Made a historically under-recorded condition visible enough to support a business case
Client and setting
A London NHS integrated care board: multiple boroughs and more than 500,000 women of reproductive and menopausal age.
The challenge
Commissioners needed to know what heavy menstrual bleeding was already costing before putting money into a new women’s and girls’ health hub. It is recorded inconsistently, and general practice, urgent care and surgical datasets each pick up only part of it. Existing information could not size the group affected or describe current activity well enough to carry a case for investment.
What we did
Built a prevalence model from the published literature: endometriosis (18% of women of reproductive age, 75% of them with heavy bleeding), fibroids (10% and 59.8%), polycystic ovary syndrome (7.5% and 47.5%) and adenomyosis (0.8% and 78.9%), checked against a 20% general population estimate.
Wrote the clinical coding and search logic for three lines of enquiry across ICD-10, OPCS-4 and SNOMED-CT, covering general practice, urgent and emergency care, outpatients and surgery.
Ran the analysis with the ICB and provider intelligence teams. They ran the queries inside NHS systems and returned the results; we specified, assured and interpreted them. No person-level data left the ICB.
Set recorded activity against modelled need to build the business case, and stated the under-coding limitations openly so the numbers were used with the right caution.
The outcome
Between 90,000 and 107,000 women are affected across the system. About 6,000 present to general practice each year, there are more than three urgent and emergency attendances a day, and around 700 operations a year, 60% of them myomectomy. Recorded demand is under a tenth of modelled need. The business case went forward, and a new model of care with it.
Timescale and team
Eight weeks from start to final analysis, within a nine-week needs assessment. Two partners and an engagement manager, with the ICB’s business insights team.
