minister, and an AI minister now, you know, you've sort of got the component parts here of something

that could be quite special. And focus more on that holistic approach from a, I think, MaryAnn, you said it, which is actually at almost at every touchpoint within the health service, think about that from both a woman's health and a female body perspective. And it doesn't happen, we know that.

But that would be a fantastic thing to just flip your mind, challenge yourself to think about what impact... Does this have a different impact for a woman and should it? And that sort of thing. But the cynic in me says, you know, who's going to grab hold of this?

There's a great opportunity to, I think, at the moment, particularly from the sort of prevention and wellness perspective, but we shall see.

Dr MaryAnn Ferreux: But I think, Charlotte, there are some really simple things in there, right? So we collect a huge amount of data, yet when I go and ask people, "Have you looked at this?

I know you've collected gender, like, or sex. Did you look at the data and see what does it look like for women and what's it look like for men?" And nine times out of ten, no one has even looked at it. Yeah. So it's been collected but not looked at. So I think, yes, there's an awareness and understanding, but we do have things at our fingertips to actually just ask some simple questions.

So simple questions around who's benefiting from the current system? Who are we missing in the data? We collect a lot of data, but I know for a fact there are whole communities that don't access care and are missing from it. So who are they, and what do they look like, and what are their needs?

And then what should it look like when we're talking about not just measuring activity, but actually looking for outcomes and impact, and what does that need to change? And I think that leadership is incredibly important. I think being able to speak to leaders that get it. Okay? So I've heard Andy Burnham speak about population health, and he's probably the only politician I've met who understood the core concepts of public health and why they're important, and understood the social determinants of health and how poverty as a key determinant within that can significantly affect your future health outcomes and those of your children.

So I think that the right people are in the right roles. It's now for us to kind of make that strong argument and case to ensure that this is absolutely at the top of the agenda. Just because a woman's in a senior leadership role doesn't necessarily mean that they're going to have any impact on changing the narrative around, supporting that kind of gender equality activism.

So I think that it's the first part of a very long process, and we need to now present a really strong business case that says this has to be a priority and this is what we need to do. So we know that the cost to the economy of women not participating in the workforce because of menopausal symptoms or because of pelvic pain or because of menstrual health issues,

we know that the women's role within families and how that can play into things like obesity, cardiovascular disease, diabetes, etc. And I think we need to make a really strong case around actually not just talking about health inequalities, but really having it as a core foundational principle when we're looking at healthcare organisations.

So a not a nice-to-have option, but actually core to their financial sustainability across the system because we know that health inequalities on their own cost the NHS £5 billion a year. It's not optional when we're in a cash-strapped situation to ignore that, to ignore why you've got patients not turning up for appointments, and understanding the role that gender, race, rurality or geography, socioeconomic deprivation can play in someone's journey to accessing care, or to participating and complying with what their treatment plan might be, and how they feel about the experience of engaging with their healthcare professionals.

So I think that there's a lot more that we can do. I think some of that doesn't cost any money, if I'm going to be honest. As Aamena said, there's loads of reports out there on a lot of this. Perhaps part of what we need to do is just bring it together, and put it into a narrative that makes sense to the person that we're trying to influence.

So, you know, if it's Yvette Cooper, who has some experience of a health portfolio, but what is it that she needs to see to be convinced that this is a priority for now? And I think we can do that. I think we have a really strong case. I think it's really how we package it up to actually make sure that that change happens in a really timely way.

Sophie Burton-Jones: Well, it's almost going back to what you were saying earlier on, in terms of there's almost so much to go at, we need to focus on some particular things. Have the business case around that. The pitch for why and how it works, and makes sense, and start with that. And as, hopefully as things improve

things branch out.

Dr MaryAnn Ferreux: Yeah. Exactly. We do that with businesses, don't we? Yeah. We go, "What's your value proposition?" Yeah. "What's your business case?" Yet we're not doing it for this, either. You know, we're not we'll ask a company or a, you know, a femtech solution to do this whole, you know, process around being really clear with your value proposition, and your story, and your narrative, and the case for change.

Yet we're not really doing it for this, and I think that it, as I said, all the parts are there. We know how much it's costing. We know that this, you know, there are loads of opportunities that offer great value for money. And I think that now's the time to really invest in putting forward our key priorities.

And bringing as wide a group as possible to collaborate to make it happen because I think we can be very internal and very insular. And I actually think this is a problem that affects everybody. Everybody has a woman in their life. Everyone had a mother. Okay? Everybody has a woman in their life, so it's affecting everybody.

So I think that we don't want to exclude people. We don't want to say, "Oh, this is a women's problem, and only women can fix it." We need male allies there too. We need men to understand their role in this and how they can can help us move this forward and do it as a collective mission.

Charlotte Lewis: I think for me the key there, one of the key points is that collective.

Because as you say, we don't have that within this sector in the same way that there are other kind of singular bodies who might be able to advocate on behalf of everybody, everybody sort of advocates on behalf of themselves and each other.

But maybe pulling that together in one place may be one of the solutions to this potential problem so that that voice can be heard very clearly and loudly. So yeah, thank you very much. Sophie, do you want to ask the next one? I can't remember where we're up to with who's doing what.

Sophie Burton-Jones: It's been a great chat. So, I guess if we switch it up slightly, and I think you both mentioned there's lots of innovation out there, and you see things all the time, whether that be abroad, whether that be in your pilots, but it doesn't get to scale up. Is there something in your mind that already exists that isn't being used at scale that you think, "Oh, I wish we could use that at scale"?

Dr Aamena Salar: I mean, that's really easy for me. It's women's health hubs and women's health services. I think that's a fundamental foundation for access to care shifting more holistically and early and maybe even starting to bring in the whole preventative angle. So I think it's a service innovation which you build on, you add in innovation to that, whether it be diagnostics, tech digital, etc.,

all of the above. But I think if women cannot get care and help in a timely fashion, any innovation is just another point solution and added to a fragmented system. So call me biased, but I think the rollout and the scale of women's health services, whatever title you decide to call it, mine was a gynaecology service when I founded it.

It's then become a hub. What is it now, a WIM? Neighbourhood team? I don't know. In a few years' time, it'll be something else. But, do you know, it's getting people to have the appropriate care by the appropriate person in an appropriate time, and that has been around since probably the advent of healthcare systems.

It's not a new innovation.

Dr MaryAnn Ferreux: And I think for me, I'm company agnostic, because I have to be, but I would say innovations that sit in, when I talked about sex-specific conditions, so I'd say things that sit within four key areas, so there's menopause, menstrual health, sexual health, and pelvic pain, if we're going to prioritise, needs to be in those four buckets.

I think there's lots of opportunity around prevention in those buckets, and awareness and management, self-management, personalised care, etc. And then in terms of general health, I think I would put mental health and weight management in there. And again, I'd love to see many more preventative strategies that sit in there.

I think there are so many opportunities, particularly if you use a really strong digital inclusion framework, to be able to do that digitally and for people to have that information on their phones and be able to do that self-care and self-management at home. Of course, there is a space for things like GLP-1s and various other things, but I think that from a sustainability perspective, again, I just come back to people are wanting, women in particular, to feel empowered to really self-manage and be able to look after their own bodies.

And I think that we haven't really talked about it, but there's a very strong recognition around data, the safety of that data and women not necessarily wanting to share, and I think there has been some really bad practice that we need to be cognisant of, and nefarious characters using that data for the wrong things.

And so, you know, I'm always really impressed by those digital apps that have that as kind of the centre of their policy and their governance, that the data sits with the women. It's not sold or used for any other purposes. And women keep control of their own data. I think that's really important, and when we've done focus groups and interviews with those from the BAME community they've particularly highlighted that as a key trust issue, and I think we really need to be cognisant of that.

So when we're talking about AI and digital for the future, we really need to think about what does the dataset look like, making sure it's as expansive and inclusive as possible, but also making sure that people feel that they've got control of their own information and their own data, or at least having the openness and transparency to be really clear with what you're using that data for.

So I think there's lots of opportunity around in those spaces and I've seen some, brilliant companies that have used things like our health equity toolkit that, and we offer some mentoring, and they have just absolutely embraced ensuring that their solutions are culturally safe and available to everybody.

And then I think there's another area that we haven't really touched on, but I'm doing some more work on, and that's thinking about women from a truly global perspective. Like, we're not just the UK. That, you know, a lot of the issues, the barriers and challenges that women face are global challenges.

And so there's something about how other systems are doing that better, and also what our sort of responsibility from a global perspective needs to be when we think of lower-middle income countries and how we might think about kind of that global and international translation moving forward.

Charlotte Lewis: Thank you very much, MaryAnn. We're going to wrap up this episode here. It's been hugely interesting, and I hope our listeners have found it interesting too. Lots to have learned, whether you know a lot about women's health already, or whether you know nothing, and you are a frequent listener to the Talking digital health podcast.

I think, as you've both said, it kind of starts with understanding, knowing more so whether that's through education, whether that's through research. But understanding the issues and being more aware is a good place to start. Thank you both very much for your time.

What's the best way for people to contact you? Is it just through LinkedIn if they've got a, a query? Yeah, fantastic. Yeah. So if you'd like to hear more from either of our guests today, please contact them via LinkedIn. And at Mills & Reeve we're very happy to discuss any legal queries you might have, whether you're buying, selling, developing, or investing in healthtech.

Our individual contact details are available on our website, which is mills-reeve.com or, of course, reach out via LinkedIn. And finally, just to say thank you all for joining this episode of Talking digital health by law firm Mills & Reeve. Thank you. Thank you. Bye. Bye. Thank you.