Transcript of VPS Podcast 6 - Vulval conditions and the new NHS: a presentation given by David Nunns

And accountability - I’m sure you know with what’s been going on in the press with the Francis report [Robert Francis’s NHS report on whistleblowers], this is absolutely crucial - we have to be accountable for the care that we provide. So, these are the aspirations that we would have as health professionals.

The government has what’s called the NHS Outcomes Framework. This is the core of what we should be doing in the health service. These are the five main areas where the government want us to develop and improve. Obviously, Domain 1 is ‘prevent people from dying prematurely’. Yes, we want patients who’ve had cancer to have an early diagnosis and effective treatment and have a better five year survival rate than our colleagues who provide healthcare in Europe. We want to enhance quality of life for patients with long-term conditions such as dementia, help people recover from illness following injury, have a positive experience of care and treat and care for people in a safe environment, protecting them from avoidable harm. So, this is at the core of what we should be doing in the NHS, and it makes common sense, doesn’t it?

So where does ‘vulval disease’ or ‘vulval conditions’ sit amongst all that? Well, you could say it falls in between Domain 2, ‘enhance the quality of life for people with long-term conditions’, and also perhaps Domain 4 ‘a positive experience of care’. Now, we know that that doesn’t happen, and that the current model of care for women with a vulval problem is flawed. We know that when women finally get, if they do get, to a vulval service, a vulval clinic, dedicated to vulval disease, this is a team of health professionals, that many of them have no diagnosis, they have incomplete treatment, or they may be given wrong treatment. And a lot of women who end up in vulval clinics have what we might consider fairly straightforward problems to manage. The care around the country’s quite patchy. Some women remain within primary healthcare; some women are seen in fantastic vulval clinics, but those services are not uniform around the country. A lot of women don’t get access to the extended team that we feel is important in managing vulval problems.

This document has been published this month and what it is, is I think quite an important document that we helped write. It’s a framework for the future. It’s available on the internet on the BSSVD website, which is the specialist society dedicated to vulval problems, a medical society. It’s a document for two groups of people. One is the providers, the health professionals, and it’s a document for the purchasers of healthcare, the commissioners. I get emails now and then from people asking me ‘What is a vulval clinic? You’ve got a vulval clinic in Nottingham – what does that mean?’ Up till now, we were never able to define a vulval service or vulval clinic, and so this document, which has included a whole host of specialist societies, from the British Association of Dermatology, the Faculty of Sexual and Reproductive Health, the British Association of Sexual Health and HIV, this is the Physiotherapy College, the BSSVD is the vulval medical college, the Worldwide Lichen Sclerosus is Fabia’s group [Fabia Brackenbury], the Royal College of GPs, Lichen Planus group and the VPS. This group, together with an expert panel, came up and defined what a woman with a vulval problem, what level of care she should have access to. I hope that this will be a reference document for both providers of care and also one that the buyers of healthcare will go to, to provide women with a comprehensive level of care, depending on her needs.

What are the standards? Well, I’m afraid you might think that this is all pretty much common sense, but what we’ve said in this document is that there are different levels of healthcare that you need as patients. Level 1 might be self-management; Level 2 might be your GP; Level 3 might be your hospital specialist clinic and Level 4 would be a vulval specialist clinic. Now, not everybody needs to be seen in the vulval clinic that is the Level 4 service, and a lot of women prefer to self-manage rather than being in a hospital system. So, the individual needs of the patient are going to determine which health professional sees that patient - the right health professional at the right time. We’ve outlined the fact in this document that patients should receive the right information on their condition; that you should be treated in facilities conducive to a vulval examination – privacy, a chaperone, curtains, it’s as basic as that, but that needs to be defined. And time: we’ve agreed that 30 minutes is an adequate length of time for a new patient to be seen in a specialist vulval clinic. 30 minutes in healthcare terms is quite a long time – your average GP might see you in about seven to ten minutes, so 30 minutes is, we feel, an adequate length of time within a vulval service, and 15 minutes for a follow-up.